March 5, 2021 at 10:33 am #100002166zpodiumKeymaster
Walensky, the former chief of infectious diseases at Massachusetts General Hospital, has already embarked on a listening tour at agency headquarters in Atlanta and regularly appears at the White House’s thrice-weekly Covid-19 briefings. But officials at the CDC and other federal health agencies said she has yet to lay out a vision for the CDC’s response to Covid-19 and beyond. They worry the agency will again be beholden to the White House — which, despite President Joe Biden’s promises to champion science, could be tempted to maintain control of the narrative by overriding experts’ policy recommendations.
“She has a really hard job,” said Ashish Jha, dean of Brown University’s School of Public Health and a former member of Biden’s transition Covid-19 advisory board. “There has been a lot of confidence shaken in the CDC. I think most people think the CDC has made some real missteps. Her job isn’t just restoring faith with the public, which she will be able to do. She’s got to look deep in the organization and see which ways the organization hasn’t functioned well during the pandemic.”
The CDC director’s role is the clearest example of the multidimensional task Biden’s Covid-19 team faces. Not only do officials need to get their arms around a pandemic that has killed more than 510,000 Americans, they have to do so while restoring trust in the institutions they now direct. The CDC made several missteps during the Trump administration on testing and on streamlining messaging around its Covid-19 guidelines.
“My immediate focus is encouraging people to receive the earliest vaccine that is available to them. We need to get shots into arms. We can’t forget: cases remain very high, and with variants spreading, we could completely lose the hard-earned ground we just gained,” Walensky said in a statement to POLITICO. “The American public and the world rely on CDC’s scientific, fact-based information and leadership. Our 24/7 mission to save lives and protect people is more critical than ever. I am doing everything I can to move CDC forward, and to assure the American people that they can count on CDC for the very best scientific and health information.”
Walensky’s colleagues said that revitalizing CDC will require her to soothe tensions of the past even as she catapults the agency back into the limelight.
“I think that during 2020 the CDC was too often silenced or muzzled. And given its expertise in combating infectious diseases and pandemics, the nation really suffered from not being able to take advantage of its leaders who have day in and day out led both domestic and international efforts around infectious disease,” said John Auerbach, the CDC’s associate director from 2014 to 2016. “You want to make sure people who have that expertise are able to use their knowledge and skills to protect the American people. I think that is very important in terms of reassuring the public that we have a federal agency that will not only have the expertise but will be able to speak frankly to the public.”
Officials who worked with the Biden transition team said it was clear that whoever took the CDC director post would face an uphill battle. The position called for a leader who not only could master the science of Covid-19 and communicate effectively, but who could also revitalize what had once been seen as the world’s leading public health agency.
Current and former federal health officials and others who have worked with Walensky said she’s the perfect fit.
“Rochelle is a friend of mine, and I have known her for years. I am a strong advocate of hers, and I strongly recommended she be made director of the CDC,” said Anthony Fauci, Biden’s chief medical officer. “She’s a very smart person and has a great reputation. She’s outstanding and working with her is very easy.”
One of the ways Walensky plans on correcting the missteps of the prior administration is by engaging with career scientists and promoting their work, officials inside the CDC said.
She has spent hours talking with CDC employees about the agency’s work on Covid-19 and what it can do to better prepare for the next pandemic. Three officials who met with the CDC director said she spent most of her time with them asking questions to better understand how each of the agency’s dozens of departments function and what they need in terms of support from her office to do their jobs better.
“It’s just been insane,” said Walensky, describing her first few weeks at the agency in a recent interview with JAMA Network. “It’s been super humbling. Getting to know this agency and the people who have been doing the hard work for I would say a year on Covid but for decades has truly been extraordinary. The dedication, the tiredlessness, the selflessness … for what they have been doing for the public is really inspiring for me.”
The trio of officials who recently met with Walensky said they told her that the agency was at a crossroads and needed a leader who could help it reemerge as a leading force not just on Covid-19 but also on other critical public health subjects.
Part of the problem, officials said, is that the CDC is split between those who believe it needs to change and become more efficient, fast-moving and modernized and those want the old systems and structures to remain in place. That internal battle has created problems for the agency in the past. For example, many of the younger CDC officials say the agency needs to streamline the leadership structure and create less overhead by centralizing different divisions. The CDC is still struggling to find a happy medium.
Over the past year, agency staff have butted heads internally and with officials from other federal and local health agencies on the way the CDC has tracked Covid-19. In particular, the agency’s data teams have come under fire for the way they collect, analyze and publish information on testing, vaccinations and mortality. One former Trump administration official called the data collection systems “arcane.” Another said the Trump administration attempted to create an entirely separate data platform, known as HHS Protect, in an attempt to bypass the CDC because the agency was “too sluggish” and that its data sets were too disparate and confusing.
The CDC has also struggled to streamline and coordinate its messaging on Covid-19 guidelines for everything from school reopening to travel. One senior administration official said the agency has aggravated current and former officials because the “CDC leaks all the time to reporters.”
At one point over the course of the summer, Trump administration officials held a series of meetings about replacing then-CDC chief Robert Redfield with someone who could “give the CDC a facelift,” as one former senior official put it.
“The CDC needs to be transformed,” that official said. “It is a quasi-academic enterprise more interested in publishing reports and admiring data and pondering than extinguishing a pandemic.”
The agency has few political appointees and most of its staff are based at its headquarters in Atlanta, rather than the nation’s capital, setting it apart from the rest of the health department.
CDC officials argue the agency has for decades led the way on investigating and containing outbreaks domestically and internationally — work that often escapes notice in Washington. That’s where Walensky comes in.
“Redfield was a public health guy and HIV guy but was always a bit outside of the mainstream,” Jha said. “Rochelle is incredibly smart, deeply knowledgeable and someone widely respected in the public health world.”
Walensky is known across the country for her leadership in the infectious disease space and has worked with the leading minds on HIV/AIDS, her colleagues said. And she has already made it known inside the agency that reforms need to be made.
“I have also charged CDC to assess our own performance on this response, so that we can learn from our successes and grow from our mistakes,” Walensky told POLITICO.
Still, the stress of leading the CDC back into the good graces of Americans is daunting, particularly for someone without prior government experience.
Officials close to Walensky who work on the administration’s Covid-19 response say the CDC director has a good relationship with Fauci, a veteran of the federal government who has years of experience communicating with the public on major infectious-disease outbreaks.
“We are constantly calling and texting each other,” Fauci said. “She’s not hesitant at all to call up and engage in active discussions about things. She doesn’t work in a vacuum. She works closely with the Biden medical team. It is a very good, collegial and enjoyable working relationship.”
Walensky sits in on briefings with the president and has at points over the last several weeks spoken up about policy recommendations she disagrees with, two senior officials familiar with those conversations told POLITICO. “She is definitely not afraid to speak her mind,” one of those officials said.
But Walensky’s success won’t be determined in closed-door meetings. It hinges on her ability to get people to listen to her and the science and data that support the agency’s policy recommendations, officials said.
The CDC has so far faced an uphill battle on that front. In recent weeks, a slew of states such as Texas and Mississippi have not only lifted their mask mandates but have also fully reopened.
The gap between the federal government’s Covid-19 response and the states’ is something the CDC has tried to address over the past several months. The CDC has deployed hundreds of officials throughout the country to work with state health officials on virus surveillance and investigations. But the agency will also be ramping up its public health messaging in the coming weeks on the importance of wearing masks, social distancing and signing up for vaccination. The CDC has also launched a campaign to reduce vaccine hesitancy, rolling out “vaccine confidence consultations” for interested jurisdictions, according to an internal memo obtained by POLITICO.
Pushing the CDC back into conversations on the federal government’s response to Covid-19 is a big first step in Walensky’s playbook, according to two senior agency officials who work closely with her. Making herself and the agency more visible by speaking at press conferences and giving media interviews is part of what the CDC director will use to rebuild the agency’s reputation, those officials said.
Those simple steps mark a major change from the Trump administration. Redfield did not often appear with White House officials at press conferences. When he did participate, he at times sat off to the side and did not answer questions from reporters. He rarely emerged for nationally televised interviews. At the same time, the CDC appeared to cave to White House pressure, revising its testing guidelines several times before the beginning of the school year.
One CDC official who spoke to POLITICO said the testing changes were the result of a “communications failure.” Another agency official said political appointees in the Department of Health and Human Services and the White House often pressured the agency to alter Covid-19 guidelines and often successfully pushed through their revisions for the final product.
Less than two months into her CDC tenure, Walensky has appeared at every Covid-19 task force press briefing and in multiple high-profile TV network interviews.
“She’s been on the job for just a few weeks. And she came in at a very tense and complicated time. She came in the middle of a big surge, with new variants emerging and vaccines coming online,” Fauci said. “One of the things you’ve seen is her grasp of the complexity of what you have to deal with during a pandemic like this. She has the communication skills, and she can communicate the data and facts in a clear, crisp way.”
Walensky’s remarks are often scripted and she sticks to talking points drafted for her by the CDC press shop and the White House. The CDC director spent hours crafting her script before appearing on national television Jan. 21, working behind the scenes with the White House on the language, according to an official with knowledge of those conversations.
Despite that close coordination, Walensky has her own voice. She is candid — sometimes more candid than White House communications staff would like — in her answers to reporters about how the country should think about big policy issues. Her statements, along with remarks made by other health officials, including Fauci, have sometimes sparked tensions inside the White House — with staff frustrated by their inability to control and fine-tune the overarching narrative about the federal government’s Covid-19 response.
In a Jan. 27 press conference a reporter asked Walensky about the accuracy of federal data showing that states and localities were using only half their vaccine supply. Walensky offered a blunt answer: She didn’t know.
“Not all vaccine that is … allocated or delivered or whatnot is available for inserting into people’s arms. Where in the pipeline that is varies by the day of the week whether it’s available that singular day,” she said.
Her answer came as the Biden White House was just beginning to get a handle on how the federal vaccine distribution system worked, and officials were trying to find ways to ramp up vaccinations. That couldn’t happen until the federal government could explain how millions of doses that had gone unaccounted for in the distribution system. The CDC director’s remarks sparked more questions from reporters about why there was such a large discrepancy between the number of doses shipped and the number administered.
A week later, Walensky’s comments on school reopening caught the White House so off guard that it ended up attempting to walk back her statements.
At a Feb. 3 press conference, which took place before the CDC released its guidelines for reopening schools, Walensky said science showed teachers did not need to be vaccinated before returning to in-classroom instruction. It was a statement that other experts had made publicly. Studies have shown transmission rates inside schools are incredibly low and that social distancing and universal masking can be used to help get students back to school safely.
But Walensky’s statement kicked off a series of heated, closed-door conversations at the White House among officials who were still in the throes of working with health officials to finish the guidelines, including specific language on vaccinations and teachers. The White House was under pressure from school unions to do more to get teachers vaccinated. And Republicans nationwide had begun attacking the Biden administration for not doing enough to lower the barrier for students returning back to in-person instruction.
The next day, on Feb. 4, White House Press Secretary Jen Psaki told reporters that Walensky had been “speaking in her personal capacity” when she said teachers did not need to be vaccinated to return back to the classroom. The entire saga confused everyone involved and underscored the extent to which the White House and the CDC were at odds about how to communicate about important policy announcements. It also raised questions about whether the White House would follow through on its promise to let scientists lead on all things Covid-19.
The situation came to a head again this week when news broke that the CDC would release its guidelines for vaccinated Americans. POLITICO was the first to report that the guidelines were set to be released Thursday and would recommend that vaccinated individuals could socialize with other vaccinated people in small group settings in the home.
The announcement was put on hold after the CDC was told to delay releasing the guidelines. Officials inside the CDC say that order has confused them and raised questions about whether outside groups are again attempting to interfere with their work.
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