Officials reorganize HHS to boost pandemic response

The Biden administration is reorganizing the federal health department to create an independent division that would lead the nation’s pandemic response, amid frustrations with the Centers for Disease Control and Prevention.

The move elevates a roughly 1,000-person team – known as the Office of the Assistant Secretary for Preparedness and Response, or ASPR – into a separate division charged with coordinating the nation’s response to health emergencies, according to seven people briefed on the plan who spoke on the condition of anonymity because they were not authorized to comment.

The reorganization allows the division “to mobilize a coordinated national response more quickly and stably during future disasters and emergencies while equipping us with greater hiring and contracting capabilities,” Dawn O’Connell, who leads ASPR and would run the new division, wrote to staff members Wednesday afternoon. The emailed memo was shared with The Washington Post.

The creation of the new Administration of Strategic Preparedness and Response, which is expected to be phased in over two years, comes at a time of growing concern about the federal government’s ability to respond to health emergencies – whether a once-in-a-century pandemic driven by a novel virus such as SARS-CoV-2 or an outbreak of a long-identified pathogen such as monkeypox that has established treatments and vaccines.

The change also comes amid mounting frustrations within the government over bureaucratic delays that officials believe have hindered their work. For instance, health officials in the Biden administration seeking to acquire more rapid coronavirus tests as the omicron variant surged this past winter ran into challenges setting up the necessary contracts, said a senior administration official who, like others, spoke on the condition of anonymity because they were not authorized to comment.

Officials in other parts of the Department of Health and Human Services said they backed the plan. CDC spokesman Kevin Griffis said in a statement that the agency is “supportive of Assistant Secretary O’Connell’s vision for ASPR – a critical partner for us in addressing public health threats.”

While ASPR, in its current form, has played a key role in responding to the coronavirus and other health crises, it has frequently been enmeshed in turf wars with other agencies, such as a heated clash with the CDC over evacuating coronavirus-infected Americans from Asia in early 2020, as well as battles over other pandemic decisions. The tensions predate the pandemic; ASPR oversees the Strategic National Stockpile, after a battle with the CDC over which agency would control it. Some Biden administration officials have privately argued those challenges could be avoided by empowering the office to be on par with the CDC and other independent HHS divisions, such as the Food and Drug Administration, the senior administration official said.

But public health experts say that a critical part of pandemic response is working with state and local health agencies and note that the CDC has a far stronger relationship with those front-line teams than ASPR. The emergency-response office also has faced scrutiny over its own operations.

Before the emergence of the coronavirus, it prioritized preparing for a bioweapons attack over a pandemic, with critics faulting then-Director Robert Kadlec for not focusing more on the threat of infectious diseases. Lawmakers also have probed why the national stockpile, which came under ASPR’s control in 2018, had inadequate supplies of protective gear and other medical equipment as the coronavirus raced across the globe in early 2020.

O’Connell on Tuesday called members of Congress to inform them of the administration’s plan, according to people with knowledge of those calls. HHS has the authority to reorganize without congressional approval, but lawmakers plan to press officials for details about how the change may affect ongoing efforts.

We’ll want to understand how this supports their covid and other emergency response efforts, and any costs impacts, said one Democratic aide who was not authorized to comment.

Several congressional panels are already scrutinizing the pandemic performance of ASPR, the CDC and other health agencies. Sen. Patty Murray, D-Wash., who leads the Senate’s health committee, on Wednesday criticized the Biden administration’s response to the monkeypox outbreak and asked for an urgent briefing on its strategy.

Meanwhile, some senior Biden administration officials said they were unaware of the plan to reorganize the department, which was approved by HHS Secretary Xavier Becerra and has been held close by his deputies.

O’Connell, who previously served as a senior health official in the Obama administration and as director of U.S. operations for the Coalition for Epidemic Preparedness and Innovations, spent weeks privately championing the plan, arguing that her office needs more authority to hire staff members and oversee contracts and the flexibility to respond to emerging crises.

ASPR earlier this year absorbed key responsibilities from the initiative formerly known as Operation Warp Speed, including the distribution of coronavirus vaccines and treatments, assigning them to a new team, the HHS Coordination Operations and Response Element, or H-CORE. In addition to its pandemic work, ASPR has helped coordinate Operation Fly Formula, an effort to quickly import baby formula from overseas to address U.S. shortages.

Biden administration officials also have sought to tamp down tensions that emerged during the pandemic, seeking to avoid the interagency feuding that marked the Trump administration’s response and frequently spilled into the press.

In an interview, O’Connell emphasized that the CDC’s relationship with state public health departments “is critical, and we rely on that as we’re distributing vaccines and therapeutics in a completely collaborative and supportive way. There’s been room, certainly, in this pandemic for each of us to do our own lines of work, while working collaboratively as part of a larger response team.”

ASPR was founded in 2006, in the wake of Hurricane Katrina and other disasters that taxed the nation’s emergency response. But the office, which operates out of the federal health department’s headquarters in Washington, D.C., has frequently come into conflict with the much larger CDC, which is based in Atlanta, employs about 13,000 people and has historically led the response to disease outbreaks, including the coronavirus.

It’s long overdue, said Kadlec, the former ASPR director who now advises Sen. Richard Burr of North Carolina, the top Republican on the Senate’s health panel. Kadlec said the change would clarify officials’ responsibilities during fast-moving emergencies. “I had requested it in my final year. No luck.”

Federal watchdogs have also faulted the confusion between ASPR’s and the CDC’s responsibilities, saying that clashes undermined the pandemic response. The Government Accountability Office last year published its probe of one episode – a chaotic effort to return hundreds of Americans to the United States in the earliest days of the coronavirus outbreak – warning that infighting between ASPR and other agencies had led to safety breakdowns that put the evacuees, federal officials and U.S. communities at risk.

Until HHS revises or develops new plans that clarify agency roles and responsibilities during a repatriation in response to a pandemic, it will be unable to prevent the coordination and health and safety issues it experienced during the COVID-19 repatriation response in future pandemic emergencies, the GAO concluded.

Other experts have warned that shifting responsibilities to ASPR could undercut the emergency response and noted that the move does not address long-standing challenges at the CDC.

This is a strategic mistake and will create more confusion, indecision and delays in responding to pandemic crises, said Scott Gottlieb, who served as commissioner of the Food and Drug Administration during the Trump administration and has advised both the Trump and Biden administrations on their coronavirus response. “CDC possesses all the tools of response and has the expertise. Ultimately, CDC needs to own this, and if they can’t execute well, that needs to be fixed.”