As they confront the growing swine flu crisis, President Obama's administration is attempting to implement a never-before-tested pandemic response plan while dozens of key public health and emergency response jobs in the administration remain vacant.
The president has yet to fill 15 top positions at the health department or name a full-time director for the Centers for Disease Control and Prevention and five more nominations -- including that of former Kansas Gov. Kathleen Sebelius to be HHS Secretary -- are waiting to be confirmed by the Senate, officials at the department said.
The top post at the CDC remains open but is being filled by an acting director. And at the Department of Homeland Security, which is leading the federal government's response to the swine flu outbreak, the functions of nearly 20 senior-level posts are being temporarily performed by career civil service employees.
The government's medical response is being coordinated by a temporary team including acting CDC director Richard E. Besser, acting HHS secretary Charles Johnson, a Bush assistant secretary previously approved by the Senate, and Assistant Secretary for Preparedness and Response Rear Adm, W. Craig Vanderwagen, another Senate-confirmed holdover.
"Having the top 20 unfilled is a significant problem for the long term," said Michael Leavitt, the HHS Secretary under President Bush. He praised the work of the civil servants, but said the Obama administration "needs to give this priority. Vetted people need to be sent to the Senate. And the Senate needs to respond."
Immense challenges
An immediate pandemic outbreak would pose immense challenges to a presidential team operating without much experience and without a long-standing plan. A National Pandemic Strategy and Implementation Plan was developed in 2005 and 2006, but has never been fully tested.
In some ways, such a scenario would combine the test posed by the Sept. 11, 2001 terrorist attacks, which occurred eight months into the administration of former president George W. Bush at a time when many key Justice Department and intelligence positions were vacant, and Hurricane Katrina in August 2005, which struck just one year after a national response plan was overhauled.
"The fact is it didn't measure up," former Bush homeland security advisor Frances Fragos Townsend said in a Feb. 2006 review of the Katrina response, saying the confusing and overly bureaucratic National Response Plan "came up short."
Leavitt, who led the government's development of the pandemic plan following an avian flu outbreak in 2005, said the crisis needs to be managed at the federal level by health professionals, not homeland security officials.
"Without a Secretary of HHS, this will begin to be managed in ways that will be inconsistent with its nature," he warned in an interview Monday. "If you were managing this out of Commerce, it would all be about trade. If it were Treasury, it would all be about the flow of money."
White House officials dismissed questions Monday about the team confronting the potential pandemic. Press Secretary Robert Gibbs told reporters that he is confident that the administration is ready to handle the crisis.
"Our response is in no way hindered or hampered by not having a permanent secretary at HHS right now," Gibbs said. "Dr. Besser and thousands of people both at CDC and throughout HHS are responding to this . . . We feel confident with the team that is there now."
At the Department of Homeland Security, only two of 21 top political appointees have been confirmed by the Senate -- Secretary Janet Napolitano and her deputy, Jane Holl Lute.
Vacant positions include the department's assistant secretary for health affairs and chief medical officer, and the leaders of the Federal Emergency Management Agency, Transportation Security Administration and U.S. Customs and Border Protection, all of which would play significant roles in battling a pandemic.
Napolitano played down concerns about the empty seats in key positions, saying those roles are being filled by career civil servants "who have a great deal of experience. As far as I'm concerned the process, the work has been moving very smoothly and with great efficiency. And so I think we're moving right along."
Napolitano has taken charge as the Principal Federal Official in charge of the domestic response, even though under the national pandemic plan developed in 2006, a subordinate was predesignated to serve as the government pandemic response coordinator, U.S. Coast Guard Vice Commandant Vivien S. Crea. Likewise, FEMA has named principal and coordinating officers to respond to a pandemic outbreak in five regions, but they also have not yet been activated.
Trying to stay ‘two to three steps ahead’
A senior HHS official said the department has been able to do its job with 40 appointees who are not subject to Senate confirmation and career staffers, and is trying to stay "two to three steps ahead" of the unfolding situation.
For instance, officials on Sunday announced that they were deploying one-fourth of the antiviral drugs in the Strategic National Stockpile, beginning with states with confirmed cases and border states. On Monday they announced that all states would be given access and the entire stockpile would be depleted in seven days, by May 3.
HHS also announced that the Food and Drug Administration is working with CDC to waive regulatory limits to push out a swine flu diagnostic test to state and local public health laboratories by mid-week. Napolitano announced that the government will allow FDA to permit the distribution of drugs such as Tamiflu to populations they normally wouldn't, such as very young children. The latter two steps were made possible by Sunday's declaration of a national health emergency.
Napolitano said the U.S. government was preparing as if a full pandemic will be declared by the World Health Organization. "We are proceeding as if we are preparatory to a full pandemic," Napolitano said. "We don't know that a pandemic actually will occur, but because we want to make sure that we have equipment where it needs to be, people where they need to be and, most important, information shared at all levels."
Washingtonpost.com staff writer Ed O'Keefe contributed to this report.