Becerra in the hot seat, again, over monkeypox response

As the Biden administration scrambled last month to defuse anger over its sluggish response to the monkeypox outbreak, Health and Human Services Secretary Xavier Becerra floated an idea: Tell people the states need to do more.

The federal government could only provide the tools and guidance needed to slow the disease’s spread, he told White House and health officials. It was up to the states to contain it, and the administration should make that clear.

The idea caused immediate alarm, according to people familiar with the matter. The Biden administration would look like it was ducking responsibility for managing a growing health crisis, officials cautioned. On top of that, it could alienate state health departments that had been critical to the fight against the coronavirus — and would be necessary allies if the U.S. had any hope of stamping out monkeypox.

Despite the warnings, Becerra went out days later and made his case.

“We don’t control public health in the 50 states, in the territories and in the tribal jurisdictions,” he told reporters on July 28. “We rely on our partnership to work with them. They need to work with us.”

The states, he added, “are ultimately the ones to determine how health care is administered in their jurisdictions.”

Activists and public health experts who had spent weeks pressuring the administration to ramp up its response were incensed. State officials wondered if they were being set up as scapegoats.

And inside the White House, the episode reinforced the belief that the Health secretary’s eagerness to pass the buck made him ill-suited to manage the health crises that have shaped President Joe Biden’s first term.

“He doesn’t want to take the heat for others,” one senior administration official vented. “He’s just out of his depth.”

Chief HHS spokesperson Sarah Lovenheim rejected the idea that Becerra wanted to put more responsibility on the states, calling it “made up.”

“There was never a conversation in which the secretary suggested anything of the sort, nor would he ever. He values our partnership with the states and has acted aggressively since Week One of the outbreak to tackle it,” she said.

The internal frustration over the monkeypox outbreak has, once more, put Becerra on the hot seat.

There is no chance of Biden firing his Health secretary, senior administration officials said, especially amid multiple public health emergencies and just months to go until the midterms. But there is growing chatter that Becerra might soon find an off-ramp.

Some White House aides believe Becerra, a former California congressman and attorney general, may resign at the end of the year to run for Senate in 2024, according to three people familiar with the discussions.

It’s an idea that Lovenheim quickly dismissed.

“He would tell you he’s not doing that today, tomorrow or next year,” she said. “He’s not running for the U.S. Senate.”

In a statement, White House chief of staff Ron Klain praised Becerra as “steadfastly committed to delivering on the president’s agenda and handling a daunting array of crises,” adding that his leadership has made the administration stronger.

Ashish Jha, the White House’s Covid response coordinator, defended Becerra as a close partner in combating the pandemic and monkeypox.

“He is remarkably tuned in to the issues,” he said. “There’s not a single decision I can think of where HHS was not meaningfully involved.”

The White House also rejected the notion that there have been tensions and called the suggestion that Becerra advocated shifting more responsibility for the monkeypox response to the states a “gross mischaracterization.”

The public support, however, masks private misgivings. According to eight current and former administration officials and others familiar with the matter, there are intensifying doubts that Becerra has the ability to help steer the administration through a critical period for public health.

As Health secretary, Becerra oversees a sprawling array of agencies including the Food and Drug Administration and Centers for Disease Control and Prevention. Yet he’s often reluctant to take a strong hand in coordinating their work, a dynamic that officials said has hampered the public health responses and allowed internal disputes to spill into the open.

And though Becerra is widely seen as a talented politician and public speaker, his political experience hasn't always translated into intricate health policy communication.

On the same call where Becerra sought to shift responsibility for the monkeypox response to the states, he also bristled at a seemingly straightforward question about whether the government could successfully contain the outbreak.

“I almost want to turn that question back at you,” Becerra challenged one reporter. “And ask you, how many vaccines do you think we need at this stage?”

Lawrence Gostin, a Georgetown University public health professor, initially considered himself a big Becerra supporter. “I thought he could be a great secretary despite not having public health background,” said Gostin, who has informally advised the administration. “But he really hasn’t shown the kind of courage and urgency that I would’ve liked to have seen.”

Lovenheim fiercely disputed the complaints about Becerra, characterizing him as a strong leader on Covid and monkeypox who has proven his critics wrong on a succession of urgent issues, from housing migrant minors at the southern border to the Supreme Court’s decision on abortion.

“Anonymous sources said he wasn’t managing the inherited unaccompanied children crisis; he found a way to shelter every child. Anonymous sources said he wasn’t tackling Covid; he closed vaccination rate disparity gaps and made ample tools available for free,” she said. “Anonymous sources said he wasn’t ready to protect reproductive rights; he announced a plan within days of the Dobbs decision that he had worked on ahead of it.”

Becerra has presided over the health department during a historically difficult stretch, his defenders inside and outside the administration said. And he has served as an eager team player even as his own priorities have been overshadowed by overlapping crises.

Indeed, when Becerra initially agreed to run HHS, some of his advisers urged him against accepting the role, two people familiar with the matter said. They’ve since watched with frustration as he’s taken blame on various fronts, attributing it to his status as an outsider to the close-knit Biden world.

Other supporters argued that Becerra’s detractors misinterpret his deferral to subordinates as passivity. Rather, they said it’s motivated by a desire to ensure there’s widespread input across the department — and a lack of concern with who ultimately gets the credit. They note Becerra has won praise in other parts of the administration for throwing himself into work on more familiar terrain for the lawyer and longtime politician, like abortion rights and efforts to strengthen the Affordable Care Act.

“He focuses, like I think good managers do and good leaders do, on uplifting those around him,” said Cristóbal Alex, a former deputy Cabinet secretary in the White House who worked closely with Becerra. “What he does is grab another chair and pull it up to the table so that important voices are also heard that otherwise wouldn’t be there.”

But the current scrutiny of his management style is not new. He was dogged by similar criticism roughly a year ago, as the administration sought to navigate the rollout of the first Covid booster shots. The effort quickly turned fraught, as the CDC and FDA battled over who should get the vaccines and on what timeline.

Officials at the White House privately blamed Becerra for failing to resolve the conflict quickly — and pointed to it as an example of his broader unwillingness to get involved in the substance of public health issues.

“Running HHS is the domestic equivalent of running the Pentagon,” said one person familiar with the dynamics. “But he doesn’t know the building, he doesn’t know the executive branch and he doesn’t know the topic.”

Earlier this year, as Becerra approached his one-year mark, aides signaled plans for a reboot aimed at making him a more visible leader on the pandemic. But significantly little has changed. An effort to make Becerra a regular part of the White House’s Covid briefings lasted only a few weeks, overtaken by what aides said was a combination of his demanding schedule and the need for the department’s top scientists to address in-depth questions.

While Becerra has remained a consistent presence in high-level White House Covid meetings, “he’s an observer,” a senior administration official said. “The White House is managing everything on this.”

The coordination problems have also persisted. A CDC plan to roll out new, more relaxed Covid guidelines last week was abruptly halted after top health officials at other agencies including the FDA and National Institutes of Health raised objections to some of the content, two administration officials familiar with the matter said. Those concerns spurred a flurry of last-minute rewrites.

For Becerra, the sudden spread of monkeypox throughout May and June offered another opportunity to reset. The outbreak was worrying, but not deadly, and initially viewed as containable.

Yet within weeks, White House officials grew concerned about the trajectory of the outbreak, three people familiar with the matter said.

Tests were slow to roll out, accompanied by unwieldy testing criteria developed by the CDC, and the federal government struggled to keep track of the mounting case count.

And despite touting initial efforts to secure more vaccines, Becerra’s department moved too slowly to ensure millions more doses it already owned could be quickly prepared for distribution. A search for alternative manufacturers remains in progress.

Nearly three months after the first U.S. monkeypox case, there are now nearly 11,000 reported cases and climbing. Health experts fear the window for limiting the disease’s spread is closing fast, exposing the administration to growing criticism it failed to recognize the seriousness of an outbreak that has overwhelmingly affected gay and bisexual men.

The situation has further dented Becerra’s standing among aides who have privately vented it’s just the latest example of the Health secretary’s hesitancy to jump into policy matters and push his health agencies to move faster.

On Aug. 2, five days after Becerra suggested states should bear more responsibility for the crisis, Biden appointed emergency response veteran Robert Fenton to run the monkeypox response from the White House.

HHS defended its early monkeypox response as a rapid effort to understand and combat the outbreak, pointing to early decisions in mid-May to order tens of thousands of vaccine doses as soon as the first U.S. cases were confirmed. The department continued to ramp up testing and vaccine supply over the next few weeks, while Becerra and other agency heads mapped out a strategy for the weeks ahead.

“Every step of the way, we’ve accelerated our response to stay ahead of the virus,” an HHS official said.

There are signs, though, that Becerra has recently taken on a fresh sense of urgency. Stung in particular by criticism that HHS had failed to secure enough vaccine doses to quell the outbreak, Becerra drove a search for alternative ways to stretch the government’s existing supply.

Health officials eventually landed on a strategy to administer doses in smaller amounts under the skin — a technique that could expand the number of available doses five-fold, but was backed by limited data and would require authorizations only available under a public health emergency.

Becerra, who had initially resisted the idea of declaring monkeypox a public health emergency, quickly reversed his position, working over the following days to convince the White House to sign off on the plan, two people familiar with the matter said.

The plan’s success will rely in large part on the health department’s ability to coordinate training on the new technique for health providers and sell the public on the merits of the approach.

But to some, the push reignited hope Becerra has recognized that his success atop the health department would be determined by his ability to assert authority over it.

“It has not been an easy ride,” said one longtime Becerra ally. “But he is the secretary. So at some point, the buck stops there.”

Christopher Cadelago contributed to this report.