Trump administration's health leadership reboot sputters

The Department of Health and Human Services keeps saying it's turning over a new leaf, but it has only been partially successful — and controversial vaccine policymaking appears to be back on the table.Why it matters: Though the agency reset was launched with the midterm elections in mind, it's already under strain and the elections are still more than three months away.State of play: Until this week, the administration had spent most of this year toning down its approach to vaccines, after it became clear through polling that vaccine skepticism was a political liability for the GOP in the midterm elections.But it wasn't just vaccines. The Food and Drug Administration had become dysfunctional enough that critics were warning of irreparable harms to the biotech industry and lost cures for patients, and the Centers for Disease Control and Prevention has been without a Senate-confirmed director for the vast majority of Trump's second term.At the same time, HHS elevated people with much more traditional backgrounds to senior positions within the department, most notably installing Chris Klomp effectively as chief of staff.Former FDA commissioner Marty Makary and top regulator Vinay Prasad both left their jobs in the following months, signaling what the biopharma industry hoped would be a reset on a relationship that had become poisonous.Other controversial personnel either left the administration or — in the case of surgeon general nominee Casey Means — failed to be confirmed.Where it stands: The projection of a return to business as usual experienced some serious cracks this week.The Senate confirmation of Sean Kaufman, the administration's nominee to lead the Administration for Strategic Preparedness and Response, seemed to be in trouble over his past anti-vaccine statements, though the Senate health committee did approve his nomination Thursday.And most prominently, the WSJ reported that President Trump has been pressuring Health Secretary Robert F.