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The public health presidency

Joe Biden will take office today facing a challenge none of his modern predecessors have had to reckon with — his legacy will depend largely on how well he handles a once-in-a-century pandemic that's already raging out of control.

The big picture: Public health tends to be relatively apolitical and non-controversial. The limelight in health care politics typically belongs instead to debates over costs and coverage. But that will all change for the Biden administration.

"The pandemic is a personal issue. It’s totally different," said Bob Blendon, a professor at both the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School of Government.

  • "A year from now, if people can't have their kids go back to school, their families are dying, they can't meet with loved ones, and they can't go to religious services, that’s totally different than the debate over the uninsured," he said.

Where it stands: Biden will be taking the reins of a situation that's arguably at its worst.

  • The U.S. surpassed 400,000 coronavirus deaths yesterday. Cases, hospitalizations and daily deaths continue to hover near record heights, and a more contagious strain of the virus is expected to soon become the dominant one.
  • The initial weeks of the vaccination campaign have been disappointing and chaotic, and widespread vaccine hesitancy, which could undermine the entire effort, will become a more tangible problem as supplies increase.
  • Political politicization, which has hindered every step of the pandemic response, is baked in and isn't going anywhere.

What's next: Biden's plans for the coronavirus hew closely to experts' recommendations, and he's named a highly experienced team.

  • But in a year or so, the results will speak for themselves: The pandemic will either be behind us, or it won't.

The bottom line: "If everybody were to be almost near normal a year form now, he would still have three more years, and other issues would surface," Blendon said. "What will be the defining issue is if it doesn’t work out.”

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