WASHINGTON — Vice President Mike Pence is in charge of the Trump administration’s response to the coronavirus. But so is Deborah Birx, the physician and diplomat who the Trump administration brought on as its response “coordinator.” Then there’s health secretary Alex Azar, the chair of the Trump administration’s Coronavirus Task Force. And of course, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, to whom they all seem to defer.
Day after day, as President Trump updates the nation on the coronavirus pandemic, it can be difficult to keep track of the phalanx of government officials behind him. They include doctors, lawyers, researchers, cabinet secretaries, and uniformed members of the Public Health Service Commissioned Corps. The group is ever shifting: Ben Carson, the housing secretary and a neurosurgeon by training, made one recent appearance. CDC Director Robert Redfield, however, has been noticeably absent at recent press conferences.
Trump has also been criticized for not appointing a coronavirus “czar,” as President Obama did during the 2014 Ebola outbreak. Instead, his approach has instead been characterized by a sprawling network of cabinet secretaries, federal agencies, and bureaucrats in a variety of roles.
Who’s really calling the shots?
STAT examines the dizzying array of federal officials — 16 in all — who are shepherding the government’s response. As Trump himself put it, the pandemic has “created a number of new stars.’’
1. President Trump: the decider
Of all the players, the president, of course, is the leading figure. He declared the pandemic a national emergency on Friday, and previously spearheaded travel bans that prevent foreigners from China, South Korea, Iran, and all of Europe from entering the U.S.
But he has also, according to some accounts, overruled the Centers for Disease Control and Prevention, misleadingly compared the coronavirus to the seasonal flu, and, recently, insisted on referring to the pandemic as “the Chinese virus” — an unscientific nomenclature that follows a wave of anti-Asian, coronavirus-related racism.
There are other examples of his inconsistent messaging: He dramatically oversold a forthcoming Google website. He falsely claimed, amid a major shortage of coronavirus test kits, that any American seeking a test could receive one. And amid a dramatic shortage of test kits, Trump said simply: “I don’t take responsibility at all.”
Trump has also developed a penchant for letting lower-ranking administration officials step in to answer tough questions about testing and medical equipment shortages. “I’ll let Mike answer that” has become something of a presidential catchphrase.
In the past week, Trump has taken on a decidedly more somber tone: He has urged Americans to avoid non-essential travel and to stop eating in bars, restaurants, and food courts. As businesses shutter to promote social distancing, he has backed efforts to send Americans who’ve been laid off a hefty check in the mail — perhaps in excess of $1,000.
2. Mike Pence, vice president: the coordinator
Facing pressure to appoint a coronavirus “czar,” President Trump tapped Pence to lead his administration’s coronavirus efforts. Pence has led near-daily media briefings on the administration’s response, and in general has taken a somber tone about the pandemic.
It’s not his first go-round when it comes to infectious diseases. Pence was governor of Indiana during the state’s HIV outbreak in 2015. Though the disease spread largely through needle-sharing among Hoosiers injecting opioids, Pence was slow to implement syringe exchange services even as public health officials urged him to — a misstep that has followed him to this day.
Pence doesn’t seem to mind taking some blows for Trump at press briefings, and he’s markedly less confrontational with reporters. He displays better command than perhaps any other federal official for the federal government’s capabilities, and he loves to tout the administration’s “all-of-government, all-of-America approach.”
3. Deborah Birx, Coronavirus Task Force chair: the veteran
Birx is a physician and diplomat who has served as the United States global AIDS coordinator since the Obama administration. She has earnestly pleaded with Americans — especially younger individuals less likely to become severely ill — to follow social distancing guidelines, particularly for others’ sake. Trump and Pence’s decision to appoint her the administration’s coronavirus coordinator was widely applauded.
But at times, her sober-minded guidance has strayed into the bizarre. At a briefing Wednesday, Birx defended the CDC’s decision not to use the World Health Organization’s coronavirus test, which is seen as a major reason the nation is so dramatically behind other countries on testing for coronavirus. Birx said the WHO tests yielded a 50% false positive rate — a fully unsubstantiated claim.
4. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease: everybody’s favorite.
Fauci has been at this for a long time. He’s effectively been the top infectious disease expert in the United States since 1984, when he was appointed as NIAID director by President Ronald Reagan. And he’s been doing groundbreaking work for even longer — his career at the National Institutes of Health dates back to 1968. While he doesn’t look or act it, Fauci is 79 (and he still runs several miles per day).
Public health officials have leaned on Fauci to provide an unvarnished view of the reality in the United States, and for his opinion on how local governments should proceed. But even he has acknowledged there’s a balance between truth-telling and toeing the line.
“You should never destroy your own credibility. And you don’t want to go to war with a president,” Fauci told Politico earlier this month. “But you got to walk the fine balance of making sure you continue to tell the truth.”
5. Robert Redfield, CDC director: the punching bag
Redfield, known for sporting three-piece suits no matter the weather, is a virologist and veteran HIV/AIDS researcher who took the helm at CDC in 2018. (He replaced Trump’s first CDC director, Brenda Fitzgerald, who resigned in scandal after it was discovered she traded tobacco stocks while running the agency.)
While Redfield, in name, is an essential part of the administration’s pandemic response strategy, he hasn’t been a vocal presence — and he hasn’t appeared at a White House briefing since March 9.
Rep. Katie Porter (D-Calif.), a freshman lawmaker known for her tough lines of questioning on Capitol Hill, took Redfield to task last week at a hearing on Capitol Hill. Citing an obscure law that would allow the CDC to waive costs associated with testing for a disease, she bludgeoned him into pledging to invoke the authority, making coronavirus tests free for all Americans.
As the CDC has struggled to ensure that there are even enough tests available for Americans experiencing Covid-19 symptoms, the New York Times recently described him as “portly, sometimes expressionless,” and circled back to call his speech “plodding and overly technical.”
6. Seema Verma, Medicare and Medicaid administrator: the technician
Verma is the person actually implementing many of the Trump administration’s biggest changes to health policy. The Centers for Medicare and Medicaid Services is responsible for regulating and overseeing both the Medicare and Medicaid programs, and it is through those levers of power that the administration has brought about an unprecedented expansion of telehealth services and directed hospitals across America to postpone elective surgeries to preserve capacity for the expected onslaught of severe Covid-19 cases.
7. Alex Azar, health secretary: the behind-the-scenes guy
Azar, a former pharmaceutical executive and veteran of the George W. Bush administration, is technically the top public health official in the United States. The agency he leads, the Department of Health and Human Services, encompasses Medicare, Medicaid, the FDA, the NIH, and the CDC. Its proposed budget for 2021 is a cool $1.4 trillion. Yet Azar, reportedly, only learned that Pence was superseding him as de facto coronavirus czar minutes before Trump made the same announcement on national television.
He’s still played a key role in overseeing HHS’ response to the crisis. Technically, Azar controls major assets like the Strategic National Stockpile, and Trump’s recent invocation of the Defense Production Act gives Azar the authority to compel private companies to shift into overdrive and start manufacturing medical supplies like masks and ventilators that are already in short supply.
To his credit, Azar, who is a lawyer by training, recently deferred a question directed at him to physicians like Birx, Giroir, and Fauci during a White House briefing. But it’s unclear whether he has been sidelined or is simply content to let other federal officials, especially those who are physicians, hold the spotlight.
8. Jerome Adams, surgeon general: the cheerleader
Adams takes his mantle of “the nation’s doctor” seriously. He’s been big on the hand-washing advice, stressing to Americans the importance of staying home during a pandemic, and has also been at the forefront of encouraging the public to donate blood amid shortages.
He also recently pleaded with Kylie Jenner and other “influencers” to spread the word about social distancing.
9. Stephen Hahn, FDA commissioner: the new guy
Welcome to Washington, Dr. Hahn. Where are the tests?
In all seriousness, Hahn — a longtime cancer doctor who was confirmed to lead the FDA in December — hasn’t exactly had an easy Trump administration onboarding. His portfolio has quickly grown to include fast-tracking efforts to ramp up testing as well as overseeing some aspects of development and testing for coronavirus vaccines and therapeutics.
And he hasn’t shied away from the truth — even if it means contradicting Trump on national television. During a bizarre White House briefing on Thursday, when Trump essentially told Americans that the antimalarial drug chloroquine would be made widely available to treat new Covid-19 cases, Hahn quickly stepped in. And he confidently walked back Trump’s remarks: The drug, he said, would continue to be evaluated using traditional scientific tools, like clinical trials.
10. Steven Mnuchin, treasury secretary: the money guy
Mnuchin, of course, hasn’t played much of a role in the global health response, but he’s been instrumental in architecting a series of agreements between Trump, Senate Majority Leader Mitch McConnell (R-Ky.), and House Speaker Nancy Pelosi (D-Calif.) to provide for free coronavirus testing; financial relief for Americans who’ve been laid off as businesses shutter; and stabilization measures for a nosediving stock market.
11. Chad Wolf, acting homeland security secretary: the airport guy
Wolf is a longtime Trump administration official who played a key role in the White House’s policy of separating the children of illegal immigrants from their parents at the U.S.-Mexico border. Now he’s tasked with the reentry of thousands of American citizens scrambling to return home from Europe, as airlines sharply reduce international travel offerings and after Trump banned non-citizens in Europe, China, South Korea, and Iran from entering the U.S.
At O’Hare Airport in Chicago last weekend, it didn’t go well.
12. Robert Kadlec, assistant health secretary for planning and response: the overpreparer
Kadlec is a career Air Force physician who made a name for himself as a top Capitol Hill biodefense expert, and before that as a top biodefense aide during the George W. Bush administration. As head of the health department preparedness wing, he directly oversees the Strategic National Stockpile, and more generally serves as Azar’s senior adviser on all things pandemics.
13. Jared Kushner, Trump’s son-in-law and adviser (not pictured): the loose cannon
Kushner, a presidential adviser and the husband of Trump’s eldest daughter, Ivanka, has sown chaos by creating an independent White House coronavirus team. The Washington Post reported that many West Wing aides view his group as a “shadow task force” that’s muddling the chain of command.
In the early going, Kushner also reportedly advised Trump to view the emerging outbreak principally through a public relations lens. Many have suggested the real public relations problem was treating a pandemic as a public relations problem.
14. Brett Giroir, assistant secretary for health (not pictured): the testing guy.
Giroir has worn many hats in the Trump administration. He served as acting commissioner of the Food and Drug Administration, bridging some of the gap between former FDA Commissioner Scott Gottlieb and the current chief, Stephen Hahn. Giroir also played a key role in a new regulation that heavily restricts the use of federal funds for biomedical research that involves fetal tissue.
Now he’s the White House’s point man on expanding the availability of coronavirus test kits — by almost every account, the federal government’s biggest failure in its coronavirus response.
15. Nancy Messonnier, director of the CDC’s Center for Immunization and Respiratory Diseases (not pictured): the alarm bell
Messonnier reportedly angered Trump officials in February by warning Americans that, due to the coronavirus, “disruption to everyday life might be severe.” At the time, Trump contradicted her prediction that the virus would spread through U.S. communities, telling reporters: “I don’t think it’s inevitable.”
In February and earlier in March, Messonnier appeared frequently with Azar, Fauci, and Redfield, but has largely been excluded from the administration’s more recent, public-facing Covid-19 efforts.
Another point against Messonnier, in the eyes of hardcore Trump allies: She’s also the sister of Rod Rosenstein, the former deputy attorney general who appointed Robert Mueller as special counsel to investigate alleged collusion between Russian government assets and Trump’s 2016 presidential campaign. In the eyes of conspiracy theorists’ view, Messonnier’s family ties aligned her with the “deep state” aiming to destabilize Trump’s presidency. In the eyes of science, Messonnier was exactly right.
16. Anne Schuchat, CDC’s principal deputy director (not pictured): the institutional knowledge
Schuchat is the highest ranking CDC official who’s not a political appointee. She served as acting CDC director twice and has played key roles in responding to the H1N1 pandemic in 2009, the SARS outbreak in 2001, and the threat of anthrax attacks in 2001.
And oh, by the way — she’s a physician who specializes in respiratory diseases.