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Officials Reorganize HHS to Boost Pandemic Response

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

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

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

The creation of the new Strategic Preparedness and Response Administration, expected to be implemented in more than two years, comes at a time of growing concern about the federal government’s ability to respond to health emergencies — whether it be a pandemic caused by a new virus such as SARS-CoV-2, or an outbreak of a long-identified pathogen such as monkey pox, which has developed treatments and vaccines.

The change also comes amid mounting frustrations within the government over bureaucratic delays that officials say have hampered their work. For example, Biden health officials seeking to obtain faster coronavirus tests when the omicron variant surged last winter ran into difficulties setting up the necessary contracts, a senior government official said. not authorized to comment.

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

While ASPR, in its current form, has played a key role in responding to coronavirus and other healthcare crises, it has often been entangled in turf wars with other agencies, such as a heated clash with CDC over the evacuation of 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 CDC over which agency would control it. Some Biden officials have personally argued that these challenges could be avoided by allowing the office to align with CDC and other independent divisions of the HHS department, such as the Food and Drug Administration, the senior management official said.

But public health experts say a critical part of the pandemic response is working with state and local health agencies, noting that CDC has a much stronger relationship with those frontline teams than ASPR does. The emergency response office has also faced criticism over its own operations.

Prior to the health emergency, it prioritized preparing for a bioweapons attack over a pandemic, with critics blaming then-director Robert Kadlec for not focusing on the threat of infectious diseases. Lawmakers have also investigated why the national stockpile, which came under ASPR’s control in 2018, lacked adequate protective equipment and other medical equipment as the coronavirus swept across the world in early 2020.

O’Connell called members of Congress on Tuesday to let them know about 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 on how the change could affect ongoing efforts.

“We’ll want to understand how this supports their covid and other emergency measures and any cost implications,” said a Democratic staffer who was not authorized to comment.

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

Meanwhile, some senior officials in the Biden administration said they were unaware of the department reorganization plan, which had been approved by HHS Secretary Xavier Becerra and kept nearby by his deputies.

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

ASPR took over key responsibilities from the initiative formerly known as Operation Warp Speed, including the distribution of coronavirus vaccines and treatments, earlier this year and assigned them to a new team called H-CORE. In addition to the pandemic work, the office has helped coordinate Operation Fly Formula, an effort to quickly import baby food from abroad to address U.S. shortages.

Biden administration officials have also tried to ease tensions that emerged during the pandemic, trying to avoid the inter-agency feud that marked the Trump administration’s response and often made it to the press.

In an interview, O’Connell emphasized that CDC’s relationship with the state’s public health departments is “critical, and we rely on it as we distribute vaccines and therapies in a fully collaborative and supportive manner. There is certainly room in this pandemic.” It has been great for each of us to do our own work, while working together as part of a larger response team.”

ASPR was founded in 2006, in the wake of Hurricane Katrina and other disasters that severely tested the country’s emergency response. But the office, which operates out of the federal health department’s headquarters in Washington, DC, has often come into conflict with the much larger Atlanta-based CDC, which employs about 13,000 people and has historically been in charge of the response to coronavirus and other diseases. outbreaks.

“It’s way too late,” said Kadlec, the former ASPR director who now advises Senator Richard Burr (RN.C.), the top Republican on the Senate health panel. Kadlec said the change would clarify officials’ responsibilities during rapidly changing emergencies. “I applied for it in my senior year. No luck.”

Federal watchdogs have also criticized the confusion between ASPR and CDC responsibilities, saying clashes undermined the pandemic response. The Government Accountability Office released its investigation into one episode last year — a chaotic attempt to send hundreds of Americans back to the United States in the earliest days of the coronavirus outbreak — warning that infighting between ASPR and other agencies had led to security disruptions that endanger evacuees, federal officials and even American communities.

“Until HHS revises or develops new plans that clarify the agencies’ roles and responsibilities during a pandemic response repatriation, it will address coordination and health and safety issues it has encountered during the COVID-19 repatriation response in future pandemics.” emergencies cannot be prevented,” the GAO concluded.

But other experts have warned that shifting responsibilities to ASPR could undermine emergency response, noting that it does not address the long-standing challenges at CDC.

“This is a strategic mistake and will cause 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 served on both the Trump and Biden administrations. advised on their response to the coronavirus. “CDC has all the resources to respond and has the expertise. Ultimately, CDC needs to own this, and if they can’t run it properly, that needs to be fixed.”

Lena H. Sun contributed to this report.


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