Opinion: To truly beat Covid, Biden must fill these jobs



At the end of this year, NIH Director Francis Collins will step down after securing the agency’s stability under Democratic and Republican presidents for 12 years. His successor, once appointed, must be confirmed by the US Senate at a time when the nation is politically and ideologically fractured, especially when it comes to the health of the population.
Meanwhile, the FDA has been without a commissioner since President Joe Biden’s administration began. Dr. Janet Woodstock has served as Acting Commissioner since Jan. 20, but under the Federal Vaccine Reform Act of 1998, her tenure is 300 days. This gives the administration until mid-November to appoint a permanent commissioner before the institution finds itself without a senior leader.

The United States has made great strides in the fight against the Covid-19 pandemic. But we can blow it all up, both short and long term, if the Biden administration fails to quickly take this key position in the FDA and prioritize stable leadership across the NIH to create a unified national approach. capable of both crisis response and routine public health preparedness.

With a national drop in new daily cases and the relative stabilization of hospitalizations and deaths, the immediate crisis of the fall is managed. It is also a moment of peril. In response to different regional conditions as we move indoors and the pandemic intersects with seasonal influenza, Covid-19 control and mitigation strategies will likely differ both for sound scientific reasons and for interference. policy deeply problematic with measures to protect public health, causing confusion and exasperation. And there is the threat of failing to address the underlying structural conditions that create deep health disparities nationally and globally. This is where having a reliable leader is essential to make decisions, implement a plan of action, communicate it publicly, and carry out the plan.
Historically, the FDA has been criticized for moving too slowly towards approving new therapies, which not only cost lives, but raise prices. In fact, because it allowed emergency use authorization, the FDA has approved Covid-19 vaccinations at an unprecedented rate – on average, 21 days for the three main vaccines now approved compared to 12 months for the 21 vaccines approved between 2010 and 2020. Still, there are still problems getting people to accept that vaccines are safe and effective.
The FDA could have benefited from someone they trust – akin to Dr.Anthony Fauci, chief medical adviser to President Biden, or Rochelle P. Walensky, director of the United States Centers for Disease Control and Prevention – providing clear messages and The reassuring approval of the FDA was based on considerable and thorough verification of the evidence for safety and efficacy. After the FDA on Friday issued emergency use authorization for the Pfizer Covid-19 vaccine for children aged 5 to 11, a continuing leader who can instill confidence in parents is desperately needed.
Even with leadership in place, building and maintaining public trust requires a consistent federal message. When initially approving the booster shots for the Pfizer vaccine, the FDA recommended making them available to people 65 years of age and older, those with an underlying health condition, or those who are working. in a high exposure environment, such as healthcare workers or teachers. However, when the CDC’s Advisory Committee on Immunization Practices recommended vaccination only for the first two categories, CDC Director Rochelle Walensky rescinded her own committee to ensure alignment with the FDA on an ethical issue. Underlying important: in the face of disagreement over risk, how broadly should the nation cast the back-up net?
Controversy over
For a decade, differences in the appreciation of such compromises have been a point of tension between the two agencies on major public health issues, including the place of electronic cigarettes in the fight against combustible tobacco. Scientific disagreements cannot and should not be covered up, but public trust is eroded when we receive mixed advice.

Therefore, filling the leadership gaps to help establish a clear vision and ensure institutional stability will not go far. Protecting public health requires a multi-agency and multi-sector response. Federal government coordination is essential, but best practices, policies and resources to support them must extend to state and local governments, the private sector, and non-governmental organizations.

The nation has a model in the National Incident Management System (NIMS), which coordinates emergency responses requiring access to resources such as food, energy, shelter or health care, managed by disparate agencies. Although we have a lead public health agency at CDC and a center for disease reporting and policy guidance, this is only one of the agencies contributing to public health goals.
We do not have a comprehensive national public health management system that can cope with both the acute crises and the chronic structural deficits that have placed us at the start of what could, without bold action, be the fifth decade. in which the United States is losing ground in terms of life expectancy. compared to peer countries. And it’s not just that life expectancy in other industrialized democracies has exceeded earnings in the United States. Life expectancy in this country has slowly eroded since 2014.
The successful management of Covid-19 and other public health threats requires sustained efforts. This requires not only investments in emergency preparedness and response systems, but also in dismantling systems that create racial, ethnic, gender and class disparities. This will require cooperation and coordination among agencies that are not accustomed to the level of interconnection required to better prevent and mitigate death and illness. And that requires leadership with the ability to go beyond stewardship to exercise acquired authority.

Loud dissent will always exist on the fringes. The vast common ground of this country will listen and do what is necessary when called upon to act and when given clear and reliable direction. Most of us can save all of us.

But only if this nation can pull itself together, take on key leadership positions and create a structure for those leaders to take public health action in a coordinated manner. Anything less risks falling short of the challenge of responding to acute crises and tackling the historically entrenched structural, social and economic conditions that hold so many of us back.

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