Public health experts slam leadership upheaval at CDC: RFK is ‘an irrefutable problem at the top’

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Management turmoil and disregard of science are crippling the U.S. Centers for Disease Control and Prevention (CDC), a world leader in medical research and key support of health care across the country, said three physician experts in public health.

Meanwhile, the Advisory Committee on Immunization Practices (ACIP) is scheduled to meet this month, but a physician in the Senate wants to put those deliberations on hold.

The developments followed the U.S. Department of Health and Human Services’ Aug. 27 announcement that Susan Monarez, PhD, was being ousted as CDC director, less than a month after being selected by HHS Secretary Robert F. Kennedy, Jr., and formally confirmed to the job by the Senate. She is contesting that removal, but at least four top aides and health experts have departed CDC.

On Aug. 28, the American Public Health Association (APHA) convened an online press conference to condemn the turnover and the larger effects across U.S. health care.

‘We’ve had enough’

CDC is the world’s most important and most credible public health agency, but the last several months have seen an effort to destroy it, said APHA Executive Director Georges Benjamin, MD, who for month has been a vocal critic of Kennedy.

Georges C. Benjamin, MD
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“If you think about it, this agency has undergone indiscriminate firings of staff, confusion over authority, confusion over when, who's working, who's in charge, what's been going on,” he said. “It has trickled down and dramatically impacted the capacity of our state and local health departments to protect the public's health, as part of that process.”

Science is important at CDC, and the American people deserve a high functioning agency guided by science, Benjamin said. Not having that is costly, he said.

“It wastes taxpayer dollars, it impacts our health in a negative way, and it costs lives, and the CDC is the nation's most important prevention agency, and we've had enough,” Benjamin said.

A problem at the top

Wendy Armstrong, MD, FIDSA
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Aug. 27 marked the worst day in a steady exodus of expert leaders at CDC. Losing four high level leaders and the uncertain status of the director makes America far less safe than the nation was at the start of that day, said Wendy Armstrong, MD, FIDSA, vice president of the Infectious Disease Society of America.

“In any organization or company, if the senior leadership team walked out en masse, we would have to recognize and accept that there is an irrefutable problem at the top — in this case, Secretary Kennedy and his continuous attacks on public health,” Armstrong said.

When public health works well, it is invisible to the public, Armstrong said. Yet the changes in the agency will have effects on the public, she added. Leaders who left oversaw programs protecting the public from foodborne illness, antibiotic resistant bacteria, diseases like West Nile virus, Armstrong said.

She continued with examples ranging from food safety of ice cream and hot dogs, to needing a test for a patient that only CDC performs in the United States. Now CDC does not have capacity to complete that test. Other examples: research will slow, affecting patients with measles, with asthma and chronic lung disease, HIV, COVID-19, and there is greater risk of bioterrorism.

“So here's the bottom line. If this is our football team, we've lost our quarterback and we've lost the entire line. You could debate whether that's the offensive line or the defensive line, but our team still expected to play in the Super Bowl,” Armstrong said.

Patients also should have the right to choose for themselves about getting vaccines, but Kennedy has taken that choice away from millions by limiting access to the COVID-19 shot, Armstrong said.

‘Sickening and frightening’

Phillip Huang, MD, MPH
_{© Dallas County Health and Human Services}

The situation is “sickening and sort of frightening” for local health departments, said Phillip Huang, MD, MPH, director of Dallas Health and Human Services in Dallas County, Texas.

Montarez and her aides really stood for integrity and the principles that health leaders espouse, not caving when there are attacks, Huang said. “I applaud them for doing what’s right,” he said.

There also are effects when local health departments don’t have resources and money to invest. Dallas County canceled more than 50 community outreach vaccination clinics against measle in the state where an outbreak happened, Huang said. Local health workers depend on the programs and expertise of CDC every day.

“Because again, CDC is the preeminent public health agency, both nationally and globally, that has the expertise, has the experts, that can provide us the best scientific information for us to respond to whatever public health threat we're dealing with,” Huang said.

What next for CDC?

During questions from the press, Benjamin agreed “absolutely” there will be trouble finding a qualified leader for CDC.

“Why would you take a job that is the one of the most important science-based jobs in the country when you know that your boss doesn't support science or evidence, nor has the leadership capacity and management capacity to figure out how to manage an employee who disagrees with them?” Benjamin said. Kennedy was so far out from established science that Montarez had no choice but to disagree, he said.

“And I don't know how anyone else could come in with a straight face and with any kind of integrity and take the job, I just don't know how you want to do that,” he said.

Armstrong cited the resignation letter of CDC leader Demetre Daskalakis, MD, MPH, who argued it is impossible for individuals who follow science to continue to do their job with any integrity when statements come out that are not vetted by experts at CDC and are not science-based. Daskalakis was director of the National Center for Immunization and Respiratory Diseases. He resigned, along with Chief Medical Officer Debra Houry, MD, MPH;

National Center for Emerging and Zoonotic Infectious Diseases Director Daniel Jernigan, MD, MPH; and Jennifer Layden, MD, PhD, of the Office of Public Health Data, Surveillance, and Technology.

Some have argued Monarez was fired for cause, but Benjamin disagreed.

“She didn't violate any legal professional or moral or ethical lines, so I don't agree with her being fired for cause. She got fired because her boss was trying to commit malpractice, and she said, no,” Benjamin said.

Physicians in private practice around the country, whether in small towns and rural areas or in large academic centers, all rely on CDC for information, testing and surveillance. It is not uncommon for doctors to call CDC experts to discuss unusual problems with patients, for both basic and very sophisticated questions, Armstrong said.

Huang agreed. An example is that once measles was eliminated in the United States in 2000, most physicians and other clinicians have not seen a case, so they rely on the federal researchers for help, he said.

Will ACIP meet?

ACIP is ready to publish its September meeting agenda, but Sen. Bill Cassidy, MD (R-Louisiana), has called for indefinite postponement of that meeting, according to a report in The Hill.

“Serious allegations have been made about the meeting agenda, membership, and lack of scientific process being followed for the now announced September ACIP meeting,” Cassidy said in a statement, according to that report.

“These decisions directly impact children’s health and the meeting should not occur until significant oversight has been conducted. If the meeting proceeds, any recommendations made should be rejected as lacking legitimacy given the seriousness of the allegations and the current turmoil in CDC leadership,” Kennedy said.

ACIP is the vaccine review board whose members were fired earlier this year, a move that prompted a wave of criticism from major organizations in U.S. health care and medicine. Kennedy appointed new members and they met in June.