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Health and Human Services (HHS) Secretary Xavier Becerra is under fire for what critics say is a lack of leadership as the Biden administration wrestles with the direction of its COVID-19 response.
Tasked with running the sprawling agency primarily responsible for responding to the COVID-19 pandemic as well as the day-to-day administration of the nation's unwieldy health system, Becerra is supposed to corral the differing health factions into a unified message on the pandemic.
But outside health experts and former officials said he's taken a back seat, ceding his authority to others, including the White House and the Centers for Disease Control and Prevention (CDC).
As administration health officials face criticism for confusing messages and guidance on topics ranging from masks to booster shots to isolation time, critics said there's a lack of coordinated communication among public health agencies, and part of the problem is the low profile of the HHS secretary.
Public health messaging during a pandemic is complicated enough, but experts say the Biden administration as a whole needs to be better at making clear that the situation is evolving constantly.
"Of all the HHS secretaries we've had, at least in the last multiple administrations, we've never had one that was a ghost when it came to a public health crisis. That's what we have now: an invisible HHS secretary. Just when we need that person the most," said Eric Topol, director of the Scripps Research Translational Institute.
Becerra's spokesperson, Sarah Lovenheim, the assistant secretary for public affairs, disputed the assertion that Becerra has not been a leader during the pandemic.
The secretary is "tackling a wealth of issues, with COVID being the focus," Lovenheim said. "The secretary drives agency operations to support carrying out the mission, whether he's coordinating our agencies to make booster doses accessible, authorizing the distribution of vaccines, or determining how to get masks in the hands of people in need of them."
But the communication missteps have been unforced errors, experts said, reinforcing a perception that the administration is overly reactive and not proactive.
In the late summer and fall, disagreements over the administration's plan for booster shots spilled over into the public. The White House announced a Sept. 20 deadline to get booster shots to every American, six months after their primary vaccine series.
But the scientific agencies were not in alignment on the timing or the evidence. Even as the White House was pushing boosters for all, outside advisers to the CDC and Food and Drug Administration (FDA) were not convinced.
Then, the CDC said people could get a booster if they wanted one; it wasn't until the Friday before Thanksgiving and the identification and emergence of the omicron variant just a week later that the agency intensified the message to recommend every adult get a booster.
Inside the White House, Jeff Zients is the administration's coronavirus coordinator. He leads a team of medical experts including CDC Director Rochelle Walensky, White House medical adviser Anthony Fauci and former FDA Commissioner David Kessler, who is now chief science officer of the administration's COVID-19 response team.
Becerra, who lacks experience as a public health communicator, is not part of that team. He is a former House member who also served as attorney general for California. During his confirmation hearing, Republicans attempted to paint Becerra as unqualified for the job for having no background as a health professional.
"I think HHS needs to step up more," said Celine Gounder, an infectious disease specialist and epidemiologist at NYU and Bellevue Hospital.
"I think there is a need for perhaps better coordination because it can be confusing to the public if there seems to be different messages coming out as different agencies. How do you reconcile that and make sense of that? I think that is one of the things the HHS secretary should be doing," Gounder added.
Lovenheim also provided a 13-page fact sheet detailing the agency's accomplishments over the past year. The highlights include pandemic-focused efforts like investing in community health centers, education campaigns to build vaccine confidence and leading a health equity task force. The agency also promoted new investments in ObamaCare enrollment efforts, as well as regulatory protections for LGBTQ+ communities.
There have, however, also been some very public missteps, and the CDC has borne the brunt of the criticism over confusing messages, something President Biden acknowledged during a press conference last week.
"The messages, to the extent they've been confusing - it's because the scientists, they're learning more," Biden said.
Last year, the CDC took heavy criticism for issuing new mask guidelines for fully vaccinated people, only to reverse course as the delta variant spread.
Just after Christmas, the agency cut in half the recommended isolation period for someone who tests positive for COVID-19. The update came from a press release, with no accompanying data or media briefing.
Confusion and criticism ensued, as public experts said the agency erred by not specifying the need for a negative test before leaving isolation. Walensky and the administration spent the next week fielding criticism.
Tom Frieden, who ran the CDC under former President Obama, said HHS needs to stand up for the CDC, to insulate it from criticism.
"I think the lack of communication coming directly from CDC reflects a combination of the fact that the White House is not always comfortable with the policies that CDC is recommending and therefore isn't comfortable with CDC speaking to the public," Frieden said.