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 “We developed a diagnostic test at the CDC, so we can confirm if
somebody has this,” Azar said. “We will be spreading that diagnostic
around the country so that we are able to do rapid testing on site.”
While coronavirus in Wuhan, China, was “potentially serious,” Azar
assured viewers in America, it “was one for which we have a
playbook.”
Azar’s initial comments misfired on two fronts. Like many U.S.
officials, from President Donald Trump on down, he underestimated
the pandemic’s severity. He also overestimated his agency’s
preparedness.
As is now widely known, two agencies Azar oversaw as HHS secretary,
the Centers for Disease Control and Prevention and the Food and Drug
Administration, wouldn’t come up with viable tests for five and half
weeks, even as other countries and the World Health Organization had
already prepared their own.
Shortly after his televised comments, Azar tapped a trusted aide
with minimal public health experience to lead the agency’s
day-to-day response to COVID-19. The aide, Brian Harrison, had
joined the department after running a dog-breeding business for six
years. Five sources say some officials in the White House derisively
called him “the dog breeder.”
Azar’s optimistic public pronouncement and choice of an
inexperienced manager are emblematic of his agency’s oft-troubled
response to the crisis. His HHS is a behemoth department, overseeing
almost every federal public health agency in the country, with a
$1.3 trillion budget that exceeds the gross national product of most
countries.
Azar and his top deputies oversaw health agencies that were slow to
alert the public to the magnitude of the crisis, to produce a test
to tell patients if they were sick, and to provide protective masks
to hospitals even as physicians pleaded for them.
The first test created by the CDC, meant to be used by other labs,
was plagued by a glitch that rendered it useless and wasn’t fixed
for weeks. It wasn’t until March that tests by other labs went into
production. The lack of tests “limited hospitals’ ability to monitor
the health of patients and staff,” the HHS Inspector General said in
a report this month. The equipment shortage “put staff and patients
at risk.”
A promised virus surveillance program failed to take root, despite
assurances Azar gave to Congress. Rather than share information,
three current and three former government officials told Reuters,
Azar and top staff sidelined key agencies that could have played a
higher-profile role in addressing the pandemic. “It was a mess,”
said a White House official who worked with HHS.
Officials across the government, from President Trump on down, have
been blasted for America’s halting response to the pandemic. Critics
inside and outside the administration say a meaningful share of the
responsibility lies with HHS and Trump appointee Azar.
“You have to blame the problem on the virus, but it’s Azar's
operation,” said Lynn Goldman, the dean of the public health school
at George Washington University, who has served on advisory boards
of the FDA and CDC. “And the buck stops there.”
HHS declined to make Azar available for an interview. Michael
Caputo, the new chief HHS spokesman, declined to answer Reuters
questions about Azar’s stewardship, saying in a statement: "We are
communicating to the American public during a deadly pandemic.”
DALLAS LABRADOODLES
Azar is a Republican lawyer who once clerked for the late
conservative Supreme Court Justice Antonin Scalia and counts current
Supreme Court Justice Brett Kavanaugh as a friend. Under George W.
Bush, Azar worked for HHS as general counsel and deputy secretary.
During the Obama years, he cycled through the private sector as a
pharmaceutical company lobbyist and executive for Eli Lilly. After
Trump’s first HHS secretary was forced out in a travel corruption
scandal, Azar stepped in, in January 2018.
Two years later, at the dawn of the coronavirus crisis, Azar
appointed his most trusted aide and chief of staff, Harrison, as
HHS’s main coordinator for the government’s response to the virus.
Harrison, 37, was an unusual choice, with no formal education in
public health, management, or medicine and with only limited
experience in the fields. In 2006, he joined HHS in a one-year stint
as a “Confidential Assistant” to Azar, who was then deputy
secretary. He also had posts working for Vice President Dick Cheney,
the Department of Defense and a Washington public relations company.
Before joining the Trump Administration in January 2018, Harrison’s
official HHS biography says, he “ran a small business in Texas.” The
biography does not disclose the name or nature of that business, but
his personal financial disclosure forms show that from 2012 until
2018 he ran a company called Dallas Labradoodles.
The company sells Australian Labradoodles, a breed that is a cross
between a Labrador Retriever and a Poodle. He sold it in April 2018,
his financial disclosure form said. HHS emailed Reuters that the
sales price was $225,000.
At HHS, Harrison was initially deputy chief of staff before being
promoted, in the summer of 2019, to replace Azar’s first chief of
staff, Peter Urbanowicz, an experienced hospital executive with
decades of experience in public health.
This January, Harrison became a key manager of the HHS virus
response. “Everyone had to report up through him,” said one HHS
official.
One questionable decision, three sources say, came that month, after
the White House announced it was convening a coronavirus task force.
The HHS role was to muster resources from key public health
agencies: the CDC, FDA, National Institutes of Health, Office of
Global Affairs and the Assistant Secretary for Preparedness and
Response.
Harrison decided, the sources say, to exclude FDA Commissioner
Stephen Hahn from the task force. “He said he didn’t need to be
included,” said one official with knowledge of the matter.
When task force members were announced January 29, neither Hahn nor
the FDA were included. Hahn wasn’t put on the task force until Vice
President Mike Pence took over in February. Two of Hahn’s
high-profile counterparts were on it from the start: CDC director
Robert Redfield and Dr. Anthony Fauci, director of the National
Institute of Allergy and Infectious Diseases.
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The HHS denied it was Harrison’s decision to leave out Hahn and the FDA, but
declined to say who made the call. The agency lauded Harrison’s work on the task
force.
In a statement, Hahn said the FDA was focused on the coronavirus epidemic, “not
on when we were added to the task force,” and that the agency was not
“excluded.”
Fauci, who has become a public face of the Trump Administration’s COVID-19
effort, said he wasn’t sure including the FDA was necessary at the start.
Initially, the Chinese government was saying the virus spread through animals,
not human to human, he said. “You would include the FDA when you want to
expedite drugs or devices,” Fauci said.
Others said the lack of a strong FDA role early on had direct consequences. Two
sources familiar with events say the White House wasn’t getting information from
the FDA about the state of the testing effort, a crucial element of the
coronavirus response.
Reached by phone, Harrison declined to answer Reuters’ questions. In a later
statement, he did not address questions about the task force but said he was
proud of his work history. “Americans would be well served by having more
government officials who have started and worked in small family businesses and
fewer trying to use that experience to attack them and distort the record,” he
wrote.
In a statement to Reuters, Azar said Harrison has been an asset. “From day one,
Brian has demonstrated remarkable leadership and managerial talents,” Azar
wrote.
LOW RISK?
In the pandemic’s early days, Azar offered words of both concern and assurance
in public. On January 31, a day after the WHO declared COVID-19 a global health
emergency, Azar declared it a public health emergency.
That same day, during the first Coronavirus Task Force briefing, Azar told the
public: “I want to stress: The risk of infection for Americans remains low.”
The United States, he said, had taken adequate precautions. Travel restrictions
and 14-day quarantines on Americans who had been to Wuhan, where the virus
originated, were imposed. Americans returning from other parts of China had to
self-quarantine.
The next week, on February 7, in another press conference, Azar repeated the
message. “The immediate risk to the American public is low at this time,” he
announced.
Behind the scenes, his aides say, Azar had alerted the White House in early
January, and then later that month spoke directly to the president. It is
unclear exactly what Azar told the president, because transcripts are not
available.
“There’s a lot of CYA going on,” said one senior administration official, who
said Azar never spelled out that stockpiles of protective equipment might be
inadequate or the tests were not working. “We were told the test was ready. That
turned out to be flat-out wrong.”
Trump denied Azar sent out alarms. “@SecAzar told me nothing until later,” he
tweeted earlier this month.
Meanwhile, Azar continued to say “the immediate risk” to Americans was low and
that travel restrictions had worked. “So I think so far, our measures have been
quite effective,” he told NPR on February 14.
Others were raising alarms. “It’s not so much of a question of if this will
happen any more, but rather more of a question of exactly when this will
happen,” Dr. Nancy Messonnier, director of the National Center for Immunization
and Respiratory Diseases, said at a February 25 news briefing.
MORE GLITCHES
Responding to Congressional concerns, Azar said HHS had launched a coronavirus
surveillance system in five cities. The plan was to test patients who showed up
with flu symptoms, to see if they actually were infected with the novel
coronavirus.
But the system was either delayed or not implemented in the cities and now is
seen by epidemiologists as irrelevant given the massive community spread and
continued inadequate testing.
By the end of February, Azar sought more money to attack the crisis as he
testified before Congress. “This is an unprecedented potentially severe health
challenge globally, and will require additional measures,” he said.
Still, he assured senators his agency was in control. “We have enacted the most
aggressive containment measures in the history of our country,” he said.
He again provided words of calm, appearing on Fox News. “But thanks to President
Trump's historically aggressive containment efforts, we've actually contained
the spread of this virus here in the United States at this point,” he said
February 25. “I think part of the message to the American people is we all need
to take a bit of deep breath here.”
“The government is working on this. You've got the right people on this.”
By the end of February, Azar and Harrison were no longer running the White House
task force. That month, Vice President Pence took control. The FDA and Hahn are
now actively involved. A Pence spokesperson said the issue of precluding the FDA
from the task force “pre-dates the VP’s leadership” and declined further
comment.
Azar seemed caught off guard by the change. “I’m still chairman of the task
force,” he told the press after Pence took over.
Given Azar’s early struggles, the White House should have taken a stronger role
over the task force from the outset, said Ashish Jha, director of Harvard
University’s Global Health Institute. “It was very clear that Azar wasn’t able
to marshal the forces across the government like he needed to,” he said.
Jeffrey Flier, a former Harvard Medical School dean, said the HHS role remains
as vital as ever. As of Wednesday, over 47,000 Americans have died of COVID-19,
and more than 830,000 have been infected.
“Clearly there was a need for better coordination of the FDA and CDC and other
agencies,” he said. “HHS has to be operating effectively in a crisis like this.”
(Reporting by Aram Roston and Marisa Taylor in Washington. Editing by Ronnie
Greene)
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