C.D.C.’s Dr. Robert Redfield Confronts Coronavirus, and Anger
Abby Goodnough and
Dr. Robert R. Redfield, the director of the Centers for Disease Control and Prevention, was in the hot seat — again.
It was his third time testifying before a congressional committee in three days, and Representative Debbie Wasserman Schultz was demanding to know who in the government was responsible for making sure Americans with coronavirus symptoms got tested.
Twice, he started an indirect reply, but twice Ms. Wasserman Schultz, Democrat of Florida, cut him off.
“I just need a name,” she said. “Is it you?”
Dr. Redfield looked pleadingly at the slight, older man sitting next to him. “I think my colleague is indicating I should respond,” said Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, who proceeded to do so in the bluntest of terms.
“The system is not really geared to what we need right now,” Dr. Fauci told the lawmakers. “That is a failing. It is a failing, let’s admit it.”
As the exchange underscored, Dr. Redfield is not the most outspoken or magnetic of the Trump administration medical experts responding to the coronavirus pandemic. He is the portly, sometimes expressionless official standing off to the side in most of the televised briefings led by Vice President Mike Pence. When he speaks, he can sound plodding and overly technical.
Yet Dr. Redfield’s agency has had an outsize role from the beginning of the nation’s response to the global health crisis, and is coming under intense criticism for the delay in rolling out widespread testing for the virus in the states, which follows the agency’s botching of the initial test it shared with state laboratories last month.
It is a huge responsibility, one that some have questioned whether Dr. Redfield, a former military doctor and prominent AIDS researcher who had no experience leading a government agency when President Trump appointed him to run the C.D.C. two years ago — and whose cautious reserve has at times come off as timidity — is prepared for.
But increasingly Dr. Redfield has become the sole face of the C.D.C. in public hearings and briefings, and has faced wrath from elected officials in both parties who are demanding an explanation as the limited testing becomes a bigger concern. Many have also questioned why the C.D.C. initially set very narrow criteria for deciding who should be tested for the virus — only those who had a fever and breathing issues and had traveled from the outbreak’s origin in Wuhan, China — which most likely impeded early efforts to contain it. Many jurisdictions are still using restrictive criteria, largely because they are so low on test kits.
“Certainly this administration has been cited repeatedly for appointing people to important positions who did not have the relevant expertise,” said Chris Beyrer, an epidemiology professor at Johns Hopkins who has collaborated on research with Dr. Redfield over the years. “But you wouldn’t say that about Bob Redfield. He’s a very seasoned public health person, and he certainly has led significant scale programs.”
On Friday morning, as criticism of testing problems ballooned, the Department of Health and Human Services announced that Adm. Brett Giroir, the assistant secretary for health, would oversee and ramp up efforts by the C.D.C., the Food and Drug Administration, state and local public health authorities, and private laboratories to expand testing. Mr. Trump also tweeted criticism of the C.D.C., saying, “For decades, the @CDCgov looked at, and studied, its testing system, but did nothing about it.” He added that President Barack Obama had made the problem worse.
As the virus has spread across the country, Dr. Redfield has spent hours on the phone with Dr. Fauci, a longtime friend, as well as elected officials and state and local public health leaders, often deep into the night. And he has worked quietly, associates say, to preserve the morale of the C.D.C.’s 11,000 employees, including almost 700 who are in the field helping states and cities respond.
A conservative Republican, Dr. Redfield in less busy times attends Catholic Mass daily, walking the short distance from his home in Baltimore to the Cathedral of Mary Our Queen. Now, he splits his time between the C.D.C. headquarters in Atlanta, where he and his wife rent an apartment close to the campus, and Washington, where these days he is relentlessly summoned for meetings and hearings.
Dr. Redfield went through college and medical school at Georgetown University on full Army scholarships after his father, a scientist who worked on RNA at the National Institutes of Health, died young. He spent the first two decades of his career as an infectious disease specialist at the Walter Reed Army Institute for Research, focusing on AIDS research at a time when the disease was still poorly understood and spreading fast.
In the mid-1980s, he was at the center of a different testing controversy — about how extensively the military should test its members for AIDS and how it should use the test results it had compiled. Dr. Redfield advocated for widespread testing and tracking as the best way to prevent the infection’s spread, while others argued it was a way for the military to flush out or otherwise discriminate against gay members. Later, he was the subject of a military investigation after colleagues suspected that he overstated the therapeutic effects of an experimental AIDS vaccine; the investigation led to a correction in some published data, but no evidence of misconduct was found.
He retired from the Army in 1996 to co-found the Institute of Human Virology at the University of Maryland School of Medicine, where the goal is to discover and distribute treatments for chronic viral and immune disorders, especially H.I.V. When Dr. Redfield left the institute, his co-founder, Dr. Robert C. Gallo, called him a major force in establishing programs to confront the H.I.V. and hepatitis C epidemics in Baltimore and around the state.
He is credited with helping the institute increase its patient base to 6,000 in Baltimore and Washington, and to more than 1.3 million in Africa and the Caribbean, where he also helped with the medical response in Haiti after the 2010 earthquake. He formed close relationships with patients, and kept photos of some who died of AIDS in his early days at Walter Reed in his office for years.
In his first two years leading the C.D.C., Dr. Redfield helped persuade Mr. Trump to take on the ambitious goal of ending transmission of H.I.V. in the country by 2030, through expanded efforts to prevent infections and treat those with the virus. And he has been a vocal champion of efforts to address opioid addiction and overdose, even sharing with the nation that one of his own sons had nearly died of an overdose and that the family struggled to find him treatment.
Dr. Redfield’s initial compensation at the C.D.C. caused an embarrassing controversy shortly after he took office. After earning about $650,000 a year at the University of Maryland, he was hired at an annual salary of $375,000, substantially higher than his predecessors and his boss, the secretary of health and human services, Alex M. Azar II.
The exceptional pay was granted under a federal provision that the Department of Health and Human Services can use to pay an official more than the approved government rate if the person provides a specific scientific need that otherwise cannot be filled. The department said this was a rare chance to hire a leading virologist.
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But Dr. Redfield had actually sought the job for years. After Senator Patty Murray, Democrat of Washington, questioned the use of this exemption to pay him such a high rate, Dr. Redfield agreed to lower his salary to $209,700.
As the coronavirus crisis has grown, he has relied on the expertise of others in the sprawling agency, many of whom have been there for decades, including Dr. Anne Schuchat, the principal deputy director, and Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Disease, who has led frequent briefings for the news media.
Unlike his predecessor, Dr. Tom Frieden, a dynamic public speaker well versed in Washington political culture, Dr. Redfield has at times come across as a deer in the headlights, including during last week’s hearings. Some have questioned whether his strict adherence to rules and a chain-of-command approach, after decades in the military, may have impeded the rollout of national testing while other countries ramped up much faster.
Dr. Redfield has repeatedly said that the role of the C.D.C. is to provide testing to state and local health departments, which are supposed to do surveillance testing to gauge the extent of community spread, rather than to private-sector labs that provide on-demand testing of patients for hospitals and doctors’ offices.
But during a crisis, the C.D.C.’s role takes on more urgency — and speed becomes crucial. The agency is charged with developing a diagnostic test that is then reviewed by the F.D.A. Once the C.D.C. tests are approved, the agency manufactures them for its network of public health labs. At the same time, the tests are generally copied by commercial labs for use with patients around the country.
For coronavirus, the C.D.C.’s initial test kit was returned by numerous state public health offices, who said it was not working properly.
Dr. Redfield has still not explained what was wrong with the test kits. Numerous times, he has referred to the issue as a “manufacturing problem” that occurred when the contractors started scaling up to produce them en masse. But others involved in the matter say the problem was at the source, C.D.C., and that the agency waited too long to alert the rest of the public health community to the issue.
He has privately expressed frustration at the slow, bureaucratic process of permitting commercial and academic institutions to make their own tests — in which the F.D.A. plays a large role. But his public explanation, that the C.D.C. is not responsible for ramping up widespread commercial testing, has not been greeted sympathetically.
“I still don’t quite know why we are not taking the test that the rest of the world is using rather than making our own,” Senator Bill Cassidy, Republican of Louisiana, told reporters on a conference call on Thursday. “If there is ever a time to cut through red tape, now is the time to cut through red tape. I am not sure the extent the C.D.C. is doing that.”
Dr. Redfield is hesitant to make bold statements or requests — when Representative Ro Khanna, Democrat of California, asked in a hearing how much money he thought necessary to modernize and bulk up the nation’s public health infrastructure, he demurred, saying, “I’d have to get back to you.”
Some of Dr. Redfield’s supporters see his understated approach as an asset.
“My impression is that he is happy to have other people take credit even when he’s been behind the scenes doing a lot of work,” said John Auerbach, the president and chief executive of Trust for America’s Health, who has known Dr. Redfield for years.
Representative Tom Cole, Republican of Oklahoma, who has gotten to know Dr. Redfield since he took the helm at the C.D.C., called him “by any stretch a really admirable human being.”
“Clearly there is going to be a post-mortem of what happened on the testing front,” Mr. Cole said. “If anybody has a criticism, that is probably the biggest criticism. And where there are legitimate questions, that doesn’t mean that Dr. Redfield failed — but something went wrong.”