Officials revamp HHS to boost pandemic response

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

The move elevates an office of about 1,000 people within the department — known as the Office of the Assistant Secretary for Preparedness and Response, or ASPR — into a separate office. division, responsible for coordinating the nation’s response to health emergencies, according to seven people briefed on the plan who spoke on 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 faster and more stably during future disasters and emergencies while giving us greater hiring and contracting capabilities,” Dawn O’Connell, who leads ASPR and would lead the new division, the staff wrote on Wednesday afternoon. The emailed memo was shared with The Post.

The creation of the new Strategic Preparedness and Response Administration, 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 it’s a pandemic of the century caused by a new virus like SARS-CoV-2, to an epidemic of a long-identified pathogen like monkeypox, which has established treatments and vaccines.

The change also comes amid growing frustrations in government over bureaucratic delays that officials say have hampered their work. For example, Biden health officials seeking to acquire faster coronavirus tests as the omicron variant surged last winter ran into difficulties establishing the necessary contracts, a senior administration official said. not allowed to comment.

Officials from other parts of the health department said they support the plan. CDC spokesperson Kevin Griffis said in a statement that the agency “supports Assistant Secretary O’Connell’s vision for ASPR — an essential 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 the response to coronavirus and other health care crises, it has often been embroiled in turf wars with other agencies, such as a heated clash with the CDC. on evacuating Americans infected with coronavirus from Asia in early 2020, as well as other pandemic decisions. Tensions predate the pandemic; The 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 that these challenges could be avoided by empowering the office to be on equal footing with the CDC and other independent divisions of the Department of Health and Human Services, such as the Food Department. and Drug Administration, the senior administration official said.

But some public health experts have warned that a critical part of responding to the pandemic is working with state and local health agencies, noting that the CDC has a much stronger relationship than the ASPR with these frontline teams. line.

O’Connell called members of Congress on Tuesday to brief them on the administration’s plan, according to people familiar with the calls. HHS has the authority to proceed with its reorganization without congressional approval, these people said. However, some senior Biden administration officials said Wednesday they were unaware of the plan, which has been held very close by the health department.

O’Connell defended the plan privately, saying his office needed more power to hire staff, oversee contracts and greater flexibility to respond to emerging crises. In addition to its work on the pandemic, the office helped coordinate Operation Fly Formula, the effort to quickly import infant formula from overseas to address U.S. shortages. O’Connell previously served as Obama’s top health official and director of US operations for the Coalition for Epidemic Preparedness and Innovations.

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

ASPR was founded in 2006, following Hurricane Katrina and other disasters that strained the country’s emergency response. But the office, which operates out of federal health department headquarters in Washington, DC, 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 diseases. epidemics.

“It’s long overdue,” said Robert Kadlec, who led ASPR during the Trump administration and now advises Sen. Richard Burr (RN.C.), the top Republican on the Senate health panel. Kadlec said the change would clarify the responsibilities of those responsible for urgent responses. “I asked for it in my senior year. No chance.”

Federal watchdogs have criticized the confusion between ASPR and CDC responsibilities, saying the clashes have undermined the pandemic response. Last year, the Government Accountability Office released its investigation into an episode — a chaotic effort to send hundreds of Americans back to the United States in the early days of the coronavirus outbreak — warning that infighting between the ASPR and other agencies had led to security blackouts that put evacuees, federal officials and even American communities at risk.

“Until HHS revises or develops new plans that clarify agency roles and responsibilities during a pandemic repatriation, it will not be able to prevent coordination issues and health and safety concerns it has encountered during the COVID-19 repatriation response in future pandemic emergencies,” the GAO concluded.

But other experts have warned that shifting responsibilities to ASPR could undermine the emergency response and noted that it does not address longstanding issues at the CDC.

“This is a strategic mistake and it 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 the Trump and Biden administrations. on its response to the coronavirus. “The CDC has all the response tools and has the expertise. Ultimately, CDC needs to own this, and if they can’t execute well, it needs to be fixed.

Lena H. Sun contributed to this report.

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