Kennedy shows minimal engagement with vast health portfolio

WASHINGTON — Shortly after the World Health Organization declared the Ebola outbreak in Africa a public health emergency, a reporter asked Health Secretary Robert F. Kennedy Jr. if he was worried about the virus. Six Americans had already been exposed. His response was brief: “Yeah, we’re working on it.”

In the nearly three weeks since, as the Centers for Disease Control and Prevention imposed travel restrictions to keep the virus from coming to the United States, Kennedy has made no public comments about the spreading outbreak. He has received few briefings about the virus from CDC scientists, although he speaks daily to the acting director, according to people familiar with his response.

Kennedy’s approach to the crisis reflects his broader management of the Department of Health and Human Services, which affects the health of 340 million Americans and provides health care to 40 percent of the population through Medicare and Medicaid.

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Kennedy has shown little interest in managing the details of work in his department, according to multiple colleagues. Instead, they say, he is single-mindedly focused on his top priorities, including food recommendations and pesticide exposures, and hunting for evidence to support his long-held beliefs that vaccines are harmful.

Deeply mistrustful of career civil officials, the secretary has surrounded himself with a close circle of handpicked advisers and stacked agencies with political appointees aligned with his views. While major posts have sat vacant and a wave of veteran health experts and scientists have departed, Kennedy has remained isolated from much of the department’s top staff.

He rarely engages with members of Congress, colleagues said, unless he is asked to testify. He has made just one known visit to the CDC, after a gunman opened fire on its headquarters and killed a police officer last August.

This examination of Kennedy’s leadership style is based on the accounts of a dozen people who have had direct contact with him as secretary, as well as other health department employees, all of whom spoke on the condition of anonymity to avoid retribution.

Kennedy and the department did not directly address questions about his leadership style.

The secretary’s detachment from much of the work of the agency, along with the administration’s deep staff cuts and his attacks on career staff, have driven down morale, they say. It’s a dynamic that could threaten the department’s ability to protect Americans in a crisis, according to public health experts and former secretaries.

Critics say one of the most urgent problems is Kennedy’s failure to act more swiftly to address a leadership vacuum. There is no surgeon general. About half of the 27 institutes and centers at the National Institutes of Health are run by acting directors. The acting chief of the National Institute for Allergy and Infectious Diseases was recently fired, as was the nation’s top drug regulator.

The leader of the Food and Drug Administration quit last month under pressure over tobacco policy. Kennedy fired the CDC director last August; it is now run on an acting basis by Dr. Jay Bhattacharya, who has another huge job as director of the NIH.

“You would never accept a major corporation operating this way,” said Michael T. Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, who has advised health secretaries of both parties.

“If the CEO lacked deep expertise in the company’s business and the leaders of its most important divisions were missing, investors would revolt,” Osterholm said. “Here, the stakes are much higher. The mission is protecting the health and safety of the American people, and we’re confronting serious disease threats without permanent leadership in some of our most important public health agencies.”

To address the management gaps, the White House and Kennedy initiated a shake-up in February, elevating Christopher Klomp, a department official and former health care executive, to serve as the secretary’s chief counselor and smooth out operations. In a statement, Courtney Spencer, who left the Labor Department two weeks ago to become Kennedy’s top spokesperson, said the health department was “aggressively recruiting top talent to fill every remaining vacancy,” adding, “Nothing has slowed our ability to execute.”

Kennedy’s allies say that while his management style may be different from that of his predecessors, he is leading in other ways by taking stands on matters of importance to Americans, including healthy eating and tackling chronic disease.

“You do not come to Washington to challenge powerful interests, disrupt decades of business as usual, and demand accountability to make friends,” Dr. Mehmet Oz, director of the Centers for Medicare and Medicaid Services and a close ally of Kennedy’s, said in a statement provided by the health department. “You do it to deliver results.”

Other advisers say Kennedy is also running into the realities of Washington, including a Congress that has refused to confirm some of President Trump’s nominees.

“Very predictably, you get into governing, you get into a toxic political environment, and a situation where there’s trillions of dollars of interest and you have the burden of having to do policy,” Calley Means, a close adviser to Kennedy, said at a recent forum hosted by Harvard University. “Nobody executes perfectly.”

Kennedy keeps a low profile at the health department’s headquarters, a hulking building that faces the National Mall near the US Capitol.

When he is in town, he exercises at his gym before work, then usually arrives at about 10 a.m. and leaves by 4 p.m., his colleagues say. He spends much of his day in closed-door meetings, according to those who work with him, and has little direct engagement with his staff.

Every Tuesday at 10:30 a.m., the chiefs of the department’s 13 operating divisions gather in the secretary’s suite to update leadership on their activities. At the outset of his tenure, Kennedy was rarely there, either virtually or in person, according to three people familiar with his schedule. Since Klomp’s elevation, he now shows up once a month. But when he does attend, he often appears disengaged and spends the time scrolling on his phone, according to people in attendance. Several described him as “checked out.”

Once, when he arrived to the meeting 15 minutes late, Kennedy offered a self-deprecating apology, according to one person in the room: “Thank you for putting up with my dysfunctional self.”

Health department officials did not respond to a request for comment about the meeting or Kennedy’s remark.

His lack of interest in matters that are not high on his priority list has meant that he has not engaged at critical moments, colleagues said.

Susan Monarez, who briefly served as Kennedy’s CDC director before she was fired, had little direct interaction with the health secretary until she ran afoul of him on vaccine policy. She later told senators that during a series of tense meetings with the secretary, she was “directed to only work with the political appointees that he had put in place at CDC, and not to speak or work with the career scientists.”

Under any circumstances, the Department of Health and Human Services is difficult to run. It has 13 operating divisions covering a vast array of issues, such as child welfare and pandemic preparedness. Past secretaries from both political parties say there are three main ingredients for success: understanding the work of the divisions, strong crisis communication, and muscular coordination with state, local, and international health leaders.

Tommy G. Thompson, who as health secretary to President George W. Bush faced complaints about his management of the 2001 anthrax crisis, spent a week at each one of the operating divisions at the outset of his tenure, and made frequent trips to Capitol Hill to advocate for the department. In an interview last year, he said he “would strongly suggest” Kennedy do the same.

“The department is so vast and so complex,” Thompson said, “and you have to be prepared.”

This article originally appeared in The New York Times.