Understanding the turmoil at the CDC

America’s national public health agency is in turmoil, with firings, resignations, and claims and counterclaims about what’s true in science and health.

Keeping up with personnel news out of the Centers for Disease Control and Prevention was difficult Wednesday evening and Thursday: Director Susan Monarez, one month into her job, was reportedly refusing to give it up after being told to resign or be fired. She was later fired, but refused to step down, and some believe her case may make its way to the Supreme Court.

In the meantime, the Trump administration named Deputy Health and Human Services (HHS) Secretary Jim O’Neill to the role of acting director of the CDC, officials told The Hill.

BBC reported that “Monarez’s departure comes about a week after a union representing CDC employees announced that about 600 CDC employees had been fired.” The article said the layoffs included “employees working on the government’s response to infectious diseases, including bird flu, as well as those researching environmental hazards and handling public record requests.”

Monarez was nominated by President Donald Trump and confirmed by the Senate in July. The Washington Post reported that “her attorneys have challenged the legality of her firing and said she would not resign after she refused to follow ‘unscientific, reckless directives.’ (Health and Human Services Secretary Robert F. Kennedy Jr.) and other officials pressured Monarez to change vaccine policy and fire senior staff, people familiar with the conversations previously told The Washington Post."

Key leaders announce resignations

The turmoil is fast-moving: At least four and perhaps more senior leaders in the public health agency resigned, including Dr. Daniel Jernigan, head of the National Center for Emerging and Zoonotic Infectious Diseases; Dr. Demetre Daskalakis, head of the National Center for Immunization and Respiratory Disease; and Dr. Deb Houry, CDC chief medical officer.

NBC News reported that Dr. Jen Layden, director of the Office of Public Health Data, Surveillance and Technology, had also resigned.

Daskalakis posted his letter of resignation on X on Wednesday, writing “enough is enough,” and cited what he called the “ongoing weaponizing of public health.” Ironically, it was addressed to Houry, who, it turns out, has also resigned.

In her resignation letter, Houry wrote: “Recently, the overstating of risks (of vaccines) and the rise of misinformation have cost lives, as demonstrated by the highest number of U.S. measles cases in 30 years and the violent attack on our agency.”

In his long and detailed resignation letter that was sharply critical of HHS Secretary Robert F. Kennedy Jr., Daskalakis wrote that he is “unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health.”

Houry told the Post she was worried that the committee members appointed by Kennedy to oversee vaccine recommendations would “unravel vaccine recommendations before CDC staff could finish research.” She said she left because of a lack of “scientific leadership.”

As The New York Times reported, “Dr. Jernigan was deeply involved in the agency’s response to anthrax, swine flu and COVID; Dr. Daskalakis helped the nation cope with an mpox outbreak; Dr. Layden established the COVID strategic science unit; and Dr. Houry built the agency’s opioid response program.”

Thursday, Kennedy told Fox News that the leaders of CDC are supposed to “execute Trump’s agenda,” adding that the public health giant is “in trouble, needs to be fixed.”

Sen. Bill Cassidy, R-La., a physician, posted on X that the high-profile departures “will require oversight” by the Health, Education, Labor and Pensions Committee.

Cassidy had voted to confirm Kennedy as HHS secretary after Kennedy assured him that vaccines would continue to be available to those who want them.

Vaccination policy differences

Vaccine policy differences appear to be a major issue in the turnover and turmoil at the CDC. Monarez and Kennedy have disagreed over vaccine policy.

Per the Times, Monarez’s attorneys, Mark S. Zaid and Abbe Lowell, claimed that HHS leaders were ignoring science to promote their politics. “It is about the systematic dismantling of public health institutions, the silencing of experts, and the dangerous politicization of science,” they wrote. “The attack on Dr. Monarez is a warning to every American: Our evidence-based systems are being undermined from within.”

New guidance issued this week for the COVID-19 vaccines said they would be available to anyone 65 and older, as well as for those who have clear health conditions that put them at risk of severe COVID-19, such as being immune-compromised. Others could have a harder time getting the vaccine.

The American Academy of Pediatrics has responded to more restrictive federal guidance on COVID-19 vaccines by issuing its own recommendations for which children should receive vaccination.

Additionally, among other vaccine-related news, Kennedy fired the Advisory Committee on Immunization Practices that made recommendations on vaccines and replaced them with a smaller group of handpicked individuals, including some who have been seen as vaccine skeptics. The new committee is supposed to meet this month.

Thursday afternoon, Cassidy released a statement calling for the panel to “indefinitely postpone” its slated Sept. 18 meeting.

“Serious allegations have been made about the meeting agenda, membership and lack of scientific process being followed for the now announced September ACIP meeting. These decisions directly impact children’s health and the meeting should not occur until significant oversight has been conducted,” he said in the written statement. “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.”

This story has been updated.