Even if the US Food and Drug Administration authorises a coronavirus vaccine in the coming days, Massachusetts General Hospital is not going to recommend it for patients until it has also been personally approved by Rochelle Walensky.
Dr Walensky is the hospital’s head of infectious diseases, and her expertise in interpreting medical data is so respected by colleagues that they want her to review the vaccine trials before they can trust the results.
She is relatively unknown in Washington, however, making her selection as Joe Biden’s choice to head the embattled US Centers for Disease Control and Prevention one of the biggest, and possibly most important, surprises of the president-elect’s picks so far.
“She comes completely out of left-field,” said Barry Bloom, professor of public health at Harvard University. “I would love to know who on [Mr Biden’s] coronavirus task force knows her. She would have been on nobody’s list.”
Medical scientists said they were overjoyed when they heard of Dr Walensky’s appointment. “I was in tears with emotion when I heard she was picked,” said Gavin Yamey, professor in global health policy at Duke University.
“After four years in which the Trump administration has denigrated science, promoted anti-scientific ideas and interfered with the CDC generally, the scientific community is breathing an enormous sigh of relief.”
Mr Biden announced his health team on Monday, putting Xavier Becerra, California attorney-general and former member of Congress, in charge of the health department and appointing Vivek Murthy as US surgeon general, a role he also held during the Obama administration.
The choice of Dr Walensky to lead the CDC stood out, given she had never previously served in government, except for some advisory positions at the National Institutes of Health.
Her new role will make her one of the most public faces of the incoming Biden administration’s coronavirus response. And it will leave her in charge of restoring funding and morale at a public health body that has been sidelined during the pandemic by a president who has disagreed with its recommendations.
Peter Slavin, president of Massachusetts General Hospital, said: “She is truly an outstanding communicator. She is great at saying just the right thing for her audience, whether that is a professional one or the general public. That is going to be crucial for this role.”
Dr Walensky, who did not respond to a request for comment, made her name as an HIV researcher, winning plaudits for her analysis finding that Aids treatments had added almost 3m years to patients’ lives across the US.
It was while working in this field that she encountered Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, whom Mr Biden also intends to appoint to his inner circle of coronavirus advisers.
Dr Fauci told the Financial Times: “She is the kind of personality, somebody who is very inclusive, who would likely be very good for the morale of the CDC. It’s had a tough year.”
Her analysis of the HIV epidemic was that testing, prevention and early treatment were key, and that doing more to monitor the spread of the disease, while costly, could save money in the long term.
She reached the same conclusions earlier this year when she switched to focus on Covid-19.
She was part of a team of researchers who modelled how the disease was likely to spread on university campuses when they reopened. The study found the best and most cost-effective way to manage the virus was to carry out low-cost tests on every student and member of staff every two days. Even if the tests were sometimes wrong, the model found this was the best way to prevent widespread outbreaks.
In the end, many universities chose not to follow such a path, and coronavirus cases spiked in the autumn when colleges returned.
Colleagues said Dr Walensky’s work on HIV also spurred her interest in health inequality — something Mr Biden has promised to tackle.
When she has appeared on US television as a coronavirus expert, Dr Walensky has frequently pointed out how the disease has hit ethnic minority communities hardest. And she has expressed concern that the kind of antibody treatment which Donald Trump received when he fell ill with the disease might not be available to poorer patients who are less able to afford them.
“She talks a lot about racial inequality and gender inequality,” said Robert Goldstein, a colleague in the infectious diseases department at Massachusetts General. “When we talk about the coronavirus vaccine distribution plan for example, she talks a lot about how to reach those people who have been hardest hit.”
While her biggest challenge will be helping to curb the spread of the pandemic, Dr Walensky will also have to deal with more prosaic political matters, such as pushing Congress for more funding for her new organisation.
Earlier this year, Robert Redfield, the outgoing CDC director, called for a doubling or tripling of CDC’s discretionary budget of just under $8bn. A draft bill from the Senate appropriations committee last month recommended a budget increase of about 2.5 per cent.
She will also have to restore morale at the institution, where many of its senior staffers have been bruised by a series of battles with senior figures in the Trump administration over everything from testing to travel advice.
While peers say she has the right skills to lead CDC in the long run, some worry that her lack of political experience might make it harder to navigate some of the institutional issues.
“She is an extraordinary communicator and is in a great position to make a big difference at CDC,” said Mr Bloom. “Just as soon as she figures out what they do.”