David Dayen reports on the new president, policy and all things political
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April 12, 2021
Where’s The Michigan Vaccine Surge?
Plus, more executive action options to lower drug prices
Gov. Gretchen Whitmer (D-MI) got her shot last week; now the rest of the state needs their dose. (Nicole Hester/Ann Arbor News via AP)
To Recap
I enjoyed last week’s project of breaking down key elements of the American Jobs Plan, with pieces on electrifying the postal fleet, replacing water pipes, and incentivizing inclusionary zoning, along with a piece on building economically without a consultant frenzy. There’s so much policy packed into the Biden plan that we’ll be continuing to look at its provisions. We even got a nice shoutout from John Oliver for one of our pieces, about long-term care.  

We built a mini-site, Building Back America, for our articles analyzing the plan, and right now there are eight of them there, with more to come. Check it out!

The Chief
The weekend yielded another record on the vaccination front, with 4.6 million shots in arms on Saturday. Many states are opening up vaccinations to all adults this week, and while fewer Johnson & Johnson shots will be distributed, I’d expect to hit a new high in the coming weekend. Nearly 36 percent of adults have received at least one dose of the vaccine.

In the race between the vaccine and the virus variants, some context has to be given. Six states are experiencing caseloads of over 200 cases per 100,000 residents, and in general high caseloads are located in the Northeast and upper Midwest. The South is looking OK (though Florida is trending badly), the Southwest and Plains are mostly fine, and California is third-lowest in the country. There were 10 deaths in all of the 10 million-plus Los Angeles County on Sunday, less than half of the national average.

Hospitalizations nationwide are stubbornly stuck around the mid-October level, but the deaths per 100,000 rate is both relatively mild and not necessarily correspondent with the states where cases are rising. Cases aren’t necessarily the relevant measurement in a situation where the population most responsible for deaths is mostly vaccinated. Still, we know that COVID-19 packs a wallop even short of death, and the vaccines can limit that sickness. Plus, inoculating a state with significant community spread prevents replication that can lead to mutations.

If you wanted to focus on a state that has a combination of all of these factors, it’s Michigan, which has the highest positivity rate from testing, the highest case rate by a factor of nearly two, and a growing death rate. Michigan is lagging behind other states in the upper Midwest and Northeast on vaccinations; more of the population is vulnerable. This has put the health system under stress. Gov. Gretchen Whitmer (D-MI) has asked high schools to voluntarily suspend in-person classes and youth sports for two weeks, as this is seen as a major vector for spread. This is someone who was almost kidnapped the last time she called for anything mandatory, so begging school districts to be reasonable is all that’s left.

Except there’s one more thing. Why isn’t the White House doubling vaccine allocations to Michigan? The governor is asking for that. It makes total sense and would involve next to no sacrifice from other states. Michigan is about three percent of the U.S. population. The rest of the nation would get about 97 percent of their allocation if we doubled supply to Michigan. And since state border walls haven’t gone up and anyone can travel freely anywhere within the U.S., stopping a viral outbreak in one place will minimize the opportunity for that outbreak to roam around the country, as we’ve been seeing for over a year. (This is why “judging” state governor’s performance is totally futile; the virus moves and mutates on its own no matter what a governor does!)

The White House has inexplicably resisted this. COVID-19 Response Team coordinator Jeffrey Zients has promised more vaccinators, testing kits, and treatments for Michigan, which acknowledges that there’s a big problem there. But there are two possible solutions to something where the spread is such that contact tracing is useless: non-pharmaceutical interventions like a lockdown (highly unlikely), and pharmaceutical interventions like vaccines (entirely available). Even if a lockdown were possible, why wouldn’t you add to the available vaccines if you have the opportunity, which you do?

It’s in the country’s best interest to surge vaccines into Michigan. I imagine the resistance is just a fear of bad press, worries about “favoritism” or something. I think some critiques of the vaccination campaign are out of bounds, and it’s hard to argue with the administration’s success. But President Biden has insisted that he would follow the science. He should try it in this case.

Senators Beg for Executive Action
It’s sad that good public servants have to use their time not devising legislation but scouring old laws to figure out what the president can do on their own. But that’s where we’re at with a resolution offered by Sen. Jeff Merkley (D-OR), imploring the Biden administration to take action to lower prescription drug prices. After a long preamble describing the urgent need for action, Merkley (joined by Sens. Warren, Sanders, and Booker) highlights specific actions that Secretary of Health and Human Services Xavier Becerra can take to lower drug prices.

Two of them mirror what we have highlighted at the Prospect for some time: section 1498(a) of Title 28 of the U.S. Code (known as eminent domain for patents) and “march-in rights” under the Bayh-Dole Act of 1980. Both involve essentially seizing drug company patents (for just compensation) and issuing them to companies who will distribute the medications to the public affordably. Merkley adds two other possibilities. First, there are “royalty-free rights,” another section of the Bayh-Dole Act that allows the government to retain patent rights on drugs funded through public research. This is similar to march-in rights except it’s the inherent right without having to seize the patent.

Then there’s the Center for Medicare and Medicaid Innovation, a division authorized in the Social Security Act to “test innovative payment and service delivery models.” Through CMI, you could test out something like an international drug pricing index, which President Trump flirted with, that would peg a price Medicare and Medicaid would pay for drugs to a benchmark of developed countries with lower prices. And you could try other options to lower drug costs too.

The point is that there are many options here, and because we have an insanely unproductive Congress it’s come down to someone like Merkley to beg the White House to use the authorities they already have. We’ll be watching at the Prospect’s Executive Action Tracker.

What Day of Biden’s Presidency Is It?
Day 83.
Today I Learned

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