The U.S. government is responding to the first major epidemiological crisis of the Obama presidency without many of its top health officials in place. Depending on how severe the swine flu epi-pandemic turns out to be, or how well the government performs its twin duties (containment and calming), this means that (a) these officials really aren't that critical for government to function in the first place, or (b) the U.S. system of nominating, vetting and confirming these appointees is dangerously slow for the challenges of the 21st century. If CNN's Sanjay Gupta had decided to accept the Surgeon General's position, he certainly would not be in Mexico City with a mask hanging around his neck. He'd be in Washington, participating in press conferences, which are, despite the government's best intentions, NOT reassuring and not terribly informative. (During a medical crisis, health reporters get their news from conference calls with dedicated bureaucrats who can cut to the chase.)
For years, Norm Ornstein and others have been urging the government to take the idea of continuity of government more seriously, That is -- there is a real potential cost to the sluggish pace of appointments. Ornstein is more concerned, though, with the government's inability to be consider its own existential existence. If half of Congress comes down with swine flu and has to be hospitalized, then what? Nothing. There are no contingency plans for states to appoint, or Congress to credentialize, representatives in times of acute diaster or trouble. Same thing if the president (who we know came in contact with someone who probably died from the flu) and his cabinet becomes incapacitated, or worse, at the same time. There are rough succession procedures, but not much else. Technically, FEMA and the DoD have secret powers (authorized by secret executive orders), and they regularly hold secret exercises, but that provides little comfort or information.
Political communication during health emergencies always falls short of the mark. (What's the difference between a "health emergency" and a "public health crisis?" Apparently, there is a difference, according to some government agencies, but we're not sure what it is.) Are there formal provisions for the Department of Homeland Security to assume power from the Department of Health and Human Services if an HHS head is not appointed?