The Volokh Conspiracy

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A Booster Shoot For Presidential Administration

President Biden assures people booster shots will be widely available. And his CDC director overrules her agency's narrow recommendations.


A quarter century ago, then-Professor Kagan published her most influential work of scholarship, Presidential Administration. She explained "that President Clinton, building on a foundation President Reagan laid, increasingly made the regulatory activity of the executive branch agencies into an extension of his own policy and political agenda." Recently, President Biden gave presidential administration a booster shot.

Earlier this week, President Biden predicted that booster shots would become available "across the board." However, the CDC Advisory Committee on Immunization Practices only recommended boosters for older Americans, as well as people at higher risk of the disease. The Committee did not recommend boosters for health care workers, teachers, and others in high-risk positions. Yet, that same day, CDC Director Rochelle Walensky overruled her committee. The New York Times reported that the reversal was somewhat chaotic:

The C.D.C.'s statement arrived well past midnight, a sign of the complicated and confusing decision-making surrounding the boosters. The C.D.C. advisers similarly spent two days debating who should get boosters and when, and could not agree on whether occupational risk should qualify as a criterion. . . .

Minutes before Dr. Walensky's statement, Dr. Amanda Cohn, who oversaw the two-day meeting of the panel, tried to prepare the advisers for the director's decision.

"Dr. Walensky is reversing the decision to not recommend use of a booster dose in persons at high risk for occupational or institutional exposure," Dr. Cohn wrote in the email. "I am hoping to share this news with you before you see it in the press."

Dr. Walensky's decision to go against her own agency's advisers came as a surprise to at least some of her staff members: The C.D.C. director's endorsement of the advisory committee's recommendations is typically just a formality. Hours before her statement, agency insiders predicted she would stick with the usual protocol because doing otherwise would undermine the process and upset the advisers as well as her own staff.

Indeed, the Times suggests that Biden's comment may have put "pressure" on #FollowTheScience.

But Mr. Biden's public embrace of booster shots has rankled many in the public health sector, including those working inside the government, who say it could have the effect of putting undue pressure on scientists to make a recommendation they do not believe is supported by the evidence.

Some public health officials and doctors say they fear Mr. Biden — who has staked his presidency on successfully managing the pandemic — is pushing for boosters because they are politically popular.

The president's Friday remarks were the second time in two months that he had suggested boosters would be available to everyone. And they were issued on the same day that Dr. Rochelle P. Walensky, the C.D.C. director and one of the president's political appointees, came under fire for allowing boosters for a broader group of people than her agency's own immunization panel recommended.

Taken together, the announcements by Mr. Biden and Dr. Walensky did not sit well with all of the scientists who advise them, raising questions about the president's pledge to always "follow the science" as he fought the pandemic. While some of them credited the C.D.C. director for charting a course through uncertain waters, others warned that politics had intruded on scientific decisions — something that Mr. Biden had promised to avoid after the blatant pressures seen during the Trump administration.

"Everybody uses this statement 'follow the science' very glibly, and I think that the science here did not warrant picking out a group of people and saying that you may be at more risk for acquiring an infection," said Dr. Sarah S. Long, a member of the C.D.C.'s advisory committee, referring to the groups of workers who were made eligible for booster shots.

Dr. Long, who is a professor of pediatrics at Drexel University College of Medicine, said that a president telegraphing his opinion before the formal public health process undermined the expert advisers, calling it a violation of the "checks and balances" built into the system. She also criticized Dr. Walensky for expanding the number of people eligible for the boosters.

Checks and Balances! More like Presidential Administration. The accountable President is in charge. Not an obscure panel of scientists.