Financial Health Chief’s Early Missteps Set Back Coronavirus Response
April 22, 2020
WASHINGTON—On Jan. 29, Health and Human Services Secretary Alex Azar told President Trump the coronavirus epidemic was under control.
The U.S. government had never mounted a better interagency response to a crisis, Mr. Azar told the president in a meeting held eight days after the U.S. announced its first case, according to administration officials. At the time, the administration’s focus was on containing the virus.
When other officials asked about diagnostic testing, Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, began to answer. Mr. Azar cut him off, telling the president it was “the fastest we’ve ever created a test,” the officials recalled, and that more than one million tests would be available within weeks.
That didn’t happen. The CDC began shipping tests the following week,
only to discover a flaw that forced it to recall the test from state public-health laboratories. When White House advisers later in February criticized Mr. Azar for the delays caused by the recall, he lashed out at Dr. Redfield, accusing the CDC director of misleading him on the timing of a fix. “Did you lie to me?” one of the officials recalled him yelling.
Six weeks after that Jan. 29 meeting, the federal government declared a national emergency and issued guidelines that effectively closed down the country. Mr. Azar, who had been at the center of the decision-making from the outset, was eventually sidelined.
Mr. Azar and other administration officials spoke to Mr. Trump about the coronavirus during a White House meeting on Jan. 29.
White House/ZUMA PRESS
Many factors muddled the administration’s early response to the coronavirus as officials debated the severity of the threat, including comments from Mr. Trump that minimized the risk. But interviews with more than two dozen administration officials and others involved in the government’s coronavirus effort show that Mr. Azar waited for weeks to brief the president on the threat, oversold his agency’s progress in the early days and didn’t coordinate effectively across the health-care divisions under his purview.
The ramp-up of the nation’s diagnostic testing for the disease caused by coronavirus, which many health experts regard as critical for limiting new infections and safely reopening the economy, has been
slower than promised and hampered by obstacles. As of Wednesday, more than four million government and private-lab tests had been administered. The president now says states bear the primary responsibility for testing, and that the federal government plays only a supporting role.
Among other functions, Mr. Azar’s agency has oversight of serology tests that would determine whether Americans have antibodies potentially making them temporarily immune to reinfection—tests that could be essential as the U.S. looks to send people back to work.
It also oversees the distribution of $100 billion in stimulus funding to the health-care system. Many hospitals, doctors, and health systems said the agency
hasn’t released the funds quickly enough or prioritized the hardest-hit hospitals. An HHS spokeswoman said the secretary was following best practices and soliciting input.
Messrs. Trump and Azar at the daily White House coronavirus briefing on March 9.
In a recent interview about the coronavirus response, Mr. Azar said he and the administration “were on this from day one,” and that he had alerted the National Security Council early on to the risk. He conceded the federal government’s testing system wasn’t equipped initially to handle the disease, but, he said, “we have adapted.” He said although the administration had run into problems creating a coronavirus test, it had produced one in record time.
“We’re obviously going to learn lessons,” he said. “This is unprecedented.”
From the start, he said, Mr. Trump has treated the pandemic with “prescient gravity.” At the Jan. 29 meeting, he said, he had interrupted Dr. Redfield because he knew the CDC director was modest, and he wanted to brag about his work in front of the president. He denied yelling at Dr. Redfield later, saying, “That’s not my style.”
Mr. Azar’s defenders say he is being unfairly blamed by White House officials eager to cover up their own missteps.
White House spokesman Judd Deere said that HHS under Mr. Azar was “leading on a number of the president’s priorities,” including the coronavirus response. Vice President Mike Pence’s press secretary, Katie Miller, praised Mr. Azar’s “partnership and collaboration” with the vice president, who took over control of the federal response from Mr. Azar in late February and heads the White House coronavirus task force.
Mr. Trump, who says he has responded to the virus aggressively, tweeted on April 12 that Mr. Azar “told me nothing until later.” He didn’t offer details on what he meant, and a White House spokesman said the president feels Mr. Azar “provided him with the most accurate and factual information we had at that time.” White House officials say there is no plan to replace Mr. Azar during a pandemic.
Still, the president last week installed a former campaign aide, Michael Caputo, to serve as assistant secretary for public affairs at HHS. The White House also appointed policy adviser Emily Newman as a liaison to HHS who will oversee the agency’s political hires. Mr. Azar has largely been sidelined over the past several weeks from discussions with the president and with the White House task force, administration officials said. He hasn’t attended the daily briefing since April 3.
Meanwhile, some in the administration view Mr. Azar as having marginalized the CDC, which hasn’t held a briefing in a month. A CDC spokesman said the agency is communicating its efforts in other ways.
In recent weeks, some administration officials have become so concerned about the lack of agency coordination that the director of the White House Domestic Policy Council began convening his own meetings with agency leaders at HHS, including from the Food and Drug Administration and the Centers for Medicare and Medicaid Services, or CMS.
Mr. Trump spoke at a corornavirus press briefing on April 3, the last one attended by Mr. Azar, left.
Yuri Gripas/CNP/Zuma Press
Mr. Azar, 52 years old, served as HHS general counsel and later deputy secretary under George W. Bush, then worked as the top lobbyist for
& Co., an Indianapolis-based pharmaceutical company. He was nominated to be HHS secretary by Mr. Trump and began serving in January 2018.
The CDC’s Dr. Redfield alerted Mr. Azar to the coronavirus threat on Jan. 3. Mr. Azar asked the National Security Council to monitor what was happening in China, but waited two weeks to brief the president on the potential severity, calling him to assure him the agency was ready to handle any cases in the U.S.
Mr. Trump dismissed coronavirus concerns as alarmist, according to those briefed on the call, and berated Mr. Azar for his handling of a ban on flavored e-cigarettes. Mr. Azar had been on thin ice with the president over that issue and his work on drug pricing, administration officials said.
Mr. Azar said in the interview that the president had never been dismissive, and Mr. Deere, the White House spokesman, said Mr. Trump took “early and unprecedented action.”
FDA chief Stephen Hahn asked HHS in January if he could start contacting diagnostic and pharmaceutical companies about possible shortages of personal protective gear and other equipment, administration officials said. He was told no. An FDA official said the agency was already conducting outreach to companies.
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Mr. Azar told associates such calls would alarm the industry and make the administration look unprepared, people familiar with the matter said. HHS officials waited weeks to contact manufacturers about possible shortages of medical supplies, the people said.
In the interview, Mr. Azar said he pushed the FDA to get involved in supply-chain issues in January, and that HHS had started addressing the need for more personal protective gear around the same time. Today, governors and health-care officials say shortages persist for protective gear for patients and medical workers.
On Jan. 28, Mr. Azar told reporters that for the individual American, the virus “should not be an impact on their day-to-day life.” adding that the administration was taking “aggressive action.” The next day, the White House announced that Mr. Azar would lead the task force responding to coronavirus. In the task force meeting that day, he assured the president that everything was under control.
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In an Oval Office meeting days later, Mr. Azar urged the president to restrict travel from China, where the virus had at that point infected nearly 12,000 people. The president agreed, and Mr. Azar
announced the restrictions on Jan. 31, the same day he declared a public-health emergency.
For weeks, Mr. Azar made nearly every major administration announcement about the epidemic. He assured lawmakers all was going well and that the virus was contained.
Administration officials said they were alarmed by the absence on the task force of the FDA’s Dr. Hahn, which they said hampered coordination between the FDA and commercial labs on testing, and CMS administrator Seema Verma.
Mr. Azar spoke about the virus on Jan. 28, flanked by Anthony Fauci, left, CDC head Robert Redfield, second from right, and Nancy Messonnier, another CDC official.
Mr. Azar dismissed those concerns, administration officials said. In the interview, Mr. Azar said the White House determined who would join the task force, and that he met with agency leaders.
In a written statement, Dr. Hahn said the FDA worked “hand-in-hand” with HHS and at no point was excluded.
Mr. Azar relied heavily on his chief of staff, Brian Harrison, who worked in the office of the deputy HHS secretary in the George W. Bush administration. Before returning to the agency in 2018, Mr. Harrison ran businesses in Texas building homes and breeding labradoodles. “I am proud of my time working in family businesses before I was recruited back to government,” Mr. Harrison said.
Mr. Azar was reluctant for weeks to involve the Federal Emergency Management Agency, which typically oversees disaster-response operations, telling associates he wanted to keep control of the response and that including FEMA would further complicate the administration’s efforts. In the interview, Mr. Azar said he invited FEMA’s participation in early February.
FEMA Administrator Peter Gaynor told lawmakers on March 20 he wasn’t invited to join the White House task force until earlier that week, and that FEMA hadn’t held its first “interagency synchronization call” until that day.
“I believe in servant leadership,” Mr. Azar said in the interview. “It is core to my being to empower leaders.”
Mr. Azar’s declaration of a public-health emergency on Jan. 31 meant that any lab that wanted to develop a test had to first seek approval from the FDA. The FDA didn’t clear any labs to conduct testing until Feb. 29, nearly a month later. For weeks, HHS blocked efforts to allow other labs’ involvement because Mr. Azar wanted the CDC to make and distribute
the nation’s diagnostic tests.
Mr. Azar told associates he favored the CDC making its own test, rather than importing ones distributed by the World Health Organization, because the WHO tests weren’t reliable, citing a study published in the Chinese Journal of Epidemiology. That study has since been retracted.
Developing a test proved more complicated than anticipated. Days after the CDC began shipping tests in the first week of February, labs began calling. The tests were giving invalid results.
Mr. Azar was incensed. An FDA official flew to CDC headquarters in Atlanta and visited the lab that had prepared the tests. The lab was a mess and it became clear the tests had likely been contaminated, said one person familiar with the matter. The CDC, which disputed that the lab was a mess, pulled back its tests, and HHS
launched an investigation. The results aren’t yet available. An FDA official said the FDA expert who visited the lab determined there was a manufacturing issue.
Mr. Trump toured the CDC in Atlanta on March 6 with, from left, Mr. Azar, CDC Director Robert Redfield, and another CDC official, Steve Monroe.
jim watson/Agence France-Presse/Getty Images
In White House meetings, Mr. Azar gave no indication there was a problem with testing, administration officials said. Throughout February, Mr. Azar continued to assure the president and the rest of the task force that HHS had the situation under control, the officials said. Dr. Redfield never gave Mr. Azar a timeline for when the testing problem would be fixed, because he didn’t know what was causing the problem, one administration official said.
In the interview, Mr. Azar said the CDC typically develops tests for novel pathogens because commercial testing can take months to develop. A person close to Mr. Azar said he relied on agency leaders to give him accurate information.
Administration officials said they struggled to get information on how many tests were available and what had gone wrong with the initial test, and that Mr. Azar insisted on being involved in all conversations between the White House and the CDC.
In a briefing with senators on Feb. 5, Hawaii Democratic Sen. Brian Schatz challenged Mr. Azar on the lack of available compounds that would allow his state to complete its own testing kits. He offered to carry a test kit home in his own suitcase. Mr. Azar pushed back, according to Mr. Schatz and others in the room.
“He took it personally,” Mr. Schatz said in an interview. “Then I got irritated because you have the secretary of HHS and the leader of the task force deciding to be dismissive of what I’m reporting from the field.”
Mr. Schatz said the two later had a more constructive conversation. An HHS official said Mr. Azar’s staff has since been in touch with Mr. Schatz’s office.
On March 6, during a visit to the CDC with Mr. Azar, the president said: “Anybody that wants a test can get a test.” That still isn’t the case. Today, the U.S. continues to lag behind other countries on tests conducted per capita.
On Feb. 25, Nancy Messonnier, a CDC official, said the agency was
preparing for a potential pandemic and that community spread of the virus was likely. The stock market plunged.
At a media briefing later that day, Mr. Azar sought to quell concerns, saying the virus was “contained.”
But it was too late. A furious Mr. Trump, flying back to Washington from India, called Mr. Azar and threatened to oust Dr. Messonnier.
The next day, the president announced he was
putting Vice President Pence in charge of the federal response—news Mr. Azar learned a few hours before the announcement.
Vice President Mike Pence, at lectern, took charge of the federal response in late February.
Chona Kasinger/Bloomberg News
Among the vice president’s first moves was to add Dr. Hahn and the CMS’s Ms. Verma to the task force. When Mr. Pence traveled to Washington state the next week to showcase the federal government’s support against the outbreak there, Mr. Azar wasn’t invited.
Since then, the president has shifted the center of the government’s response to FEMA, allowing it to access billions of dollars and mobilize personnel to aid the U.S. response.
Mr. Azar has privately acknowledged his clipped wings. He recently snapped at a White House aide inquiring about a congressional briefing, telling the aide he was “not even really the secretary of HHS anymore,” and to ask someone else, according to administration officials.The person close to Mr. Azar said the comment would have been in the context of HHS now playing a supporting role to FEMA.
In task force meetings, Mr. Azar’s role has shrunk. Earlier this month, a handful of administration officials, including Ms. Verma and Dr. Hahn, briefed lawmakers. Mr. Azar wasn’t there.
—Michael C. Bender contributed to this article.
Write to Rebecca Ballhaus at Rebecca.Ballhaus@wsj.com and Stephanie Armour at email@example.com
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