U.S. President-elect Joe Biden’s picks for his health care team indicate greater federal role in national COVID-19 strategy, restoring scientific focus and emphasis on equitable distribution vaccines and treatments.
This is a change from President Donald Trump’s strategy where states have been largely left to mobilize resources, acquire protective equipment, develop a strategy and the implementation of restrictions often without clear direction from the federal government.
With the announcement Monday from the California Attorney General Xavier Becerra as health secretary and half a dozen other key appointments, Biden aims to leave behind the personality dramas that have sometimes blossomed under Trump. He hopes to reduce the federal response to a more methodical approach, seeking results by applying the scientific knowledge of what he says will be transparent and disciplined.
“We are always going to have a federal, state and local partnership,” said Dr. Georges Benjamin, executive director of the American nonprofit association for public health. “I just think there will be better direction from the federal government and that it will work more collaboratively with the states.
In a sense, what Biden has isn’t quite a squad yet, but a set of players selected for key positions. Some have already worked together as members of Biden’s coronavirus advisory board. Others will need to dress quickly.
By announcing most of the key positions in one package, Biden signals that he expects his appointees to work together and not as lords of their own bureaucratic strongholds.
“These are not land-conscious people,” said Drew Altman, CEO of the Non-Partisan Kaiser Family Foundation, a clearinghouse for healthcare information and analysis. But, “it’s up to the administration (Biden) to make them an effective team.”
A Washington saying, sometimes attributed to the late President Ronald Reagan, states that “people are politics”.
Here’s what Biden’s health choices say about the policies his administration is likely to follow:
Stronger federal management
Becerra’s selection as Secretary of Health and businessman Jeff Zients as White House coronavirus coordinator indicates a more assertive federal role for the coronavirus.
Under Trump, states have at times been left to fend for themselves, such as when the White House initially called on states to test all residents of nursing homes without providing infrastructure, only to have to rectify this omission later.
Zients made a name for themselves rescuing government programs gone awry, such as the Affordable Care Act – also known as Obamacare – on the HealthCare.gov website. Becerra has experience managing the California attorney general’s office, which is larger than some state governments.
Former Health and Human Services Secretary Kathleen Sebelius knows the two men in her service in the Obama administration and says she doesn’t see them working against the grain.
A secretary Becerra “can’t get up every morning and think only of COVID,” she said. He will “be working on COVID and coordinating the assets of the FDA, CDC and NIH, but he will have a lot of other things to do.” Meanwhile, “Zients will be the railway engineer who will make sure the trains run on time.”
States are ready for the federal government to take a more assertive role, she said. “Governors – Republicans and Democrats – are eager to finally have a federal partner,” she said. “They not only felt lonely, but didn’t know what was coming out of the White House.
Science in the foreground
Biden’s selection of infectious disease expert Dr Rochelle Walensky as head of the Centers for Disease Control and Prevention, Dr Anthony Fauci’s elevation as medical adviser, and Dr Vivek Murthy’s return as general surgeon are read in the medical community as a restoration of the traditionally important role of science in public health emergencies.
“This means the response plan will be grounded in health science,” said Dr Nadine Gracia, executive vice president of Trust for America’s Health, a nonprofit that works to promote public health. .
Under Trump, “those of us who practice medicine today were appalled,” said Dr. Wendy Armstrong, an infectious disease specialist at Emory University School of Medicine. “The people with the most expertise did not have the voice that many of us would have liked to have… It signals to me that the government is ready to put in place expertise that can guide its plan.
Walensky, a widely recognized HIV / AIDS expert, gained her coronavirus experience as head of infectious diseases at Massachusetts General Hospital in Boston during the first wave this spring.
“She was a real leader when it came to COVID,” said Dr Rajesh Gandhi, infectious disease physician at Mass General. “She organized infection control policies within the hospital, she organized treatment studies, she organized tests, and conducted tests.”
Focus on equity
Even more than the appointment of a Latino politician as Secretary of Health, Biden’s selection of Dr Marcella Nunez-Smith from Yale University is interpreted as a sign that his administration will work for a fair distribution of vaccines and treatment among racial and ethnic minorities, who have suffered. a disproportionate number of deaths from COVID-19.
This challenge is met with widespread skepticism among minorities that the health system has their best interests in mind.
The first indications are that the vaccines are very effective, said Altman of the Kaiser Foundation. But polls indicate a strong backwash of doubts, especially among African Americans.
“While states will be able to make the final decisions on who will receive the vaccine, there must be guidance around those decisions so that they are fair and equitable across the country,” Altman said. “You don’t want to have the kind of variations that people will look at and say, ‘It just wasn’t fair.’ “