DAVE DAVIES, HOST:

This is FRESH AIR. I'm Dave Davies in today for Terry Gross. Perhaps no issue is more critical to the outcome of the presidential election than the COVID-19 pandemic, and much depends on public perceptions of the Trump administration's handling of the crisis. Our guest, Politico reporter Dan Diamond, recently reported that politically appointed Trump loyalists in the government had demanded the right to review and seek changes in weekly scientific reports by the Centers for Disease Control and Prevention on the status of the coronavirus outbreak.

The revelation drew harsh criticism from public health experts and prompted the departure on leave of the key official involved in the effort. That story was one of many investigative articles Diamond and his colleagues at Politico have written about efforts at the Department of Health and Human Services to present a positive spin on the administration's policies, including spending millions of dollars on communications consultants with ties to the Republican Party. Dan Diamond investigates health care politics and policy at Politico. He authors a daily online digest of health, politics and policy news called Politico Pulse. And he hosts the podcast "Pulse Check" which features conversations with lawmakers, leaders and thinkers. He spoke to me from his home in Washington, D.C.

Dan Diamond, welcome back to FRESH AIR. Let's talk about this big story that you had. You wrote a piece - I guess a little more than 10 days ago - that politically appointed officials in Department of Health and Human Services were seeking to review and edit COVID-19 reports issued by the CDC. First of all, what are these reports? What's the normal procedure governing their production and release?

DAN DIAMOND: These reports - the Morbidity and Mortality Weekly Reports - are created by career scientists inside the Centers for Disease Control. And these are treated like sacred texts. I spoke to officials who worked in the Obama administration, who worked in the George W. Bush administration. And the protocol was that these reports arrived with virtually no interference from political appointees. Maybe there was a little grumbling about what day a report might be released, but the idea that political appointees might want to go in and change the documents, to edit what the scientists had written, that is a major departure from where the process has been.

DAVIES: Right. Now, the key figure here was Michael Caputo, who was appointed the chief communications official for the Department of Health and Human Services. Tell us about Michael Caputo.

DIAMOND: Michael Caputo is someone with a complicated and unusual back story. He is a longtime Republican communications operative. He is not someone who had a medical or scientific background before being abruptly installed as the health department's top spokesperson five months ago. What he did have was a longtime friendship with President Trump. And he was also very close to Roger Stone, the president's ally.

And when my colleague Daniel Lippman and I broke the news back in April that Mr. Caputo would be the top spokesperson at the health department, it came as a shock to many political appointees at HHS who did not know that he was coming. The Cabinet secretary of the department, Secretary Alex Azar, had not been the driver of that decision. So Mr. Caputo walked in the door of the health department in the middle of this once-in-a-century pandemic having been personally recruited by the president. And the goal was very much to execute the president's agenda and to knock down any messaging, any communications that were seen as conflicting with what President Trump was saying about coronavirus.

DAVIES: So we have a circumstance here where a Cabinet official who typically appoints their own senior staff discovers that the White House has told - this is your new communications guy.

DIAMOND: Yeah, it doesn't normally work that way, Dave. The Cabinet secretary runs usually his or her own fiefdom. And to have a very senior person come in like this with virtually no warning and also with his own communication, his own line to the president - highly unusual, except for maybe in the Trump administration, where we've seen this more often than any administration I can recall.

DAVIES: Caputo has quite an interesting background. He worked in Russia for a while, right?

DIAMOND: He did. He worked in Russia. He advised former President Boris Yeltsin there. He did connect with Donald Trump over the possible purchase of the Buffalo Bills at one point. He was the driver to Roger Stone, the longtime operative and friend of the president. And he was involved in the Trump campaign in 2016 before being ushered out after tweeting about the removal of Corey Lewandowski. But he's someone that the president has kept close. And when Mr. Caputo was suffering financial trouble earlier this year, the president personally reached out with the offer to be the health department's spokesperson.

DAVIES: He brought in an adviser named Paul Alexander as a scientific adviser. A little curious that he would need to bring in someone from the outside to the Department of Health and Human Services, which is rich with scientific expertise. What did Paul Alexander bring to this?

DIAMOND: You're not wrong in that the federal government has so many scientists. I was talking to a former Bush official who said, if I ever needed scientific advice, I didn't need to bring in my own person. I would just call up Francis Collins at NIH or Tony Fauci. But Michael Caputo had made a friend, Paul Alexander, who appeared on his radio show. Mr. Alexander is a part-time professor at McMaster University in Canada, where he studies health research. He's not a doctor himself but has studied the scientific method. And Caputo brought him in as someone who would personally counsel him on what researchers around the health department were saying, and also to use Mr. Alexander as a cudgel, to unleash him on scientific experts around the government that Mr. Caputo disagreed with.

Paul Alexander would get into extended email battles with top officials - or not just battles, chide them, try to muzzle them. My colleague Sarah Owermohle reported a few days before I wrote my story that Paul Alexander was trying to muzzle Tony Fauci, the infectious disease expert, for speaking about the risks of coronavirus to children. He didn't want Tony Fauci to talk about this in public. Paul Alexander also spent months battling with the CDC over what he thought were efforts to undermine President Trump in the literature or in some of the statements that the CDC was making.

DAVIES: Was he successful in muzzling Fauci from speaking about infection among kids?

DIAMOND: Fauci is a very difficult person to muzzle, so Dr. Fauci has continued to proclaim what he believes to be the science here. But I do think that the effort of someone in the communication shop to try and stop top scientists from speaking about the science - that's highly irregular. And the fact that it would be this new hire that Michael Caputo brought in from McMaster University in Canada, I think that just underlines the unusual nature of where we are, Dave.

DAVIES: OK. So what exactly did you learn about these efforts to manage the CDC's Morbidity and Mortality Reports on the COVID-19 epidemic?

DIAMOND: Mr. Caputo and his aide, Paul Alexander, believed that the scientists at the CDC were either burying data points within these reports that would conflict with what the president was trying to say about the coronavirus or that the scientists were being too pessimistic overall, that they weren't lining up with the president's more optimistic take about the state of the pandemic. There was a report about the spread of coronavirus at a Georgia summer camp that caught their ire. And they wanted caveats added to stress that maybe the people who got sick with coronavirus, it was because of their own behavioral decisions, that they didn't do enough to protect themselves.

The issue with this, Dave, is once you start telling the scientists how they should do the science and when the people doing the telling are people in the public affairs shop, it starts raising the question of, where does the science end and the spin begin? The public affairs shop was successful in slowing down some of the reports, including one on hydroxychloroquine, a report about the malaria drug favored by President Trump. They were successful, I understand, in adding a few caveats or changing the messaging a bit around the release of some of the bulletins. But at the same time, they weren't successful in their ultimate goal, which was to either edit all the reports before they were released to the public or even stop the reports from going out until Paul Alexander could be the person making decisions on what would be in each report.

DAVIES: How did the career staff at the CDC respond to these efforts?

DIAMOND: The career staff at CDC, Dave, have been beaten down in 20 different ways since the start of this pandemic. At times they've been attacked by President Trump as as a group that he said has failed on the response. There have been senior officials who have been sidelined for things that they've said or things that they've written. So I think it's important to look at this in the context of the broader response and how CDC by the summer was already dealing with various encroachments from the White House and scrutiny from political appointees. Now, that's not to say that CDC got everything right. The agency did botch the rollout of a coronavirus test back in February. Had that test worked, there's a good argument that the outbreak would have been caught earlier, that the entire shape of the response would be very different today.

There are officials who have been punished by the White House for speaking out when they were speaking the truth but maybe they were saying their warnings at a time that came as a surprise to top political appointees. So there have been real tension points for a long time. But I do think that this was a red line for obvious reasons. And some career officials and political appointees at CDC did raise concerns. They tried to play down the demands and requests from Caputo. But when you're in the middle of a fusillade of emails and berating and bullying, it's understandable, I think, that CDC officials were looking for compromises. And one of those compromises was to give the political appointees more heads-up time on what was coming - maybe not with every report, but they bowed to some of the pressure with some of the reports.

DAVIES: All right. We're going to take a break here. Let me reintroduce you. Dan Diamond investigates health, politics and policy for Politico. We'll talk more after this short break. This is FRESH AIR.

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DAVIES: This is FRESH AIR, and we're speaking with Dan Diamond, a reporter who investigates health, politics and policy for Politico. He and his colleagues have done many stories in recent weeks about political influence being exerted on health policy in the Trump administration, including efforts to edit scientific reports from the Centers for Disease Control and Prevention, the CDC.

So when you did this story about efforts by Michael Caputo - the political appointee - and others to, in effect, review and edit the weekly reports from the CDC, how did independent public health experts react?

DIAMOND: With shock and horror. These reports are a cornerstone of how public health is done in America and around the world. These reports have been around for decades, not just about coronavirus but offering updates on the spread of other viruses, diseases. The emergence of HIV was chronicled in 1981 MMWR. Dr. Tony Fauci has said he read that report 40 years ago almost, and that changed his career. It set him on the path that he's on today.

So the idea that a political appointee, let alone an appointee like Michael Caputo who comes out of communications and not a medical and scientific background, that he and his team would be influencing the content of those reports? That was a line that provoked anger and frustration in the public health community writ large and also gave within the health department - there were Trump political appointees who told me that for all their support for how Michael Caputo has been their bulldog, their combative spokesperson defending the agency, defending the department, this was something that many officials themselves were not comfortable with.

DAVIES: And, of course, congressional Democrats were outraged. Many called for the resignation of Alex Azar, the secretary of Health and Human Services. As all of this was erupting, Caputo posted a Facebook video which has since been taken down. I mean, you can find it if you look for it. And I wanted to ask you about it. But first, I thought we would listen to about a minute and a half of this. It's pretty long. But this is a section of Michael Caputo, the spokesman for the Department of Health and Human Services who is now on leave, talking about the crisis surrounding the revelations of his seeking to alter or potentially alter the scientific reports from CDC. Let's listen.

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MICHAEL CAPUTO: I'm under siege. It's been going on for a couple of weeks. And I don't care because I have the president's support. I know that because he's told me so. They're after me for two reasons. I want to tell you what they are so you understand and you understand that I'm not going anywhere. They're going to have to kill me, and unfortunately I think that's where this is going. The partisan Democrats, the conjugal media and the scientists, the deep state scientists want America sick through November. They cannot afford for us to have any good news before November because they're already losing.

Donald Trump right now, if the election were held today, would win - not by much, not by much. And I want to talk about that for a minute. But he would win. And that's why Kamala Harris is out there talking like an anti-vaxxer. I know some people on my feed are against vaccines, and I encourage you not to get one if you don't want one. I encourage you to follow freedom anywhere it leads. But I'm going to get a vaccine. In fact, as assistant secretary of health, I'll be one of the first ones to get a vaccine. And I know it's safe because I'm involved in its development - not as a - you know, just watching it closely.

And let me tell you something - there is tons of positive news out there about this pandemic, and the Democrats can't have it. Their conjugal media can't have it. And there are scientists working for this government who do not want America to get better. Did you hear me? There are scientists who work for this government who do not want America to get well, not until after Joe Biden is president. It's a fact. I know it because I've heard it.

DAVIES: And that is part of a Facebook video from Michael Caputo, the spokesman for the Department of Health and Human Services - now on leave. Our guest is Dan Diamond, reporter for Politico, who has written about efforts by Caputo to review and potentially edit reports from the CDC. Dan Diamond, what else should we know about what's on this video? It's pretty long.

DIAMOND: (Laughter) I think it's an unusual video. But at the same time, one of the only unusual things about it is that Mr. Caputo was caught saying this into a camera. These are things that he believes, he's said privately. He's continued to repeat them despite being on medical leave. And this is the distillation of what President Trump and a number of his key supporters in the government believe, that the federal bureaucracy, particularly scientists at the CDC and others across the health department, are not doing everything they can, in they're telling, in their belief, to help fight the pandemic and that they are trying to slow the response because they have political concerns about the president.

Again, my team at Politico, we have found no evidence of this deliberate slowing. But I do think that the president and his team believe they're at war with these career officials. Often when the president has attacked the CDC or overruled career officials, the guidance has found its way into the public anyway and leaks to the media. And that's why Mr. Caputo and the president and others in that orbit believe that they're battling with their own health department even as Mr. Caputo is publicly representing the health department as its top spokesperson.

DAVIES: You know, in the video, which goes on a while, does he also say that there's a - that there could be armed insurrection after the election if Trump loses?

DIAMOND: He does say that, Dave. The video hits on a number of things well beyond Mr. Caputo's role as health department spokesperson. He talks about the possibility - essentially, a violent civil war after the election. He alleges that the clashes around the country, the protests that have happened in major cities with the antifa groups, he calls them hit squads that are training for future work, especially if there is a clash around the election. Again, no evidence to suggest this. But this is part of the theory that has emerged on the right that the nation is girding for major conflict. And it's well beyond the work that he's done at the health department.

DAVIES: So at some point in this controversy, you reported that Caputo had a meeting with staff at the Department of Health and Human Services to apologize. What did he apologize for? What did he say?

DIAMOND: That's right. So a few days after our report on Friday about the CDC meddling and a day or two after the Facebook Live video, my colleagues, Adam Cancryn, Sarah Owermohle and I reported that Mr. Caputo said, I'm sorry. This is not something that the health department spokesperson should say in public. This could hurt the Trump administration's response to the vaccine development. I don't want to distract from all the good work that we're doing around the health department. And also, I may need to take medical leave. He said that he was dealing with personal health issues that had cropped up, that it caused him some stress and that, perhaps, it was time to step away to deal with his health, which also coincided with the period of scrutiny that was coming now on his comments and on his actions.

DAVIES: Right. And he does refer in the video to struggles with his physical health and, he says, his mental health - doesn't really explain much more. So he did depart - under what circumstances?

DIAMOND: Mr. Caputo, about a week ago, took a 60-day medical leave. Now, that's notable for a few reasons, Dave. First, he's only been at the department for five months. So to be at the department for a handful of months and then to leave for a handful of months, I can't think of anything quite like this before. Secondly, this means that Mr. Caputo will be not at the health department through the election. The medical leave will end after the November 3 election. And there's some question about whether he'll even return.

But there are a number of efforts that were underway that he helped launch or that he was playing a major role in, including the Operation Warp Speed rush to develop a vaccine. That was one of Mr. Caputo's pet projects, to handle the communications around that effort. He won't be around to work on that. And I think that has changed the dynamic of the communications coming out of the health department just in the past few days.

DAVIES: And his scientific adviser, Paul Alexander, is he still around?

DIAMOND: Paul Alexander left the health department the same day that Mr. Caputo took medical leave. He was an odd fit. Paul Alexander, his only champion really was Michael Caputo. No Caputo, No Alexander.

DAVIES: Let me reintroduce you here. We're going to take a break. Dan Diamond covers health politics and policy for Politico. We will talk more after this short break. I'm Dave Davies. And this is FRESH AIR.

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DAVIES: This is FRESH AIR. I'm Dave Davies, in today for Terry Gross. We're speaking with Dan Diamond, who investigates health politics and policy for Politico. He's written many stories about the efforts of political appointees of the Trump administration to put a positive spin on their handling of the coronavirus pandemic, including seeking to review and change scientific reports produced by the Centers for Disease Control and Prevention.

So Mr. Caputo's gone, but things are hardly quiet in the government's health agencies. A couple times within the past week or so, the Centers for Disease Control has issued some statements or guidance related to COVID-19 and then kind of reversed field, right? You want to explain these and tell us what's going on?

DIAMOND: Sure. The CDC, which plays a major role in responding to disease, trying to prevent it - it's in the agency's own name - controlling and preventing diseases. The CDC has been issuing guidance across the pandemic on how the nation should be responding to the threat of COVID-19, whether that's guidance around mass gatherings or the reopening of businesses or even how COVID-19 itself spreads. And there's been a major debate over whether the virus spreads via airborne transmission.

The CDC has bounced back and forth several times on whether this is a major vector of transmission. The CDC updated its guidance over the weekend, suggesting that the virus can travel through the air, that indoor ventilation is essential to making sure that Americans do not contract COVID-19. But by Monday morning, the agency was already backtracking, pulling that guidance down, saying that it'd been posted in haste and putting up then an edited version of the guidance that was more cautious about how the virus was spreading.

And, Dave, I think this is part and parcel of the political constraints around CDC that we've seen for months. The agency has been hemmed in when it has tried to issue these guidances (ph). Often, they're being edited by multiple parts of the federal government. Sometimes the edits are being made to other edits, I've been told. And that can create a process where it's not clear when the guidance is done, when it's ready and whether the CDC has ultimate authority at times over its most dire warnings. This has been something that's been hotly debated simply because if the virus is spreading by lingering in the air, that changes the risk profile for Americans and changes what we should be doing every day to protect ourselves from the virus.

DAVIES: So what's the current guidance from the CDC about how COVID-19 is primarily spread?

DIAMOND: The CDC says that COVID-19 is thought to spread mostly between individuals, people who are in close contact and when people expel respiratory droplets - when they sneeze, talk, cough, sing - and that others might inhale those droplets. The issue is whether the virus hangs in the air longer, and that's what the CDC has been going back and forth on in recent updates to its guidance.

DAVIES: There was kind of a dust up between Robert Redfield, the director of the CDC, and the president when Redfield said in a, I believe, congressional testimony that, you know, we won't really have a vaccine widely distributed until late next year, and he said, you know, the mask he's holding might be more effective than a vaccine, essentially, and the president corrected him. What's the effect of that kind of exchange?

DIAMOND: Dave, it's yet another example of the president, who's not a scientist, thinking he knows best about how to combat a pandemic, where the scientists know best. Dr. Redfield, other senior officials, have repeatedly said that we need a multipronged approach to containing COVID-19. Even if a vaccine arrives, it might not be totally effective at slowing the spread of the virus, people might still get sick. Some of the silver bullets that the president has attached to, like hydroxychloroquine, have not panned out. But what we do know is that masking and distance are two ways that we can help slow the spread of how COVID-19 transmits.

So I think what Dr. Redfield was trying to say was that we know masking is going to be a short-term fix. And the president, who has at times attacked masks and sent signals to his followers that masks are overrated - the president is yet again undermining what the scientists are trying to say about the state of the science.

DAVIES: Do you think that kind of rebuke from the president will have a chilling effect on, you know, independent scientists within the government for speaking publicly?

DIAMOND: If it was the first time last week, I might say yes. But we already know, after months, that the CDC has been repeatedly cowed, that its top officials, career officials, who normally in the middle of a pandemic would be holding daily briefings with reporters, that they don't appear, that the CDC's guidance has been caught in review from multiple different offices and agencies. So I think the effect of the president speaking out about Dr. Redfield is just part of that pattern that has already led to the CDC being very much secondary and not the primary actor in the pandemic response.

DAVIES: We're speaking with Dan Diamond. He covers health politics and policy for Politico. We'll talk more after this short break. This is FRESH AIR.

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DAVIES: This is FRESH AIR. And we're speaking with Dan Diamond, a reporter who investigates health politics and policy for Politico. He and his colleagues have done many stories in recent weeks about political influence being exerted on health policy in the Trump administration, including efforts to edit scientific reports from the Centers for Disease Control and Prevention, the CDC.

Well, Dan Diamond, there was another story that you had about a $250 million contract that the Department of Health and Human Services has granted to, quote, "defeat despair and inspire hope" over the coronavirus pandemic. Tell us about this contract.

DIAMOND: This contract appeared in the past few weeks, Dave. My colleague Daniel Lippman at Politico was first to catch wind of it. And it is an enormous, enormous advertising expenditure. It dwarfs spending on other efforts that were underway for other political initiatives and some public health initiatives. It also was steered quite closely by Michael Caputo, the political spokesperson who had no medical or scientific background. Historically, when these campaigns come out of the health department, there are public health experts playing a central role if not playing the key role in shaping, say, how the nation is advertising messaging around the opioid epidemic.

So from the jump, it had some unusual characteristics. And the messaging around the contract - the idea of inspiring hope and defeating despair - that's a message that Mr. Caputo was espousing as soon as he stepped into the job at HHS back in the spring. It's also something that President Trump himself believes - that Americans need to be as optimistic as possible about the state of COVID-19. The question then is, why is this massive campaign being unveiled so close to a presidential election? And is that campaign something that the president, Mr. Caputo and others are using to try and boost how Americans think the Trump administration has handled this outbreak?

Democrats have stepped in and have called on the health department to pause the contract. There are undergoing investigations now into its nature. It's also something that we're continuing to report on very closely at Politico. I think everyone in public health understands the need for clear, crisp communication around COVID-19. The issue is a campaign that arrives at this point in the year that would seem to have political fingerprints all over it.

DAVIES: I have to say - I mean, I'm covering government, and you know, we get used to big numbers. But $250 million is, you know, spending on the scale of interstate highway construction. That's not what you think of as a communications campaign. What were they going to do, buy ads? I mean, how do you spend $250 million? I know it's a big country.

DIAMOND: You know, I was talking to an official the other day who said, you know, prepare for the Super Bowl sponsored by the Health Department (laughter)...

DAVIES: Wow.

DIAMOND: ...With Super Bowl ads on COVID-19. Now, that would actually come after the election interestingly enough. But I think the campaign was going to lean very heavily on public service announcements and TV commercials, so that's a lot of TV and a lot of video ads. There are still ads being cut is my understanding. The campaign could take a very different shape now that Michael Caputo's on medical leave. But $250 million is a lot of money not just being put towards public health communications, that's money that could be put toward a lot of other things in the middle of a pandemic.

DAVIES: There was another controversy over messaging and the pandemic involving the FDA, the Food and Drug Administration, and its saying - encouraging things about blood plasma transplants as a treatment for COVID-19. You want to explain what happened here?

DIAMOND: You know, as you mention these, it really is just a parade of communications mishaps or massive scrutiny. FDA, the Food and Drug Administration, regulates and approves treatments, therapies not just for COVID-19, but they're playing a central role in helping rush therapeutics out to Americans who might be afflicted by COVID-19. Recently, there was a dust-up over blood plasma - convalescent plasma and its benefits in potentially reducing the effects of COVID-19.

DAVIES: This is blood plasma from someone who has already taken and - survived COVID-19, right?

DIAMOND: That is correct. This is an idea that the FDA commissioner had spoken aggressively about, that President Trump and his aides really were hopeful on - that taking plasma from people who have recovered from COVID-19, that that could be used to help other people recover from COVID-19. And the FDA went ahead with what's known as an emergency use authorization that cleared the lanes for convalescent plasma to be used as an emergency treatment in the response to COVID-19.

Now the issue, Dave, is that the evidence so far has been thin on whether convalescent plasma is going to be a major help and that when the FDA unveiled this treatment, that some of the claims that the FDA was making were overstated, that this agency that historically has been apolitical and not involved in political messaging was yet again tied up in what seemed to be the president's effort to convey an optimistic take on the state of coronavirus - that the science was taking a backseat to making a bold political statement about how coronavirus was being contained.

DAVIES: Right. And in this case, eventually the commissioner of the FDA, Stephen Hahn, apologized - right? - and said, listen; we shouldn't have said what we said.

DIAMOND: Within about a day, as condemnation rolled in and as fear has risen that FDA would be used as a political prop, I think the commissioner saw the winds and took to Twitter to apologize. He called me to convey his apology, too, and say that he got it wrong, wanted people to be clear that he understood why overstating the data had been a mistake and that FDA was committed to the science moving forward. But that apology itself caused problems inside the health department and inside the White House. There were some, like Michael Caputo, who didn't want to see the FDA commissioner apologize, who thought that it was giving in to the critics of the administration when I think it was just an effort to make sure that the science was grounded in what scientists had actually found.

DAVIES: And we should just note, I mean, that the FDA is going to have to approve a vaccine, so its credibility is pretty important going forward.

DIAMOND: Absolutely. And Dave, I think what listeners should know about the FDA - there has been a long-running fight all year over hydroxychloroquine, the malaria drug that the president seemed to think would be a silver bullet in fighting coronavirus. Back in the spring, FDA first granted an emergency authorization for hydroxychloroquine before later pulling it away given the lack of evidence. In the public health world, the whole hydroxychloroquine affair has been scandalous, with President Trump publicly suggesting that he had the FDA commissioner at his beck and call. Fox News TV hosts stumped for the drug, in some cases got meetings with the commissioner. And to make it all worse, there was virtually no evidence that the drug worked to stop coronavirus. And if anything, there's been evidence arguing the opposite - that it put people at risk.

Many senior officials at FDA, including Commissioner Hahn, have been haunted by the dust-up over hydroxychloroquine. They worry that the institution, their own reputations have been harmed. And that's why there has been such an effort to, first, walk back any overstatements about plasma and, second, to try and establish guardrails to govern what will happen with a coronavirus vaccine in the coming weeks and months.

DAVIES: Let me reintroduce you. We're going to take a break here. We're speaking with Dan Diamond. He investigates health politics and policy for Politico. We'll talk more after this break. This is FRESH AIR.

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DAVIES: This is FRESH AIR, and we're speaking with Dan Diamond, a reporter who investigates health politics and policy for Politico. He and his colleagues have done many stories in recent weeks about political influence being exerted on health policy in the Trump administration, including efforts to edit scientific reports from the Centers for Disease Control and Prevention.

You and your colleague Adam Cancryn wrote an investigative piece recently about Seema Verma, who runs the Center for Medicare and Medicaid Services in the Department of Health and Human Services. It's a really big, high-level job with far-reaching responsibility. That story, which I guess was spring of last year, prompted apparently an inspector general investigation of Ms. Verma. Let's talk about this. First of all, who is Seema Verma? What are her responsibilities?

DIAMOND: Seema Verma is a top health official who has close ties to Vice President Mike Pence. When he was governor of Indiana, she was the key adviser to him over the Medicaid program in the state. Back in 2016, shortly after the election, President Trump unveiled his, as he called it, dream team to run health care - first, Tom Price, the first health secretary that the president chose, who later left the health department after Politico investigated his use of charter jets - something I've talked about on FRESH AIR before - and then standing with Tom Price, Seema Verma, who was going to oversee Medicare, Medicaid, the Affordable Care Act. It's a really, really big job.

And her team really felt that she was equivalent, in many ways, to the Cabinet secretary - that she had a $1 trillion budget, that her role and responsibility was its own power center. But at the same time, despite Seema Verma and her team believing in their work's importance, she clashed first with Secretary Price, later with Secretary Azar. And her team really believed that she was not getting the support, she was not getting the communications visibility that someone in her position should have been granted.

DAVIES: Right. So apparently, you and the inspector general found out about the use of private contractors, including a lot of communications consultants, on her behalf and for the department. What were the scale of the payments here?

DIAMOND: I had learned fairly early on that Seema Verma and her team were using contractors to manage their communications, which was unusual. There are hundreds of federal workers who work under Seema Verma specifically on communications, on PR, on Web strategy. But she had turned to these Republican-aligned consultants back in 2017 to do things like write her speeches, handle her events, even manage her Twitter account. Adam was first to get wind of how one of those consultants was specifically focusing on polishing Administrator Verma's brand. And this was through a multimillion-dollar contract. At the time, it is about a $2 million contract specifically for these consultants to work directly with the administrator - set up events for her, book interviews with reporters for her, even pitch her for awards and panels.

We dug into that in the spring of 2019. I remember vividly when that story popped up. Within hours, Democrats were calling for investigations. The inspector general opened its own probe. And over the course of the following year and a half, these different probes continued, even as we were doing our own reporting, and found that in many cases these consultants were getting paid significantly more than the career civil servants. One person that Administrator Verma had wanted to hire but couldn't - his job was blocked by the White House, so she brought him in as a consultant instead - he made more than twice as much as Secretary Azar himself over the course of a year, writing her speeches and offering her counsel and sometimes traveling with her around the country.

And she really did have this this retinue, this group of staff attending to her needs when she traveled, when she spoke with reporters and when she was trying to raise her own profile in Washington.

DAVIES: You know, apart from the spending involved in these consultants working for Administrator Verma, there were questions of having outside consultants play roles that they arguably should not have - you know, directing federal employees, handling market-sensitive information. You want to tell us a little bit about that?

DIAMOND: Seema Verma's team of consultants were really the brain trust around some of the most high-profile issues that she worked on. The Trump administration prioritized work requirements for the Medicaid program - the idea that Americans who are low income on Medicaid should, in some cases, have to demonstrate that they have jobs or they're seeking jobs if they want to be covered by Medicaid. This policy has been roundly opposed by public health experts. They say it gets it wrong - a lot of people on Medicaid may not be able to work, that the connection between working and getting health care should not exist for the poorest Americans.

But Seema Verma pressed ahead. And the team that worked very closely with her, including writing an op-ed that appeared in The Washington Post, it was these outside Republican consultants. And in some cases, these consultants knew weeks or months ahead of time about proposals that Seema Verma was working on even before career officials in the government knew. There was a effort to interest reporters in Seema Verma's changes to how health data gets shared, something big in my world called interoperability. Some of that information was being taken and shown not just to the contractors but also to reporters. And we looked at the investigation. There are emails where career officials and even some of Seema Verma's own political aides were worried that, by sharing too much information outside the agency, that that would cause problems for developing the proposal and move the market in a way that is seen as either unethical or even outright illegal.

DAVIES: All right. A lot of stuff here. How did the Department of Human Services and Seema Verma herself respond to all this?

DIAMOND: There are different responses based on who we talked to in the Department of Health and Human Services. So Seema Verma has decried these investigations. Initially, she said that the inspector general report this summer was misleading and cherry-picked. More recently, she has turned to that report because it's more favorable than the Democratic report and suggested that it's a validation because it didn't find all the things that the Democrats found, though the reports are very different in what they were looking at and their scope.

But Verma has continued to do her job as this term winds down. There are many critics of administrator Verma inside the health department, people who believe that she has operated without significant oversight from Secretary Azar and are unhappy that there was no punishment levied. So while the party line is that HHS supports Seema Verma, there are many officials who do not.

DAVIES: So there's a lot that's happened here and a lot you've reported on. You know, the stakes here are clearly really high for the president in public perceptions of his handling of the pandemic. What are you expecting to see over the next two months?

DIAMOND: There are a few flashpoints, a few developments that we at Politico, reporters at other outlets are watching very closely, Dave. I think the most important is the development of a coronavirus vaccine. The land speed record for developing a working vaccine before this year was about four years for the development of the mumps vaccine. That record will almost certainly be smashed by the development of a coronavirus vaccine in the span of months or maybe a year.

There are nine, 10 vaccines that are nearing the potential for approval. The federal government is arraying (ph) around the possibility of making some of these vaccines available via the emergency authorization, maybe just for health workers or people at highest risk. But that could happen before the end of the year, quite possibly before the election. And the idea that politics would influence that decision is something that is on the minds of not just every reporter but a lot of government officials too who want to be extremely careful that they're not rushing a vaccine to market that could harm people or undermine confidence in the public health response.

I also think we're watching how the administration continues to communicate or not about coronavirus. The president on Monday night in a speech said that the virus, quote, "affects virtually nobody." That's patently false. There are hundreds of thousands of Americans who have been sickened, hospitalized or killed by the virus. I would bet that their families and friends would say that the virus has affected them, to say nothing of the people afflicted by COVID themselves. We are at a threshold of about 200,000 confirmed deaths from COVID-19 and then hundreds of thousands of more people who have been hospitalized for the virus, who may have developed symptoms that don't go away over the course of some weeks. There are people really suffering. And that issue has receded as the nation has gotten inured to the idea that COVID-19 is just this background noise as the presidential election assumes more and more of the foreground.

DAVIES: Well, Dan Diamond, Thank you for your reporting. And thanks for speaking with us again.

DIAMOND: Dave. Thanks for having me back on FRESH AIR. I hope all listeners are staying safe at this unusual time.

DAVIES: Dan Diamond investigates health care, politics and policy at Politico. He authors a daily online digest of health, politics and policy news called Politico Pulse. And he hosts the podcast "Pulse Check."

On tomorrow's show, Yannick Nezet-Seguin, the young charismatic conductor of the Metropolitan Opera and Philadelphia Orchestra talks about Verdi's "Requiem." He chose the piece for his inaugural performance as the music director in Philadelphia. The concert was recently rebroadcast on WHYY-TV. We'll hear some of the performance and talk about the piece and its meaning. I hope you can join us.

FRESH AIR's executive producer is Danny Miller. Our technical director and engineer is Audrey Bentham, with additional engineering support from Adam Stanishevsky (ph). Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Sam Briger, Lauren Krenzel, Heidi Saman, Therese Madden, Thea Chaloner, Seth Kelley and Kayla Lattimore. Our associate producer of digital media is Molly Seavy-Nesper. Roberta Shorrock directs the show. For Terry Gross, I'm Dave Davies. Transcript provided by NPR, Copyright NPR.