WASHINGTON — Signs of internal turmoil at the Food and Drug Administration are raising concerns among former agency officials as widely anticipated deadlines on COVID-19 boosters and vaccines for children near.
A high-stakes debate about whether the booster shots are necessary recently led to upheaval at the FDA’s Office of Vaccines Research and Review, namely the sudden sidelining of that office’s two most experienced regulators.
The drama comes amid a critical month for U.S. vaccine policymaking. FDA documents on COVID-19 boosters for Moderna and Johnson & Johnson recipients are expected to become public ahead of meetings of the FDA’s independent advisers on vaccines next week.
Other FDA briefing documents on vaccines in children 5 to 11 years old are expected before the independent advisers meet again on Oct. 26.
The chaos in the vaccines office also underscores the fact that, nine months into the Biden administration, the FDA lacks a permanent leader. The White House has yet to nominate a commissioner. Acting Commissioner Janet Woodcock, a longtime career official, has temporarily led the FDA since January.
“There are strong reasons we don’t just go by a company’s press release or a paper in a journal. There were times when I was at FDA that we would have different conclusions than even the best medical journal,” said Jesse Goodman, a Georgetown University biotech policy expert and former FDA chief scientist. “When it comes to something that turns from the conclusion of a scientific paper to public health policy for the whole United States in the space of a few weeks, that’s when we need to be really careful to get it right.”
Goodman criticized Woodcock for signing off on an announcement by President Joe Biden recommending booster shots for every American by the week of Sept. 20, a recommendation that put pressure on the FDA and appears to have been premature.
“It’s important not just to have a permanent commissioner but also a permanent commissioner who understands the importance of these scientific agencies,” he said.
Clearly Woodcock is a political tool. Who is being criticized for signing off on political games endorsed by Biden. And clearly Goodman is saying Woodcock is NOT qualified for the position she’s been gifted.
Dispute over boosters
Tensions rose when the FDA’s top vaccine reviewers, Office of Vaccines Research and Review Director Marion Gruber and Deputy Director Phil Krause, opposed the push to broadly offer third shots.
Their boss, Center for Biologics Evaluation and Research Director Peter Marks, supported the White House’s booster plan, but Gruber and Krause said immunity from two shots is durable for most people and that extra doses should be donated abroad. Gruber and Krause publicly announced their views in The Lancet and said they would retire later this year.
But last week, Marks, whose background is in cancer drugs, announced he would take over the vaccines office. The announcement came as a surprise, given that Gruber and Krause had previously announced they would stay on longer.
Machinations that clearly benefit big pharma.
The departures of Gruber and Krause will result in four vacancies among the 31 leadership positions in the vaccines office listed on the CBER website.
“Peter Marks is not a vaccine expert,” said Norman Baylor, president of Biologics Consulting Group and former director of the FDA’s vaccines office. “He doesn’t have the years of regulating vaccines or understanding vaccinology like Phil and Marion.”
Not a vaccine expert? That’s convenient for big pharma profits.
“If you’re a reviewer and you have a question, you have someone to huddle with who’s been in the trenches much longer on this subject matter. So it’s going to have an impact,” Baylor continued.
The news also rattled Goodman.
“While I had been disappointed that Dr. Gruber and Dr. Krause were going to leave the agency, I had been glad to see when that was announced that they were going to be there through this period where the booster and pediatric applications were being reviewed,” said Goodman, who once led CBER. “It was really unexpected when … the [CBER] director put himself in charge of that.”
‘Loss of expertise’
“It represents a loss of expertise that could help them on those issues. It’s also a little unusual that you wouldn’t appoint someone from within that discipline or within that office,” he said. “There are other experienced people.”
The depth of analysis the FDA can conduct on the question of whether booster shots are necessary has been a sore spot for the departing regulators.
Krause bristled in a Sept. 17 public meeting with Pfizer, complaining that the drugmaker had not turned over much of its data for independent number crunching.
Meanwhile, in order to determine whether immunity had waned, the FDA requested a study from Pfizer that compared clinical trial participants who had received a placebo and “crossed over” to receive a vaccine more recently with people who received the vaccine months earlier.
Goodman said Biden’s announcement that the U.S. booster program would begin during the week of Sept. 20, which occurred in advance of FDA decision-making, undermined the scientific review.
“Those data are being used without taking the days or weeks it would require for FDA to perform their own analysis,” Goodman added.
“That’s just horrible. I’m surprised people haven’t made more noise about that,” said Peter Lurie, president of the Center for Science in the Public Interest and former associate commissioner for public health strategy and analysis at the FDA, referring to the lack of FDA analysis on the Pfizer datasets. “The thing that sets FDA apart from all other drug regulatory agencies is the claim that it independently analyzes the data that comes from drug companies.”
The FDA did not respond to a request for comment.
Workload weakens morale
Krause’s criticism of Pfizer’s analysis occurred during a meeting of the FDA’s independent advisers, the Vaccines and Related Biological Products Advisory Committee, and may have influenced its members’ decision to reject booster shots for most Americans.
The vote helped shape the FDA’s decision to pare down Pfizer’s request for approval of its booster shot for Americans age 16 or older to an authorization for just the Americans most vulnerable to severe disease or infection.
Without Gruber and Krause on hand to ask critical questions in full view of the FDA’s independent advisers and the public, those gaps in analysis may not cause the same stir when it comes to booster shots for Moderna and Johnson & Johnson or shots for children under age 12 later this month.
Meanwhile, agency morale is strained under the intense workload, former FDA officials say.
A recruiter for the pharmaceutical industry, who did not want to be named to protect her job, said it is easier than ever to hire FDA employees who might have stayed in public service if not for the pandemic.
While disagreement among scientists on high-profile decisions affecting the public health of millions of Americans is expected, the level of dissent spilling into view may be unprecedented.
“This is unusual,” said Baylor. “There’s always internal debate and disagreement. But then you reach consensus. At least in the 20 years I worked there, that’s the way we worked.”
“There are many internal meetings and discussions and then you come out in lockstep with what the consensus is,” Baylor continued. “This seems like the gulf is so wide, there may not be consensus.”
So many question that beg asking about the vaccine approval aka rubber stamping process.
Keep in mind this previous report:
The United States has secured 400 million doses of the Pfizer-BioNTech and Moderna vaccines, enough for 200 million people, and is close to arranging 200 million additional doses by summer, with options to buy up to 500 million more. It also has advance purchase agreements for more than 1 billion doses from four other companies whose inoculations do not yet have U.S. regulatory approval.