One report found that Department of Health and Human Services political appointees regularly sought to water down the work of the Centers for Disease Control and Prevention, while another detailed Trump’s effort to push top health officials to approve an unproven treatment for emergency use.
While political officials make the ultimate calls, there is extensive evidence of an attempt to interfere in the recommendations of health officials that could call those final decisions into question.
These are hardly the first examples of such meddling. Let’s run through the big ones.
Political pressure on CDC
The Post this weekend confirmed a Politico report that political aides at HHS “sought to change, delay and prevent the release of reports about the coronavirus by the Centers for Disease Control and Prevention because they were viewed as undermining President Trump’s message that the pandemic is under control.”
The Post’s Lena H. Sun reports that HHS spokesman Michael Caputo, a close Trump ally, and Caputo adviser Paul Alexander have spent months scrutinizing the reports and even demanding that they be allowed to make edits. The report is based upon actual emails, which Caputo confirmed were authentic.
While Caputo claimed that their pleas were often rejected, CDC advice on the use of hydroxychloroquine and information about what happened at a Georgia sleep-away camp were both delayed. The first risked undermining Trump’s push for the drug, which the FDA authorized for emergency use and then reversed course on, while the latter risked undermining Trump’s advocacy for reopening schools, because it suggested children of all ages were susceptible to the virus and could spread it to others. The political officials sought to edit guidance that the CDC had already made public on at least two occasions.
The Post previously reported in July that Alexander, who at one point cast the CDC’s work as “hit pieces,” also reacted angrily to CDC recommendations for pregnant women, suggesting they read “in a way to frighten women … as if the President and his administration can’t fix this and it is getting worse.”
Pushing for plasma
The Food and Drug Administration’s recent decision to approve another treatment for emergency use — convalescent plasma — was controversial from the beginning. The decision came shortly after Trump very publicly applied pressure and shortly after health officials were reported to remain skeptical. FDA Commissioner Stephen Hahn also overhyped the treatment in a news conference with Trump, misstating data used to bolster the decision. (Hahn later apologized.)
And now the New York Times has filled in some details about the pressure campaign behind the scenes. From its report Saturday:
… On Wednesday, Aug. 19, Mr. Trump called Dr. Francis S. Collins, the director of the N.I.H., with a blunt message.
“Get it done by Friday,” he demanded.
It wasn’t done by Friday, and on Sunday, regulators at the Food and Drug Administration still had not finished a last-minute data review intended to ease N.I.H. doubts.
But on Sunday night, the eve of the convention, the president announced, with the F.D.A.’s approval, that plasma therapy would be available for wider use, and he declared that it could reduce deaths by 35 percent, vastly overstating what the data had shown about the benefits.
The FDA, like the CDC, is supposed to make such decisions according to the science, not political pressure.
Plasma wasn’t the only treatment approved for emergency use under obvious political pressure: Trump also pushed very publicly for hydroxychloroquine, which the FDA initially approved for emergency use and then later pulled back on.
Trump told “Fox & Friends” in late March that “hydroxychloroquine is something that I have been pushing very hard. I got the very early approval from the FDA. It was going to take a long time, and Dr. Stephen Hahn, the head of the FDA, gave us an early approval, a very quick approval, a 24-hour approval.”
Trump added: “And I got it done, because I said: ‘Look, some of these people are very sick and they’re not going to make it. Let’s do it. Let’s get it done.’ ”
Again, this doesn’t point to sober-minded, apolitical decisions by health officials. In fact, it sounds a lot like the Times’s report on Trump demanding the approval of plasma — which he ultimately got.
Watered-down testing guidelines
Trump has repeatedly made odd comments about how expansive testing just makes the case numbers look bad. His claims come even as health officials have stressed that a strong testing regime is needed to prevent the spread of the disease.
But late last month, the CDC quietly altered its testing recommendations, scrapping guidance that anyone who comes in contact with someone with the coronavirus should get tested, and instead saying people without symptoms “do not necessarily need a test.”
That flies in the face of the scientific evidence about the ability of asymptomatic people to spread the virus. The CDC has estimated that 40 percent of people who test positive for the virus show no symptoms but may be highly infectious and spread it to other people. Infectious-disease experts have said the adjusted advice is wrong.
Pressure to dispute Washington Post interview
Trump’s aversion to dire forecasts and bad news was perhaps most evident in April, when he bristled at CDC Director Robert Redfield’s comments to The Washington Post. Redfield had projected a very difficult winter, because of the confluence of the coronavirus with flu season.
After Redfield told The Post that the coming winter may “actually be even more difficult than the one we just went through,” Trump repeatedly claimed Redfield had been misquoted and held a news conference in which he invited Redfield to respond.
Except Redfield actually confirmed the quote, while disputing The Post characterizing his comments as saying the situation could be “worse.”
“I’m accurately quoted in The Washington Post,” he said. (Redfield said he didn’t agree with the idea that the situation could be “worse,” despite having said it could be “more difficult.”)
It’s also worth noting that since this scene in April, health officials have repeatedly echoed Redfield’s concerns about what lies ahead when the weather turns colder.
The most recent reports aren’t the only evidence of political appointees pushing health officials for more favorable recommendations on reopening schools.
The CDC was already planning to issue new guidelines for schools in the coming days. But Vice President Pence on Wednesday explicitly tied the effort to Trump’s ire.
“The president said today we just don’t want the guidance to be too tough,” Pence told reporters. “And that’s the reason next week the CDC is going to be issuing a new set of tools.”
That’s extremely blunt.
The CDC initially declined to update its guidance. By late July, though, it issued new guidance, scaling back its recommendation about keeping students six feet apart and stating that schools consider closing only if there is “substantial, uncontrolled transmission” — rather than they should definitely close under such circumstances.
There is a certain amount of give and take when it comes to these things. But generally speaking, whatever apolitical health officials recommend should be evaluated and incorporated — or not — into the plans of those elected or appointed by elected officials. As top federal infectious-disease expert Anthony S. Fauci has noted, those are the people responsible for decision-making and taking into account things beyond health officials’ expertise, like the economy.
The trend, though, seems to be toward influencing that advice as if it’s designed or just happens to undermine the eventual decisions of Trump. And in light of Trump’s tendency to downplay the entire situation, it’s wholly relevant that the recommendations of health officials are being disregarded, at best, and might have been changed, at worst.