Health Care

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 office within the department — 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, and a memo obtained by The Washington Post.

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 staff on Wednesday afternoon. The emailed memo was shared with The 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 to a once-in-a-century pandemic driven by a novel virus like SARS-CoV-2, to an outbreak of a long-identified pathogen such as monkeypox, which 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, Biden health officials seeking to acquire more rapid coronavirus tests as the omicron variant surged last winter ran into challenges setting up the necessary contracts, said a senior administration official not authorized to comment.

Officials in other parts of the health department said they backed the plan. CDC spokesman Kevin Griffis said in a statement the agency is “supportive of Assistant Secretary O’Connell’s vision for ASPR — a critical partner for us in addressing public health threats. We will continue to work closely together to advance and protect the health of the American people.”

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

But some public health experts have cautioned that a critical part of pandemic response is working with state and local health agencies, noting that CDC has a far stronger relationship than ASPR with those front line teams.

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 pursue its reorganization without approval from Congress, those people said. However, some senior Biden administration officials said on Wednesday they were unaware of the plan, which has been held very close by the health department.

O’Connell has privately championed the plan, saying her office needs more authority to hire staff, oversee contracts and greater flexibility to respond to emerging crises. In addition to its work on the pandemic, the office has helped coordinate Operation Fly Formula, the effort to quickly import baby formula from overseas to address U.S. shortages. O’Connell previously served as a senior Obama health official and as director of U.S. operations for the Coalition for Epidemic Preparedness and Innovations.

O’Connell emphasized in an interview that 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 coronavirus and other disease outbreaks.

“It’s long overdue,” said Robert Kadlec, who led ASPR during the Trump administration and now advises Sen. Richard Burr (R-N.C.), the top Republican on the Senate’s health panel. Kadlec said the change would clarify officials’ responsibilities urgent responses. “I had requested it in my final year. No luck.”

Federal watchdogs have faulted the confusion between ASPR and 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 even 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.

But other experts have warned that shifting responsibilities to ASPR could undercut the emergency response and noted that it does not address long-standing challenges at 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 its 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.”

Lena H. Sun contributed to this report.

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