Outside the Beltway

CDC Shakeup Presaged Mask Order

The politics of science comes full circle.

James Joyner · Tuesday, May 18, 2021 · 17 comments

The incredibly controversial announcement by the CDC last week that it was radically changing guidelines for fully vaccinated individuals, which seems to have caught senior officials in both the federal government and state governors by surprise, was seemingly facilitated by a reorganization of the agency.

POLITICO has a thorough report.

Centers for Disease Control and Prevention Director Rochelle Walensky is shaking up the agency’s Covid-19 response to consolidate oversight amid mounting criticism over its guidance for vaccinated people, according to three senior health officials with the knowledge of the situation.

The changes in recent weeks include creating a clear reporting chain from the new director of the agency’s vaccine task force — which helped rewrite rules for mask-wearing —up to Walensky. The head of that task force had originally reported to both CDC and the White House. Walensky has also reshuffled the CDC’s pandemic modeling and data, analytics and visualization task forces.

Better editing would have been useful here, in that the lede paragraph contradicts the follow-on and, indeed, the rest of the report. While the shakeup may be ongoing, the main moves that led to the recent changes have happened over weeks.

At the same time, the agency is weathering its first high-level departures during the pandemic. Last month, the agency’s chief respiratory disease scientist and vaccine task force leader Nancy Messonnier announced her resignation shortly after Walensky rejiggered the task force’s reporting structure. And on Monday, the CDC’s second-in-command, principal deputy director Anne Schuchat, said she would retire this summer.

The loss of two longtime CDC leaders combined with Walensky’s reshaping of the Covid-19 response is solidifying the CDC chief’s power, giving her control over some of the most critical policy conversations related to the pandemic. The changes she has madeare also reinforcing her agency’s independence from the White House. As POLITICO has reported, several senior White House officials — including some on the White HouseCovid-19 task force—said the CDC did not warn them until the morning of the announcement that vaccinated people can forego masks in most situations.

The linked stories about the two departures are interesting but don’t raise huge red flags. Schuchat last out to Walensky for the top job and they’re clashing; it makes sense that she would move on to more lucrative pastures. Messonnier just seems tired of having to conduct science under political pressure but, alas, that’s public policymaking.

Walensky decided to overhaul the structure of the agency’s Covid-19 response after several listening tours within CDC revealed pandemic task forces that were either no longer serving their original mission or that could be streamlined under a central leadership structure, a senior health official with knowledge of Walensky’s thinking said. As the number of new infections has dropped, the CDC’s focus has shifted to offering advice aimed at helping Americans return to normalcy — such as telling vaccinated people that they can forego masks in most situations.

A senior Biden health official described the reshuffle at the CDC as “a long time coming.”

“When Biden entered office, there were some very early conversations about how the CDC was going to be handled … who was going to lead it and what it needed to do to get back on track,” the senior health official said. “Dr. Walensky was chosen for the top job and was highly sought-after. But I think it is fair to say there have been some hiccups over the last few months that have created some tensions within the agency. And I think we’re starting to see the CDC director make some moves to change things.”

So, first off, Walensky was in fact extraordinarily highly regarded. Her selection drew almost universal praise (albeit, granted, any change from the previous administration was likely to be received as a godsend). But that doesn’t mean her choices are going to be popular within a federal bureaucracy, let alone one as prestigious as CDC.

This, though, is confusing:

In a statement, CDC spokesperson Jason McDonald said the agency has “reorganized the incident management structure to best suit each phase of the nation’s response to COVID-19.” He added that “previous reorganizations added efficiencies and improved collaboration.” Another senior CDC official said Walensky “is informed of changes but not directly involved with decision-making” on restructuring within the agency.

This seems to contradict the rest of the report. Did Walensky make the changes after a listening tour? Or is someone else driving them and only “informing” her of them. It certainly seems like the former:

The first hint that a major reorganization was underway came in late April, when Messonnier — then-head of the Covid-19 vaccine task force — went on leave. At the time, CDC officials described it as an unplanned vacation. Behind the scenes, Walensky had decided that the vaccine task force should be placed squarely under the oversight of the agency’s senior leadership, rather than reporting both to CDC brass and the White House, three senior health officials said.

Messonnier, who had operated semi-autonomously, was told the vaccine task force would now report to the CDC’s incident response team overseen by Henry Walke, director of the agency’s Division of Preparedness and Emerging Infections, who reports to Walensky. Two weeks later, Messonnier resigned after about 20 years at the agency. It was one of the first high-profile departures from CDC during the pandemic, despite the months of pressure and attacks the agency had weathered from the Trump administration.

At the time Messonnier announced her exit, several CDC officials said the vaccine task force had been reshaped because the vaccine rollout was running smoothly and the group’s mission was changing. Putting the group under the incident response team was a positive sign, CDC officials said, because it meant there was less need for extensive oversight of the vaccine. The vaccine task force had overseen distribution, administration and implementation.

More recently, Walensky has reassigned agency employees who were previously part of the Department of Health and Human Services’ interagency Covid-19 workgroup, the “joint coordination cell,” which recently dissolved. Some of those officials have either gone back to working their normal CDC jobs full time or are serving on CDC task forces.

I don’t have the public health background to have a strong opinion on the merits of these changes. But I have quite a bit of expertise in bureaucratic politics and this raises some red flags. Not so much the sidelining of Messonnier, which is easily explainable, but the dissolving of the interagency working group and reshuffing of those seconded from HHS. That strikes me as a deliberate move to diminish the power of the career officials to ram through the political preferences of the administration and/or its appointees.

That’s a lot of windup for this:

Through all of these changes, the agency was writing and rewriting its guidance on safety protocols for vaccinated people.

The CDC drew up the first version of that advice in early March. After two days of meetings and calls with senior officials on the White House’s Covid-19 task force and HHS, the CDC was told to “hold off on releasing” the recommendations, as POLITICO previously reported. A senior White House official denied any interference and said the CDC merely needed time to read officials in, not change the guidelines.

The agency eventually issued the guidelines on March 8 — advising vaccinated people that theycould gather together without masks or staying 6 feet apart. The recommendations also said vaccinated people could gather indoors, maskless,with unvaccinated people from one other household. Then, on April 2, CDC said that fully vaccinated Americans could resume domestic and overseas travel as long as they wore masks in public.

Three weeks later, the agency put out a major update: Vaccinated people no longer needed to wear masks indoors or outdoors when in small groups with other fully vaccinated friends and family — and in some circumstances could go maskless with unvaccinated people.

That version of the guidelines came under widespread criticism. People within the Biden administration complained that CDC’s language was confusing. Republicans on Capitol Hill and across the country argued that the agency was too cautious and prescriptive in ways that limited the activity of vaccinated people.

CDC officials have long argued that the vaccine guidelines only evolve as the science becomes available and supports changes. But a senior administration official with knowledge of the situation said officials inside the CDC, White House and HHS have often disagreed on whether to loosen restrictions for vaccinated individuals.

At the end of March and beginning of April, several officials inside the CDC argued the science did not support rolling back things like mask mandates, particularly because the guidelines could signal that it was safe for all Americans to forgo adhering to public health measures. Other senior officials argued the country had vaccinated enough individuals that it was safe to give those people the choice to visit with other fully vaccinated Americans.

While I’m generally speaking a “follow the science” guy on this, managing a pandemic is inherently political. Epidemiologists, immunologists, virologists, and other medical specialists have unique expertise and policymakers ought to weigh their advice heavily. But they’re not experts in economics, mental health, and so many other things that must factor into decisions like when and under what conditions people must lock down, when masks must be worn, what capacity businesses may be at, who gets priority in vaccine distribution, and so many other decisions. They’re inherently political calls that we elect politicians to make in accordance with applicable conditions—which include the public mood and issues of political culture.

It will come as no surprise to regular readers that I did not trust the Trump administration to make these judgments. Ditto many Republican governors and mayors. (But not just Republicans; Andrew Cuomo and Gavin Newsome haven’t exactly covered themselves in glory, either.) I think President Biden is an honorable man and have no reason to think otherwise of Dr. Walensky. But that doesn’t mean that People Are Tired of This Shit isn’t a major factor in the calculus to change the guidelines.

We went from clearly being too slow to being abrupt. I think the new guidelines are right. But there should almost certainly have been more lead time for state and local officials and businesses to prepare. Because, post-announcement, the momentum shifted almost instantaneously. People like me, who dutifully wore their masks in support of the community goals of flattening the curve and follow-on goals and got vaccinated as soon as our turn came, were still begrudgingly masking because we understood that there was no way for others to know whether we were vaccinated. But the sudden green light means that I’m now more than a little annoyed if a store proclaims that I need to mask up despite the CDC, Commonwealth of Virginia, and Defense Department all telling me I don’t.