January 06, 2021

The Senate Should Act Quickly on Confirmations to Fight the COVID Pandemic

Filling key health-related positions was not a priority during recent presidential transitions. By their 100th day in office, only 28% were filled under Trump and 35% under Obama.

By Christina Condreay

As medical professionals and essential workers begin to receive the coronavirus vaccine, the nation enters a new phase of the pandemic. Yet even with this positive development, the country faces thousands of deaths from the virus each day and will likely be dealing with the pandemic for months to come. With the inauguration of President-elect Joe Biden only days away, the new administration will need key health officials in place quickly to coordinate the government’s response and assure continuity during the change in leadership.  

Biden’s plan for a COVID-19 response includes providing 100 million vaccines in 100 days and reopening schools safely by May. To achieve these goals, he must have personnel in key decision-making positions. Recent history, however, shows that under the last two presidents, most health-focused jobs were not among the earliest filled. In fact, under Presidents Donald Trump and Barack Obama, only about one-third of leadership positions responsible for coordinating health efforts were confirmed by the Senate within 100 days of taking office.

To study the priority given to these roles, the Partnership for Public Service’s Center for Presidential Transition identified 50 Senate-confirmed positions relating to public health and emergency response. The list is comprised of positions held by individuals on the current coronavirus task force, health-related nominees already announced by Biden and the positions of those who participated in the 2016 transition pandemic tabletop exercises. Additionally, the Center examined job descriptions for more than 400 positions across 22 agencies. The final list of 50 includes agency heads and Cabinet department secretaries, as well as assistant and undersecretaries responsible for less visible but important agency subcomponents.

Pandemic response positions during the Trump administration

Of these 50 key positions, only 14 were filled during the first 100 days of the Trump administration (28%). When the pandemic began in early 2020 – and Trump had been in office for three years – only 28 of these 50 positions or 56% were filled with a Senate-confirmed official.  Even though the Senate confirmed these officials, significant turnover occurred during Trump’s first three years. Between Inauguration Day and March 1, 2020, 20 Senate-confirmed officials in pandemic response positions had resigned.

The lack of Senate-confirmed officials was due in part to Trump’s slow pace of nominations. During Trump’s first year in office, he submitted nominees for just 27 of the selected positions. In his second year, Trump submitted nominations for only 11 more. Another cause of the delays was the length of time it took the Senate to vote on nominations.

All told, 42 of the 50 health-related positions were filled at some point during the Trump presidency, even if not by the start of the pandemic. On average, the Senate took 99 days to confirm those nominations.

Pandemic response positions during the Obama administration

The Obama administration filled a few more of these health-related jobs early in its first year, but only by a small margin. During the first 100 days, 35% of these positions had a Senate-confirmed official, including four holdovers from President George W. Bush’s administration. There was a notable difference, however, in staffing these positions during Obama’s second year. By the end of Obama’s second year in office, the administration had sent nominations for 39 of the 50 positions to the Senate.

Due to key holdovers from the Bush administration and five recess appointments, a permanent official served in 49 of the health-related positions by the end of Obama’s third year. The Trump administration added a Senate-confirmed position, the director of the National Counterintelligence and Security Center, which is included in our list. On average, the Senate took 71 days to confirm officials for those positions during the Obama administration.


An effective strategy to fight the pandemic requires a smooth transition of power and continuity in leadership. Although many health-related positions were not filled quickly during the last two administrations, the Senate and Biden administration have a joint obligation to expeditiously nominate and confirm officials for these critical roles to deal with the current crisis.