Senior Executive Service steps into the CDC leadership vacuum, BARDA grows up

Per Wikipedia- Rochelle Paula Walensky (née Bersoff; born April 5, 1969) is an American physician-scientist who is the director of the Centers for Disease Control and Prevention and the administrator of the Agency for Toxic Substances and Disease Registry. Prior to her appointment at the CDC, she was the Chief of the Division of Infectious Diseases at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. Walensky is an expert on HIV/AIDS.

<actually, she is not really a scientist. She is an MD with a masters degree in public health or MPH. Not trained as a scientist, in case you were wondering>

First a reality check. Has CDC done a good job in messaging regarding public health? Here is an article from Business Insider (an amazing misnomer) published three days ago, which corporate press outlet is generally an unfailing supporter of the current executive branch administration.

“42% of Americans think monkeypox is at least as large a public health threat as COVID-19 now: poll” (!!!)

New polling from YouGov shows that only 1 in 3 Americans consider COVID-19 a bigger threat than monkeypox.

Most Americans believe COVID-19 and monkeypox are now equal threats. COVID continues to kill hundreds daily.

A minority of respondents said the country is "very prepared" or "somewhat prepared" for another pandemic.

Only 1 in 3 Americans consider COVID-19 — a disease that continues to kill hundreds of people each day in the United States — a bigger threat than monkeypox, which has so far infected relatively few and killed none, according to a new YouGov poll.

The rest of Americans consider the two diseases to be equal threats (33%), no threat at all (18%), or aren't sure (10%), while 9% of respondents consider monkeypox a greater threat than COVID-19.

The poll, which was conducted over the internet between August 4 and 7, revealed that Black respondents were much more likely to view the two viruses as equal threats — 55% did — while 25% of white respondents believed them to be equal threats.

I suggest that the answer to the hypothetical question of whether CDC is doing a good job communicating issues relating to public health with the American public is self evident.

Real Clear Politics from two days ago:

Top Doc Slams CDC for Not Researching Kids' Heart Injuries

"The fact the US, CDC, NIAID, FDA, etc etc. have to rely on a Thailand preprint for the first prospective study of cardiac biomarkers is mind-boggling negligence. The US and this CDC have shown that either they are incompetent to take safety signals seriously, or indifferent to safety. They earn Grade F. This study should have been done in the USA, by Pfizer 1 month after EUA was granted. End of story,"

Pew Research Center:

Americans Reflect on Nation’s COVID-19 Response

Fewer than half say the country has given the right amount of priority to the needs of K-12 students, public health, quality of life

“As levels of public concern over the coronavirus outbreak recede, Americans offer a lackluster evaluation of how the country has balanced priorities during the outbreak. A majority of U.S. adults say the country has given too little priority to meeting the educational needs of K-12 students since the outbreak first took hold in February 2020. Assessments of the nation’s response across other domains are little better: Fewer than half of Americans say the country has done about the right amount to support quality of life and economic activity or to protect public health.”

We could go on and on. I think that all can see that US Centers for Disease Control and Prevention (and in particular, the current Director (former Harvard Med Professor) Rochelle Walensky, MD, MPH) has failed to meet expectations during two “Public health emergencies” in a row (COVIDcrisis and Monkeypox containment) and has become a political liability. So President Biden promptly stepped in to remove and replace her with a more experienced and competent Director, right? Not so much. It appears that the Administrative State (Senior Executive Service) had to do an intervention, and that rather than the (logical) termination of an arrogant and entitled academic who has failed to provide effective leadership through two declared Public Health Emergencies, Professor Walensky has been kneecapped and given the bureaucratic equivalent of training wheels, but is likely to continue her new career as a broadcast celebrity on CNN and MSNBC (if she can be bothered to leave her home in Maine from where she currently “manages” the CDC, and travel down to New York or Atlanta). Her future job awaits, it would seem, and Dr. Sanjay Gupta should be looking over his shoulder.

In the meantime, what are Dr. Walensky’s prescriptions for curing the CDC of its ailments? More power and more money.

I love Harvey’s short summary of the situation:

CDC’s Ludicrous Makeover

BY HARVEY RISCH

The CDC’s announcement covers everything except the fundamental problem to which the director and the external reviewer are blind: industry subservience and epidemiologic incompetence.

CDC has published numbers of fatally flawed study reports over the last two years in MMWR, its captive journal.  No amounts of “moving faster” will fix this problem.  It took CDC two years to figure out that the vaccines are not an effective public health tool for reducing infection spread, something that I and numerous colleagues have been saying for more than a year. 

CDC has still not recognized that for Covid, masks are useless, that distancing is useless, that general population testing is virtually useless for managing the population pandemic. 

That the CDC has reviewed itself and only found trivialities and not the systematic problems that caused it to produce repeatedly failing policies shows that this review exercise was only window dressing.  It was not a serious review.

The CDC needs a completely different independent external review to understand how it as a public health agency with MD and PhD epidemiologists could get so much science wrong for so long.  The current makeover plans are ludicrous, will fool no one, and will not restore any of the large amount of public trust that has been lost by its poor performance over the last 2.5 years.

Let’s take a moment to dissect the puff press piece that I think was the best of a bad lot from corporate press covering this story, although still full of spin from top to bottom.

Politico, 17 August 2022

“CDC director orders agency overhaul, admitting flawed Covid-19 response

Rochelle Walensky wants to boost transparency by releasing data more quickly and to improve communication with the public.”

Starting with the title- I see no signs that Walensky was the one directing this reorganization. And is the speed of data release and public communication the real problem here? In short, no. Lack of integrity is the problem. Dishonesty, regulatory capture, rampant evidence of corruption, or as the NY Times has stated on February 26, 2022:

The C.D.C. Isn’t Publishing Large Portions of the Covid Data It Collects

“The agency has withheld critical data on boosters, hospitalizations and, until recently, wastewater analyses.”

“Two full years into the pandemic, the agency leading the country’s response to the public health emergency has published only a tiny fraction of the data it has collected, several people familiar with the data said.”

“Much of the withheld information could help state and local health officials better target their efforts to bring the virus under control. Detailed, timely data on hospitalizations by age and race would help health officials identify and help the populations at highest risk. Information on hospitalizations and death by age and vaccination status would have helped inform whether healthy adults needed booster shots. And wastewater surveillance across the nation would spot outbreaks and emerging variants early.”

“The C.D.C. is a political organization as much as it is a public health organization,” said Samuel Scarpino, managing director of pathogen surveillance at the Rockefeller Foundation’s Pandemic Prevention Institute. “The steps that it takes to get something like this released are often well outside of the control of many of the scientists that work at the C.D.C.”

If you compare the NY Times piece of February 26, 2022 and the “Overhaul” which Dr. Walensky has “ordered”, there is almost a perfect match. There is the appearance that the NYT obtained a pre-read of one of the internal HHS analyses/reports which are behind this reorganization.

Continuing with the Politico article:

The Centers for Disease Control and Prevention is launching an overhaul of its structure and operations in an attempt to modernize the agency and rehabilitate its reputation following intense criticism of its handling of the coronavirus pandemic and, more recently, the growing monkeypox outbreak.

“Rehabilitate its reputation” is a pretty damming admission of failure to meet expectations.

On Wednesday, CDC Director Rochelle Walensky shared a series of changes with CDC leadership and staff designed to “transform” the organization and its work culture by improving how the agency shares information, develops public health guidance and communicates with the American public.

Are these changes really coming from the Director?

“For 75 years, CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations,” Walensky said in a statement. “As a long-time admirer of this agency and a champion for public health, I want us all to do better.”

Well, that will certainly help morale <sarcasm>. Her statement was pre-recorded and broadcast to all CDC employees, by the way. She certainly likes to be on TV. That sounds to me like the behavior of an autocratic and isolated “leader”.

The CDC restructuring follows two reviews conducted in recent months, one by Health Resources and Services Administration official Jim Macrae into the CDC’s pandemic response and another by CDC Chief of Staff Sherri Berger into agency operations.

Oops. Now we are getting somewhere. Who is Jim Macrae? Politico has “forgotten” to add that little detail.

James Macrae, M.A., M.P.P.

Associate Administrator
Bureau of Primary Health Care
Health Resources and Services Administration
U.S. Department of Health and Human Services

Jim is a member of the Senior Executive Service (ES-00), the top bureaucrats who actually run the administrative state.

Who is Sherri Berger?

CDC Chief of Staff Sherri Berger

Ms. Berger is also a career bureaucrat and member of the Senior Executive Service (ES-00)

So, two senior Administrative State bureaucrats, both members of the Senior Executive Service (one of whom is Dr. Walensky’s Chief of Staff (!!) have stepped in and run internal audits/”reviews” of how the CDC is performing under her direction.

What did they find?

The reviews concluded that the “traditional scientific and communication processes were not adequate to effectively respond to a crisis the size and scope of the COVID-19 pandemic,” according to an agency statement.

Specifically, Macrae’s review, which included 120 interviews with CDC staffers and people outside the agency, recommended a series of improvements, including releasing scientific findings and data more quickly to improve transparency, translating science into practical and easy-to-understand policy, improving communication with the public, working better with other agencies and public health partners, and training and incentivizing the agency’s workforce to respond better to public health emergencies.

Mike drop moment. Bad morale (as has been documented in prior publications):

“Health experts are quitting the NIH and CDC in droves because they're embarrassed by 'bad science' - including vaccinating children under 5 to 'make their advice palatable to the White House,' doctors claim”.

Not playing well with others (agencies). Validation of all of the sins mentioned by the NYT. Personally, I have long wondered why the NYT published that story. I now strongly suspect that they were acting as a conduit from senior executive service (ergo Administrative State) as a work around to avoid having key findings buried by the executive branch.

There is consensus within the CDC that it “needs to make some changes for how it communicates and how it operates — to be faster, to be nimbler, to use more plain spoken language,” said a CDC official, who was granted anonymity to discuss the changes before they were announced.

Hmm, Anonymous “CDC official”. Discussed the changes before they were announced. So Politico has been holding this story, which was leaked to them anonymously by a CDC official. I could speculate who that could be, but I think you can infer as well as I can.

“People work incredibly, incredibly hard and care deeply about trying to make sure that the American people have the right information,” the official said. “Maybe the way that a lot of the [Covid-19] response was structured, and some of the incentives that people have here, are just not aligned properly to really put the focus toward getting information to people quickly and how that information can benefit Americans’ health.”

“Incentives are not aligned”. Well, if that does not sound like SES/HR speak, I do not know what does.

An embattled agency

The CDC has come under intense pressure from Americans of all political stripes since the earliest days of the pandemic.

It has fended off a battery of allegations over the course of the crisis, from putting politics over its vow to “follow the science” to bungling messaging to putting Americans’ lives at risk as pandemic restrictions have eased.

Uh, yeah. Not to mention directly promoting propaganda, attacks and defamation of dissenting scientists and physicians, railroading experimental vaccines through the ACIP down to infants, censoring information, spinning falsehoods, etc., etc., etc.

As public health officials came under attack across the country, so has the agency’s authority to implement Covid-19 mitigation measures, with critics on one side accusing the agency of federal overreach and critics on the other accusing the agency of not doing enough.

The CDC’s authority has been challenged in multiple court cases. Last year, the Supreme Court struck down its moratorium on evictions during the pandemic. The government has appealed a Florida federal district court judge’s April decision to strike the CDC’s directive that people wear masks on airplanes, trains and other public conveyances.

About which the CDC and NIH still are resisting disclosure of the scientific basis for their mask mandates - basically because there is no scientific basis. We now know that the “scientific basis” as promoted by Matthew Pottinger and his sock puppet Deborah Birx was basically “we should do it because the CCP are doing it”.

This year, the agency has struggled to strike a balance between the competing interests of a virus that continues to find ways to evade vaccines and natural immunity, and a public that is weary of taking the sort of precautions that federal and state governments have mandated.

As the Omicron variant swept the nation, the agency came under fire for shortening its recommended quarantine guidelines. This spring, its shift to assessing community-level risk by weighing hospitalizations and the burden on the health care system over the level of transmission was both confusing and put Americans at unnecessary risk, many public health experts say.

No recognition that the vaccines are contributing to the immune escape problem. Still no acknowledgment of the abundant science concerning “original antigenic sin” or Immune imprinting (see also here). Oh yeah, I forgot. Dr. Walensky is not scientifically trained in virology or immunology.

Last week, the CDC’s decision to lift quarantine recommendations for unvaccinated individuals exposed to the virus, including in schools, also drew criticism from doctors and public health experts who say the agency is embracing individual responsibility over public health when it is responsible for the latter.

I love the anonymous “public health experts” line. Could we please name these? Otherwise this is just Politico spinning an issue.

Several school districts, including those in New York City and Philadelphia, are taking more precautions than the CDC now recommends as students return.

Let’s be more blunt. These schools are imposing mandates which exceed CDC guidance, after two school seasons of basically throwing up their hands, shrugging their shoulders, and saying “the CDC made me do it”. By their actions you will know them.

Walensky has repeatedly pointed out that the agency was underfunded before the pandemic started, noting that the public health workforce was seriously depleted and the agency has been hamstrung by structural issues, including limited access to data from states.

Aha! The real problem is not having federal authority (per the US Constitution) to regulate medical practice and not having enough money to fulfill the CDC mandate. Good to have that clear. NOT a leadership problem. Nothing to do with the clear incompetence of CDC Director Rochelle Walensky.

In an interview with POLITICO earlier this year, she said the CDC alone would not be able to bring Covid-19 under control, and called for broader investment in public health at the state and local levels.

So we should send lawyers, guns and money?

“I actually really think many people have thought this is CDC’s responsibility, to fix public health [and] the pandemic,” Walensky said. “The CDC alone can’t fix this. Businesses have to help, the government has to help, school systems have to help. This is too big for the CDC alone.”

So now she tells us. Too big for the CDC. I think that many can see a remedy. Get rid of the incompetent CDC, or at least fire and replace its incompetent director.

Nevertheless, Americans’ approval of the agency’s job steering the nation through a pandemic that has killed more than a million Americans has plummeted.

Ya think?

In March 2020, 79 percent of Americans said public health officials, including those at the CDC, were doing a good job responding to the pandemic, according to a survey by Pew Research Center. By May 2022, only 52 percent of Americans thought so, Pew found.

The agency’s more recent handling of the monkeypox outbreak, which many epidemiologists worry is now past the point of containment in the country, has again sparked widespread criticism that the CDC is unable to rise to the demands of a complicated public health crisis as it unfolds in real time.

The way you handle something like this Monkeypox situation has always been “track, trace, quarantine”. hello? Anyone home? Perhaps they did not teach that at Harvard. Or perhaps the cohort getting infected is too sensitive, and like Voldemort, shall not be named?

A new roadmap

Among the structural changes to come out of the reviews are the appointment of former HHS Deputy Secretary Mary Wakefield to lead a team overseeing the overhaul, as well as the creation of a new executive council, built by Wakefield and reporting to Walensky, that will “determine agency priorities, track progress and align budget decisions, with a bias toward public health impact.”

Another shoe drops. Walensky has been kneecapped, and will have a new “executive council” put in place to actually run the CDC. Who is Mary Wakefield?

Per Wiki: Mary Wakefield (born August 12, 1954) is an American nurse and health care administrator, who served in the Obama administration as acting United States Deputy Secretary of Health and Human Services from 2015 to 2017, and as head of the Health Resources and Services Administration from 2009 to 2015.

“Wakefield was named administrator of the Health Resources and Services Administration (HRSA) by President Barack Obama in February 2009. The agency has a budget of $7.5 billion agency that distributes funding across some 3,000 grants spanning 80 programs, and received an additional $2.5B under the Affordable Care Act.

As the administrator of HRSA, she oversaw the approximately 1,100 federally supported community care clinics that serve people without health insurance or who are under-insured; she oversaw the disbursement of $150 million in funding to those clinics under the Affordable Care Act to help people enroll in the program, and another $250 million in competitive grant funding to build new community care clinics and increase services. She also administered the disbursement of $55.5 million in grants to increase the nurse and dentistry workforces.”

So another ex-Obama administration bureaucrat has been brought in to run the CDC via committee. Wonder who put her in this position?

Former head of Health Resources and Services Administration. So I think we can infer what happened here. SES bureaucrat James Macrae, M.A., M.P.P. got the receipts, did the analysis, and put his old boss in charge of the CDC. This storyline that all of this has been driven by Walensky reeks of spin.

The agency did not offer a specific timeline for when the council would be established, but noted broadly in a statement that “the work ahead will take time and engagement at all levels of the organization.”

Short notice. No time yet to appoint or operationalize the committee. Wonder how long those reports have been languishing in Walensky’s in-box. Since February when they appear to have been leaked to the NYT?

The overhaul of the CDC’s approach to communicating with the public has already begun, and will include revamping and streamlining the agency’s web site and creating simplified public health guidance. The agency will also create a new equity office, working across all functions of the organization from hiring to policy to improve the agency’s diversity.

Roh roh. Wokeism strikes again. Let’s see how well that works out. I predict a cascading spiral of infighting involving employee weaponization of these new guidances.

The overhaul seeks to change “the CDC’s culture” by moving away from a “misaligned” approach of incentivizing staff to publish their research in scientific publications and instead encouraging personnel to produce research and data aimed at public health policy and action, the CDC official said.

And the person to shift the CDC from being too academic to focusing on meeting real world needs is a Harvard Professor with no prior significant industrial or public experience?

The agency is also considering measures that will speed up the publication of data and scientific findings, training more staff to be ready to respond in a public health emergency and setting up emergency staffing to ensure there are no personnel gaps during a crisis.

Walensky will also seek more authority for the CDC, through Congress and the Biden administration, to mandate data collection from states, to move money to external partners faster during an emergency and to offer more competitive salaries for recruiting, among other things.

And there is the close. Walensky, in reward for her gross and chronic incompetence, should be rewarded with more authority including ability to interfere with states rights to manage medical care, and more money for recruiting more woke personnel.

All I can say, in the most non-partisan way, is that they better push that through very soon, before all of the House is out on the campaign trail. Because next January, I suspect that providing Walensky and her CDC with more authority and more money will be the last thing that a Republican congress will have interest in.

And in other news, BARDA grows up and is now on equal footing (sort of) with CDC and NIH. Looking forward to what Tony Fauci has to say about that! That little issue may explain why this was engineered without full Whitehouse involvement.

Key player in this:

Dawn O'Co​nnell

Assistant Secretary for​ Preparedness and Response
U.S. Department of Health and Human Services

Press coverage:

Biden administration plans to elevate pandemic response office

The reorganization will put the office's director on a par with those of larger agencies like the CDC and FDA

As you know, Dawn O'Connell (background in literature and law) has been tapped to take over CDC pandemic responsibilities as head of ASPR, founded in 2006.

Here is her memo on that topic:

ASPR Team: As you know firsthand, ASPR is at the forefront of many of HHS’s and the Biden-Harris Administration’s top priorities. Whether your work involves strengthening our core preparedness and response capabilities, tackling new and emerging challenges, or providing essential support services to the team, please know that the work that you do matters and that it is making a big difference. In recognition of the tremendous value this team brings to the Department and the American people – and due to the increasing size and scope of what we do – I asked Secretary Becerra to consider making us an Operating Division and I am pleased to report that Secretary Becerra has made the critically important decision to elevate our team from a Staff Division to an Operating Division (OpDiv)! This change allows ASPR to mobilize a coordinated national response more quickly and stably during future disasters and emergencies while equipping us with greater hiring and contracting capabilities. As an OpDiv, we are now in the same category as other large HHS teams with core operational responsibilities such as CDC, NIH, FDA, CMS, and ACF. This change is an important next step for our organization which has continued to grow and evolve since its creation in 2006 – the pace of which has quickened over the past year. This change is also a recognition of the good work you all have been and continue to do on behalf of the American people. ASPR has always had key operational responsibilities including the missions of the National Disaster Medical System (NDMS), the Biomedical Advanced Research and Development Authorit (BARDA), and Medical Reserve Corps. In recent years, however, particularly during the multi-year COVID-19 pandemic response, ASPR’s operational functions have grown significantly to include the Strategic National Stockpile (SNS) in 2018, public health supply chain in 2020, and the establishment of the HHS Coordination Operations and Response Element (H-CORE) at the beginning of 2022. Each of these mission expansions added significant operational responsibility to ASPR pushing it against the limits of a typical Staff Division that traditionally provides functional (i.e. financial, communication, policy and legislative) support to the Secretary and the Department. Along with this reclassification, moving forward we will be known as the Administration for Strategic Preparedness and Response (ASPR). The adjustment to our name signals our elevation to an OpDiv, while maintaining the equity and brand recognition we have built with key internal and external stakeholders, particularly over the course of the pandemic. These changes are complementary to the broader ASPR reorganization, which we will begin implementing in the second half of the year. I wanted to secure the OpDiv status change first so that we can incorporate it into our next generation organizational structure. While the name change is immediate, enhanced capability in hiring and contracting will be made over a period of time to ensure a seamless and gradual transition of key responsibilities from the Assistant Secretary for Administration to our ASPR team.

We will have more to share about the elevation to OpDiv in the coming days and weeks, but I wanted to make sure to tell our team first before sharing with other stakeholders. Dawn

Official statement by Ms. O’Connell