Tensions mount between CDC and Biden health team over boosters

Las Vegas tried to reopen without widespread vaccination, but those plans crashed into reality. Will things be different this time?

One senior administration official said the Biden administration’s public pledge to let science lead was faltering behind the scenes. “The CDC is getting out what it can when it can,” the official said.

But a second senior administration health official pushed back against the idea that the Sept. 20 booster target was foisted on Walensky. The person said that the federal government’s top health leaders agreed to the language and September date before the White House announced the plan in August. The time frame was established based on the FDA’s projections of when it could review specific company data as well as data from manufacturers, that official said.

Some at CDC say the agency needs to change its approach, by working quickly with the White House Covid team to develop policy recommendations during what they describe as one of the most chaotic and critical periods of the pandemic. In addition to the planned booster rollout, the CDC and FDA are poised to consider the use of Covid-19 vaccines for children under 12, a group that has seen more infection and death as the nation has returned to in-person schooling.

But it is the nascent booster plan that has generated the most friction of late. Three senior officials said they were surprised by the White House’s September deadline, arguing that it set the CDC and FDA on a tight timeline to crunch data, publish vaccine efficacy studies and approve or authorize the shots.

White House officials and Anthony Fauci, the president’s chief medical adviser, were eager to begin doling out boosters later this month, citing data from Israel and other countries that suggested vaccines’ efficacy was waning and that breakthrough infections were on the rise. These officials pushed the CDC to share publicly the data from its ongoing studies of vaccine performance and breakthrough cases.

Walensky and other senior CDC officials, who agreed vaccine efficacy was declining and that Americans would eventually need booster shots, noted in their conversations with the broader Biden Covid team that the CDC did not yet have enough data from its studies on the matter. Its analyses, which looked at infection rates among frontline health workers and residents of specific cities such as New York and Los Angeles, would take weeks to complete.

The White House, and FDA and CDC leaders, are “trying to align” the two agencies more, one official said, particularly amid the departure of two top FDA vaccine regulators, Marion Gruber and Philip Krause. The pair announced their retirements this month, in a move that one former official attributed to frustrations with CDC’s role in the booster plan.

FDA’s frustrations with CDC are longstanding and predate the pandemic. The agencies have clashed on data around perennial problems like foodborne illnesses and issues related to other disease outbreaks and emerging conditions, such as the lung injury called EVALI that has been linked to e-cigarette use. FDA has long argued that CDC moves too slowly, two former officials said.

That the Biden White House “is starting to exert a little more pressure [on CDC] is long overdue,” said a former Trump health official. “[President Donald] Trump’s mistake was not understanding that the way to fix it wasn’t to publicly berate them … but to actually lead and reform.”

The FDA said in a statement that its “longstanding collaboration with CDC continues to have a positive impact on our nation’s public health.” It added: “Particularly for vaccines, our agencies have always had, and continue to have, shared responsibilities where FDA makes regulatory decisions and CDC’s immunization advisory committee provides clinical recommendations.”

No matter the motivation, the CDC advisory committee episode in late August only reinforced perceptions in the White House that the agency represents the weakest link in a Covid-19 response predicated on close collaboration and extreme competence.

In the aftermath, some officials outside the CDC working on the Covid-19 response have placed blame for turmoil around boosters squarely on Walensky, who they argue has struggled to instill a sense of urgency in the agency’s top scientists. Others have taken a more sympathetic view, chalking the issues up to institutional problems within the CDC that Walensky is trying to iron out.

In a sign that even the CDC director herself recognizes the agency has repeatedly fallen short on messaging, multiple people with knowledge of the matter said Walensky has recently weighed bringing on new communications staff. The agency’s main spokespeople are career employees who predate Walensky’s arrival in January.

She has also has tried to streamline CDC’s pandemic response team, tapping respected agency veteran Henry Walke to lead the way. Three former health officials applauded Walensky’s restructuring earlier this year, arguing that it could break down some of these issues even though many felt the move sidelined CDC veteran Nancy Messonnier, who resigned earlier this year after decades at the agency working on respiratory illnesses.

The reorganization started in the spring, before the Delta variant became the dominant Covid strain in the United States, causing massive upticks in cases and hospitalizations. With Delta’s rise, officials on the CDC pandemic team told POLITICO, they have grown increasingly overwhelmed. Within the last two weeks, Walensky has moved to yet again build back up that team.

Since the Biden administration began in January, the CDC chief has worked to address inefficiencies within the agency, streamlining its Covid-19 response and ensuring her office coordinates more closely with the White House, two senior CDC officials said. One of her main goals, those officials said, has been to put the agency back on the map after the Trump administration sidelined its scientists throughout 2020. Biden, too, promised to let science, and science agencies, lead the policy conversations around Covid.

Senior administration officials working on the pandemic response have grown frustrated with the CDC’s messaging on Covid policies, including masks, over the last several months — and what they see as a sluggish response to crises such as the emergence of the Delta variant. Much of the criticism pointed at the CDC focuses on its data collection and analysis, officials said.

The agency has for years struggled with obtaining accurate disease data from state health departments, and the pandemic strained the country’s public health infrastructure, causing massive delays in reporting and case investigation. That has made it difficult for CDC to gather information on breakthrough infections to inform the administration’s policies around boosters.

The CDC also often publishes its studies in medical journals, but that approach can delay the release of critical information to the public. Walensky has recently taken steps to address the issue, telling CNN this month that the CDC worked with the New England Journal of Medicine to release data about pregnant women and vaccines on its website before it published the findings in the journal.