In times of public health crisis, leadership is critical — not just from our elected officials, but also from the heads of the health institutions that help shape our understanding of, and response to, public health threats. So it’s concerning that soon two key institutions — the US Food and Drug Administration and the National Institutes of Health — could both be without their top leaders.
At the end of this year, the NIH director Francis Collins will step down after ensuring stability at the agency under both Democratic and Republican presidents for 12 years. His successor, once nominated, must be confirmed by the US Senate at a moment in which the nation is politically and ideologically fractured, particularly on matters of population health. Meanwhile, the FDA has been without a commissioner since the start of the President Joe Biden’s administration. Dr. Janet Woodstock has served as acting commissioner since January 20, but, per the Federal Vaccines Reform Act of 1998, her term limit is 300 days. This gives the administration until mid-November to appoint a permanent commissioner before the institution will be without a top leader. The US has made great strides in addressing the Covid-19 pandemic. But we can blow it all, in both the short and long term, if the Biden administration fails to move quickly to fill this key position at the FDA and prioritize stable leadership across the NIH to create a unified national approach capable of both crisis response and routine public health readiness. With a national decline in new daily cases and the relative stabilization in hospitalizations and deaths, the immediate crisis of the fall is managed. It is also a moment of peril. In response to different regional conditions as we move indoors and the pandemic intersects with seasonal influenza, Covid-19 control and mitigation strategies will likely differ for both sound scientific reason and deeply problematic political interference with protective public health measures, sowing confusion and exasperation. And there is the threat of failing to address the underlying structural conditions that create profound health disparities both nationally and globally. This is where having a reliable leader to make decisions, implement a plan of action, communicate it publicly and see the plan through is key.
