After months of being sidelined or outright attacked by President Donald Trump, a growing number of government scientists and physicians are pushing back against the president's political agenda when it comes to the pandemic.
The Food and Drug Administration issued beefed-up safety standards for a vaccine in September, making the president's push for a vaccine before Election Day all but impossible. After initially acquiescing to the White House, the Centers for Disease Control and Prevention reversed controversial guidelines that had called for less testing for individuals exposed to the novel coronavirus who showed no symptoms.
And Deborah Birx, the White House coronavirus response coordinator who no longer sees Trump regularly, travels the country urging state and local officials to adopt mask mandates, close down bars and restrict large gatherings -- measures antithetical to Trump's contention that the virus has been defeated and people should return to their lives.
The officials taking these stands have been emboldened by a worsening pandemic, an adrift White House and their belief that Trump's first term may be his last, say several administration officials who spoke on the condition of anonymity because they were not authorized to discuss these issues.
"We're really fighting to get the right information out and to get people to understand what needs to be done," said one senior health agency official who spoke on the condition of anonymity for fear of retaliation. "None of us at the agencies are wavering on that, I can assure you. We're definitely at a place where we know what we want to do, we know how we're going to do it, and we're going to stick to it."
Several administration officials described an unfocused White House, saying the coronavirus task force has fewer meetings, and Trump spends little time now thinking about how to handle the virus, instead mocking it at political rallies. Many of the administration's top doctors, including Birx, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Surgeon General Jerome Adams, are beside themselves over the growing influence of presidential adviser Scott Atlas, a neuroradiologist with no infectious-disease experience whose disputed views about herd immunity have gained currency with Trump, the officials said.
Birx has argued fiercely with Atlas in task force meetings, disputing his assertions of a receding threat from the pandemic by bringing charts and graphs demonstrating otherwise, according to two people familiar with the situation who requested anonymity to reveal private discussions. She has also insisted that the scientists Atlas often cites are outliers on issues ranging from masks to whether herd immunity is an effective strategy.
The White House insisted Trump continues to listen to all of his medical and health advisers.
"President Trump relies on the advice and counsel of all of his top health officials every day and any suggestion that their role is being diminished is just false," said White House spokesman Judd Deere. "For months in the midst of a global pandemic, the media has celebrated large gatherings of so-called 'peaceful protesters' some of whom have burned down, looted, and rioted in cities across the country. It can't be the case that one group is allowed to assemble but those who support President Trump are not."
With the election days away, scientists and agency heads are also focused on trying to preserve the integrity of their agencies during a potentially unstable and critical lame-duck period -- and in some cases burnish their own tarnished reputations for a post-Trump era, say agency insiders and outside experts.
The scientists' efforts to set their own agendas could be short-lived. Many of the people overseeing the pandemic response are expected to change even if Trump wins reelection. CDC Director Robert Redfield is likely to leave, or be asked to resign shortly after the election, no matter the result, according to several senior administration officials. He has always said he planned to step down at the end of this term, regardless of the election's outcome.
Rumors are also rife that FDA Commissioner Stephen Hahn may be asked to leave or quit, and the future of their direct boss, Health and Human Services Secretary Alex Azar, remains uncertain if Trump were to win a second term. Some senior career scientists are also considering a departure if Trump is reelected, according to officials who talked on the condition of anonymity because they were not authorized to discuss the issue.
How big a difference the scientists' pushbacks make in the larger pandemic response is unclear. Some public health officials say the changes have been too little. Some have urged Redfield to take more dramatic steps to spotlight the interference, for instance, to quit as he released all of his correspondence showing how the White House has pressured the agency to change public health guidance.
Much of the focus has been on Hahn and Redfield, both of whom Trump has excoriated on Twitter and in public briefings. For months, they have faced pressure not only from him and top White House aides, but also from Azar, who has criticized both subordinates to Trump and his staff, and blamed them for numerous missteps in the response. People close to Hahn and Redfield said the result has been an extraordinarily difficult work environment.
FRUSTRATIONS
Within the CDC, sources say much of the pushback has come from career scientists fed up with the White House's repeated blocking or watering down of guidelines that tell the public how to minimize the risk of getting sick.
At times, Redfield, a former Army physician, has backed them, for instance, when he reversed course in September on heavily criticized guidelines for coronavirus testing for asymptomatic individuals imposed this summer by the White House coronavirus task force. Redfield sought the reversal after an outcry from experts who said the new guidelines would have resulted in less testing of people believed to be a major source of spread, according to an agency official who spoke on the condition of anonymity to share internal deliberations.
The CDC also recently took another step at odds with the White House agenda by expanding the number of people at risk of contracting the coronavirus by changing the definition of who is a "close contact" of an infected individual. The move could make it more difficult for schools and workplaces to reopen, a top Trump priority.
CDC civil servants also refused to sign off on an Health and Human Services request to endorse the use of hotels to house migrant children to protect them from the spread of the coronavirus. The request was sent to Redfield, and it is not known whether he will sign the declaration himself. In the spring, when White House officials asked the CDC to produce a public health justification for sweeping border controls, career officials balked but Redfield agreed.
And career staff describe being frustrated about the time they've spent responding to data requests from the White House and Health and Human Services to demonstrate the United States is doing better than other countries and then having to refute the White House's misinterpretations of that data, according to one official. When staff members have pushed back, saying the data comparisons don't show U.S. superiority, they've been asked to redo them -- comparing the United States to Europe as a whole, for instance, rather than to individual countries. Even so, the United States looked worse in comparison, one official said.
Redfield was not available to comment. Health and Human Services spokeswoman Caitlin Oakley said that the agency "has never tried to force any conclusion on the CDC's data and under President Trump, HHS has always provided public health information based on sound science. Throughout the covid-19 response, science and data have driven and will continue to drive the decisions at HHS."
Like Redfield, Hahn had no Washington experience when he was tapped to lead the FDA. The 60-year-old radiation oncologist, a former top official at MD Anderson Cancer Center in Houston, was confirmed as FDA commissioner last December, just weeks before the pandemic hit. Initially, he seemed to enjoy going to the White House and getting attaboys for prodding a supposedly sluggish agency, according to three senior administration officials who spoke on the condition of anonymity because they were not authorized to talk on the issue.
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"He was star-struck," one of the officials said.
But Hahn took heavy criticism this spring after his agency granted, then revoked, emergency clearance for hydroxychloroquine, the malaria drug touted as a "game-changer" by Trump but later found to be ineffective and potentially dangerous for covid-19 patients. In August, he was roundly denounced by outside experts after he sharply exaggerated the benefits of convalescent plasma at a White House news conference to announce the FDA's authorization of the treatment.
Shocked by the criticism, Hahn apologized on Twitter, in the press and at the FDA for his mistake.
He called Eric Topol, director of the Scripps Research Translational Institute, who had written a blistering column about his missteps and called on Hahn to resign. The FDA chief was "quite distraught, there was deep pain," Topol said of their conversation. Based on that and subsequent discussions, Topol said he now has confidence Hahn will protect career scientists deciding whether and when a coronavirus vaccine should be made available.
Many believe Hahn's disastrous handling of the convalescent plasma announcement was a turning point for him.
"The convalescent plasma experience was very painful," said a senior administration health official who spoke on the condition of anonymity to discuss private conversations. "He's always seen himself as a good doctor... . You get the sense he felt like he was letting his patient down."
A key test occurred in September when the White House blocked issuance of the FDA's strengthened vaccine criteria, angry that it would delay a vaccine approval past Election Day. With the guidance bottled up by top administration officials, FDA staff posted a condensed version on the agency's website as part of a briefing book for its outside vaccine advisers, a move Hahn supported. The White House backed down then, but Trump later accused the FDA of a "political hit job."
"If you are sitting where Hahn is, you are weighing having the president and the president's people [angry] at you versus your reputation and place in history," said Robert Wachter, chairman of the department of medicine at the University of California at San Francisco who has known Hahn from the 1980s, when they were co-chief residents at UCSF. "There aren't many bigger and more important decisions than the vaccine. That is the central issue right now, the game-changer."
FDA career officials have also stepped up to insist on an independent vaccine process, worried the politicization of the issue would drive down public acceptance of the eventual product. In August, Peter Marks, the FDA official who oversees vaccines, said he would resign if the administration cleared a coronavirus vaccine that was not ready.
Other issues have emerged as flash points between the FDA and its political overseers: Hahn has clashed with Azar over the FDA's authority to regulate certain coronavirus tests. He has also tried to shield FDA employees from White House pressure on vaccines and treatments, directing the president's aides to call him, not career officials, according to agency insiders.
Another senior health official said Hahn's transformation should not be overstated. "He's an accidental hero," said the official, who credited Hahn for making changes in the communications office after the convalescent plasma incident. Before that, he said, Health and Human Services was getting reports of internal FDA activities, "creating incredible chaos."
FAUCI, BIRX
The other doctors on the White House task force have also become more forceful advocates of steps they see as crucial to combating the virus in the growing number of hot spots enveloping the country. Always outspoken, Fauci, the nation's leading infectious-disease expert, has become still blunter, saying the surging infections might require a national mask mandate and warning against a "herd immunity" strategy pushed by Atlas.
"This idea that we have the power to protect the vulnerable is total nonsense because history has shown that's not the case," Fauci said this month on "Good Morning America."
Birx, a longtime associate of Fauci's, started traveling to states a few months ago and, after Atlas arrived, ramped up her efforts to help states and localities in the throes of the pandemic. In the "doctors' group" -- a subset of the task force she started months ago -- Birx, Fauci, Redfield and Hahn discuss the latest developments and what messages should be sent to states and localities. She delivers them frequently in regional television and radio appearances.
She recently criticized the lack of masks in North Dakota, which has had more coronavirus infections per capita than any other state and over the past month has experienced a stunning surge in hospitalizations and deaths.
"Over the last 24 hours, as we were here and we were in your grocery stores and in your restaurants and frankly, even in your hotels, this is the least use of masks that we have seen in retail establishments of any place we have been," Birx told reporters Monday, according to The Bismarck Tribune.
A White House official described Birx's work is part of the administration's so-called Embers Strategy, which presumes there are small outbreaks across the country that need to be stamped out, even as new daily infections approach a record 100,000.