Who Will Lead HHS and CDC Under Joe Biden?
A speculative but informed list
Joe Biden will be president of the United States, inaugurating what could be a major shift in how Covid-19 is being tackled. As they say in Washington, personnel is policy. So who is going to be tapped for the top health jobs under the new administration? Below is a list of potential candidates for a variety of roles that cover public health, administration, and health care policy. It’s speculative but informed based on interviews and other public reporting. (If you think I have this totally wrong, feel free to email me at firstname.lastname@example.org or suggest names in the comments.)
The roles of director of the Centers for Disease Control and Prevention and Secretary of the Department of Health and Human Services are unique in that not only do they need to have a wide breadth of public health knowledge (including likely infectious disease experience given that the nation is experiencing the worst pandemic in history), but they also have to run large bureaucracies and are seen as some of the most important communicators on health and health care issues. The CDC is an independent agency within HHS, the latter of which has over 80,000 employees. Politico has speculated, based on reporting, that the Biden team may lean toward governors and former governors for the HHS job due to the natural political skills elected officials have and the fact that governors oversee health care as a large part of their state budgets. However, that’s not an absolute directive, and there are many people who seem like contenders who don’t fit that bill.
Given the massive health inequities in the United States, which have only become even more apparent during the pandemic, there’s hope (at least from this blog) that the public health leadership of the U.S. will be more representative of the country as a whole.
Here’s some informed conjecture.
Folks on the radar
On Monday, the Biden-Harris transition team announced its Covid-19 advisory board. These are public health experts who are tapped to advise the transition team on how the incoming administration should tackle Covid-19 (it’s unclear if this is through policy guidance alone or other measures). I’m listing the names and blurbs from the press release below. It’s reasonable to assume that some folks on this list could eventually be tapped for other formal health administration titles as has happened in the past, especially Vivek Murthy, MD, who has HHS experience and served as U.S. surgeon general from 2014 to 2017.
Co-Chairs and Advisory Board Members:
Dr. David Kessler
David A. Kessler, MD, is Professor of Pediatrics and Epidemiology and Biostatistics at UCSF. Dr. Kessler served as FDA Commissioner from 1990 to 1997, appointed by President George H.W. Bush and reappointed by President Bill Clinton.
Dr. Vivek Murthy
Vivek Murthy, MD, MBA, served as the 19th Surgeon General of the United States from 2014–2017. As the Vice Admiral of the US Public Health Service Commissioned Corps, he commanded a uniformed service of 6,600 public health officers globally. The officers focused on helping underserved populations, protecting the nation from Ebola and Zika, responding to the Flint water crisis, and natural disasters such as hurricanes.
Dr. Marcella Nunez-Smith
Marcella Nunez-Smith, MD, MHS, is an Associate Professor of Internal Medicine, Public Health, and Management at Yale University and the Associate Dean for Health Equity Research at the Yale School of Medicine. Dr. Nunez-Smith’s research focuses on promoting health and healthcare equity for structurally marginalized populations.
Dr. Luciana Borio
Luciana Borio, MD, is VP, Technical Staff at In-Q-Tel. She is also a senior fellow for global health at the Council on Foreign Relations. Dr. Borio specializes in biodefense, emerging infectious diseases, medical product development, and complex public health emergencies. She served in senior leadership positions at the FDA and National Security Council, including as Assistant Commissioner for Counterterrorism Policy and Acting Chief Scientist at the FDA, and Director of FDA’s Office of Counterterrorism and Emerging Threats.
Dr. Rick Bright
Rick Bright, PhD, is an American immunologist, virologist, and former public health official. Dr. Bright was the director of the Biomedical Advanced Research and Development Authority (BARDA) from 2016 to 2020 and the Deputy Assistant Secretary for Preparedness and Response at the Department of Health and Human Services. He also previously served as an advisor to the World Health Organization and the United States Department of Defense. His career has focused on the development of vaccines, drugs, and diagnostics to address emerging infectious diseases and national security threats.
Dr. Ezekiel Emanuel
Ezekiel J. Emanuel, MD, PhD, is an oncologist and Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. From January 2009 to January 2011, he served as special advisor for health policy to the director of the White House Office of Management and Budget. Since 1997, he has served as chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health (NIH).
Dr. Atul Gawande
Atul Gawande, MD, MPH, is the Cyndy and John Fish Distinguished Professor of Surgery at Brigham and Women’s Hospital, Samuel O. Thier Professor of Surgery at Harvard Medical School, and Professor of Health Policy and Management at Harvard T.H. Chan School of Public Health. Dr. Gawande is also the founder and chair of Ariadne Labs, a joint center between Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health for health systems innovation, and of Lifebox, a nonprofit organization making surgery safer globally. He previously served as a senior advisor in the Department of Health and Human Services in the Clinton Administration.
Dr. Celine Gounder
Celine Gounder, MD, ScM, FIDSA is a Clinical Assistant Professor at the NYU Grossman School of Medicine and cares for patients at Bellevue Hospital Center. From 1998 to 2012, Dr. Gounder studied TB and HIV in South Africa, Lesotho, Malawi, Ethiopia and Brazil. While on faculty at Johns Hopkins, Dr. Gounder was the Director for Delivery for the Gates Foundation-funded Consortium to Respond Effectively to the AIDS/TB Epidemic. She later served as Assistant Commissioner and Director of the Bureau of Tuberculosis Control at the NYC Department of Health and Mental Hygiene.
Dr. Julie Morita
Julie Morita, MD, is Executive Vice President of the Robert Wood Johnson Foundation (RWJF). Morita previously served as the Health Commissioner for the City of Chicago for nearly two decades. She is a member of the American Academy of Pediatrics and has served on many state, local, and national health committees, including the CDC’s Advisory Committee on Immunization Practices, and the National Academy of Sciences’ Committee on Community Based Solutions to Promote Health Equity in the United States.
Dr. Michael Osterholm
Michael Osterholm, PhD, MPH, is Regents Professor, McKnight Presidential Endowed Chair in Public Health and the director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota. Dr. Osterholm previously served as a Science Envoy for Health Security on behalf of the State Department. For 24 years (1975 to 1999), he worked in the Minnesota Department of Health; the last 15 years as state epidemiologist.
Ms. Loyce Pace
Loyce Pace, MPH, is the Executive Director and President of Global Health Council. Over the course of her career, Loyce has championed policies for access to essential medicines and health services worldwide. Ms. Pace has worked with Physicians for Human Rights and Catholic Relief Services, and previously served in leadership positions at the LIVESTRONG Foundation and the American Cancer Society.
Dr. Robert Rodriguez
Dr. Robert Rodriguez graduated from Harvard Medical School and currently serves as a Professor of Emergency Medicine at the UCSF School of Medicine, where he works on the frontline in the emergency department and ICU of two major trauma centers. He has authored over 100 scientific publications and has led national research teams examining a range of topics in medicine, including the impact of the COVID-19 pandemic on the mental health of frontline providers. In July 2020, Dr. Rodriguez volunteered to help with a critical surge of COVID-19 patients in the ICU in his hometown of Brownsville, Texas.
Dr. Eric Goosby
Eric Goosby, MD, is an internationally recognized expert on infectious diseases and Professor of Medicine at the UCSF School of Medicine. During the Clinton Administration, Dr. Goosby was the founding director of the Ryan White CARE Act, the largest federally funded HIV/AIDS program. He went on to become the interim Director of the White House’s Office of National AIDS Policy. In the Obama Administration, Dr. Goosby was appointed Ambassador-at-Large and implemented the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). After serving as the U.S. Global AIDS Coordinator, he was appointed by the UN Secretary General as the Special Envoy for TB.
The composition of the committee feels strategic in terms of getting quality voices in the room for a science-backed approach to the pandemic and for signaling what’s to come. The Biden administration likely wants to find people who can provide the best strategies for getting the pandemic under control as well as boost the morale of the health agency employees who have felt sidelined, silenced, and compromised. Take for example Rick Bright, the former top vaccine official in the Trump administration who became a whistleblower. His inclusion on the Biden-Harris Covid-19 advisory board sends a signal of restoration to all three agencies. Promoting people within the organizations who have stuck through the four years will likely also happen or at least be considered (see the first person suggested for CDC below). It should be noted that jobs that manage entire agencies require congressional approval; however, the CDC director position does not.
Here’s who else is likely on the radar
Anne Schuchat, MD: As the principal deputy director of the CDC — and the interim CDC director from January to July 2017 and February to March 2018 — Schuchat is viewed by many in public health to be an obvious contender for the director job. She has extensive knowledge of the agency, and she’s been hands-on during prior health emergencies including H1N1, SARS, and Ebola. In prior pandemics, she led daily briefings, which many in the media are hoping will pick up again. An October ProPublica feature revealed that Schuchat has clashed with the Trump administration, including Covid-19 task force leader Deborah Birx, and that she’s viewed by CDC insiders as “the defender of the agency’s principles.”
Mary Bassett, MD: The current director of the FXB Center for Health and Human Rights at Harvard University was formerly the commissioner of the New York City Department of Health and Mental Hygiene from January 2014 until August 2018. There’s a tradition of the former New York City health department lead becoming head of CDC with Tom Frieden, MD. She has a great TED Talk on why doctors should believe in social justice.
Richard Besser, MD: The president and CEO of the Robert Wood Johnson Foundation was a former acting director for the CDC and ABC News’ former chief health and medical editor. He was the acting director of the CDC during the H1N1 pandemic in the U.S. During the Zika pandemic, I ran into Besser while reporting in Brazil, and he had shrewd advice about what the major questions of the response were. His media and communications savvy could work in his favor for sharing Covid-19 messaging. He could also be under consideration for HHS roles.
Mary Katherine Wakefield: She’s a nurse and health care administrator who served as the acting Deputy Secretary of Health and Human Services in the Obama administration from 2015 to 2017 and as head of the Health Resources and Services Administration from 2009 to 2015. Given the immense work of nurses during the pandemic, giving Wakefield the top job would send a good message of recognition to a large but often overlooked group of health care workers.
Peter Kilmarx, MD: Kilmarx is an expert in infectious disease research and HIV/AIDS prevention and is currently the deputy director of the Fogarty International Center at the National Institutes of Health. He led the CDC efforts to quell the Ebola pandemic in Sierra Leone. He’s been in touch with a wide range of contact tracing and epidemiology experts during the pandemic.
Margaret Ann “Peggy” Hamburg, MD: Hamburg — yet another former New York City health commissioner — served as the commissioner of the Food and Drug Administration under the Obama administration and is currently the chair of the Board of the American Association for the Advancement of Science. She’s also worked at HHS and the National Institutes of Health. If the administration is looking for someone with U.S. health agency knowledge, Hamburg is an obvious name to consider.
Tom Frieden, MD: The former head of the CDC before Robert Redfield and the current president and CEO of Resolve to Save Lives, an initiative of Vital Strategies, has become a prolific science communicator during the pandemic. His name is likely in the mix.
Scott Gottlieb: Whether he actually makes a final shortlist, Gottlieb — who was thought of as an effective former head of the FDA — is likely a name being considered.
Michelle Lujan Grisham: The governor of New Mexico is on Politico’s list of contenders for the top HHS spot. She ran New Mexico’s health agency in the past, and she currently co-chairs Biden’s transition team.
Mandy Cohen, MD, MPH: The North Carolina Health Secretary is also on Politico’s list and was a top official at the Centers for Medicare and Medicaid Services under the Obama administration.
Beth Cameron: The vice president for global biological policy and programs at the Nuclear Threat Initiative previously served as the senior director for global health security and biodefense on the White House National Security Council. She wrote a sharp critique of Trump’s pandemic response in March as she had helped write the nation’s “pandemic playbook” under Obama.