CDC leadership changes: Health experts wonder what’s coming next

Robert F. Kennedy, Jr., and Susan Monarez, PhD

Experts in medicine and public health continued watching for what happens next at the U.S. Centers for Disease Control and Prevention (CDC), the agency that many argue is the world leader in public health.

This week, CDC Director Susan Monarez, PhD, was fired and four top aides left the agency, which falls under the jurisdiction of the U.S. Department of Health and Human Services (HHS) and Secretary Robert F. Kennedy, Jr.

The White House has tapped HHS Deputy Secretary Jim O’Neill to serve as acting director at CDC, according to reports from CBS News and The Hill.

“CDC has problems,” Kennedy said on Fox News. “We saw the misinformation coming out of COVID, they got the testing wrong, they got the social distancing, the masks, the school closures, they did so much harm to the American people.”

President Donald J. Trump has great ambitions for the agency, but the administration must examine if there is a deeply embedded malaise within CDC, Kennedy said. CDC needs strong leadership that will execute on the president’s ambitions, he said.

Kennedy declined to comment on Monarez specifically, but said the agency needs fixing and the administration will do so. He added it may be the case some people will not be working there anymore.

Finding support

The other CDC staffers who left were

• CDC Chief Medical Officer Debra Houry, MD, MPH.
• National Center for Immunization and Respiratory Diseases Director Demetre Daskalakis, MD, MPH.
• National Center for Emerging and Zoonotic Infectious Diseases Director Daniel Jernigan, MD, MPH (CAPT, USPHS, RET)
• Jennifer Layden, MD, PhD, of the Office of Public Health Data, Surveillance, and Technology.

CBS News had footage of a rally outside the CDC’s Atlanta headquarters with employees cheering at least three of their former colleagues. The network also had interview footage with Daskalakis and Houry, with Daskalakis stating he saw “ideology permeating through science in a way that is going to harm children and adults.”

“I think we are seeing things that are happening that are making our country less prepared to be able to respond to the everyday pathogens. All of that meant that I could not stay because I would be doing harm,” he said in an interview with news contributor Celine Gounder, MD, who also is editor-at-large for public health at KFF Health News. In additional coverage, supporters cheered when Jernigan exclaimed: “Let’s get the politics out of public health,” and get back to objectivity and science that leads to the best decisions for public health.

Criticism continues

Meanwhile, health organizations continued rounds of criticism for the actions.

The Society for Healthcare Epidemiology of America (SHEA) issued a statement this week arguing that the nation “stands at a critical crossroads, where strong, trusted public health leadership is essential to restoring confidence through evidence-based practices and guidance.”

“What all the professional societies, including my society, believe in, we believe in public health guidelines should be evidence based on peer reviewed published literature,” SHEA President David J. Weber, MD, MPH, told Medical Economics. Shea also is a distinguished professor of medicine and pediatrics and medical director of the department of infection prevention at UNC Medical Center in North Carolina.

“Our goal is to protect our public to reduce the risk of infectious diseases, which maintain, which remain a serious cause of death and hospitalizations in the United States,” he said. “And our goal is to eliminate or eradicate diseases, if we can or mitigate the impact of those diseases. And of course, we have about 70 diseases, roughly, that are reportable to the Centers for Disease Control, and we rely on the CDC for many things.”

CDC coordinates surveillance of diseases around the country. Its scientists write guidelines and recommendations, based on the best available scientific evidence, dealing with infection control and vaccines. It maintains laboratory capacity for diagnosing uncommon and unusual diseases, which helps patients and the public by controlling spread of disease, Weber said.

Leadership needed

Weber also outlined his preferences for a new CDC leader.

“I think that person should be a physician with appropriate training as a physician, beyond that, they should have had a substantial experience in dealing with public health,” Weber said. “As physicians, we learn how to deal with the individual patient in front of us, but here we're dealing with groups of people and reducing their risk for disease. That's not part of the average training for the average physician. So we should get people who have extensive experience in public health. Ideally, that person would also have enough of a scientific background, again, to develop and read the scientific literature to be able to follow the best evidence-based practice for interventions that are both safe and effective.”

Recommendations, not rules

Patients and some physicians may have a misperception about CDC. It is not a regulatory agency that makes requires for physicians and patients to follow, Weber said.

Instead, it provides disease surveillance, guidelines and guidance based on scientific evidence, and protection from food outbreaks. CDC guidance protects animals as well, helping prevent diseases that can be transmitted from animals to humans. CDC also develops guidance to slow or stop transmission of diseases that transfer from person to person, Weber said.

Trickle-down health effects

Outside Washington, D.C., the CDC acts as a financial pass-through, distributing much of its budget to state and local health departments based on needs for particular diseases, Weber said.

“We are faced now with dramatic cuts in the CDC,” Weber said. “About 20% of their staff has been eliminated, and potentially even more dramatic cuts in the overall funding of the CDC, and up to 40%. That will not only affect the CDC itself and all the good things I've told you, but it's going to affect every person in the United States, because these cutbacks will dramatically affect their city and their state public health departments, which are providing local care to people at their clinics and providing guidance on doing outbreaks and food, agriculture, other types of outbreaks, and protecting the public in those local areas.”

Additional responses

SHEA was not alone in issuing statements condemning the circumstances that led to the removal of Monarez and the exit of other key leaders.

Firing Monarez as director “is another example of this administration’s ruthless and destructive political agenda which continues to politicize public health. It will cost lives,” said a statement from Richard Besser, president and CEO of the Robert Wood Johnson Foundation. “This firing is designed to silence dissent across the government. With this firing and the resignation of other top CDC leaders, the agency loses its ability to provide the best health advice to the American people. That will also cost lives.”

Besser called Monarez a principled public servant and scientist and “one of the last lines of defense against this administration’s reckless health agenda.”

The American Public Health Association convened an online press conference warning that the leadership upheaval at CDC is adding to the country’s public health risk. The American Medical Association and the Infectious Diseases Society of America also issued statements condemning the changes.