January 22, 2021

Weekly line: What it was like to run President Trump's health agencies, according to former leaders

Daily Briefing
    By Ashley Fuoco Antonelli, senior editor

    Stephen Hahn and Robert Redfield led FDA and CDC, respectively, under former President Donald Trump, helming the nation's two biggest public health agencies amid an unprecedented public health crisis and time of political discourse. In recent days, both Hahn and Redfield have spoken with various media outlets about their time in the Trump administration, reflecting on what it was like dealing with political pressures—and what they wish would have gone differently.

    Here's what they had to say.

    Hahn: FDA and White House had 'a clash of cultures that affected many of the conversations'

    Hahn was confirmed as FDA's commissioner in December 2019—about one month before officials reported the first case of the novel coronavirus in the United States. During Senate hearings on Hahn's nomination for the role, Hahn—who had been working as CMO of MD Anderson Cancer Center in Houston—pledged to rely on "science and data" while in the position.

    But the agency came under intense scrutiny last year amid reports that it was facing political pressure to authorize a Covid-19 vaccine before last November's presidential election—and, more concerningly, before robust clinical trial data on the experimental vaccines' efficacy and safety was available. FDA officials, including Hahn, sought to address Americans' concerns by promising to share as much data on Covid-19 vaccines as possible and ensure that officials would adhere to science when reviewing vaccine candidates.

    On Tuesday, Hahn told Politico that pressure was real, and it set up "a clash of cultures that affected many of the conversations" between FDA officials and Trump's White House. "I heard loud and clear from the White House—President Trump and others—that they wanted FDA to move faster," Hahn said.

    Although Hahn said he never heard directly from Trump on the issue, Hahn said White House staff pressed FDA officials to accelerate their decisions regarding Covid-19 treatments and vaccines. For example, Hahn said both Trump and White House officials pushed FDA officials to authorize the anti-malaria drug hydroxychloroquine as a Covid-19 treatment—which the agency did, but then revoked a few months later, after research showed the drug was not effective at treating Covid-19.

    "With time, particularly over mid- to last summer and then into fall, there was a substantial amount of pressure," Hahn told Politico.

    Hahn said Trump's White House was very "results oriented," and that sometimes constructed a false dichotomy between making decisions quickly and making them accurately. "So that was a little bit of a clash of cultures that affected many of the conversations," Hahn said.

    Hahn told Politico he had similar interactions with officials at HHS, which oversees FDA, that ultimately pitted him against HHS Secretary Alex Azar in some instances. "It's fair to say there's been ups and downs in the relationship," Hahn said.

    For example, Hahn criticized Azar's decision late last week to implement term limits for several directors across various federal health care agencies, including some top officials at FDA. Later, Hahn expressed frustration with HHS' recent decision to scale back FDA's oversight of genetically modified animals.

    Separately, during an interview with Bloomberg News on Tuesday, Hahn said he was "disgusted" with the riot that took place at the U.S. Capitol earlier this month—and it made him consider resigning from his post. "[W]ith respect to [Jan.] 6—I was horrified and I was disgusted by what happened. We live in a democracy. There is no place for what we saw and those who are responsible for the actions that took place on the physical grounds of the Capitol should be held accountable," he said.

    However, Hahn said, "We [had] a lot of things going on that are important from a public health point of view that required my attention and the senior leadership's attention." He added, "Making a statement with a resignation certainly was a topic of consideration," but "I think our public health mission and the need to provide leadership during a very critical time was more important."

    Overall, Hahn told Politico that his time at FDA left him thinking that the agency should have more independence from the presidential administration. "There's a lot of different models out there, but I think given what we've seen over the last year, particularly in the public health emergency, really bring[s] this issue into the fore," Hahn said. "Our rallying cry and our north star has always been science and data."

    Redfield: Coronavirus mitigation measures became 'a political football'

    During an interview with the New York Times last weekend, Redfield lamented similar political issues at CDC and said he was disappointed the Trump administration wasn't able to get America's coronavirus epidemic under control.

    Trump appointed Redfield, who was a leading HIV/AIDS researcher and professor at the University of Maryland Medical Center, as CDC's director in March 2018. As the Times reports, Redfield led CDC through "one of the most tumultuous periods in its history," and "[h]e was frequently criticized for moving too slowly to protect the United States from the coronavirus, especially regarding the initial rollout of coronavirus tests, while being attacked by … Trump and others within the administration for contradicting their overly optimistic scenarios of the likely course of the pandemic."

    Redfield told the Times that it was difficult for him to leave CDC when he knows America's coronavirus epidemic hasn't yet reached its peak. "[T]he worst days haven't come," he said. "It would have been more rewarding to leave when the pandemic is under control."

    Redfield said the biggest challenge he faced during his time at CDC "was trying to operationalize an effective public health response against the greatest pandemic that this nation has had in a century in an environment where there's been probably more than 30 years of underinvestment in public health across this nation." He explained, "The core capabilities—data analytics, laboratory resilience, the public health work force—has been chronically underinvested in. That was a real frustration."

    Redfield also told the Times that a "lack of consistency of public health messaging and the inconsistency of civic leaders to reinforce the public health message" harmed America's response to its coronavirus epidemic, adding, "You can read between the lines what that means—'civic leaders.'"

    Redfield said that lack of consistency caused a misalignment throughout the country and created a false dichotomy of pitting coronavirus mitigation measures against the economy. "Controlling the pandemic was always, in my view, aligned effectively with maintaining the economic health of our nation. It wasn't an either/or," he said. "I'm very disappointed that some civic leaders decided to make this issue of mitigation a political football, rather than embracing the public health measures."

    Still, Redfield said he's "proud" of some of the work the Trump administration did to address America's coronavirus epidemic. For example, he touted the administration's work in rolling out Covid-19 vaccines, noting that the United States administered one million doses of the vaccines on two separate days last week.

    "We laid a foundation for vaccine administration," Redfield said, adding that he hopes President Biden's administration will continue to build on that progress.

    Going forward, Redfield said he believes policymakers should focus on rebuilding America's public health infrastructure first, so the country can respond to public health crises faster. "When they're talking about rebuilding infrastructure, the first infrastructure that they have to rebuild is the public health infrastructure in this nation. We need to be overprepared from a public health perspective rather than underprepared, particularly when it comes to challenging infectious pathogens," Redfield told the Times, "[b]ecause timing is everything."

    Have a Question?

    x

    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.

    X
    Cookies help us improve your website experience. By using our website, you agree to our use of cookies.