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By Daniel Payne and Krista Mahr

CDC Director Rochelle Walensky’s order to overhaul the agency is facing reality. | Chip Somodevilla/Getty Images

REALITY CHECK — The CDC’s push to change is facing its first hurdles (and they aren’t small).

The agency’s limited authority, entrenched culture and dependence on congressional action have already come up against the new directives to get information about health crises out faster to Americans, Krista and Erin Banco report.

Transparency and messaging were crucial elements of Director Rochelle Walensky’s order to overhaul the CDC after its bungled Covid-19 response. A drive to be more open with the public about what agency scientists do — and don’t — know was a key element of the plan.

“In a pandemic, you don't have time to wait. You have to take action to help people,” Walensky said. “We haven't been able to be as nimble as we've needed to be.”

If Walensky’s effort fails, the CDC risks repeating the mistakes it made during the pandemic, particularly around effective messaging. Public trust in the agency has plummeted over the last three years — and a further decline would mean even fewer people are listening to the government when another new disease (or new wave of Covid) emerges.

We’ve been here before.

Previous CDC directors have tried to improve the patchwork and antiquated system of disease data collection and reporting that relies on a chronically underfunded and understaffed national public health workforce.

But, like everything, Covid-19 changed things. These liabilities have come into the spotlight, spurring widespread demand for change that could help Walenksy overcome some of the major hurdles in front of her.

She still needs help to realize her vision. The director has asked Congress for support in expanding the agency’s authority to collect better public health data and for more funding to help build up and train the depleted public health workforce.

But help doesn’t seem to be on the way, given the lack of appetite for putting more money into public health.

“We want to make sure we get the answer right, but when we know the answer, we shouldn't wait to convey it to others,” she said. “I think people within the agency recognize the need for change.”

WELCOME TO FRIDAY PULSE, where our thoughts go out to the writers of a book about Liz Truss — set to be released over a month after her tenure ends.

Send your favorite Truss headlines — as well as news and tips — to dpayne@politico.com and kmahr@politico.com .

TODAY ON OUR PULSE CHECK PODCAST , Ben Leonard talks with Alice Miranda Ollstein about the upcoming decisions in Congress on telehealth funding. Plus, a dispatch from Pennsylvania, where a statehouse race is testing whether the GOP’s last abortion-rights supporters can survive.

A message from PhRMA:

The 340B program may be driving up costs for some patients. A new analysis finds average costs per prescription for a patient is more than 150% greater at 340B hospitals than at non-340B hospitals. It’s time to fix the 340B program. Learn more.

The CDC’s independent vaccine advisers voted unanimously Thursday to add most Covid-19 vaccines offered in the U.S. to the childhood, adolescent and adult immunization schedules. | Rogelio V. Solis/AP Photo

CDC RECOMMENDS COVID SHOTS AS ROUTINE IMMUNIZATIONS — But that isn’t a mandate, POLITICO’s Lauren Gardner reports .

The CDC’s independent vaccine advisers voted unanimously Thursday to add most Covid-19 vaccines offered in the U.S. to the childhood, adolescent and adult immunization schedules.

The schedules are updated every fall and then go into effect the next year — consolidating the CDC’s guidance into a single document for states that take the recommendations.

Covid vaccines’ inclusion on the schedules don’t constitute mandates, particularly for schoolchildren, which aren’t decided by the federal government. It’s up to states — or local jurisdictions, depending on the state — to decide which shots to require.

Still, the committee’s vote sparked controversy and debate on social media about what the additions mean for vaccine requirements after Fox News’ Tucker Carlson asserted Tuesday that the CDC would trigger mandates for students.

“This doesn't represent new recommendations. This represents sort of a summary of existing recommendations,” said advisory panel member Matthew Daley, a senior investigator at the Institute for Health Research at Kaiser Permanente Colorado. “But I will acknowledge ... there is symbolism in adding Covid-19 to the childhood immunization schedule, and that symbolism is that we view this as routine and that we view this as Covid is here to stay.”

TUNE IN TO THE PULSE CHECK PODCAST: Keep your finger on the pulse of the biggest stories in health care by listening to our daily Pulse Check podcast. POLITICO’s must-listen briefing decodes healthcare policy and politics, and delivers reality checks from health professionals on the front lines. SUBSCRIBE NOW AND START LISTENING .

REPUBLICANS EYE ‘FAMILY GLITCH FIX’ AS A POST-MIDTERM BATTLE — House Republicans sent a letter telling the Treasury Department to preserve documents and communications related to the administration’s recent rule fixing the Obamacare “family glitch,” Daniel reports.

That policy, which would expand health insurance subsidies to one million Americans, is an "illegal expansion" of health coverage, the Republicans on the Ways and Means Committee said in the letter.

It signals a larger investigation that is likely on the way, should the GOP win a majority in the midterm elections next month.

The Biden administration has described the fix as “the most significant administrative action to improve” the ACA since it was passed in 2010, but Republicans have said the administration doesn’t have the authority to change the policy without congressional action.

A message from PhRMA:

AHA, AMA WEIGH IN ON SURPRISE BILLING SUIT — The American Hospital Association and American Medical Association filed an amicus brief in the Texas Medical Association’s case against HHS over the surprise billing rules from the Biden administration.

This comes after the groups dropped their original case against the government — also arguing against the new rules for deciding billing disputes — because a change in the final rule rendered that suit outdated.

The filing, which the groups signaled last month, again claims that the administration’s policy gives insurers an unfair advantage over providers in surprise billing disputes.

MOST TEENS DON’T STOP GENDER-AFFIRMING HORMONES, STUDY FINDS — A study from the Netherlands found that about 98 percent of adolescents who started hormone therapy because of gender dysphoria continued the therapy.

The group of 720 individuals represented the largest study of adolescents continuing hormone therapy to date. Those assigned male at birth in the study had a median age of 14 years old when starting puberty blockers and 20 years old at the end of follow-up. For those assigned female at birth, the ages of starting treatment and the end of follow-up were 16 and 19, respectively.

“We found that the vast majority of people continued using gender-affirming hormones, which is reassuring in the context of recent increased public concern regarding regret of transitioning,” said Marianne van der Loos, one of the researchers.

The study comes as renewed concern — and sometimes outrage — over teens’ gender affirming care grows, becoming a key political issue for some midterm races in the U.S.

FIRST IN PULSE: HEALTH SPENDING GROWS, BUT SLOWER THAN INFLATION — That’s according to a new report from Altarum , which found national health spending in August grew nearly 5 percent year over year.

The report also found that health care jobs returned to pre-pandemic levels, with the sector gaining 60,100 jobs in September 2022.

But that doesn’t mean staffing issues are over, with leaders across the public and private sectors highlighting the need for workforce solutions throughout the industry.

STAY AHEAD OF THE CURVE: Our Future Pulse newsletter will continue to bring you the biggest stories at the intersection of technology and healthcare, but now five times a week. Want to know what’s next in health care? Sign up for our Future Pulse newsletter. If you aren’t already subscribed, follow this link to start receiving Future Pulse .

Ana Mascareñas is now senior adviser for environmental justice in the Office of the Assistant Secretary for Health at the Department of Health and Human Services. She most recently was a consultant at the University of Washington School of Public Health.

Josh Mandel , Microsoft’s chief architect for Healthcare, has joined Graphite Health's advisory board.

Terry Wilcox has been elevated to the role of CEO at Patients Rising, a national patient organization that advocates for individuals with chronic illness.

Rachel Derby was named executive director of Patients Rising Now, the 501(c)4 group dedicated to demanding transparency in healthcare.

MacKay Jimeson was named executive director of the Patient Access & Affordability Project, which is the think tank and public policy arm of Patients Rising. Jimeson has experience in the biopharma industry as a former Pfizer executive.

Ms. Magazine’s Roxy Szal writes that abortion and equal rights top young women’s concerns in the midterms in battleground states.

ProPublica’s Kathleen McGrory and Neil Bedi report that America’s decision to not ban asbestos has led to some workers paying a price.

A message from PhRMA:

The 340B program grew, yet again, hitting a whopping $43.9 billion in sales at the discounted 340B price in 2021. But there has not been evidence of corresponding growth in care provided to vulnerable patients at 340B covered entities. And making matters worse, fresh data show that 340B may actually be driving up costs for some patients and our health care system as whole. The program of today is having the opposite effect of what Congress intended when they created 340B. That’s a problem. It’s time to fix the 340B program. Learn more.

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