Biden's presidency could bring a smoother vaccine rollout and an overall decline in coronavirus cases, experts say

• President-elect Joe Biden will inherit the world's biggest coronavirus outbreak when he takes office in January.
• But public-health experts think the process of distributing a vaccine will likely be smoother under Biden's administration than it would have been under Trump's.
• Experts also expect Biden to institute lockdowns in coronavirus hotspots.
• These measures, combined with Biden's championing of masks and social distancing, could prompt a decline in cases.

President-elect Joe Biden will inherit the world's biggest coronavirus outbreak when he takes office in January. Over the last nine months, the US has seen far more cases and deaths than any other country. New daily cases have reached record highs in the last two weeks, leading many experts to expect the fall-winter surge to be the nation's largest, and perhaps deadliest, yet.

Although the US pandemic response isn't likely to change under Trump for the next few months, public-health experts think Biden's new administration, once it takes office, might achieve a smoother vaccine distribution process than Trump's administration would have. They also anticipate a steady decline in coronavirus cases, due to Biden's championing of public-health measures including masks, social distancing, and lockdowns in areas where transmission gets too high.

"I'm not sure that the election will determine what happens with this latest surge, but what our response is after that certainly will differ," Dr. Leana Wen, a public-health professor at George Washington University, told Business Insider.

If Trump had been reelected, experts say, hundreds of thousands of additional lives might have been lost, given that schools and businesses would probably have continued to stay open in hotspots, and the administration's messaging about masks would have continued to be mixed and politicized. Experts also worried that Trump might not have prioritized an equitable distribution of vaccine doses across all parts of the country in a second term.

Here's what the pandemic response could look like in 2021 under Biden.

More masks, more testing

The University of Washington's Institute for Health Metrics and Evaluation predicts that the US could see around 165,000 more coronavirus deaths from now until February 1. But if 95% of the US population wears masks, roughly 61,000 of those lives could be saved, according to the institute's model.

Experts anticipate that Biden's support for masks and social distancing will encourage more Americans to adopt these practices. The president-elect has said he would consider a national mask mandate, though legal experts say he may only have the authority to enforce mask-wearing on federal property or in federal facilities. At the very least, Biden plans to work with governors to implement mask requirements.

"First, I'll go to every governor and urge them to mandate mask-wearing in their states. And if they refuse, I'll go to the mayors and county executives and get local masking requirements in place nationwide," Biden said in October.

Biden has also pledged to ramp up coronavirus testing by creating a government-backed test-development program and establishing at least 10 drive-through testing sites per state. On top of that, he plans to enlist at least 100,000 additional contact tracers.

But experts say the US's high daily case numbers now mean testing and tracing won't be enough on their own.

"Testing and contact tracing will still be very important, but right now what needs to be done is to slow down the rate of spread," Wen said. "And that includes targeted measures like closing high-risk settings."

New lockdowns in hotspots?

As president, Biden will likely reinstate lockdowns in coronavirus hotspots across the country. That wouldn't have been necessary if transmission hadn't gotten so high, experts said.

"When it gets as bad as it appears to be in some parts of the country, and potentially others in the weeks to come, you really have little choice left than to do a short-term lockdown, trying to get the numbers down to a point where testing and contact tracing can actually have an impact," Marissa Levine, a public-health professor at the University of South Florida, told Business Insider. "I hate to say that because we didn't necessarily have to be in this position."

Biden has proposed a measured approach to lockdowns: His administration would tailor reopening guidelines to individual communities based on their levels of transmission.

"There is this false choice that [Trump] is perpetuating between total shutdown versus doing nothing," Wen said. "The truth is, there is a lot that we can do in order to control the virus while also keeping the economy going."

Under Trump, new lockdowns were highly unlikely. The president has also consistently highlighted the voluntary nature of face coverings and held events and rallies without mask requirements.

"We're not going to control the pandemic," White House Chief of Staff Mark Meadows said in a CNN interview on October 25. He added that the Trump administration planned to rely primarily on a future vaccine or treatment to prevent deaths, without stopgap interventions.

"The strategy is saying, 'We're not going to even try to reign in the virus. We're going to let it infect as many people as the virus wants to until we can get to a vaccine or a therapeutic,'" Wen said.

The consequences of that approach, she added, would be grim.

"While it may seem like a very tempting thing to do, it will result in hundreds of thousands, if not more, deaths," Wen said.

A smoother vaccine rollout under Biden

Experts do not think the result of the presidential election has much bearing on when a coronavirus vaccine gets approved.

Any vaccine candidate must pass several checkpoints: An independent scientific board will monitor clinical trial data, then decide whether it's promising enough to send to the Food and Drug Administration. The FDA will grant emergency authorization if it determines the vaccine to be safe and at least 50% effective.

"The science will determine a timeline, not what party is in control of the White House," Wen said. "There should be no difference in terms of the timeline for emergency-use authorization or for approval of the vaccine. What will be different, though, is how well the vaccine distribution and manufacturing is going to be rolled out."

The Trump administration's Operation Warp Speed program is currently manufacturing vaccine doses in large quantities while clinical trials are ongoing. It recently contracted with McKesson Corporation to deliver vaccine doses across the US once one gets approved. Administration officials estimate that could happen before the end of 2020, or in the first quarter of 2021.

But Trump's plan required states to come up with their own vaccine distribution plans. Experts worried that decentralized approach , could slow the process of administering shots, particularly in remote areas, and cause supply-chain issues.

"I have serious concerns about the Trump administration's ability to deliver the vaccine, especially to communities that are the most impacted by coronavirus," Wen said prior to Election Day. "We've already seen the failures of the Trump administration when it comes to testing and us running out of reagents for tests and swabs. We're also seeing supply chain issues with PPE, with critical medications."

Biden has pledged to invest $25 billion in vaccine manufacturing and distribution. Under his administration, Levine said, it's possible that states might revert to distribution plans used during previous public-health crises, like the H1N1 pandemic in 2009.

"One of the good things about a Biden administration is that we might resurrect some of the things that actually worked well and not try to create whole new distribution systems that really don't build on the distribution expertise that already exists," she said.

Most importantly, experts say, Biden's promise to let scientists lead his coronavirus response could reassure Americans that it's safe to get vaccinated — a critical element of the vaccine rollout. The president-elect has called for data on trial results to become public before a vaccine is distributed.

"If anything, a Biden administration will speed up the availability and accessibility of a vaccine," Wen said. "For a vaccine to have an effect, it needs to be trusted and there are many people now who do not trust a vaccine because they fear political interference with the scientific process."