Yeah, I don't get why an assistant secretary needs to be a four star. Or part of that uniformed service at all. I think the Surgeon General is normally just a three star. An assistant secretary is likely higher than the surgeon general (I didn't look at their org chart), but it should be a civilian position, IMO.
From the Wiki Universe.
[quote[ If the appointee is also a serving uniformed officer of the commissioned corps, by statute, he or she is appointed as a four-star admiral and is the highest ranking officer in the commissioned corps,[1][2] as no other position in the Public Health Service is designated as a four-star office. The president may also nominate a civilian appointee to also be appointed a direct commission in the commissioned corps if the nominee so chooses.[/quote]
I don't know if he was already in the USPHS but it doesn't seem to matter, the President can give a direct appointment for guy. To me this smacks of posturing by the new Admiral and the Administration, like in look at how woke we are the other side would never allow this.
bob