As Vivek H. Murthy advised Joe Biden on the pandemic during the 2020 presidential campaign, culminating in Murthy’s nomination as surgeon general, he also maintained a lucrative side business: coronavirus consultant to the private sector.

Murthy was paid millions of dollars last year in coronavirus-related consulting for Carnival Corporation’s cruise lines, Airbnb’s rental properties and other firms, in addition to collecting hundreds of thousands of dollars in speaking fees from dozens of organizations, according to ethics documents that Murthy filed this month. The disclosure caught the attention of longtime health policy hands — saying that Murthy has the most financial entanglements of any surgeon general pick in recent history — and of watchdogs who raise questions about how credible he would be as a spokesperson on the pandemic response and presidential adviser.

“We didn’t have a full window into how enmeshed he was in the selling-advice process,” said Jeff Hauser, who leads the Revolving Door Project, part of the Center for Economic and Policy Research, a progressive think tank. “There are large questions in the minds of the public about the health and safety risks that might exist in areas like the cruise industry, and we want the surgeon general to give people completely impartial advice.”

Murthy, whose Senate confirmation hearing is scheduled for Thursday, is expected to narrowly win confirmation to return to the role of surgeon general, six years after his first grueling confirmation battle as President Barack Obama’s nominee — and four years after President Donald Trump abruptly fired him, shortly after taking office. Murthy’s financial disclosures could complicate his candidacy given strong conservative opposition to him on other grounds — such as his longtime advocacy of treating gun violence as a public health problem. But Republicans have thus far stayed away from his finances and it’s unclear whether Democrats will raise the issue, despite repeatedly chastising Trump’s health nominees for their corporate ties.

But Murthy is unlikely to be confirmed if Democrats suffer a single defection — and Sen. Joe Manchin III (D-W.Va.), who supports gun rights and voted against Murthy in 2014 citing his political activism, “has not decided how he will vote on Dr. Murthy’s nomination,” said Sam Runyon, the senator’s spokesperson.

Murthy declined to comment on his financial disclosures, and Biden administration officials defended the nomination.

President Biden has nominated Vivek H. Murthy to be surgeon general. Murthy spoke about Biden in a Democratic National Convention speech on Aug. 20, 2020. (The Washington Post)

“If confirmed to serve for a second time as Surgeon General, Dr. Murthy will provide the public with clear, accurate health information to keep them safe, rooted only in facts and science,” a Department of Health and Human Services official said in a statement, speaking on the condition of anonymity to discuss a nominee in advance of his confirmation. “The Biden administration has committed to the highest level of ethics for all nominees, which is critical to earn and keep the public trust, and he has signed a strict and thorough ethics agreement.”

While the surgeon general serves as the nation’s public health spokesperson and traditionally has a limited voice in policymaking, Biden has pledged that the Harvard- and Yale-educated doctor — who advised Biden for years in the Obama administration, on the board of the Biden Institute at the University of Delaware, and most recently, during the presidential campaign and transition — will have an expanded role.

“He’ll also be a key adviser to me and help lead an all-government approach to broader public health issues,” Biden said in December, announcing Murthy’s nomination. “I mean this sincerely, Vivek, I’m grateful for your willingness to continue to stay in public service.”

Murthy disclosed at least $2.6 million in consulting fees and speaking engagements since January 2020, in addition to serving as an adviser to four companies that focus on health services and products, according to his ethics paperwork and two people with knowledge of Murthy’s duties who spoke on the condition of anonymity to discuss sensitive financial details.

Murthy was paid $400,000 by Carnival Corporation — the parent company of the cruise ship marooned off the California coast, the Grand Princess, as well as of the similarly virus-ravaged Diamond Princess. The ships became symbols of the early outbreak, with then-Surgeon General Jerome M. Adams repeatedly quizzed by reporters about whether cruises were safe. The industry has been essentially shuttered by regulators since March amid warnings the vessels are “petri dishes” for the virus to spread.

A Carnival spokesperson confirmed that Murthy had advised the company’s coronavirus response. “We have been working with a number of world-leading public health, epidemiological and policy experts to support our ongoing efforts for developing enhanced protocols and procedures for the return of cruise based in the latest knowledge around protection and mitigation,” said Roger Frizzell, a spokesperson.

Murthy also received $410,000 in cash and 2,000 stock shares — now worth an additional $402,000 — from Airbnb as he advised the travel-rental company on virus safety protocols to navigate the pandemic. Airbnb publicized Murthy’s guidance, and his name is invoked hundreds of times across the website, including by renters eager to advertise their homes’ safety. “We’re excited to share that we’ve implemented the new Airbnb enhanced cleaning protocol developed with guidance from Dr. Vivek H. Murthy, the former U.S. Surgeon General,” reads one listing, touting a condominium in Mexico.

Mattie Zazueta, an Airbnb spokesperson, confirmed Murthy’s compensation and that he advised the company on health and safety practices between April and November last year.

Meanwhile, Murthy received $292,500 to advise cosmetics giant Estée Lauder on mental health practices during the pandemic, and he was paid more than $600,000 by Netflix as he advised the company’s film and TV productions about whether it was safe to return to work.

“We are grateful for his advice and counsel, which was overwhelmingly appreciated by our leaders and employees,” said Marki Zabar, an Estée Lauder spokesperson. Netflix declined to comment.

Murthy was also paid at least $522,650 to deliver about three dozen speeches to a range of audiences, which included hospitals and health insurers, as well as firms like Google and UBS Financial Services, on a variety of topics, including a book that Murthy wrote on loneliness. Murthy most recently delivered a speech on Jan. 14 to Duke University’s ethics institute about the value of working in the public sector. Murthy disclosed that he was paid $30,000 for the hour-long remarks, which was part of Duke’s “Virtues & Vocations” series.

Murthy this month pledged to government ethics officials that if confirmed, he will “not participate personally and substantially” in matters involving his former consulting clients for one year, unless he’s authorized to do so, and also promised to follow Biden’s broader ethics pledge, which would require recusals from certain client-related matters for two years. In addition, he said he would step down as an adviser to Behavioral Health Group and three other firms that had retained him.

A spokesperson for Sen. Patty Murray (D-Wash.), who chairs the Senate health committee that will hear Murthy’s nomination, said the senator was confident in Murthy’s ethical pledges and planned to vote for him, calling him “a known, trusted leader on matters of public health.”

“His paperwork shows he has met the independent Office of Government Ethics requirements, including appropriate recusals” said Helen Hare, Murray’s spokesperson.

Most of Murthy’s consulting work came after Biden effectively cinched the Democratic nomination in April 2020, after rival Sen. Bernie Sanders dropped out of the race, and he was sometimes touted in speeches as a Biden adviser.

Hauser, whose organization panned Trump health officials for their many corporate ties during the coronavirus response, said he’s particularly concerned about Murthy’s months-long engagements with companies like Carnival and Airbnb, which Hauser argued could subtly affect his decision-making process.

“Going from corporate adviser to public heath official, I think that’s a considerably different job than coming in from academia or a hospital,” he said, praising Murthy’s résumé but criticizing his “entrepreneurialism” in his years out of office.

Other watchdogs shared similar concerns, although said they were reassured by Murthy’s disclosures and ethics pledge.

“Vivek H. Murthy’s prior employment and investments clearly pose a conflict of interest,” said Craig Holman of Public Citizen. “But the Biden administration and Office of Government Ethics are making a meaningful effort to manage these conflicts.”

On Capitol Hill, Murthy’s consulting work has created an awkward situation for Senate Democrats who attacked Trump’s health nominees for their corporate ties but have been silent on Murthy. For instance, Sen. Elizabeth Warren (D-Mass.) repeatedly highlighted the financial entanglements of former Food and Drug Administration Commissioner Scott Gottlieb, even after he left office and joined Pfizer’s board. “This kind of revolving door influence-peddling smacks of corruption,” Warren wrote in July 2019, three months after Gottlieb had resigned from the FDA. Warren’s office did not respond to repeated requests for comment about Murthy’s financial disclosures.

Some Democratic aides maintained that it was appropriate to criticize the corporate ties of Trump appointees like Gottlieb and HHS Secretary Alex Azar because they were appointed to regulate the health industry, whereas Murthy would be serving in a more amorphous role.

Meanwhile, Senate Republicans said they were cautious about bringing up Murthy’s financial entanglements at Thursday’s hearing, arguing industry experience could be an asset — reiterating a stance they took during the Trump administration — but that they planned to attack Murthy’s policy stances.

“We don’t like his position on guns being a public health issue,” said a Senate GOP health committee aide, speaking on the condition of anonymity to discuss the confirmation battle. The aide predicted a Senate floor vote on Murthy would split along party lines and require Vice President Harris to break a 50-50 tie.

Outside of government, watchdogs like Hauser say they remain uneasy about health officials like Murthy, who cycle between government positions and private sector consulting.

“We’re not arguing that you should hermetically seal public servants in cocoons so they never talk to people in the industry,” Hauser said. “I do worry about the ability of companies to develop these sorts of relationships when people are out of office, and then call on them when they go back.”