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White House

Biden upends Trump's calculation of who gets federal vaccination help

This time, vaccines and supplies are going to underserved communities. "Anything Trump did, we're doing the opposite," said one official.
Image: California State University of Los Angeles Mass Vaccination Site
Members of the National Guard and officers from the Federal Emergency Management Agency at a new mass Covid-19 vaccination site on the campus of California State University, Los Angeles on Tuesday.Frederic J. Brown / AFP - Getty Images

WASHINGTON — When the Biden White House started looking for sites for four small vaccination centers across New York state, federal agency officials ranked the best spots based on a county-by-county "social vulnerability index" that measures average income, unemployment, race and a dozen other factors.

The data said Chautauqua County, a sparsely populated expanse known primarily for its wine-industry vineyards, was a leading candidate to get vaccine shots to the underserved.

But state officials said no. There were better places than Chautauqua to achieve the White House goal of vaccinating more Black and brown people, they said. They pushed back against the Federal Emergency Management Agency and the Centers for Disease Control and Prevention, which are expanding the federal footprint in the country's race to vaccinate, a Biden administration official familiar with the fight said.

Because New York's logic fit President Joe Biden's mandate better than the CDC's data did, the White House backed off.

"The state prevailed," said the official, who spoke on condition of anonymity because he was not authorized to discuss the matter publicly.

The details of the Biden administration’s selection method for vaccine distribution sites — and the planned locations for future vaccine mega centers — have not been previously reported.

The episode illuminates a key aspect of the change that occurred in the politics of the national fight against Covid-19 when Biden took office Jan. 20. As Biden has acted to strengthen the federal government's hand in coordinating vaccination efforts across the country — particularly in empowering FEMA as the lead response agency — he has also reversed the politics of combating the crisis.

Former President Donald Trump used his power over federal resources and contracting dollars to reward governors, senators and business leaders who praised him privately and publicly as he sought re-election. By contrast, Biden has prioritized vaccinating people who are both vulnerable and representative of his political coalition. His administration is even providing support to vaccination sites in churches, hoping to persuade more Black and Hispanic people to get the shots.

Trump faced a barrage of criticism from Day One of the pandemic that his priorities and mismanagement were hampering the response. Now, Biden is trying to balance his top priorities: getting as many shots into arms as quickly as possible while ensuring that the process prioritizes low-income and minority communities, without doing so in a way that creates delays.

"Heavy emphasis on communities of color, minority communities, economically and socially disadvantaged," a FEMA official said. "Anything Trump did, we're doing the opposite."

Chautauqua County, which is about 90 percent white, won't get one of the four upstate New York centers, each of which is expected to vaccinate up to 1,000 people a day. Instead, the "federally supported" facilities are scheduled to open the first week of March in Buffalo, Rochester, Albany and Yonkers, all of which are in counties that are more heavily populated, more heavily minority and more politically crucial to Democrats than Chautauqua County.

"New York has prioritized equitable vaccination access with aggressive efforts targeted at reaching communities that were hit the hardest by COVID," New York Gov. Andrew Cuomo said in a statement. The Bronx and Queens locations for two federally "managed" distribution centers, which can vaccinate up to 3,000 people a day, had already been picked.

The White House declined repeated requests to interview administration officials about the federal vaccination effort, and Cuomo's press office did not reply to a request for comment.

But Andy Slavitt, the White House senior adviser for the Covid-19 response, praised the way the administration is using metrics during a briefing for the media Friday.

"The goal is to launch vaccination sites that use processes and relocations that promote equity and deploy the CDC's social vulnerability index," he said.

In New York, the index was ultimately used in a more targeted fashion than countywide statistics, a FEMA spokesperson said.

In conjunction with its own regional office and New York's government, FEMA officials in Washington "identified clusters of census tracts with a CDC Social Vulnerability Index of .75 or greater, a population of 30,000 or greater, and proximity and availability of transportation," the spokesperson said in an e-mail response.

Empowering FEMA

When the pandemic first overwhelmed the U.S. in the late winter of 2020, Trump set up an interagency White House coronavirus task force and tapped the Health and Human Services Department as the lead agency for the response. His administration undercut FEMA's regional offices by requiring states to bypass them and request aid directly from Washington, letting his hand-picked task force make the big allocation decisions.

He empowered senior adviser Jared Kushner to create an ad hoc group partly embedded at FEMA headquarters to coordinate the acquisition and distribution of personal protective equipment and coronavirus tests, largely through private companies. Much of the federal government's main disaster response agency was reduced to a supporting role.

Biden has taken a markedly different and more traditional approach to FEMA, centering it as the federal government's coordinator for vaccine distribution.

Image: Oakland Coliseum Mass Vaccination Site
A worker builds the framing of a tent as he sets up the new mass vaccination site at Oakland-Alameda County Coliseum in Oakland, Calif., on Feb. 12.Justin Sullivan / Getty Images

The agency has opened "federally managed" vaccination centers — megasites that are expected to provide thousands of shots a day — in Oakland, California, and Los Angeles. Two in New York City — in the Bronx and Queens — are set to open this week, and four are scheduled to open in Florida, in Hillsborough, Miami-Dade, Duvall and Orange counties, in the first week of March.

While the White House announced the opening of a managed center in Philadelphia on Friday, it wasn't immediately clear whether the debilitating winter storm in Texas would affect plans to open locations in Houston, Dallas and Arlington next week.

Under Biden, the federal government is routing some vaccine supply away from the states so it can ensure that people of color aren't denied access by state and local governments that don't prioritize reaching them.

The "supported" sites are federal-state partnerships in which the state provides the vaccines and tracks them, while the "managed" sites are fully run by the federal government. The Biden administration is also developing plans to open federally managed shot-distribution centers in Illinois, Ohio, North Carolina, Georgia and Michigan in March, according to administration documents obtained exclusively by NBC News.

Biden had promised to set up 100 federally supported vaccination centers in his first 30 days in office — an easy bar to clear given that FEMA documents show that more than 400 state and local centers have received some federal assistance.

"This program is directed toward underserved communities," the administration official said. "Under the prior administration, they were counting on using Walgreens and the other pharmacies. These are a little more directed."

The FEMA spokesperson said the Trump administration didn't have a tracker to monitor state vaccination sites that were receiving federal assistance.

"Since March 2020, FEMA has been activated to support Covid-19 operations, coordinating with federal agencies to provide equipment, supplies and personnel, as well as obligating more than $57.5 billion to support overall response efforts," the spokesperson said. "FEMA was also working with jurisdictions to address requests for resources to support vaccine administration. However, prior to Jan. 20, we did not have a tracker in place to provide a specific count of federally supported sites."

In some cases, vaccination sites have been set up in churches, which federal officials believe may help make Black and Hispanic people be more comfortable with getting inoculated. Polls show members of these communities are less likely to say they will definitely get vaccinated. And churches offer undocumented immigrants the additional security of sanctuary from arrest.

Experts in disaster management say Biden's early actions demonstrate a commitment to using the federal government's infrastructure — such as the relationships FEMA's regional offices have with state and local officials — in ways Trump didn't.

"What I can see is a more coordinated effort between the federal government, the states, and that goes down to the more local level," said Elizabeth Zimmerman, senior executive adviser to the disaster preparedness and response firm IEM, who is a former associate administrator in FEMA's office of response and recovery. "Hopefully, that will mean more results — that people will be able to get their vaccine and not be in line for eight hours hoping that they're going to get one."

Federal resources as aid, not leverage

On Jan. 21, the day after he took office, Biden issued an executive order waiving the requirement that states put up 25 percent of the cost of deploying National Guard troops to assist in the Covid-19 crisis response. The waiver applied retroactively to the beginning of the pandemic. Then, in early February, he waived all cost-sharing responsibility for the states related to aid requests made to FEMA.

That helped state budgets, but it cost the federal government $3 billion to $5 billion, according to administration estimates. Biden also has proposed giving $350 billion to state and local governments as part of his $1.9 trillion legislative relief package, which is making its way through Congress.

Ann O'Leary, who was chief of staff to California Gov. Gavin Newsom until late December, said Trump constantly used his power over federal aid to states as political leverage. She recalls California's making the list of states that would get cost-sharing waivers to deploy National Guard troops but then being told by White House officials in September that Newsom had to "make his case" to Trump personally to secure the assistance.

"You had to kiss his ring in order to get the 100 percent match," O'Leary said in an interview. Trump gave Newsom 30 days of liberty from the 25 percent cost share, but that meant Newsom would have to ask again right before the November election.

Newsom asked for the first month of help but not the second month.

O'Leary said Biden's approach, including putting FEMA out front to coordinate federal agencies' relief efforts, removes the president's political interests from the equation.

"They just have the capacity to deal with everything, from the people power to the data to the supply chain," she said. "It's a game changer in not playing politics on disaster response."

A spokesman for Trump didn't respond to a request for comment.