President-elect Joe Biden’s picks for his healthcare team indicate a stronger federal role in the national COVID-19 strategy, reestablishing a guiding stress on science and a focus on equitable distribution of vaccines and treatments.
With California Attorney General Xavier Becerra’s announcement on Monday as health secretary and half a dozen other key appointments, Biden aims to leave behind the personality dramas that have sometimes blossomed under President Donald 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’re always going to have a federal, state and local partnership,” commented Dr. Georges Benjamin, executive director of the nonprofit American Public Health Association. “I just think there will be better direction from the federal government and that it will work more collaboratively with the states.
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In a sense, what Biden has isn’t quite a squad yet, but a set of players selected for key positions. Some have previously 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 information and analysis on healthcare. 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 healthcare choices say about the policies his administration is likely to follow:
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 nursing home residents without providing infrastructure, only to have to rectify this omission later.
Zients has made a name for itself rescuing government programs gone awry, like the “Obamacare” website HealthCare.gov. 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 they didn’t know what was coming out of the White House.”
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 wished we had. … This signals to me that the government is ready to put in place an 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.”
Even more than the appointment of a Latino politician as Secretary of Health, Biden’s selection of Dr Marcella Nunez-Smith of Yale University is seen 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 care system has their best interests in mind.
The first indications are that the vaccines are very effectivesaid 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.’ “
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