The transfer of presidential power conferred through the electoral process is a great and admirable American tradition, a pillar of American democracy admired around the world.

At noon on January 20 Joe Biden was sworn in as the 46th American President, and Kamala Harris was sworn in as his Vice-President. The ceremony, watch intently by millions of Americans and people around the world, was its own historic blend of constitutionally endorsed ritual, tradition, and the unique moments and circumstances that make up each transition of power and each Inauguration Day.

In 2021 it marked the exit of an incumbent who is destined to rank among America’s worst presidents and an administration that was defined by constant chaos, corruption and scandal. It was overshadowed by the exigencies of the coronavirus pandemic and a huge military presence in response to fears of civil unrest. It was only the beginning of a process to heal a divided nation.

On a cold and blustery day, Biden looked out on a scene very different from that the last time he stood at the Capitol to be sworn in as Vice-President and he now confronts a task even greater than that he faced with Obama in 2009 when the nation was reeling from the Global Financial crisis.

Like Obama in 2009 and unlike Trump in 2017, his inauguration message was one of hope, renewal, resolve and optimism and most particularly, of the need for unity.

Biden’s speech was authentically Biden and it was a relief to hear, once again, a president say the expected things. His key point was that unity is essential to the path forward, that without unity (which he called “the most elusive of all things in a democracy”) there can be no restoration and repair, only exhausting bitterness and fury.

He reminded us that while democracy has prevailed, it is also fragile, and he highlighted that the struggle between the American ideal that all men are created equal and the harsh, ugly reality of racism, nativism and demoralisation must be addressed. His reference to the need to reject a culture in which facts are manipulated and even manufactured served to remind us of the times we have just lived through.

In a low-key but deliberate reference to racial divisions in the United States as have been highlighted by the Black Lives Matter movement, he said that “The dream of justice for all will be deferred no longer” and called for Americans to work together to “write an American story of hope, not fear. Of unity not division, of light not darkness. A story of decency and dignity, love and healing, greatness and goodness.”

Biden knows what he must do, he realises the enormity of the task ahead and the magnitude of the divisions that must be healed, and he pledged that his “whole soul is in it”. His themes were brilliantly echoed in the beautiful poem from the National Youth Poet Laureate, Amanda Gorman. Her poem, “The Hill We Climb” said this: “the new dawn blooms as we free it, for there is always light if only we’re brave enough to see it, if only we’re brave enough to be it.”

Tradition and history

Ever since John Adams succeeded the first president, George Washington, the transfer of power between presidents has been complicated, often fraught, sometimes vindictive, but it has ultimately always been peaceful. The situation is made more difficult if the new president has wrested power from an opposing party.

The first bitter transition came early, in 1801, when the Republicans beat the Federalists. After a nasty election campaign which played out in the partisan press and confusion over vote counting (the result was ultimately decided after 36 ballots in the House of Representatives), Thomas Jefferson was declared the presidential winner. John Adams left Washington in the middle of the night so he would not have to attend Jefferson’s inauguration the following day. But ultimately Adam’s peaceful handover of power served to engrave America into history as a democracy.

Adams understood that the election of 1800 was about far more than two men trading power or knowing when to let go. Rather, an election was the country’s best mirror. “The Nation, if it has any Eyes, will see itself in a Glass. I hope it will not have reason to be too much disgusted with its own Countenance,” he wrote to his wife, Abigail.

This electoral crisis – so reminiscent of today’s – informed Jefferson’s first year in office. Jefferson sought to unite a bitterly divided nation (his inauguration speech began that process) while delivering federal policies in accordance with his party’s philosophy to reduce taxes, bolster civil liberties, and liberalise the naturalisation of immigrants as citizens. This enhanced his popularity and undermined the Federalist opposition, which rapidly declined, giving him leverage with the  Congress.

Some years later Jefferson described the election of 1800 as “a revolution in the principles of our government”. We can hope that Jefferson’s subsequent success is indicative of what Biden can achieve.

The dark shadows

Biden’s inauguration took place against the backdrop of an out-of-control pandemic and a heavy military presence, with the subsequent absence of crowds and celebrations. There were more National Guards than invited guests and masks were ubiquitous.

There were echoes of other inaugurations. In 1861, Abraham Lincoln confronted a capital in lockdown with the nation on the abyss of Civil War; the president-elect was smuggled into Washington via Baltimore.

In 1933, when Franklin Delano Roosevelt was inaugurated, the nation was gripped the Depression and a Republican president incapable of acting. FDR spoke directly to the people then, “The only thing we have to fear is fear itself,” he declared. “The people of the United States have not failed. In their need they have registered a mandate that they want direct, vigorous action. They have asked for discipline and direction under leadership.”

It’s not the first time the ceremony and celebrations have been minimalist. The weather in Washington was so bitterly cold for Reagan’s second inauguration that it was held indoors with only a select invited crowd and the parade was cancelled.

It is true that in one sense the scene on the Mall for Biden’s inauguration was dystopian with just a few hundred masked people sitting socially distanced. However, the mass of flags on the Mall was inspired and for me this and the spareness of it all served only to highlight the grandeur of the surroundings, the solemnity of the ceremony, and the importance of the event.

And let’s be honest – it was all made so much better, so much easier, by Trump’s absence.

Biden’s great empathy shone through with the simplicity of the National COVID-19 Memorial Ceremony at the Reflecting Pool in front of the Lincoln Memorial the night before – there was nothing forced, ever word was heartfelt and genuine, and there was none of the self-aggrandisement that was ever present in Trump’s public speaking.

The task ahead

As President Biden promised – and as is imperative – his team has been working diligently in the lead-up to Inauguration Day, they have already hit the ground running. The key issues are getting control of the pandemic an efficient and equitable rollout of vaccines and tackling the economic impacts.

But they must also move swiftly to undo the damage that the Trump Administration has wrought in health care, welfare programs, environmental areas, immigration policies and race relations, and to repair America’s international standing and relationships. These will be Biden’s priorities.

The Trump presidency was marked by battles over truth and science. There remain endless battles to be endlessly fought on this front if Biden’s presidency is to be accepted as legitimate and if the United States is to see progress on key issues such as controlling the pandemic, vaccinations and climate change.

The rents in the national fabric and the rifts in American society will not be easily healed. Biden must work to gain the trust of Trump’s base with straight talk, good government and strong actions to improve their lives: everyone needs healthcare, education, and a decent wage; economic growth that lifts up those who’ve been left behind is essential; and his Administration must address the root causes of racial inequalities that so adversely impact minority communities and the deaths of despair (from suicide, substance abuse, and gun violence) that are hurting and alienating working-class white communities.

Most of the senior Biden team are already nominated or appointed, although the most senior Cabinet positions will require Senate confirmation. As promised, it is a team that reflects America in a thoroughly inclusive and contemporary sense.

The announcements from Biden and others about the priorities and how these will be tackled are impressive. Not that there is any genius about these – rather that they stand in such stark contrast to the policy paucity of the Trump Administration. As a recent article in the New York Times pointed out, the Biden plan for combating coronavirus is so obvious and straightforward that it is “the most damning indictment of the Trump administration’s coronavirus response imaginable”.

I’m simply going to compile a list here of the statements and policies in health and related areas that I think are important. As these serve to highlight, Biden has an enormous task ahead, with little room for failure – the Democrats have a majority of just six in the House of Representative and only Kamal Harris’ vote to break the tie in the Senate.

However, with Trump gone (and without his social media accounts) perhaps Republican lawmakers’ allegiances to him will diminish, but most likely Trumpism is all its nastiness will linger and hinder Biden’s efforts.

Biden’s appointees

The lists of all nominees and appointees can be found here.  The Washington Post has an interactive that tracks nominees and unfilled positions.

Importantly, Biden and Harris have made clear that this will be an administration where “science is always at the forefront”. The Director of the Office of Science and Technology will, for the first time, be a Cabinet-level position. This position will be filled by Dr Eric Lander, well-known for his work on the human genome.

His deputy will be Dr Alondra Nelson, a social scientist who studies science, technology and social inequity. She has already spoken out about the importance in expanding opportunities in the STEM fields. “As a Black woman researcher, I am keenly aware of who is missing from these rooms,” she said, speaking at the event where Biden introduced his science team.

Harris’ speech at the announcement is worthwhile reading.

The Biden health team is here. They come to the task with established expertise in health issues, familiarity with the health laws, and good communication skills.

Xavier Becerra will lead the Department of Health and Human Services; he will be the first Latino to do so.  As California Attorney General he has taken some ground-breaking positions on health care. He has sued the Trump administration dozens of times on health care, birth control, immigration, climate change and more, with California leading the defence of the Affordable Care Act before the US Supreme Court. As the Biden Administration looks to undo the damage Trump has done to Obamacare and then to build it up further, his leadership and expertise will be crucial.

Trump’s other choices for senior roles in health – Andrea Palm as Deputy Secretary, Dr Rachel Levine as Assistant Secretary, Dr Rochelle Walensky to head up the Centres for Disease Control and Prevention, Dr Vivek Murthy to reprise his former role as US Surgeon General and Dr Anthony Fauci and Chief Medical Advisor to the President have all been warmly welcomed.

Assuming Senate confirmation, Dr Levine will be the first openly transgender federal official. In her role as Assistant Secretary she will oversee much of the agenda around prevention. Her expertise includes work on the opioid crisis, medical marijuana, eating disorders and LGBT medicine.

Putting together a Coronavirus Task Force was one of the first things Biden did after his election. I wrote about this for The Conversation in November. Since then, he has added additional members to increase diversity and expertise.

The Task Force has three eminently qualified co-chairs: the former head of the Food and Drug Administration, Dr David Kessler who will also head up Operation Warp Speed; Dr General Vivek Murthy; and researcher-scientist Marcella Nunez-Smith, an expert in health equity issues who will lead a new advisory group aimed at reducing disparities in response, care and treatment.

Biden’s priorities

The Biden Build Back Better website has lots of information about Biden’s policies and initiatives (I’m not sure what will happen to this after Inauguration Day).

In particular, the Biden-Harris plan to beat COVID-19 is here and the healthcare agenda they campaigned on is here.

The website is headed “Restoring American Leadership: Ready on Day One” and this is exemplified in a recently released memo from White House Chief of Staff, Ron Klain, to incoming senior staff. It outlines what will be done in the first ten days to address the COVID-19 crisis, the resulting economic crisis, the climate crisis, and a racial equity crisis. It makes encouraging reading.

On Day One Biden was busy signing some seventeen Executive Orders to overturn those put in place by Trump. The first Executive Order he signed requires the wearing of masks on federal property.

There is much to do in healthcare and everyone has ideas and proposals; here are some of the more realistic:

As an aside, I loved this article in Vox: “The Trump presidency is over, and Obamacare is still alive.”

Also recommended, from STAT: The 9 biggest challenges Biden will face on COVID-19 from today on; and Welcome back to the global health stage America, you have a lot of work to do.

Biden coronavirus stimulus bill

One of Biden’s first actions after ascending to the presidency was to send his US$1.9 trillion coronavirus stimulus bill to the Congress for action. This has been described as a “science-led New Deal to end pandemic suffering”.

Billed as the American Rescue Plan, the package augments many of the measures in Congress’ historic $3 trillion coronavirus relief bill from March and in the $900 billion legislation from December, which was scaled back to garner support from Senate Republicans.

Now that Democrats control both chambers and the White House, Biden is pushing for the big steps he says are needed to address immediate needs and control the coronavirus pandemic. He also plans to lay out an economic recovery plan in coming weeks that aims to create jobs and combat the climate crisis, among other measures.

The package includes:

  • US$1400 / person in stimulus payments
  • Enhanced unemployment aid
  • Rental assistance and eviction moratorium
  • Extra funding for food assistance
  • More funding for childcare
  • Subsidies for health insurance premiums via Obamacare
  • Restoration of emergency paid leave
  • Assistance for small business
  • Aid for states and schools
  • Increased support for vaccines and testing
  • US$15 hourly minimum wage.

Biden also sent the Congress the U.S. Citizenship Act of 2021. This is a bill to transform the American immigration system. It includes an eight-year path to citizenship for undocumented immigrants and an expedited path for Dreamers, Temporary Protected Status holders, and agricultural workers. The bill would additionally use various tools to establish safe, orderly migration and humanitarian protection channels from Central America and increase accountability and transparency in immigration enforcement.

Hope and science

Harkening back to President John Adams’ thoughts that elections mirror the nation, the early days of the Biden – Harris Administration must necessarily involve a harsh reflection in history’s mirror of Trump’s legacy, American society, and the nation’s commitment to democracy. At the same time, this cannot be allowed to dominate or displace the essential work of government to “Build Back Better”.

There is every hope that Biden’s presidency will “restore the soul of America” as he promised in his first speech after being elected. He sees as his mandate that:

Americans have called on us to marshal the forces of decency and the forces of fairness.
To marshal the forces of science and the forces of hope in the great battles of our time.”