WASHINGTON – White House officials have grown so frustrated with top health official Xavier Becerra as the pandemic rages on that they have openly mused about who might be better in the job, although political considerations have stopped them from taking steps to replace him, officials involved in the discussions said.

Top White House officials have had an uneasy relationship with Becerra, the health and human services secretary, since early in President Joe Biden’s term. But their dissatisfaction has escalated in recent months as the omicron variant has sickened millions of Americans in a fifth pandemic wave amid confusing and sometimes conflicting messages from top health officials that brought scrutiny to Biden’s strategy, according to three senior administration officials and two outside advisers with direct knowledge of the conversations.

The frustration with Becerra comes as top White House and health officials face growing criticism for health messaging missteps, as well as controversial policies about coronavirus testing and isolation. The administration has also struggled in the face of a tsunami of cases that have overwhelmed hospitals and shuttered some schools and businesses because so many workers became infected.

White House and HHS officials denied those tensions and pointed to the administration’s work on delivering vaccines, as well as new covid treatments and diagnostic tests, as evidence of a productive working relationship.

“Since day 1, the administration has managed a strong, coordinated COVID-19 response thanks to Secretary Becerra and HHS officials at every level of government,” White House spokesman Kevin Munoz said in a statement.

Becerra, a former California attorney general and longtime congressman with little health-care experience, was never given a clear role in a response that is run out of the White House, prompting defenders to say it is unfair to blame him for recent stumbles. Still, his low profile has become more confounding as the pandemic has worn on and health officials have made statements that sometimes blindsided the president and bewildered the public, some officials and outside experts say.

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They also said the health secretary isn’t fulfilling a core responsibility of his job, which is to act as a de facto field marshal coordinating the nation’s vast health bureaucracy to achieve the White House’s strategy, even though he does not set it. For instance, they cited officials’ airing of differences over booster shots and covid-19 isolation guidance as confusing and unnecessary. They said the tension between Becerra and the White House has complicated the pandemic response at a time when Americans are already exhausted and struggling to make sense of ever-changing guidelines.

“He hasn’t shown up,” said Eric Topol, director of the Scripps Research Translational Institute and a prominent covid analyst, adding that Becerra has been “like a ghost” during the pandemic. “An HHS secretary has so much authority and power to help. And we have no evidence that any of it is being exerted.”

Topol, who wrote an editorial in Science magazine this month, saying Becerra had “shirked” responsibilities such as collecting covid data and coordinating his deputies, said he had heard similar concerns from people close to the White House. The secretary has “to step up or step aside,” Topol said.

More on the COVID-19 pandemic

Several administration officials voiced similar displeasure with Becerra’s leadership, although they would not do so on the record because they were not authorized to speak with the media. The health secretary “is taking too passive a role in what may be the most defining challenge to the administration,” said one senior administration official.

This story is based on interviews with 28 senior administration officials, health agency officials, outside advisers and experts, most of whom spoke on the condition of anonymity to detail sensitive discussions.

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As health secretary, Becerra oversees a $1.5 trillion agency charged with responding to myriad national crises, including disease outbreaks, extreme weather events and housing migrant children at the border. He is responsible for coordinating policy rollouts and communications among health agencies such as the Food and Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention, a job made particularly difficult by the pandemic. The nation’s most prominent health officials, including CDC Director Rochelle Walensky, Surgeon General Vivek H. Murthy and Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, all report to Becerra or his deputies.

Bipartisan lawmakers have raised concerns about the agency’s persistent coordination difficulties, from collecting infectious-disease data to clearly communicating health guidance. A government watchdog last week echoed those criticisms, saying such issues have plagued responses to emergencies across four presidential administrations and, if left unaddressed, will “hamper the nation’s ability to be prepared for, and effectively respond to, future threats.”

Yet removing Becerra would likely draw the ire of the Congressional Hispanic Caucus and other grass-roots groups that pressed Biden to appoint more Latinos to his Cabinet. Officials are also loath to take on a complicated staffing change with a divided Senate as they prioritize confirmation of a new Supreme Court justice and navigate election-year politics.

Biden is also averse to firing staffers and unlikely to make major changes unless there are glaring reasons to do so, one senior official said. As a result, the informal conversations about replacing Becerra are unlikely to escalate to serious deliberations in the near future.

“Since day 1, the administration has managed a strong, coordinated COVID-19 response thanks to Secretary Becerra and HHS officials at every level of government,” White House spokesman Kevin Munoz said in a statement.

HHS officials also praised Becerra’s work on the pandemic and said he deserved credit for other policy accomplishments, such as record enrollment this year in the Affordable Care Act’s health insurance exchanges.

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“He’s been just a great thought partner,” said Dawn O’Connell, assistant secretary for preparedness and response at HHS, citing Becerra’s guidance on key priorities. For instance, O’Connell’s team on Jan. 1 took on direct oversight of distributing tests, masks and other medical supplies across the nation, a responsibility that previously rested with the team known as Operation Warp Speed and was jointly managed with the Department of Defense. While the Government Accountability Office warned it was “unclear” whether HHS was ready for the transition, O’Connell said that Becerra had helped empower her team so it could “hit the ground running” this month.

“We’ve got these vaccines out, we’ve got boosters available. Tests are being delivered to American households, masks are being handed out. And the secretary has just been there to support that effort,” she said.

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The White House’s frustration with the health secretary reflects a complicated dynamic that has its origins in how the administration set up the pandemic response.

From the start, the effort was run out of the White House and led by presidential counselor Jeff Zients, a former Obama economic adviser with extensive management experience known for helping repair HealthCare.gov, the health insurance website that struggled to launch in 2013, but no public health background. He communicates directly with health leaders, including Fauci, Walensky and Murthy, often referred to as “the team of doctors.”

Although all of those officials technically report to Becerra or his deputies, the health secretary was never given a clear role in the response and joined the administration in late March, more than six months after Biden aides had begun to draw up a detailed covid battle plan. And compared with senior officials like Zients, Murthy, Fauci and others working on the covid response team, Becerra had fewer ties to Biden or his inner circle.

That chain of command is further complicated by the fact that the White House has taken a hands-off approach to the CDC and some other health agencies because it is sensitive to charges of political interference after Biden repeatedly criticized the Trump administration’s meddling in scientific debates and policies during his campaign. It is sometimes unclear who makes final decisions or is in charge of carrying out initiatives, with Zients absorbing much of the portfolio that would have gone to an HHS secretary in previous administrations.

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As a result, several officials described an often confusing structure, with leaders like Fauci, Walensky and Murthy dealing primarily with Zients’s team, others reporting jointly to Becerra and Zients, and some messages getting muddled or lost as a result. Zients has faulted Becerra for not ensuring the White House knows what’s coming from the health agencies – particularly the CDC – according to six people familiar with the matter. Zients disputed that characterization through a White House official.

Tensions have also grown as a result of the pandemic’s persistence; many Biden officials thought the emergency phase of the pandemic would end by last summer and the White House would be able to turn to other issues.

Celine Gounder, an infectious-disease expert at New York University and a member of Biden’s covid transition task force, said it’s unclear “how much of [Becerra’s] role or non-role is driven by him versus the White House.”

“Certainly whether it’s him or the White House itself, there does need to be better coordination,” she said. “That isn’t to say there should be suppression of certain ideas but rather coordination of different agencies. He is certainly one person who could be doing that.”

White House and HHS spokespeople said that Zients and Becerra speak throughout the week and have a standing formal check-in. The White House and HHS also set up omicron-specific working groups on testing, vaccines, surge needs and other key issues, a White House official said.

Senior officials also said they take every effort to be transparent.

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“I keep two lines of communication open at all times,” said O’Connell, the HHS emergency response chief, saying she “first” relays information to Becerra’s office and then informs the White House. “That’s always my goal: never to surprise anybody.”

Some officials say that Becerra has missed opportunities to be more proactive while facing a steep learning curve to master a sprawling, 80,000-person department responsible for the nation’s food safety, most of the U.S. clinical medicine trials, and many other health and social services programs, in addition to overseeing sensitive issues such as housing unaccompanied migrant children.

While Becerra had years of experience as a lawmaker and lawyer who worked on health-care issues, he now faces a different set of challenges in trying to implement programs like the Affordable Care Act, rather than defend them in court. The health secretary convenes a morning meeting most days where he gets briefed by top health officials on work related to the pandemic. But he mostly listens to updates without offering input or asking probing questions, two people familiar with the calls said.

The result, those people said, can be policy stumbles and conflicts that are worked out in public view.

The battles and challenges between the agencies need to be reconciled, and he’s not doing it. He has a $1.5 trillion budget. He has FDA, NIH, CDC. All of those agencies need help, and they certainly need to be rebuilding, and none of that is happening.”
— An outside adviser

“The battles and challenges between the agencies need to be reconciled, and he’s not doing it,” said one outside adviser. “He has a $1.5 trillion budget. He has FDA, NIH, CDC. All of those agencies need help, and they certainly need to be rebuilding, and none of that is happening.”

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When the CDC announced in December, for instance, that it was halving the isolation and quarantine times for those infected with or exposed to the virus without requiring a negative test, Walensky, Fauci and Murthy voiced conflicting messages about the new guidance in public interviews. White House officials were embarrassed by the rollout, which invited fierce public blowback, and thought Becerra or one of his staffers should have coordinated those messages ahead of time, according to two senior administration officials.

Becerra “is all their bosses. And could coordinate them. But he doesn’t,” said a person involved in the covid response.

Sarah Lovenheim, HHS’s chief spokesperson, disputed such descriptions of Becerra’s style, writing in an email that “anyone who knows the Secretary knows that he’s a good listener – and that he always asks questions.” The purpose of his regular meetings, she added, “is usually to receive updates and understand ongoing developments, not to make major policy decisions. Major decisions require in-depth, focused discussion for which separate time is reserved for the team to engage.”

She also noted that Becerra wants to ensure that the administration’s doctors are able to speak freely, particularly after the Trump administration sought to muzzle top experts.

The “covid response is driven by the science and data,” Lovenheim wrote, adding that HHS informs the White House of “any high-level actions and decisions.”

“And, as the Secretary has often said, the quarterback on covid strategy is in the White House,” Lovenheim wrote. “The Secretary and the HHS team working on covid engage in constant communication.”

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Inside HHS, Becerra has defenders who describe him as approachable and thoughtful, while focused on issues like lowering the rate of Americans without health insurance and closing persistent racial and ethnic gaps in U.S. health outcomes. He is well-liked by his staff, who feel empowered to carry out their jobs.

Some administration and outside advisers say it is unfair to blame Becerra for recent stumbles when the White House has commanded the response.

It’s very clear to me that the White House is not looking for Becerra to be involved.”
— An outside adviser, who spoke on the condition of anonymity

“It’s very clear to me that the White House is not looking for Becerra to be involved,” said one outside adviser, who spoke on the condition of anonymity to be candid. “What you can’t do is say, ‘We’re going to run it out of the White House,’ but not be involved with the agencies. Or if there is a role for Becerra, they should articulate it to him.”

– – –

Becerra was a fallback choice for Biden and his team, who struggled to agree on a health secretary during the presidential transition and were turned down by other candidates.

But with the pandemic stretching into the second year of Biden’s presidency – and officials worried about the potential for yet another variant to pose problems – Becerra’s relatively low public profile has become more troublesome. It is also a stark departure from his predecessors’ roles during health crises.

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Alex Azar, who led HHS during the Trump administration, appeared a dozen times during the first year of the pandemic on Sunday morning television shows such as NBC’s “Meet the Press” and its counterparts on ABC, CBS, CNN and Fox News, where the White House traditionally dispatches senior officials to put its decisions in the best light. Obama-era health officials like HHS Secretaries Kathleen Sebelius and Sylvia Mathews Burwell also regularly appeared on the programs, and the Biden administration has followed suit, having White House coronavirus coordinator Zients and Fauci appear multiple times over the past year.

But since being sworn in as health secretary, Becerra has yet to appear on a single Sunday morning TV show. The Association of Health Care Journalists on Nov. 29 separately faulted the health secretary for his “low profile,” calling on him to hold more visible and frequent media briefings.

“It’s time for Secretary Becerra to come out of hiding,” Felice Freyer, the group’s president, said in an accompanying statement. Freyer this week said that the group had not received a response and that Becerra was still failing to hold regular, open-ended briefings.

Lovenheim, Becerra’s spokesperson, said that it was “patently false” that Becerra keeps a lower profile than his predecessors, citing his travel to more than 20 states and his frequent appearances on TV and radio. She added that Becerra holds briefings with the media at least once per week but suggested that other matters took precedence.

It’s time for Secretary Becerra to come out of hiding.”
— Felice Freyer, president, Association of Health Care Journalists

“Would you rather have a Secretary who prioritizes TV appearances over getting tests, therapeutics and vaccines into the hands of people who need them?” Lovenheim wrote.

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Becerra’s role overseeing the federal government’s health bureaucracy means that some pandemic initiatives must go through him. And he has sometimes pushed back on proposals championed by officials leading the response.

In the spring, for instance, as administration officials searched for ways to encourage more Americans to get vaccinated, they coalesced around a plan to pay some doctors more if they encouraged their patients to get the shots. The proposal would have paid doctors through the government health insurance programs Medicare and Medicaid, which fall under HHS and collectively cover more than 100 million people.

But the plan came to a halt at one point because of Becerra’s concerns that it lacked sufficient oversight and might lead to fraud, according to two people with knowledge of the discussions.

Some White House and HHS officials were incensed by Becerra’s opposition to the proposal, which drew on evidence that Americans were skeptical of politicians’ recommendations on vaccines but trusted the advice of their physicians.

“He sees too many things like a former attorney general and career congressman – and not like the top health official during a pandemic,” said one of those involved in the discussions.

A scaled-back version of the plan did take effect last month, when Medicaid began reimbursing doctors for talking to parents about vaccinating their children, a move cheered by health-care groups that sought the policy for months.

Lovenheim said the health secretary never “opposed” the plan last spring but wanted to focus on Medicaid, which serves children and younger adults who have far lower vaccination rates than seniors in Medicare.

“He raised serious reservations about efficacy and program integrity tied to trying to do this through Medicare,” Lovenheim wrote, suggesting that Becerra deserved credit for what was ultimately announced. “The proposal successfully went where he suggested it should go.”