The weekend's chaos at the FDA is prompting questions around how much more the agency can take before its functionality is seriously impaired.

Why it matters: An agency is only as good as its workforce, and after months of high-profile departures and open hostility from top health officials, some argue the FDA's performance is already deteriorating.

Text messages from current FDA staffers shared confidentially with Axios show people disturbed by the turmoil and increasingly motivated to leave the agency — a threat heightened by how many experienced career officials have already left.

• "If they could get enough money elsewhere, if they could get remote jobs, if they could get as much vacation, they would just leave," a former FDA staffer told Axios, speaking of current staffers.
• "I don't know that I've talked to anyone who's happy there."

Driving the news: The agency's top drug regulator resigned over the weekend amid a lawsuit alleging he used his position to get revenge against a former business associate.

• The official, George Tidmarsh, denied the allegations and told the New York Times he believed he was being retaliated against for raising concerns with a new agency program to speed certain drug approvals.
• He told Endpoints News he'll fight his ouster.

Between the lines: "Good people leave and the other problem is, because of all of this perceived chaos, it becomes even harder for the FDA to recruit new employees," said Peter Pitts, a former associate FDA commissioner and president of the Center for Medicine in the Public Interest. "And it's never been easy."

• The upheaval came on the heels of explosive reporting about the agency's biologics and vaccines regulatory arm, with Stat writing that the division has become "rife with mistrust and paranoia" under the leadership of Vinay Prasad.
• Prasad made headlines earlier this year when he left the agency under criticism from right-wing activist Laura Loomer, only to return a couple of weeks later.

The big picture: The pharmaceutical and biotech industry depend on the agency being predictable and reliable to shepherd millions of dollars in investments.

• "When pharmaceutical companies on their own or smaller companies with their venture capital partners see that you can't predict what the FDA is going to do from day to day, they simply take their investment dollars and place them elsewhere," Pitts said.

The other side: "The FDA continues to carry out its mission to protect public health with the same rigor and independence the American people expect," said HHS spokesperson Emily Hilliard.

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Walgreens is unveiling an expanded tracker of flu and COVID-19 to monitor where they're spreading across the country this winter, the company shared first with Axios.

Why it matters: Commercial and academic tools are becoming more important for identifying respiratory virus hotspots this year as federal data becomes less available.

Driving the news: Walgreens is adding COVID-19 data to its existing flu prevalence tracker to create a more comprehensive picture of when and where respiratory viruses are spiking this winter, the company told Axios yesterday.

• Walgreens will pull in data each week from its stores on flu and COVID-19 test results, prescriptions for antivirals and sales of over-the-counter flu and cold products.

The tracker will let people see what's happening both nationally and near them, said Rick Gates, chief pharmacy officer at Walgreens.

• Consumers can see flu and COVID-19 prevalence by state on the tool.

State of play: The CDC's public flu and COVID-19 trackers have not been updated since before the government shutdown, concerning some doctors and public health scientists as respiratory virus season gets underway.

• Even before the shutdown, communication blackouts at HHS since the Trump administration started have periodically slowed data releases.
• The director of CDC's National Center for Immunization and Respiratory Diseases, Demetre Daskalakis, also resigned earlier this year.

The big picture: In addition to company efforts like Walgreens', several universities are tracking the spread of respiratory viruses and other illnesses based on sources like state and local health department data.

• But "none of these systems, by themselves or even collectively, will ever replace what CDC does," said Jennifer Nuzzo, a professor and director of the Pandemic Center at Brown University School of Public Health who runs one such tracking effort.

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Health care is a pretty big backdrop to tonight's off-year elections, with both parties battling for an edge on health care costs and the future of the Affordable Care Act and Medicaid.

Why it matters: The elections come during a shutdown fight over ACA subsidies — and just months after deep Medicaid cuts in the GOP tax and spending package.

• Here's what to keep an eye on tonight:

1) The cost conversation. Democrats are watching the Virginia and New Jersey governors' races for any traction their candidates — Abigail Spanberger in Virginia and Mikie Sherrill in New Jersey — might get from talking about the cost of health care for families.

• Spanberger, for example, has talked about lowering prescription drug prices through price transparency laws and targeting pharmacy benefit managers.
• Republican Jack Ciattarelli of New Jersey has carved out an unusual path on costs: He wants to "crack down on insurers to lower costs," but he's also calling for new "free-market health systems that make care more accessible and affordable."

2) Medicaid. Both Ciattarelli and Republican Winsome Earle-Sears of Virginia have played down the impact of the Medicaid cuts, while Spanberger and Sherrill have hammered the issue and warned that the cuts will be disastrous.

3) The Affordable Care Act. Here's where the Democratic candidates have made their biggest stand on costs, with former President Barack Obama joining both at campaign rallies this weekend to warn that "health care premiums for millions of people are about to double or even triple next year."

• Republicans counter that Democrats didn't make a serious effort to stop the increases earlier, with one senior GOP aide telling us the ACA fight is only about "keeping up the act like they're fighting for something — anything — other than just being against President Trump."

Our thought bubble: It's a pretty high bar for the election results to be decisive enough to force an ACA solution and end the shutdown on their own, short of a truly lopsided set of results.

• But maybe, just maybe, it will help Congress to have the election out of the way.

A group of centrist House Democrats and Republicans yesterday unveiled a proposal that they believe could finally cut through the partisan impasse that has kept the government shut down for more than a month.

Why it matters: The rare bipartisan coordination is the latest signal that lawmakers in both parties — particularly moderates and those in battleground districts — are growing fed up with the extended shutdown.

Driving the news: Reps. Don Bacon (R-Neb.), Tom Suozzi (D-N.Y.), Jeff Hurd (R-Colo.) and Josh Gottheimer (D-N.J.) released a broad outline for a potential compromise extension of the ACA tax credits.

• The enhanced premium tax credits would be extended for two years, with a phased-out income cap for those making between $200,000 and $400,000 a year.
• The proposal also includes several reforms, including requiring ACA marketplaces to confirm that recipients haven't died, creating a new standard for cracking down on fraud and providing more transparency on the value of recipients' tax credits.

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Would you have guessed that Tylenol maker Kenvue would be bought after being the target of President Trump's attempts to draw a link between autism and the use of Tylenol during pregnancy?

• That's what happened Monday morning, as Kimberly-Clark announced it would acquire Kenvue for more than $40 billion in cash and stock, Axios' Ben Berkowitz reports.

What we're watching: Whether regulators will be interested given Kenvue's role in the autism claims (which Kenvue strongly rejects).

• So far, no word from either HHS or FDA.

👀 Pfizer said it filed a second lawsuit against Novo Nordisk and Metsera in a bidding war over the obesity biotech. (CNBC)

💸 Equifax, the leading income-verification company, could get a big financial windfall from Medicaid work requirements that will be implemented starting in 2027. (New York Times)

😡 Specialists are lashing out against the new Medicare payment "efficiency adjustment." (Modern Healthcare)