How state health departments might view Joe Biden's COVID response plan

With the novel coronavirus surging in states across the country, state leaders are scrambling to develop plans to contain the outbreak as many critics say the Trump administration remains largely disengaged.

But former health officials and experts told ABC News that those offices may have a stronger ally in their fight next year -- the incoming Biden administration.

Jeanette Kowalik, the director of policy development for the nonprofit health policy group Trust for America's Health and former health commissioner for Milwaukee, said state public health offices have been largely left to their own devices during the pandemic, and as a result, the country has developed a range of rules and regulations.

The pandemic has also become highly politicized, including the debate over mask mandates, with some states refusing to implement such measures despite evidence they can save lives.

President Donald Trump demurred from wearing a mask for months, jabbed President-elect Joe Biden for wearing one and questioned the efficacy of mask wearing. He has also sparred with and publicly contradicted the government's scientific experts.

Overall, the administration, while giving guidance through the Centers for Disease Control and Prevention (CDC), has largely deferred to the states on public health aspects of the pandemic and focused on economic recovery and vaccine development instead.

'Good start' but steep challenges for Biden

Kowalik and other experts predict that governors, mayors and health officials will be receptive to Biden's health policies, which include increased testing and a bigger push for masks across the nation.

"We're trained to adhere to whatever is at the national level," Kowalik told ABC News. "The fact that the Biden administration is committed to science is a good start."

While there may be some state leaders who, due to political ties, refuse to abide by the new administration's guidance, some of the experts said the rising COVID-19 dangers and the possible harsher winter will force them to reconsider.

The country is experiencing a daily caseload that is higher than ever and a death toll approaching the spring peak, and as a result, some leaders are already showing signs of following Biden's example, according to Dr. Georges Benjamin, the executive director of the nonprofit American Public Health Association.

Many health experts say the new administration's challenges are steep, but any amount of increased coordination will go a long way.

Benjamin said the CDC has released broad COVID-19 related guidance including wearing a mask, social distancing and limiting crowds. When it comes to having states enforce those protocols, the agency's members have been "keeping their heads down," because of the current administration's orders to focus on the economy over containing the spread, he said.

Kowalik, who left her position as Milwaukee's health commissioner in September, recalled how there was increased tension between state leaders and health offices over that debate.

State leaders who wanted to ease stay at home restrictions or not issue mask mandates would argue that the White House backed their proposals and move forward, she said.

An exit poll conducted by ABC News during the election found that a majority of Democratic voters favored containing the virus even if the economy took a hit while a majority of Republican voters favored the opposite.

'Major shift in tone' may help bring along opponents

Even though Biden won't assume office until January, many health experts say his announcements and plans during the campaign and transition show a more unified vision dedicated to keeping people healthy.

The president-elect has called for a national pandemic dashboard that breaks down COVID-19 data by ZIP code, expands the nation's testing capability and contact tracing, and for a national mask mandate.

"The Biden administration was clear that it would use science to guide how they manage the pandemic," Kowalik said. "That is a major shift in tone and a clear directive to health officials and leaders."

Experts who spoke with ABC News acknowledged the mask issue will be tough to enforce, especially since many Americans are still reluctant to wear them. However, Biden's continued promotion of the idea, both with his words and image of him wearing one during appearances, sends a strong message to the world, according to Benjamin.

"When you have a president wearing a mask, and encourage governors to do it in a way that is not threatening…that can change people's behavior," Benjamin said.

Kowalik added that the professionals that Biden has already chosen for his COVID-19 response give local health officials promise there will be a stronger direction from Washington.

Two days after he was projected to be the winner of the election, Biden announced a 13-member COVID-19 task board that included former Surgeon General Vivek Murthy and former Food and Drug Administration (FDA) Commissioner Dr. David Kessler.

"The majority of members are people who are well-known," Kowalik said of Biden's team. "That is definitely needed because the situation warrants hard science."

Prioritizing vaccine distribution

Michael Sparer, the chair of the department of health policy and management at Columbia University's Mailman School of Public Health, told ABC News the most important part of the Biden administration's COVID response will be eventual vaccine distribution.

Trump's Operation Warp Speed initiative laid out the groundwork for developing and delivering the vaccine in unprecedented time. However, the president was critical of the FDA's strict guidelines over the vaccine's approval.

Sparer said he expects Biden will build on this groundwork and provide states with a more detailed rollout, without any conflict with the FDA over approval or with the states over distribution.

"It will be distributed locally, but the effort by the Biden administration will be done under a national plan," Sparer said. "There will be efforts to straddle that middle ground."

Tailored reopening plans

Kowalik said the new administration's health departments would also offer state leaders a compromise by providing states with advisories and reopening plans that fit their specific needs.

She noted the Trump administration attempted this strategy in April with its reopening benchmarks offered to states that were contingent on increased testing and data that showed a continuous downward trend in cases.

However, the administration allowed several states to move forward with their reopenings in the spring despite not meeting the criteria. Biden had conference calls with governors and mayors and said he will continue to reach out during his transition and first weeks in office. He's also pushed for a "dimmer switch" method of reopening that is selective with restrictions.

"The CDC usually had a couple of options that were malleable," Kowalik said. "Having more than one plan for states to choose from and an overall outline of goals is key."

Benjamin acknowledged that partisan politics may prevent full cooperation, but the virus's growing threat has already forced some state leaders to rethink their strategies.

On Nov. 16, Iowa Gov. Kim Reynolds reversed her stance on a statewide mask mandate after her state saw a record 1,500 people hospitalized that day.

Around that same time in Wyoming, 21 health officials wrote a letter to Gov. Mark Gordon to implement a mask mandate as the seven-day average of new cases has jumped from 73.4 on Nov. 1 to 218.1 on Nov. 23, according to state health data.

"A vast majority of the people have not yet seen the disease affect somebody," Benjamin said. "I think as [the COVID-19 numbers] grow, there will be more recognition from those leaders that they need to listen to the science."