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The trickiest vaccine launch in U.S. history

Even if the federal government manages to secure the cash needed for COVID-19 vaccine distribution — and that's a big if — there's still a huge task ahead at the state level.

Why it matters: America has never attempted to vaccinate so many people on such short notice, with so many lives on the line.

1) Record-keeping: States will turn to their existing immunization registries, AP reports.

  • Pharmacies and doctors’ offices will need to be able to look up records, so people don’t have to return to the same place for their second shot.

2) Storage: Smaller pharmacies and doctors' offices are needed to make getting shots more convenient, but the Pfizer vaccine needs to be stored at -94°F.

  • About 60% of pharmacy chains nationwide — Walgreens Boots Alliance, CVS Health, Walmart, Kroger and Costco Wholesale, so far — agreed to partner with the federal government to ramp up access, HHS announced today.
  • The private sector will also be needed to help with shipping and storage and technology lags from remote or tribal areas.

3) Return visits: The CDC is considering ways to help Americans remember to get the second shot with the same brand, per AP:

  • One would be to issue cards that people would get with their first shot, like the polio immunization cards many older Americans remember.
  • In a rural part of South Carolina, one community health center is planning multiple reminders, including text messages and calls from health workers.
  • In rural Minnesota this fall, masked nurses in traffic vests reached into cars to give passengers flu shots as a way to social distance, but it also served as a test run for a COVID vaccine.

The bottom line: The government needs to get its messaging right this time.

  • The CDC and other agencies can't afford a repeat of this spring, when they gave bad guidance about face masks and testing that is still confusing many Americans.

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Why it matters: If Fauci's prediction comes true, it could save countless programs from going extinct next year.

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President Trump is likely to announce he'll run again in 2024, perhaps before this term even ends, sources tell Axios.

Why it matters: Trump has already set in motion two important strategies to stay relevant and freeze out other Republican rivals. 

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Nursing homes are still getting pummeled by the pandemic

Data: AHCA/NCAL, The COVID Tracking Project; Chart: Naema Ahmed/Axios

The U.S. has gotten no better at keeping the coronavirus out of nursing homes.

Why it matters: The number of nursing home cases has consistently tracked closely with the number of cases in the broader community — and that's very bad news as overall cases continue to skyrocket.

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Biden faces a showdown over digital services taxes between the U.S. and EU

A fight over foreign countries' efforts to tax big American tech companies' digital services is likely to come to a head in January just as Joe Biden takes office.

The big picture: Governments have failed to reach a broad multilateral agreement on how to structure such taxes. That could leave the American firms that dominate consumer digital services — including Google, Facebook and Apple — stuck with massive tax bills from different countries.

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Biden economic team will write crisis playbook for a new era

Joe Biden's economic team faces a daunting task helping the millions of Americans who have lost their jobs or otherwise been financially ravaged by the coronavirus. But most of them have first-hand crisis experience, dating back to when Barack Obama inherited a crumbling economy when he took office in 2009.

Why it matters: Most of President-elect Biden's economic nominees served in the Obama Administration, and wish that they could have gone biggerto help America recover from the 2008 financial crisis. But it's not going to be easy for them to push through massive fiscal spending in 2021.

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