In the midst of what international health officials fear could be the start of a flu pandemic, the U.S. Department of Health and Human Services is still without most of its top political leaders.
The Senate is set to vote Tuesday on the nomination of Kansas Gov. Kathleen Sebelius to become the agency's secretary. Sebelius' confirmation has been held up by, among other reasons, Republican concerns about her political ties to a doctor in her state who performs abortions in the second and third trimesters of pregnancy.
But Sebelius' lack of confirmation has, in turn, prevented the appointment of the next tier of department personnel and Senate confirmation hearings on several lower-level HHS nominees.
Michael Leavitt, President Bush's last HHS secretary, said the department's top 20 positions are vacant or being held by acting personnel.
"The secretary of HHS is the key player throughout the federal government in a pandemic or natural medical disaster," Leavitt told reporters on a conference call. Thus, he said, having that post unfilled is a serious problem.
But the Obama administration says that's not the case. "Our response is in no way hindered or hampered by not having a permanent secretary at HHS right now," said White House press secretary Robert Gibbs at Monday's briefing. "There are professional staff over there as we speak, helping to coordinate this."
Public health experts tend to agree with Gibbs. "There certainly are a lot of vacancies," said Eric Toner, senior associate at the University of Pittsburgh's Center for Biosecurity. "But in all of those positions, there are acting people with years of experience who know the system, know the plan and so far seem to be doing a good job."
Much of the credit goes to Leavitt and the Bush administration for its multibillion-dollar pandemic planning effort started in 2005, which included pandemic summit meetings in each of the 50 states. But Jeff Levi of Trust for America's Health, a public health advocacy organization, says the Obama administration also deserves high marks for selecting the right career people to put in charge on an acting basis.
For example, he says, it's more than luck that put Richard Besser temporarily at the helm of the Centers for Disease Control and Prevention. Besser had previously headed the agency's emergency preparedness programs.
"I think the administration was very clear when they came in that one of the things they need to be most concerned about was that if there was an emergency of this kind, would the right people be in charge — and that's one of the reasons that Dr. Besser was chosen," Levi said.
Toner said HHS officials seem to be coordinating well with officials at the Department of Homeland Security, which also has authority in public emergencies like disease outbreaks. He said Sunday's White House news conference featuring Besser and Homeland Security Secretary Janet Napolitano was an excellent example of interagency cooperation.
"They explained very complicated issues in a very understandable way; they were calm; they were reassuring, but not overly so; they stressed the serious nature of the outbreak, but without scaring people. They were pitch-perfect; they got it just right," he said.
Soon, however, HHS will need its political appointees in place for tasks such as asking Congress for more money. "We're still $870 million short with the original estimate for what would be needed to build our research and development capacity for pandemic flu," said Levi. "We have not given money to state and local health departments since fiscal year 2006 to support their pandemic preparedness. We're going to need to replenish the stockpile for anti-flu drugs. We need to build our supply of masks and respirators."
In fact, some of that money was included in the economic stimulus bill passed by the House earlier this year. But it was removed at the insistence of a small group of Senate Republicans, who wanted to make the bill less expensive.
"Everybody in the room is concerned about the pandemic flu, but does it belong in this bill? Should we have $870 million in this bill? No, we should not," Sen. Susan Collins (R-ME) said back in February.
Collins' office on Monday issued a statement clarifying that she is a longtime backer of efforts to prepare the nation for a potential flu pandemic, and that her point was simply that she thought the funding should go through the regular budget process, not the fast-track stimulus bill.
The statement also chided the Obama administration for not filling top positions in the Department of Health and Human Services — and called on her colleagues in the Senate to "move promptly to confirm Governor Sebelius for HHS Secretary."