As President Joe Biden’s health secretary, Xavier Becerra runs the sprawling department responsible for delivering on the administration’s vow to end the coronavirus pandemic. But when Biden’s senior health officials gathered one Sunday in August to make the high-stakes decision that all adults should get Covid-19 booster shots, Becerra wasn’t included on the call.
The nation’s top health official was instead preparing for a multi-day tour up the East Coast to tout Biden’s broader agenda, while others including Surgeon General Vivek Murthy and CDC Director Rochelle Walensky mapped out the specifics of the government’s booster strategy.
The episode, described by two administration officials, was emblematic of Becerra’s first six months atop the Department of Health and Human Services. During a period dominated by difficult choices and intense debates over the direction of the pandemic response, the former lawmaker and California attorney general has ceded much of the authority to the White House and government scientists — and seldom been the one giving orders.
Administration officials say Becerra’s limited role has left the government without a strong intermediary between a fast-moving White House and HHS’ methodical scientific agencies — contributing to breakdowns in coordination that have hampered the response and fueled accusations of political interference.
Becerra has steered clear of internal policy debates that have raged between HHS’ public health agencies, according to interviews with a dozen current and former administration officials and others familiar with the situation. And he’s played a secondary role in selling those Covid-19 policies to the public, often taking a back seat to subordinates like Murthy, Walensky and top infectious disease doctor Anthony Fauci.
“They brief him,” one person close to the pandemic response team said. “But he’s not a decider on response activities.”
Becerra’s reticence represents a sharp contrast from past administrations, where the HHS secretary had historically been highly visible in tackling top-tier health issues. And it’s noteworthy as health agencies under him feud with the White House over key aspects of the response.
That shift reflects the degree to which the White House has consolidated power over the response under coronavirus coordinator Jeff Zients, a Biden confidant who oversee his own pandemic team. It’s also the consequence of a concerted effort to lean on the administration’s top medical experts to steer the Covid-19 effort — and a recognition of Becerra’s own lack of experience as a public health policymaker and communicator.
But the results have proved particularly painful in recent weeks, as disagreements within the government over boosters left the public confused and Biden’s plans for the vaccination campaign’s next critical step up in the air.
“Normally, there’d be an internal process to figure out where we’re all going to land” led by the HHS secretary, said a person familiar with the situation. “Instead, it’s playing out in public.”
In an interview, Becerra told POLITICO he believes he’s “absolutely” been empowered as part of the Covid-19 response, and he emphasized his department’s involvement in the booster debate and other aspects of the effort.
“HHS has fingerprints on everything that’s being done on Covid,” he said. “And our team has worked — not only well, but successfully — with the White House to try to really communicate information and get out the facts and use the science, and so we’ve been an integral part of this.”
The health secretary defended the decision to preemptively set a Sept. 20 target date for distributing booster shots to all U.S. adults, while also insisting the plan was always dependent on getting sign-off from the CDC and Food and Drug Administration.
And he disputed the notion he’s been removed from major policy decisions, arguing that the pandemic response has been a team effort — with his job being to translate the scientific decisions made by the government’s health experts into concrete initiatives.
“What I think HHS does very well is, it takes all that expertise and that science, and it helps package it better for practical applications,” said Becerra, who added that he’s routinely briefed on the direction of the Covid-19 response.
Indeed, HHS has helmed on-the-ground programs advocating for the vaccines and targeting underserved communities. It’s deployed so-called surge response teams of medical personnel to aid hard-hit states. The department is also responsible for doling out billions of dollars in relief funding authorized by Congress.
Yet HHS’ central role underscores the extent to which Becerra himself has stayed on the margins of the public-facing response effort. To date, he has not participated in any of the administration’s Covid-19 briefings, where officials routinely roll out new policies and messaging.
Within the health department, officials said a team of public health specialists including top CDC, FDA and National Institutes of Health officials have led the daily work on the pandemic response — often working directly with the White House.
“Becerra’s clearly got a different perspective,” said Eric Topol, director of the Scripps Research Translational Institute, referring to his involvement in health issues as a 12-term lawmaker and as California attorney general. “But he hasn’t had any face in the pandemic.”
White House spokesperson Kevin Munoz said Becerra is leading a department with myriad responsibilities. “The secretary has been a strong partner to the White House on a number of important issues, including to our Covid response team. We are stronger because of his leadership,” Munoz said.
‘Nobody is calling balls and strikes’
Becerra’s lower profile is in part a consequence of the structure that Biden installed when he first assumed office — putting Zients in charge of a dedicated White House pandemic team with broad authority to direct response efforts across the government.
The approach is similar to the Obama administration’s strategy for passing the Affordable Care Act, which assigned a White House office to craft the policy and left implementation to the health department.
“Covid is an all-hands-on-deck issue,” said former HHS Secretary Kathleen Sebelius. “[Becerra] has a role in all that … but President Biden also wanted people who did nothing other than wake up in the morning and think about Covid.”
But it’s also a recognition of Becerra’s own personal background. He has no medical expertise and had not previously held a top health policy position. That has limited Becerra’s ability to contribute to the in-depth debates underpinning the direction of the pandemic response, two administration officials said.
Rather, Becerra has spent nearly every other week away from Washington, stumping for Biden’s agenda around the country and promoting the Covid-19 response in local communities.
Those are tasks tailored to Becerra’s strengths as a speaker and politician, said people involved with the pandemic response, who described him as widely liked within the Covid-19 operation and a willing team player.
Still, as fissures emerged over the direction of Biden’s vaccination campaign, some privately questioned why Becerra had not taken a stronger hand in managing relations between the White House and his department’s public health agencies.
At the White House, officials grew increasingly frustrated at the CDC over the pace of its vaccine research — and their inability to push the agency to move faster, for fear of violating Biden’s pledge to let his scientists lead the response. The CDC and FDA, in turn, have clashed over how much power each should have in determining the specifics of the looming booster rollout.
Those tensions spilled into public in recent weeks, punctuated by the resignations of two top FDA vaccine regulators who later publicly opposed the plan to give boosters to all Americans.
“Part of the reason this is happening is nobody is calling balls and strikes on FDA and CDC,” said a person involved in the Covid-19 response. “You don’t want the White House to be telling FDA and CDC what to do, but there’s nothing wrong with Becerra telling them what to do.”
Becerra downplayed the wrangling over the booster rollout, chalking it up to an eagerness to give Americans a sense of what to expect.
“They said, we’re going to shoot for a goal — we’re forecasting for you what we think is going to happen,” he said. “And so we may tell you a day or a week or what we think, but it’s all, again, subject to what the science says.”
Yet in a sign that the department is trying to tighten up its messaging, HHS recently brought on well-known Democratic communications specialist Leslie Dach to help better coordinate Covid-19 communications across the department.
‘He’s just had to deal with it’
Among Becerra’s critics and supporters alike, the health secretary’s quieter role on Covid-19 has driven concern that it will be equally difficult to establish himself as a leader on other big priorities, as well as to convince Biden to invest heavily in the rest of HHS’ agenda.
The White House is largely steering the administration’s efforts to slash drug prices and expand Medicare benefits as part of a massive social spending package in Congress, while leaving the policy specifics to Democrats on Capitol Hill to hash out.
HHS recently grew more involved in that process, people familiar with the negotiations said. But for months, it was unclear to those closely following the drug pricing issue who at the department was even in charge of it. When reporters began surveying lobbyists and advocates on the question earlier this summer, some named Sarah Despres, Becerra’s counselor for public health and science.
That turned out to be wrong — and caused a stir within the department when it appeared in print.
Becerra tasked a high-level team to work on the issue and produce a drug pricing outline, though a spokesperson said only that the effort was led by other counselors in the secretary’s office — and that “Sarah Despres was not involved in the decision-making.”
When asked whether Congress’ final package needed to give HHS power to negotiate drug prices — a key element of Biden’s health platform — Becerra argued it was crucial to significantly lowering costs but ultimately would “take what they will give me.”
In the meantime, Becerra has busied himself responding to an assortment of crises, from the record numbers of migrant children crossing the southern border earlier this year to a devastating hurricane along the Gulf Coast and the intake of thousands of Afghan refugees. Those have fallen partially under HHS’ jurisdiction, yet have taken up significant time and resources and won little in the way of outside praise.
Despite housing and then uniting tens of thousands of unaccompanied immigrant minors with sponsors in the U.S., HHS is still grappling with the need to house children in emergency shelters — and has faced sharp criticism and an ongoing investigation by its internal watchdog over the conditions at one Texas location.
“He inherited it, and he can’t complain,” said a Becerra ally. “He’s just had to deal with it.”
As for the rest of his agenda, Becerra rattled off a lengthy list that includes broad goals like further expanding health coverage, tackling the resurgent opioid epidemic, strengthening women’s health care, limiting tobacco use and enacting a ban on so-called surprise bills.
But accomplishing much of that is dependent on first defeating the pandemic, he added. Until then, many of his own policy ambitions would have to stick to the shadows.
“That’s job one, it’s job two and it is job three,” he said. “You really can’t get to the other things if Covid is still surrounding you.”