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Essay – Quick, Name the Secretary of HHS

Covid-19 testing


24 Dec. 2021. Here’s a little game to play at your holiday meals — without looking at your phone or other prompting, name the U.S. Secretary of Health and Human Services. I would guess 999 of 1,000 people in the U.S. can’t do it, and that would include many of the savviest news reporters in Washington, D.C.

Our country and world are in the worst health crisis in a century, and the U.S. cabinet secretary with the word “health” in the title is missing in action. Yet the Department of Health and Human Services or HHS houses the agencies responsible for …

Health research, National Institutes of Health (NIH)

Public health guidance, Centers for Disease Control and Prevention (CDC)

Drug and medical device regulation, Food and Drug Administration (FDA)

Health insurance for elderly and low-income populations, Centers for Medicare and Medicaid Services (CMS)

The Washington Post today notes that in the first week after President Joe Biden took office, he promised a wartime effort to contain the Covid-19 pandemic. When I hear the words “wartime effort,” I think of World War II, when from Pearl Harbor to V-J Day the main thing that mattered in the U.S. was winning the war, and each sector of the government and economy was mobilized in that effort.

Apparently, the current HHS Secretary is thinking of something other than WWII. If there was any effort at HHS to make Covid-19 the top priority, breaking down organizational silos in the department and creating procedures to hasten approvals and clarify public health messages, they’re not evident. The White House did establish a separate coordinator for Covid-19 policy government-wide, but HHS is where most pandemic activity takes place.

More needed than vaccines

While FDA succeeded in authorizing and later approving vaccines for adults and children, and straightening out vaccine distribution, the Biden administration since discovered there’s more to beating Covid-19 than giving vaccines. CDC’s messaging on vaccines, for people of certain ages and various health conditions, was at times contradictory and confusing, most recently with booster shots. In addition, inexpensive testing for Covid-19 infections is widely available in Europe, but still hard to find today in the U.S.

And early warning of new viral variants remains a patchwork system in the U.S. We learned about the omicron variant in late November, thanks to work by researchers and health authorities in South Africa. Viral surveillance systems in the U.S., however, only began taking shape this year. Science & Enterprise reported yesterday, for example, on the Rockefeller Foundation, not HHS, funding an early-warning system for Covid-19 and other respiratory diseases at five health care providers.

But perhaps the biggest failure of HHS so far is the lack of leadership needed for this crisis. Last spring, few people imagined a leading cable television network would promote crackpot rumors and misinformation about Covid-19 vaccines each night, with leaders of a political party echoing those same messages at the state and federal levels. But that’s where we are today. So far at least, HHS with its many experts on public health seems unable to respond effectively.

The public face of the administration’s Covid-19 efforts up to now is Anthony Fauci, director of National Institute of Allergy and Infectious Diseases, part of NIH. Fauci is very good at describing the state of the pandemic and vaccines, but he has paid a high price for this role, with continued threats to his safety and his family. It’s way overdue for the HHS secretary to take the heat off one of his department’s key executives.

Provide simple, clear guidance

A look at speeches and public remarks made by the HHS secretary since the emergence of the omicron variant in late November shows only one reference to Covid-19 and omicron, on 29 Nov. in a speech to the World Health Assembly. Three other speeches by the HHS secretary since then deal with other topics, with no public remarks on any subject after 8 Dec. Yet as recent as 21 Dec., speakers at an extremist conference, including a Fox News host, made threatening remarks about Fauci, with so far no response from the HHS secretary, either spoken or written.

What’s needed is an HHS secretary that can go on the cable news networks, including Fox News, at least every week and provide simple, clear guidance for families in the U.S. Transportation secretary Pete Buttigieg goes on Fox News to talk about infrastructure, why can’t the HHS secretary do the same with health matters?

Also needed is an HHS secretary to take command of the entire department’s Covid-19 activities, to better integrate and coordinate those processes. For example, in 2020 NIH started a challenge competition to encourage development of new tests for Covid-19 infections, including inexpensive tests done at home. While NIH’s program produced many new Covid-19 test candidates, as reported by Propublica, they ran into FDA’s existing medical device clearance rules, designed for non-emergency circumstances. As a result, companies submitting new tests, often with NIH funding, had to wait for months for FDA to respond. It took until 15 Nov. of this year for FDA to finally issue new guidance to speed authorization of Covid-19 diagnostics, particularly at-home tests.

Who could fill that leadership role at HHS? I would recommend Atul Gawande, a practicing endocrine surgeon at Brigham and Women’s Hospital in Boston, and prolific writer of books and articles in the New Yorker magazine. Gawande is nominated to be Assistant Administrator for Global Health at USAID, but given the desperate need for leadership and an assertive public face at HHS, USAID should find another candidate.

By the way, the current HHS secretary is Xavier Baccera. (I had to look it up as well.)

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