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How Dr. Deborah Birx's political skills made her the most powerful person on the coronavirus task force

As the relationship between Dr. Anthony Fauci and President Donald Trump publicly disintegrated over the past few months, Dr. Deborah Birx, Fauci's former mentee, solidified her standing inside the White House, to the point that sources familiar with the situation say she has essentially taken charge of running the task force day to day.

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Vivian Salama, Pamela Brown, Kristen Holmes
Kate Bennett, CNN
CNN — As the relationship between Dr. Anthony Fauci and President Donald Trump publicly disintegrated over the past few months, Dr. Deborah Birx, Fauci's former mentee, solidified her standing inside the White House, to the point that sources familiar with the situation say she has essentially taken charge of running the task force day to day.

Birx spearheaded the administration's recent decision to have hospitals send information on coronavirus patients to a new federal database, a source involved with the process told CNN, bypassing the US Centers for Disease Control and Prevention, an agency Birx has often complained about to colleagues. She has also been a forceful advocate for the President's push to reopen schools, forming a working group to create new guidance after the President criticized the CDC's initial recommendations, calling them "too tough" and "expensive."

Birx's forward-facing role as a public health expert masks an ambitious political chameleon, whose staying power in numerous administrations during her three decades in government has come at no small cost to her management style and her notoriety among peers, according to interviews with more than a dozen people who have worked with her, including current and former administration officials.

Birx's rise inside the Trump administration has surprised many of her former colleagues, given her past as an Obama appointee. It's also tainted her reputation among some public health experts who view her as having sold out to a chaotic, poorly managed response that has put Trump's political fortunes over the health and safety of Americans.

"Her reputation is finished," a former State Department colleague said, mentioning specifically the moment in April when, with Birx sitting nearby, Trump talked about using disinfectant as a cure for coronavirus. "It's one thing to be disagreeing on policy, but you're a medical doctor and you're going to sit in room with this President who says you can inject yourself with bleach?"

"I feel she has signed her fate in blood with these guys," the person said. "She's a Trumper now."

A spokesperson for the vice president's office pushed back on the notion that Birx has lost her standing inside the public health community, saying her goal is to "put health and safety before any other consideration."

Fauci pushed back as well. "I disagree that her current role has tainted her reputation," Fauci said, adding that Birx is "in a difficult position" and that she "essentially lives in the White House."

Fauci maintains that he and Birx have retained a "very strong relationship" despite their differences in standing within the White House. "She's not a political appointee but she's in a very political environment," Fauci said. "I think you've got to cut her some slack and give her a break -- I think she's doing a very good job. "

Birx did not respond to requests for comment from CNN about her relationship with the President or her motivations for continuing in the role as he continues to push back against the advice of her medical counterparts.

Not just a 'grandmother with the scarves'

Since joining the National Security Council in February, Birx, a former Army physician who ran the State Department's global AIDS program under former President Barack Obama, has proven to be a savvy political operator inside the White House, amassing power from her role coordinating the task force under Vice President Mike Pence.

She is the only task force member who briefs Pence every day, and she has become a fixture in the West Wing. With her office near the vice president's, Birx has built a close working relationship with Pence, who is known to defer to Birx in meetings and at briefings, and has referred to her has his "right hand."

Birx has become a frequent traveler on Air Force 2 alongside Pence, touring the country with charts and graphs and meeting with local officials to walk them through her data. This week, Birx spent much of her time meeting with Southern governors in Louisiana, Mississippi, Georgia and Alabama to assure them it is safe to bring children back to the classroom.

Birx and Pence have also connected on a deeper personal level, sources say, especially over their shared Christian faith. Birx, who grew up in rural Pennsylvania, received her undergraduate degree from Houghton College in New York state, which describes itself as a "Christian liberal arts" school.

"I would imagine her religious side helps her understand and connect with Pence, and vice versa," said a former State Department colleague of Birx, who worked with her for several years in the George W. Bush administration and remains in frequent contact with her. "Pence would be the kind of person she would like: religion, military, and, most importantly, knowing what needs to be said to the boss to keep your job."

Birx has also fostered close ties with the President's son-in-law and senior adviser Jared Kushner and the President's daughter Ivanka Trump.

"She's an outside-the-box thinker but also not afraid to get dirt under her fingernails," said Kushner, who credits Birx for coming up with an idea earlier in the year to speed delivery of supplies to hospitals, many of which were complaining they still didn't have what they needed. Rather than sending supplies to governors, Birx suggested sending them straight to the hospitals.

According to Kushner, when Birx was met with internal pushback, she and a few other White House officials began calling up hospitals around the country, including in New York, Michigan and Louisiana, to figure out how to ship supplies directly to them.

Known for her signature scarves and motherly pleas for caution, Birx has made herself indispensable to members of Trump's inner circle at a time when other medical experts have found themselves in the President's crosshairs.

"Don't let the 'grandmother with the scarves' persona fool you. She is a phenomenal and adept politician," said Birx's former State Department colleague. "She has lasted this long in no small part due to her bureaucratic maneuvering. This isn't just about what she knows about disease, or her experience. This is a shrewd and deft political veteran."

'A lot of guys who don't like smart women'

Birx's career in the Army, where she achieved the rank of Colonel, gives her a strict adherence to the chain of command, sources say, and she is fiercely loyal to whoever is in charge.

According to one former colleague, Birx learned in the Army what it meant to be a capable woman surrounded by men.

"There are a lot of guys who don't like smart women. She's very smart," this person said. "Early in her career, a lot of the guys would avoid her or wouldn't engage her, so she developed a little bit of a persona, in order to break through to be one of the guys."

Birx has also proven to be a savvy briefer of the President, knowing what to tell him and how, and often using what her former State Department colleague said was "Trump language," referring, for example, to points the President frequently makes about how increased testing has resulted in higher numbers of cases.

"She knows how to remain on his good side," the person said. "You aren't in politics for as long as Deb has been and don't know how to kiss the ring."

One senior White House official who has been with Birx during her interactions with the President said, "She's very to the point and raises something only if it's serious enough to bring to his attention." The official also noted that Birx hasn't made enemies in a tough West Wing where knives are always out.

That's partly because she has diligently stayed on message.

"In Washington there's a lot of temptation to play to the press. The media would have made her a hero if she had gone against the administration," said another senior administration official. "She was there to be effective and built trust with everybody - people really trust her and like her."

This person said that Birx has also proven to be a cool head during some of the most intense moments of the crisis. "It's overwhelming coming into a crisis situation -- when this happens pressure is immense and you get to see what people's characters are," the person said. "She was tremendous."

"She's been training for this for almost last 30 years with the work she's done," the person said. "Because of her we saved a lot of lives."

With cases rising and more than 140,000 people dead in the US so far from the virus, some experts, however, argue that Birx has not done enough from inside the White House.

'Fauci was like God'

Most mornings, before the sun rises, members of the coronavirus task force receive a colorful packet of graphs and charts laying out the virus' state of play in the US. Those packets are routinely compiled by Birx, who has made changing the way data is collected and disseminated a top priority during her time on the task force.

Recently, Birx's data has focused on mortality and hospitalizations in Southern states that are seeing a surge in cases. Understanding and explaining why that is happening has been a key task for Birx. Her solution in the end was to convince the White House to change the way the data is collected, ordering hospitals to send data on Covid-19 patients directly to the Department of Health and Human Services, and not to the CDC.

This decision came after months of simmering tensions between Birx and the CDC, which she has faulted for having an antiquated system for collecting death-related data, one that often lags weeks behind. While the White House has insisted that the new method will improve the government's handle on Covid-related data, some experts believe it unnecessarily undermines the nation's top health agency in Atlanta.

This again proves to be where the divide between Birx's methods and those of Fauci have resulted in a longer leash from the White House, and a more vocal and visible presence for Birx. That's not to say she isn't fond of Fauci. "She gets along with him well," said Birx's former State Department colleague, who is familiar with her interactions with Fauci. "They just have different styles. He speaks his mind no matter what; she plays with the long-game top of mind."

Others offered a less flattering perspective.

"Personally, we love her, but she tells people what they want to hear and sometimes it's conflicting," said one senior Trump official.

One former Trump administration official said that Birx's methods are at times overtly self-serving. "Everything for her is transactional," this person said.

During the first several weeks of the crisis, Birx and Fauci appeared to work in tandem. But recently their paths have diverged as Birx has taken a more active leadership role on the task force, and Fauci has found himself increasingly unpopular inside the White House.

A source close to the task force described Fauci and Birx as now having very separate roles. Birx plays the inside game, the source said, while Fauci feels a need to speak truth to power on the virus. The source added Birx has made it abundantly clear that she is "reticent" to criticize Trump's response to the pandemic.

Birx's prominent role leading the task force and overshadowing Fauci during the pandemic has surprised some of her former public health colleagues who worked with both of them during the Ebola crisis.

Another former senior State Department official who used to work with Birx said that Fauci was clearly the most senior public health expert in meetings during Ebola. "Fauci was like God when it came to infectious diseases, and when he spoke everyone would stop to listen," the person said. "Now the administration has tried to put Birx above him and she's accepted that place."

One senior administration official pushed back on the idea that Birx's role on the task force overshadows Fauci's, saying the two just have different skill sets. "Dr. Fauci's expertise is not necessarily traveling and meeting with local leaders to formulate plans," the official said, adding that the National Institutes of Health is playing a large role with vaccine and therapeutic solutions.

'A dazzling reputation'

Particularly noteworthy is that Birx has risen inside the Trump White House despite being a former Obama political appointee. Earlier in the Trump administration, Birx was able to rely on her extensive network of allies around Washington to keep her job as the US Global AIDS Coordinator at the State Department, where she oversaw the implementation of the President's Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to combat a single disease in history, as well as all government engagement with the Global Fund to Fight AIDS, Tuberculosis and Malaria.

"(Birx) used all of her firepower and influence to stay," said her former Bush-era State Department colleague, who added there were pushes from big pharmaceutical groups directly to the White House, encouraging Trump-land to keep her on.

In 2014, when it came time to find a new person to lead PEPFAR, Obama officials were enamored by Birx's career. A former AIDS researcher at Walter Reed, Birx was at the time the director of CDC's Division of Global HIV/AIDS, where she received the William Watson Jr. Medal of excellence for "advancing the agency's HIV/AIDS response."

Birx had a "dazzling reputation," said a former Obama administration official. This person noted that then-CDC Director Tom Frieden spoke very highly of Birx as well. Frieden declined to be interviewed for this story.

A congressional aide who worked with Birx on PEPFAR funding said she received high marks on Capitol Hill for being responsive and on top of things but also down to earth.

"There was no reluctance to meet with staff. She wasn't so important that she would only meet with members of Congress," the aide said, adding that "she was willing to talk about any issue no matter how sensitive -- with the right goals in mind and trying to use funds in the most effective ways to reduce the spread of AIDS."

Birx soon got a reputation for being a tough, no-nonsense leader, something that rubbed some colleagues the wrong way. Birx's leadership came under question earlier this year after the publication of a report by the State Department Inspector General, which characterized the leadership of PEPFAR as reportedly "dictatorial," "directive," and "autocratic." Birx is never mentioned by name in the report although almost a dozen people interviewed by CNN said she was partly responsible for fostering a "toxic" work environment.

Birx signed a formal response to the OIG report that concurs with recommendations to "promote open dialogue and trust" between the head office and country teams.

Others, however, saw her tough approach as an asset. The former senior State Department official who used to work with Birx said she angered ambassadors by telling other countries they needed to come up with the money themselves rather than rely on US funds. But the former official said it wasn't necessarily viewed internally as a bad thing and that Birx was viewed by many as being "tough, responsive and on top of things."

Birx at the White House

The former Obama administration official said many members of the public health community initially viewed Birx's participation on the Trump coronavirus task force as a positive. There was hope that Birx could be like former Defense Secretary Jim Mattis, this person said, and moderate the President's worst instincts. But as the pandemic raged on and Trump downplayed its severity, those hopes were dashed.

The former official described feeling dismayed to see Birx as an "administration apologist and not the voice of the public health community."

Rev. Charles King, the CEO and co-founder of the New York City HIV services organization Housing Works, was a strong advocate for Birx to keep her job at the State Department under Trump. He also said he is dismayed by Birx's time on the task force.

"Periodically over the course of the last four months, I have seriously questioned some of the things Dr. Birx has said when she's with the President or representing the President," King said. "There have been times when Birx has gone much further to placate the President than I think is reasonable and I just hope it doesn't hurt her reputation in the long term."

From the beginning of her time on the task force, Birx has taken a public role, frequently briefing the press with flow charts. She regularly calls upon millennials to act smart, wear masks and practice social distancing for the sake of older generations.

In the early days of her tenure on the task force, she took to the White House podium to offer a touching personal story about her mother's lifelong regret for unknowingly contracting and bringing home the flu during the 1918 pandemic, which ultimately led to her grandmother's premature death.

But her ability to stay in the President's good graces -- no easy task for even the most seasoned political operators -- has underscored her ability to navigate any political terrain, close observers said. As the President and his top advisers continue to craft a coronavirus strategy that often shuns the advice of medical experts in favor of an aggressive return to normal, Birx has opted to play "good cop" and execute the President's wishes, regardless of the political cost.

"She cut her teeth in the military," one of her former colleagues said. "She's very familiar with chain of command...It's not in her fiber or her being to push back in any way. If (Trump) says: 'make this happen,' she's going to do it."

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