‘HHS has been kicked in the teeth’

The coronavirus outbreak burning its way through the United States has taken a different kind of toll on staff at the center of the nation’s response.

Officials here, at the Health and Human Services department headquarters, have worked around the clock since mid-January to first prepare for the possible Covid-19 outbreak and then manage the pandemic it became. But the Trump administration’s repeated stumbles have provoked a daily deluge of attacks, watchdog probes and open speculation about the future of the department’s leader, Secretary Alex Azar, culminating in a spate of reports about how White House officials were discussing Azar’s potential replacements this past weekend.

While President Donald Trump swiftly rejected those reports and praised Azar, more than 15 current and former staff who spoke to POLITICO described an atmosphere of exhaustion and dysfunction — capped off by White House efforts to weaken the health secretary.

“I don’t think people appreciate how tired the department is,” said one former Trump HHS appointee. “Your effectiveness wears down after you’ve been in a fight — and for 100 days, HHS has been kicked in the teeth.”

The white-hot spotlight has ensnared multiple top officials like Centers for Disease Control Director Robert Redfield and Surgeon General Jerome Adams, as critics dissect their past predictions — such as Redfield’s reassurances about test development, and Adams’s advice against wearing masks — and seize on new gaffes. Congressional probes have been launched into claims of Covid-19 wrongdoing, including the ill-timed ouster of the department’s vaccine chief, Rick Bright. Meanwhile, the president pushed the department to prioritize unproven malaria drugs, rattling career officials who said that politics were taking precedence over public health.

Azar — who brimmed with confidence at the crisis’ start in January, said three people who were around the health secretary at the time — has been significantly marginalized by the White House, which has also directed the hiring of several top appointees and key projects.

One of those appointees is newly installed public affairs chief Michael Caputo, a Trump loyalist who has brawled with media outlets like The Wall Street Journal, Fox News and CNN in the past week alone and fed critical comments to conservative outlets.

“Every fake news shot at a cabinet secretary is an attempt to destroy the president, and I’m just not going to stand for it," Caputo told POLITICO in response to questions for this story. "We’re focused on getting the job done and not on palace intrigue."

In tweets widely suspected to be encouraged or even written by Caputo, Azar also has taken to rejecting critical coverage as “fake news” — using the term on Twitter four times in the past two weeks after never using it in his first two years.

“While the #FakeNews media and their leaker allies collude to destroy this President, his Administration is following his leadership 24/7 to protect Americans and end a global health crisis,” Azar tweeted on Sunday. Caputo declined to comment on whether he played a role in Azar’s tweets.

The sentiments expressed in the tweets may endear Azar to Trump’s loyal base but have unsettled many career officials and some political appointees, too.

“That doesn’t even sound like him,” said one senior career official, who said he’s respected Azar’s department leadership but is alarmed by the secretary’s recent turns of phrase. “That sounds like a Trump rally.”

Health chief loses ground inside agency

The uncertainty over the future of Azar — largely seen as a stabilizing force at HHS, after Trump fired former Secretary Tom Price in September 2017 over a charter-jet scandal — comes at a pivotal moment for the hard-hit department, as officials try to juggle the Covid-19 response on a dizzying number of levels. Various arms of HHS are urgently searching for a vaccine, implementing an amorphous new payment scheme to subsidize hospitals for coronavirus treatment, determining whether to approve new drugs under intense pressure from Trump, and trying to jumpstart the perpetually behind-the-curve testing system.

HHS' top spokesperson acknowledged the intense workload but compared it to challenges across the economy.

"Today Americans are taking care of their families and home schooling their children while working from home. HHS staffers are no different," said Caputo.

Azar’s own internal weakness also has shifted his governing style over the 80,000-person department. Gone are the days when the health secretary ushered out staff for rude or conspiratorial tweets. Now Caputo — who penned comments like “millions of Chinese suck the blood out of rabid bats as an appetizer and eat the ass out of anteaters,” just weeks before assuming his new HHS post — freely uses Twitter to amplify attacks on Democrats and rivals.

Caputo stood by his deleted Twitter posts in a recent interview with CNN and last week re-shared some of his deleted retweets that had been flagged by CNN, including one that featured a photo of billionaire George Soros and claimed he was the “real virus.” Caputo is now working to bring in allies from his time in political communications, said three people with knowledge of his recruitment efforts. A spokesperson said only that Caputo is working to fill long-vacant slots in the HHS communications shop.

The tougher stance against critics has rallied some Trump appointees, who appreciate Caputo's willingness to spar with the media after months of damaging headlines. But others worry that Caputo is set to politicize the department's communications at a time of a public health crisis, noting his weeks of attacks on China and Democrats' handling of Covid-19 before joining HHS this month.

"I don't want my team's work to get on Caputo's radar" and be potentially spun, said one public-health official.

Azar also was unable to prevent White House-directed changes to the health department’s refugee office, including the ouster of the refugee chief that he’d installed to fix the troubled office after the disastrous 2018 family separation crisis. The moves signal a possible return to the hardline immigration policies that sparked lawsuits and condemnation by public health advocates — and caused so many problems for Azar and the department during the 2018 crisis.

Meanwhile, Azar’s feud with deputy Seema Verma — a battle that defined the department across 2019 and attracted attention across Washington — has been largely settled: Verma has won, for now. The Medicare chief has been feted by industry groups and gotten bipartisan acclaim for her quick actions to roll back regulations and speed funds to hard-hit hospitals during the Covid-19 pandemic. Verma also has become one of the Trump administration's more frequent speakers at coronavirus briefings, underscored by a C-SPAN tracker that’s been passed around by some department officials, while Azar has failed to appear at a White House press briefing since April 3, despite leading the internal task force across January and most of February.

It’s a stark reversal from Verma’s shaky status last year, after the department’s inspector general and four congressional committees launched probes into Verma’s use of taxpayer funds on personal publicity, following a POLITICO investigation. Those efforts have been slowed by the Covid-19 outbreak. A spokesperson for the inspector general told POLITICO this week that the watchdog report on Verma’s spending would arrive by “late spring.”

Verma's ascendance has cheered her allies, who maintain that her rivalry with Azar last year was driven by the secretary's unhappiness that Verma had cultivated her own line to the White House and was attracting her own media. "She's just trying to do her job and isn't looking for any of this crap," said one former official.

But Azar's simultaneous sidelining has frustrated many officials inside HHS, who worry that the secretary's weakened position is further destabilizing the department — and what's next.

"I’m of two minds,” said one senior career official. “Why is he still there after all the attacks? But why would he stay? He’s been treated so badly.”

“If he goes, I hope we don’t get Seema,” the official added.

Explosive claim by vaccine expert also wears on department

A more recent complication: Last week’s ouster of vaccine expert Bright, which attracted national attention and prompted House Speaker Nancy Pelosi and other Democrats to demand an investigation. Bright has alleged that he was removed as chief of the Biomedical Advanced Research and Development Authority because he raised concerns about Trump’s push to acquire unproven malaria drugs, and his high-powered legal team — who also represented Christine Blasey Ford, accuser of Supreme Court Justice Brett Kavanaugh — have vowed to file a whistleblower suit.

The vaccine expert’s removal in the middle of the quest to find a Covid-19 vaccine also became a cable TV staple — “This is like the Patriots pulling Tom Brady in the 4th quarter with the team down by 6,” Andy Slavitt, Verma’s Obama-era predecessor, said on MSNBC last week — and sparked some bipartisan concerns. “Rick Bright was an outstanding partner to me, to FDA, and to our shared public health goals,” tweeted Scott Gottlieb, Trump’s former FDA commissioner.

Inside the department, Bright is viewed as an important avatar of career officials' frustration over the malaria-drug episode. "I'm glad that someone is finally saying bluntly what [infectious-disease expert Anthony] Fauci can't, which is how ridiculous it is that president was touting these drugs" despite scant evidence, said one HHS official.

But HHS leaders have been frustrated with the way Bright's ouster has been portrayed. Their assertion: Transferring the vaccine chief was driven by personality conflicts and management style that predate the Covid-19 outbreak, and previous attempts to move him were complicated by his status as a career civil servant. POLITICO also learned about those efforts before the Covid-19 outbreak. Two former officials and one current official compared the relationship between Bright and his boss Robert Kadlec, the assistant secretary for preparedness and response, to the fraught dynamic between Verma and Azar.

HHS leaders have maintained that they will be vindicated when probes find that the story of Bright’s ouster is more complicated, adding that there are internal documents showing that Bright himself supported the acquisition of malaria drugs — but for now, they warily wait for his whistleblower complaint, having tossed his email for damaging snippets.

Beyond the scrutiny on senior leaders, health department officials have grown concerned about lower-level staff getting caught in the crossfire, as a growing number of HHS officials become the subject of investigative reports, talking-points on cable TV and even fodder on social media.

"It's tough to do this job on a normal day," said one official. "Now I've got to worry that [MSNBC's Rachel] Maddow is going to dig through my resume."

Regardless of what happens next, it's clear what won't: a return to the agenda that Azar carefully laid out in early February at the HHS state of the department address, a new ritual he began last year, modeled on Trump's own State of the Union address that week.

"In the year to come, and the five years I hope I have ahead, we have our work cut out for us," Azar said on Feb. 6, having listed out goals to lower drug prices, address serious mental illness and other public-health aspirations that have been largely shunted aside by the pandemic's demands.

"In other words, we have lots to do — but the entire HHS family should be very proud of what we've accomplished so far," Azar said. "I can't wait to get to work with all of you on our important goals this year."