with Alexandra Ellerbeck

The government’s sweeping health-care agency will lack a permanent secretary tomorrow when President-elect Joe Biden is sworn in. His pick to lead the Department of Health and Human Services, Xavier Becerra, is waiting along with other Biden nominees on confirmation from a slow-moving Senate.

But no such obstacle exists for Rochelle Walensky, incoming chief of the Centers for Disease Control and Prevention. 

Because the position of CDC director doesn’t require Senate confirmation, Walensky will be able to immediately take the reins at the nation’s public health agency at a critical moment. Moments after Biden takes the oath of office, Walensky will also be sworn in as CDC director, to lead an agency in which she has promised to restore public trust after a bungled pandemic response.

Part of the reason the position isn’t subject to Senate confirmation is because the CDC largely doesn’t create policy, unlike other HHS branches like the Food and Drug Administration or the Centers for Medicare and Medicaid Services. Its job is mainly to monitor public health and engage the public.

It will take longer to put in place Biden’s other HHS picks.

It’s the Senate’s job to confirm more than 1,250 politically appointed positions to the executive branch. Nineteen of those are positions at HHS.

But it’s been a strange month. Democrats didn’t even know they’d control the Senate until the Jan. 5 Georgia runoffs. And the following day, a pro-Trump mob invaded the U.S. Capitol, setting off a second round of impeachment efforts in Congress.

Compared with past presidential transitions, Biden will enter office with far fewer nominees confirmed. It’s not because Biden’s transition team hasn’t been working quickly. It has appointed 206 White House officials, a record and more than double the number of appointments President Barack Obama had made at this point in 2009, our colleague Matt Viser reports.

“[Biden] also has already announced 44 nominees that need Senate confirmation, which surpasses Obama, who held the previous record at 42 nominations announced before the inauguration,” Matt writes. 

“But though early nominations are typically swiftly confirmed, Biden may not have any Cabinet officials confirmed on his first day, the first time this would have happened since 1989,” he adds. “Two of Trump’s Cabinet picks were confirmed on Inauguration Day in 2017, and President Obama had six confirmed at the start of his first term.”

Sen. Amy Klobuchar (D-Minn.), who serves on the Joint Congressional Committee on Inaugural Ceremonies, describes preparation for an extraordinary Inauguration. (The Washington Post)
Biden’s transition team hasn’t said who will lead HHS in the interim.

Biden will need to designate someone to be the agency’s acting secretary until the Senate confirms (or possibly rejects) Becerra. This person could be a long-term “career” civil servant, or it could be a Senate-confirmed lower political appointee of either the old or new administration.

“The expectation is they will be there a week or two weeks while they get Becerra confirmed,” said Michael Leavitt, who served as HHS secretary under George W. Bush. “There is an expectation most of the decisions will be made by the White House, and that person is somewhat duty-bound to simply sign on behalf of the agency.”

One possibility is Eric Hargan, the HHS deputy secretary who briefly took the helm between President Trump’s first secretary, Tom Price, and his second, Alex Azar. Another is Norris Cochran, deputy assistant secretary of budget, who led the agency at the beginning of the Trump administration before Price was sworn in. Another name being floated is Francis Collins, the longtime director of the National Institutes of Health, whom Biden is retaining.

Biden will also have to name acting heads of HHS's many subagencies. For example, top FDA career official Janet Woodcock is said to be in line for the job of acting commissioner.

Besides Becerra and Collins, Biden has announced three other HHS nominees who require Senate confirmation.

He has reportedly tapped Pennsylvania Health Secretary Rachel Levine to be his assistant secretary of health, according to news reports this morning.

Biden has also nominated Vivek H. Murthy as surgeon general and Andrea Palm as deputy secretary. Palm has been leading the Wisconsin Department of Health Services. Both she and Murthy held roles during the Obama administration; Murthy as surgeon general and Palm as acting assistant secretary for legislation, chief of staff and senior counselor to the secretary.

That leaves 15 more appointee positions at HHS that require Senate confirmation.

The positions include administrators of the CMS, the FDA and Substance Abuse and Mental Health Services; seven assistant secretaries; chief financial officer; commissioner of Children, Youth and Families; general counsel; inspector general; and director of the Indian Health Service (check out The Washington Post’s nominee tracker here).

Ahh, oof and ouch

AHH: Prominent anti-vaccine groups received money from a government program aimed at helping small businesses.

“Five prominent anti-vaccine organizations that have been known to spread misleading information about the coronavirus received more than $850,000 in loans from the federal Paycheck Protection Program, raising questions about why the government is giving money to groups actively opposing its agenda and seeking to undermine public health during a critical period,” The Post’s Elizabeth Dwoskin and Aaron Gregg report.

“The groups that received the loans are the National Vaccine Information Center, Mercola Health Resources, the Informed Consent Action Network, the Children’s Health Defense and the Tenpenny Integrative Medical Center, according to the Center for Countering Digital Hate, an advocacy group based in the United Kingdom that fights misinformation and conducted the research using public documents,” they continue.

It's unclear whether the loans violated the terms of the government’s program to help small businesses. Carol Wilkerson, a spokesperson for the U.S. Small Business Association, told The Post that in general, if PPP applicants met the requirements, they received a loan. This has sparked some backlash to the program, with critics pointing to cases where massive restaurant chains and hotels benefited from loans to their affiliates.

“Although it’s unclear whether the anti-vaccine groups broke any rules, its receipt of public assistance is in many ways a consequence of the scattershot way in which the Paycheck Protection Program delivered hundreds of billions of dollars with few guardrails or preconditions,” Elizabeth and Aaron write.

OOF: A growing share of coronavirus cases in California are linked to several large outbreaks in the state.

Experts stress that they need to look more closely at the circumstances of the Northern California outbreaks, as well as at the latest variant — this one, known as L452R — before declaring it more contagious or more dangerous than the virus already broadly circulating,” The Post’s Fenit Nirappil reports

Scientists know little about the new variant, which was first detected in Denmark in March, but its link to a growing share of cases raises the possibility that it is driving new infections. The variant is not the same as the highly contagious one first identified in the United Kingdom.

“California publicized the variant at a late Sunday news conference after researchers identified it in about 25 percent of samples collected between Dec. 14 and Jan. 3, a surge from 3.8 percent of samples collected in the preceding three-week period,” Fenit writes.

Charles Chiu, a virologist at the University of California at San Francisco who spoke at the briefing, called the numbers “suggestive” and “a little worrisome,” but stressed that they could be the result of random change, several superspreader events or bias in sampling.

OUCH: An independent panel investigating the coronavirus faulted the WHO and China.

A group of experts reviewing the global handling of the coronavirus pandemic criticized China for not adopting more forceful public health measures a year ago to contain the initial outbreak of the virus. An interim report from the group also faulted the World Health Organization for not declaring an international emergency until Jan. 30 and not using the term pandemic until March 11, Reuters’s Stephanie Nebehay reports.

“What is clear to the Panel is that public health measures could have been applied more forcefully by local and national health authorities in China in January,” the report said in reference to the initial outbreak of the new disease in Wuhan, China.

The panel is led by former New Zealand Prime Minister Helen Clark and former Liberian President Ellen Johnson Sirleaf. It is expected to publish recommendations in a final report to be released in May.

Coronavirus’s global impact

The WHO is warning of a ‘catastrophic moral failure’ as rich countries take vaccines.

“WHO Director General Tedros Adhanonom Ghebreysus, who has repeatedly warned richer countries against excluding poorer ones by cutting bilateral deals with vaccine suppliers, took his rhetoric up a notch in his opening remarks at an executive board session,” The Post’s Paul Schemm and Jennifer Hassan report.

“I need to be blunt: The world is on the brink of a catastrophic moral failure — and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries,” Tedros said. He noted that 39 million doses have been administered in more than 40 higher-income countries, while one poor country has given only 25 doses.

Tedros said that wealthy countries should hold off on vaccinating young and healthy adults until after vaccines had gone to older people across the world. He also raised concerns that some countries and companies will not follow through with commitments that they have made to Covax, the international health agency’s project aimed at ensuring equitable vaccine supply.

“Even as they speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around Covax, driving up prices and attempting to jump to the front of the queue,” he said.

More in coronavirus

  • The Los Angeles air quality regulator has lifted restrictions on the number of monthly cremations, put in place to prevent pollution, in order to ease a backlog caused by covid-19 deaths, the Los Angeles Daily News reports.
  • A state senator from Minnesota died after attending a party to celebrate the Republican Party’s narrow election victory in the state legislature in November, the New York Times’s Trip Gabriel reports. Jerry Relph was one of four attendees at the party to test positive for the virus.
  • Biden plans to block Trump’s order lifting travel restrictions from Europe, Reuters’s David Shepardson reports. Trump signed an order on Monday lifting restrictions imposed in response to the pandemic, but it was not set to go into effect until Jan. 26, six days after he leaves office.

Elsewhere in health care

A group representing safety-net hospitals says it has suspended contributions to members of Congress who voted against certifying the election results.

America’s Essential Hospitals, which represents more than 300 hospitals, didn’t clarify how long the suspension would last, but said it “will use this time to ensure our criteria for political donations align with our organizational values and commitment to social responsibility and democratic ideals.” 

The Blue Cross Blue Shield Association made a similar announcement last week.

Some Trump health officials are struggling to find work in the private sector.

“It’s that magical time, when government staffers trade in their badges and their lowly government salaries for jobs at some of Washington’s most powerful (and highest paying) law firms and lobbying shops,” Stat News’s Nicholas Florko reports. “But this transition could be a little different.”

Ivan Adler, a recruiter for lobbying firms, told Stat News that he’s seen firms bristle at hiring Trump administration officials, especially those seen as more political.

Still, some health staffers have made the jump. They include Kimberly Brandt, who served as principal deputy administrator for operations and policy at CMS, and Greg D’Angelo, who worked as the associate director for health programs at the Office of Management and Budget. Brandt will go to the lobbying firm Tarplin Downs & Young, which represents several prominent drugmakers, while D’Angelo is now a vice president at the Nickles Group, which represents the American Hospital Association and a number of other major health-care players. 

Sugar rush