Rochelle Walensky was shocked. The director of the Centers for Disease Control and Prevention was working from her home outside Boston on a Friday night in late July when she was told that Americans were spreading the coronaviruses.
From the moment he took office, President Biden focused on vaccines. The reality sank in when Dr. Walensky was briefed about a cluster of breakthrough cases. The Delta variant, which had ravaged other parts of the world, was taking hold in the United States. Being vaccine free would not prevent people from getting the variant.
Dr. Walensky said it was a heart sink moment. The discovery called into question the Biden administration's focus on vaccination as the path out of the Pandemic. It made Mr. Biden sound nave in his July 4 message that the nation had moved closer than ever to declaring its independence from a deadly virus.
Mr. Biden promised a full-scale wartime effort in his first 100 days in office. The C.D.C. discovery marked the point at which the virus began exposing the challenges it would present to his management.
It is a image.
17 million children between the ages of 12 and 15 became eligible for the vaccine in May.
Mr. Biden and his team have done a good job, including getting a vaccine into 85% of Americans and rolling out life-saving treatments. The United States is a better place to fight the Omicron variant of the virus now that most schools and businesses are open and the death rate is lower because of the vaccine.
An examination of Mr. Biden's first year of fighting the virus, based on interviews with scores of current and former administration officials, public health experts and governors, shows how his effort to confront "one of the most formidable enemies America has ever faced."
The White House was not prepared for the sharp turns that the Pandemic would take. The administration didn't anticipate the nature and severity of the variants even after warnings from the rest of the world. Even after it was clear that the shots could not always prevent the spread of disease, it continued to focus on vaccinations.
The administration did not increase the supply of at- home Covid tests until the fall because they lacked a sustained focus on testing. Americans were unable to find tests that could determine if they were sick because of the lack of foresight.
The president was worried that pushing certain containment measures would only make the cultural and political divide in the country worse, as he hid an organized Republican revolt over masks, mandates, vaccine passports and even the vaccine itself. The nation's precarious economic health and the political blowback that Mr. Biden and members of his party could face made him all the more cautious. He spent months trying to convince Americans to get shots.
It was Mr. Biden who brought order to the chaotic vaccine distribution in the first month.
The C.D.C. bureaucracy was battered by the Trump White House, which undermined the government's credibility with the public and helped foment anger throughout the country over masks and other efforts to contain the virus. Mr. Biden couldn't bridge those divisions.
There is a memorial in Washington for American deaths.
The Omicron variant has begun to diminish in parts of the country, but Mr. Biden is still facing huge economic and political pressures. He doesn't want to drive the country back into a recession by rejecting extreme measures. No matter how he turns, his decisions will carry a cost.
Mr. Biden is trying to make headway on other priorities, such as a bipartisan infrastructure deal, appointments to the federal bench and social spending legislation. The White House was consumed by a chaotic exit from America's 20-year war in Afghanistan in August and September.
Mr. Biden's approval ratings were dragged down by the swine flu as it became a measuring stick for his presidency. The number of people who have died from the virus has increased every week since he was inaugurated.
Dr. Luciana Borio, a former acting chief scientist of the Food and Drug Administration, advised Mr. Biden's transition team. You have to plan for the future.
The C.D.C. director was brought on by Mr. Biden to restore faith in the agency. Stefani Reynolds worked for The New York Times.
On March 2, officials from the C.D.C. and other agencies held a conference call to discuss creating a federal "passport" to enable airlines, restaurants and other venues to electronically verify vaccination status.
A presentation prepared for the meeting stated that a chaotic and ineffective vaccine approach could hamper the response to the Pandemic.
Within weeks, public health officials began hearing a different message from the White House, where Mr. Biden and his team were wary of Republican politicians.
One federal health official said that the White House unofficially said that the policy was not a policy.
The scientists at the C.D.C. decided to dismantle their working group because of the patchwork of state and private efforts to track inoculations and the paper coronaviruses vaccination record cards that can be lost or counterfeited.
The core of Mr. Biden's strategy was vaccines.
By the summer, a chorus of voices inside and outside the government was urging Mr. Biden to mandate the shots.
Public health experts said that asking people to get vaccinations was not enough. Most Republican governors opposed vaccine requirements, and some of them had the power to prevent schools and businesses in their states from putting them in place.
Several of the president's advisers said he believed federal vaccine mandates would backfire. The idea of requiring domestic airline passengers to bevaccinated was shut down by Mr. Biden.
More modest initiatives were immediately attacked. Jim Jordan, a Trump ally and a frequent Biden critic, was among the many Republicans who pounced when the administration announced an enhanced door-to-door outreach campaign to get Americans vaccinations.
The Biden Administration wants to knock on your door to see if you are up to date on your vaccinations. What is next? Do you own a gun?
A patient with Covid-19 problems was moved by nurses in Mountain Home, Ark.
Mr. Biden was hopeful even as there were ominous signs.
The world was caught in a race between vaccines and variant, and the virus was winning, warned scientists. In India, the Delta variant pushed Covid cases from 10,000 to 414,000 in a single day. There were more Delta cases across England.
The president and his team believed the United States would be spared from Delta's ravages. The White House was counting on it.
The vaccines worked, he said in an interview.
In May, Dr. Walensky added to the sense of optimism with an announcement that caught many people by surprise: Americans who have been vaccinated can take their masks off with little to no risk of spreading the disease.
The White House's Covid-19 coordinater and Mr. Biden's chief medical adviser spoke to reporters.
The public would be confused by the sudden change, but the White House was ecstatic. Being able to drop masks indoors could mean a huge economic boost, a psychological reprieve for the public and an opportunity to ease the fierce cultural battles over Covid.
Three weeks after Mr. Biden declared that the country was emerging from the darkness, the outbreak in Provincetown forced Dr. Walensky to confront a painful truth: her decision about masks had been wrong. The virus could be transmitted by vaccinated people.
She had a lot of decisions to make. She didn't want to put masks on all of America again because of a single outbreak. Investigations in Texas and other places confirmed the findings.
Deaths were up 45 percent from the previous week, hospitalizations were up 46 percent and cases had increased by 450 percent since June 19 when they had reached a low, according to an internal assessment by the Department of Health and Human Services.
The world was caught in a sprint between vaccines and variants, and the virus was winning, according to scientists.
Dr. Walensky told Americans to wear masks again in areas with high case counts.
Dr. Walensky was brought on by Mr. Biden to restore faith in the agency. The new guidance left it to local health officials to determine where masking was required, which made it confusing for the public.
Most governors and mayors abandoned mask mandates by that time.
The question of vaccine mandates was still looming over the Biden team. Dr. Fauci concluded that the voluntary measures his boss favored wouldn't be enough because of the Delta variant's seriousness.
His private message to the president was that they wouldn't get people vaccine unless they mandated it.
In September, the president agreed after meeting with four business leaders who told him they had successfully required all of their employees to get vaccine. One of them, Greg Adams, the chief executive of the Kaiser Permanente health system, told the president about an unvaccinated colleague who had died.
After the F.D.A. gave formal approval to the Pfizer vaccine, Mr. Biden was ready to go beyond pleading with people. A meeting with his Covid team was planned for the next day, but he wanted it to happen sooner.
Mr. Zients told his deputy to stop. He said they had 58 minutes.
Mr. Biden announced mandates for health care workers, federal contractors and the vast majority of federal workers, as well as a requirement that all companies with more than 100 workers have weekly testing.
Public health experts said the mandates were appropriate. The president had been correct in his prediction that the new policy had made the federal government too intrusive in many areas of American life.
The Supreme Court allowed the health care mandate to stand even though it struck down the requirement for large employers.
The political pressure to bear on a fraught scientific debate was brought about by Mr. Biden's premature announcement of the booster rollout.
One day in August, a senior federal health official scribbled on a note.
Mr. Biden was going to announce a plan to give booster shots to adults who had completed their initial shots at least eight months earlier.
According to two people familiar with her stance, the acting F.D.A. commissioner did not want the White House to announce a start date. She warned her regulators not to act quickly because they were still waiting for data from vaccine manufacturers, and they would need to review it.
She and Dr. Walensky were told that the booster plan would have to be scaled back. One person with knowledge of the call said they were met with a long silence.
The problem was laid bare in the episode. Some of the most difficult public health decisions are hammered out by a few senior health officials who are not in charge. They are overseen by a man who has no public health expertise, but is known for his logistical and planning skills. There is no single public health expert who can guide the response or stand up to the White House.
A senior federal official said there was no formal decision-making process. Who is in charge of this?
Elizabeth Gillander, a resident at Fircrest Senior Living in McMinnville, Ore., received a booster shot at a mobile vaccine clinic.
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Mr. Biden likes to call them the team of "docs." They include Dr. Walensky, Dr. Woodcock, Dr. Fauci, and Dr. David Kessler. Several current and former White House officials said that Mr. Becerra plays a limited role in setting policy, but he disputes that.
In May, Dr. Walensky announced that people who are fully vaccine free can wear a mask indoors or outside.
The change might be coming according to Mr. Biden and Mr. Zients. The change was only learned of by some White House aides the night before Dr. Walensky announced it to the public.
It wasn't like, "OK, let's have a Zoom call tonight about the pros and cons of the mask mandate." Dr. Fauci said that didn't happen. He was asked if he tried to modify the decision before it was made.
The C.D.C. announced last month that it was shortening the recommended isolation period for people with Covid. After five days, people with resolving symptoms can stop isolating, but they should get a negative test first. The agency revised its guidance after it was criticized for not saying that the best approach is to use an antigen test at the end of the five-day isolation period.
The vaccine site in the Northway Mall parking lot gave out boosters.
Richard Besser, a former acting C.D.C. director, said that when a public health measure could be alleviated, it was never framed clearly enough.
Political pressure to bear on a fraught scientific debate was brought about by the premature announcement of the booster rollout by Mr. Biden.
The F.D.A.'s vaccine division wanted to offer booster shots to as many Americans as possible. The White House announcement that vaccines would be offered to younger, healthier people was viewed by two key subordinates as political arm-twisting.
After announcing that they were leaving the agency, they outlined their position in an extraordinary public dissent in the British medical journal The Lancet. In an interview, Dr. Krause said that he saw a breakdown of the process of regulation.
Advisers to the C.D.C. and F.D.A argued to scale back Mr. Biden's promise. Adults weren't universally eligible for a booster until late November. Some governors were so impatient that they cleared adults in their states to seek boosters without federal approval.
Only 43 percent of adults have received a booster. The data published by the C.D.C. showed that boosters were reducing the number of infections from the Omicron variant.
As the Omicron variant spread, it became harder to find tests.
By the time Omicron arrived in South Africa, Dr. Fauci knew it was going to be bad.
He was alarmed by the high number of changes. The variant was moving fast. The line went straight up on the chart that South Africa's researchers showed him.
The reason became clear. The vaccines gave protection against Omicron, but the variant was more flexible than Delta in evading the body's defenses. People who had been boosted might get sick.
The revelations made it more important for everyone to know if they had been exposed to the disease. The administration failed to ensure a supply of at- home tests that could confirm an infection in 15 minutes.
Amazon, Walmart and other national chains were out of stock soon. Americans lined up outside the pharmacy to make sure their families were protected over the holidays. The administration was left scrambling for a quick fix to a long-term supply problem it had mostly ignored.
The administration made a bet that they could allow demand to determine the supply of tests, unlike their strategy with vaccines and Covid treatments. The Biden team spent $16.6 billion to buy vaccines and Covid treatments, but only signed $3 billion worth of contracts to buy tests in September and October.
In nine speeches, Mr. Biden did not mention needing tests. At the time, public interest in tests was flagged.
Long lines for the distribution of at- home Covid-19 testing kits in Washington.
Workers at Abbott Labs in Maine were told to take unsold test kits apart and throw them away. They were laid off.
The administration initially resisted calls to give out free tests. The White House felt that tests should be covered by insurance, not by the government, according to a top aide. The administration wanted to give free tests to places that needed them the most, like schools and nursing homes, according to Dr. Tom Inglesby, a senior adviser in charge of testing.
He said it was very expensive to buy all tests for everyone.
The bet was not a good one. By the end of the year, Mr. Biden promised 500 million free tests for all Americans. The first of those tests has just begun, and the majority of them will not arrive until after the administration's own experts predict Omicron will have peaked later this month.
In an interview with ABC in December, Mr. Biden said he wished he had thought about ordering half a billion.
The allocation of 1,000 medical personnel to six states was announced by Mr. Biden.
As the administration heads into its second year of battling the Pandemic, Omicron and Delta have shown that the virus can cause hospitals to become crisis zones. There are millions of unvaccinated and officials are watching for signs that a retooled vaccine might be needed soon. Antiviral pills seem to be a breakthrough in treatment.
The nation could reach a kind of truce with the virus, with clusters of outbreaks, or the virus could weaken to a threat more akin to a common cold, according to experts.
The White House needs to plan for them all. Some former Biden advisers want the president to plan for the new normal and accept that Covid-19 is here to stay.
There is no evidence that Mr. Biden is changing his strategies. As his second year begins, he is keeping his public health team intact.
During a news conference in the East Room of the White House on Wednesday, he said that some people may call what is happening now the new normal. I call it a job that is not done.
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