Youngkin pick for medical adviser bucks trends on covid
Gov. Glenn Youngkin has named a respected physician who opposes blanket vaccine mandates and downplayed the threat of the coronavirus to children as his lead adviser on pandemic response.
The choice of Marty Makary, a Johns Hopkins surgeon and Fox News contributor, signals that Youngkin, R, will upend the approach of outgoing governor and pediatric neurologist Ralph Northam, D, to public policy at a critical time in the pandemic, political science and health experts say.
The first signs of that shift came Saturday, just after Youngkin was sworn in as the 74th governor of Virginia. Among his first official acts, he signed an order, effective Jan. 24, aimed at giving parents of public and private K-12 schools the ability to opt out of mask mandates in schools.
Makary's nomination came amid a flurry of appointment announcements that - like the new governor's campaign team - include a mix of movement conservatives and establishment stalwarts.
"A number of appointments play to the very conservative wing of the party, which in and of itself is not unexpected. This guy did not run to be the next Larry Hogan. He ran with a broad base of support, the Trump wing and the Republican establishment," said Mark Rozell, the dean of the Schar School of Policy and Government at George Mason University.
Youngkin nominated Richard Cullen, the uber-connected former chairman of the legal and lobbying giant McGuireWoods and a former U.S. attorney and Virginia attorney general, as his counselor, a top policy and legal post. Youngkin also tapped Andrew Wheeler, a former coal lobbyist who was President Donald Trump's Environmental Protection Agency chief, as his secretary of natural resources; and Kay Coles James, former president of the Heritage Foundation, the conservative think tank, as the next secretary of the commonwealth.
While Makary serves Youngkin's political needs and is compatible with the views the governor has shared, Rozell wondered whether the appointment is in the best interests of public health and science.
"He will be giving critical advice at a very critical time of the pandemic spread," he said.
More than 29,000 people have died of covid-19 in D.C., Maryland and Virginia in the nearly two years since the coronavirus was first detected. State and local officials have deployed an evolving patchwork of policies amid fluctuating infection rates, which have been sharply on the rise for weeks due to the omicron variant.
Makary is chief of islet transplant surgery at Johns Hopkins and a professor at the Hopkins School of Medicine and in the business school, where his research focuses on public health policy, vulnerable populations, disparities in health care and health-care costs, according to his official biography.
He is a Thomas Jefferson University-educated physician who completed his residency in surgery at MedStar Georgetown University Medical Center. He has been elected to the National Academy of Medicine and is the author of several books, including "The Price We Pay: What Broke American Health Care - and How to Fix It."
Leana Wen, an emergency medicine physician and public health professor at George Washington University, has often crossed paths professionally with Makary, especially in Baltimore, where she was health commissioner. She also is a Washington Post contributing columnist.
Wen, an advocate for vaccine and mask mandates, said she disagrees with Makary on many issues but praised him as a researcher grounded in science and data who may not have the classical interpretation of studies he uses to back his opinions.
"[Youngkin] is choosing an independent thinker who isn't afraid to buck the establishment and has very strong views on how to expedite change and to overhaul bureaucratic processes," she said. "It is true [Makary's] views on covid are outside the mainstream on public health. I have always appreciated his ability to question conventional wisdom on public health. . . . Both of these things can be true."
Wen and Makary have often faced off over pandemic policy, including in a closed lecture to retired general Wesley Clark's leadership institute in August and around the same time in dueling pieces in U.S. News, in which Makary said, "I'm pro-vaccine but blanket requirements outside of health care go too far."
He said people who choose not to get vaccinated "are making a poor health decision at their own individual risk" but "pose no public health threat to those already immune," and likened the decision to smoking or not wearing a helmet when cycling.
Yet Makary has been criticized for overstating the protection of previous infection and undervaluing masks, especially for children.
In a Post op-ed last fall, he interpreted several well-known studies to say that "emerging science suggests that natural immunity is as good as or better than vaccine-induced immunity," expressing frustration with the Biden administration for arguing that vaccine-conferred immunity is preferable to "immunity caused by natural infection." He has often said one dose of a two-dose RNA vaccine regimen made by Pfizer-BioNTech and Moderna may be all that is necessary for children who have had the coronavirus.
The Centers for Disease Control and Prevention late last year found that immunity after infection and vaccination lasts for at least six months but that vaccines offer more consistent protection and a huge boost in antibodies for previously infected people, which is especially true with the omicron variant. Public health experts also say the coronavirus is just as contagious in children as in adults, if not more so, although kids as a whole have a lower chance of being hospitalized and a lower mortality rate.
Makary co-authored a commentary for the Wall Street Journal in August that detailed what the authors said were possible adverse affects on some children who wear masks long-term - from difficulty breathing and seeing to acne and increased levels of carbon dioxide in the blood. (The CDC has reported that pediatric cases of the coronavirus rose more sharply in places without school mask requirements.)
"Any child who wants to wear a mask should be free to do so. But forcing them to make personal, health and developmental sacrifices for the sake of adults who refuse to get immunized is abusive," Makary and his co-author, H. Cody Meissner, wrote, adding that the mandatory vaccination of teachers would help.
In a recent appearance on Fox News, Makary said, "What we've tragically called a breakthrough infection" is actually the "normal virus landing in someone's nasal system. You test positive, but you're still protected with the vaccine." He called the CDC-recommended N95 face masks "hard to wear" because they may leave an indent on some people's faces, saying that they should be limited to nursing home staff. He also said he preferred rationing a limited supply of tests to blanket testing.
Virginia Democrats, through spokesman Jayce Genco, called the appointment "dangerous, irresponsible and deeply troubling" and proof that Youngkin will govern from the far right, which "will prolong the pandemic and cost Virginians their lives."
In addition to Makary, Youngkin named to his medical advisory board: Nancy Howell Agee, chief executive of Carilion Clinic; Kathleen Gorman, chief operating officer of Children's National; Alan Levine, chief executive of Ballad Health; Bogdan Neughebauer, Sentara Healthcare physician; and Anand Shah, a former deputy commissioner at the Food and Drug Administration.
A Youngkin spokeswoman, Macaulay Porter, called the board members "independent and experienced voices." She said that Youngkin and the board will assess all options and do what is best for Virginians, adding: "Glenn is proud to have Marty as a member and grateful he decided to help Virginia through this crisis."
Rozell said the stakes are high.
"A political scientist makes a bad political prediction, no one gets hurt," he said. "[Makary] is in the field of public health. What he projects affects behavior in the public, and that has consequences."
In a sign that leaders are closely watching what is to come, University of Virginia officials this month moved up the deadline for students, faculty and staff to receive coronavirus booster shots from Feb. 1 to Jan. 14 - the day before the inauguration.
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The Washington Post's Alice Crites and Laura Vozzella contributed to this report.
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