The Government Accountability Office (GAO) announced last week that it would review whether the CDC’s and FDA’s scientific integrity and communications policies have been violated, as well as whether those policies are being properly implemented to assure scientific integrity throughout the agencies. The review is being conducted at the request of several U.S. Senators “in light of public reports that the Trump Administration has improperly exerted political influence on the CDC and FDA” since the onset of the COVID-19 pandemic.
As Senators Elizabeth Warren (D-MA), Gary Peters (D-Mich), and Patty Murray (D-WA), told the GAO in their request:
The CDC’s and FDA’s independence as scientific agencies is crucial to safeguarding the public health and saving lives. These agencies must be able to develop, review, and disseminate public health data, guidelines, and other information that are based on science, facts, and medical principles – not the political imperatives and moods of a president and his advisors.
Yet, they charge that
the Trump Administration has reportedly pressured the CDC and FDA throughout the COVID-19 pandemic, repeatedly applying political pressure and imposing orders on career scientists that undermine the agencies’ credibility and independence.
Citing reports from major media organizations, agency announcements, and Mr. Trump’s Twitter account, the Senators’ letter catalogued numerous instances of putative political interference in CDC and FDA decision-making, interference they say “seeds confusion, erodes public confidence, and diminishes the agencies’ credibility”. (SBM’s David Gorski lamented this erosion of trust in a recent post, “In the age of COVID-19 pandemic, can we trust the CDC and FDA anymore?“, citing a number of the same public reports relied upon by the Senators in their request to the GAO.)
Offenses against scientific integrity on the Senators’ list include:
- The White House’s allegedly overruling CDC officials who wanted to recommend, in March, that elderly and physically fragile people not fly on commercial airlines due to the coronavirus.
- Reported interference, in April, by Vice President Pence, and again by the White House this month, in an extension of the CDC’s “No Sail” order prohibiting cruise ship voyages, despite evidence that cruise ships have been a major source of outbreaks.
- The Department of Health and Human Services (HHS, of which the CDC and FDA are a part) political appointees’ reported “significant efforts to edit, water down, and caveat CDC’s Morbidity and Mortality Weekly Reports”.
- In May, the White House’s blocking the publication of the CDC’s “Opening Up America Again Framework”, eventually published only after the White House required substantive changes.
- HHS officials accusing the CDC of “undermining the President” when it released information on pregnant women and COVID-19.
- HHS political appointees excoriating a CDC official for remarks she made about the U.S. needing to take its virus response seriously, accusing her of being “duplicitous” and undermining the President.
- In July, the White House ordering the CDC to stop collecting certain COVID-19 data, “instead filtering the data through a third-party contractor at HHS” resulting in “significant issues with the quality, completeness, and transparency of data”. [Although it was not cited in the list, NPR has reported on apparent irregularities in HHS’s awarding the contract and the contractor’s financial connections to Mr. Trump.]
- Mr. Trump and Mr. Pence exerting “considerable public pressure on the CDC to revise its guidelines for schools”. This resulted in new guidance, which the White House reviewed and substantially edited.
- The appearance of “highly-criticized” testing recommendations for asymptomatic patients (since reversed) on the CDC website, not written by CDC scientists but dropped there by HHS, “flouting the agency’s strict scientific review process” and containing “elementary errors”.
- The FDA’s Emergency Use Authorization (EUA) for hydroxychloroquine (since revoked), a drug highly touted by Mr. Trump for COVID-19 but widely criticized for lack of quality evidence.
- In August, Director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, and National Institutes of Health head Dr. Francis Collins reportedly voiced concerns that data did not support the FDA’s EUA for convalescent plasma and the authorization was put on hold. Mr. Trump called Dr. Collins and told him to “get it done by Friday” and suggested to reporters that the FDA wanted to limit its use until after the election. On August 23, the FDA issued an EUA for convalescent plasma.
- HHS Secretary Alex Azar allegedly overruling the FDA when he revoked the agency’s ability to regulate lab-developed diagnostic tests, including COVID-19 tests.
- In August, Mr. Trump made a “clearly spurious” claim that the “deep state” at the FDA is delaying potential COVID-19 treatments and vaccines until after the election.
- After remarks by the lead career official in charge of FDA vaccine review suggested that the FDA’s forthcoming guidance will set a higher bar for a vaccine EUA, Mr. Trump said it “sounds like a political move” and that the White House “may or may not” approve the guidance. After a news report that the White House had actually blocked the guidance, the Administration reversed course.
The review is grounded in the GAO’s jurisdiction to investigate and evaluate, at the request of Congress, federal programs and activities, and provide “information, analyses, options, recommendations, and other assistance to help the Congress make effective policy, funding, and oversight decisions”. The GAO has already issued three reports on the federal government’s response to the pandemic, the most recent of which criticizes the CDC on an issue raised by the Senators’ letter — guidance on reopening schools:
Portions of CDC’s guidance on reopening K-12 schools are inconsistent, and some federal guidance appears misaligned with CDC’s risk-based approach on school operating status. CDC should ensure that its federal guidance on reassessing schools’ operating status is cogent, clear, and internally consistent.
In this case, authority for the GAO review is grounded in the CDC’s and FDA’s policies on scientific integrity and the premise that those policies are being violated by the Trump Administration. According to the request, the CDC’s “Guidance on Scientific Integrity” requires that CDC employees “affirm a commitment to ensure that research and services are based on sound science, meet real public needs, and help achieve public health goals” and states that the “CDC has a responsibility to conduct the best science and is committed to disseminating scientific findings and results without being influenced by policy or political issues”. Likewise, according to the FDA’s policy on scientific integrity, the agency promotes an environment where “scientific decisions are protected from political influence”. The FDA policy requires “shielding the agency’s science and its scientific staff from political influence” and “maintaining a firm commitment to science-based, data-driven decision-making” and is “committed to a culture of openness with the media and public that values the free exchange of ideas, data and information”.
The GAO is asked to audit the implementation of these policies and “understand the extent of any undue political influence at the CDC and FDA”, an issue which raises “a larger concern about independence of CDC, FDA, and other public health agencies”. It is also asked to identify “current structures . . . in place at these agencies to allow them to independently carry out their missions” and recommend “additional structures or steps . . . to enhance the agencies’ abilities to independently carry out their missions, free from political influence”.
The review will not happen quickly. According to the GAO, “the required skills will be available to initiate an engagement in about three months”.
Interestingly, in a poll just out, 36% of respondents said they trusted health officials’ COVID-19 information at agencies such as the CDC and FDA, with 26% saying the same about their state or local governments. Sixteen percent trusted information from Mr. Trump “a great deal or quite a bit”.
Meanwhile, the revelations continue. A day before the GAO’s letter agreeing to the review, Pro Publica published an extensive exposé of the CDC’s failures during the coronavirus pandemic headlined “Inside the Fall of the CDC“. It reports the White House’s rejection of the CDC’s guidance on reopening houses of worship, including elimination of a warning about the dangers of singing. Part of the Administration’s meddling included a call from the Vice President to a CDC infectious disease expert, telling him that the White House’s edits to the guidance were not optional and the CDC’s failure to use them was “insubordinate”.
On October 14, Science ran its own in-depth news report on plummeting confidence in the CDC, titled “The inside story of how Trump’s COVID-19 coordinator [Dr. Deborah Birx] undermined the world’s top health agency”, including the charge from CDC insiders that Dr. Birx “flouted science and undermined the agency to placate the president”. As well, CDC head Dr. Robert Redfield “has quietly complied with many of the administration’s demands”.
According to Science, many CDC execs and professionals plan to leave the agency if Trump is re-elected as public confidence in the agency has eroded.
In 2015, CDC was viewed favorably by 70% of the public, the highest for any agency measured. But in March, the percentage of the public that held a “great deal” of trust in CDC dropped to 46%. In September, it was only 19%.
Also last week, The Wall Street Journal [paywall] and Axios [free] reported that an open letter from current and former CDC Epidemic Intelligence Officers, first published in May, topped 1,000 signatures. The letter begins:
We hereby express our concern about the ominous politicization and silencing of the nation’s health protection agency during the ongoing COVID-19 pandemic. In previous public health crises, CDC provided the best available information and straightforward recommendations directly to the public. It was widely respected for effectively synthesizing and applying scientific evidence from epidemiologists and biomedical researchers at CDC and worldwide. Its historic credibility was based on incomparable expertise and 70+ years of institutional memory. That focus and organization is hardly recognizable today.
Saying the “absence of national leadership on COVID-19 is unprecedented and dangerous”, the signatories “urgently call upon the American people to demand and our nation’s leaders to allow CDC to resume its indispensable role”.
All of this was before Mr. Trump, this week, called Dr. Fauci a “disaster”, claiming that people were “tired” of hearing about the virus from Fauci and “these idiots, all these idiots who got it wrong” and complaining that Fauci “loves being on television” and has made “a lot of bad calls”.
A GAO investigation into improper political influence at two of the nation’s top scientific agencies may be the least of Mr. Trump’s worries, but hopefully it will result in new safeguards against politicians meddling in science, part of a larger effort to mend the guardrails of democracy this Administration has all too easily blown through.
Note to Readers: If you are eager to learn more about the government’s COVID-19 mismanagement you can follow along on American Oversight’s COVID-19 Oversight Hub.