CDC in Confusion in the Wake of Firing of Director, Resignations

Things were left in a rather confused and unsettled state on Wednesday evening, August 27, as Health and Human Services Secretary Robert F. Kennedy Jr. pushed Susan Monarez, Ph.D., who less than a month ago had begun in her role as Director of the Centers for Disease Control and Prevention (CDC), out of her job, with President Donald Trump making the final decision, even as Dr. Monarez refused to resign. And four very senior CDC officials resigned on Wednesday evening, blasting Secretary Kennedy and what they described as an anti-vaccine campaign. Dr. Monarez had only been confirmed by the Senate in late July, and had been sworn into her office on July 31.

Here’s how Sheryl Gay Stolberg, Apoorva Mandavilli, and Christina Jewett of the New York Times explained it, in a breaking-news report published at 10:03 PM eastern time: “The White House said late Wednesday that it had fired Susan Monarez, the new director of the Centers for Disease Control and Prevention, after a tense confrontation in which Health Secretary Robert F. Kennedy Jr. tried to remove her from her position and she refused to resign. Dr. Monarez, an infectious disease researcher, was sworn in just a month ago by Mr. Kennedy, but had clashed with the secretary over vaccine policy, people familiar with the events said. Four other high-profile C.D.C. officials quit en masse, apparently in frustration over vaccine policy and Mr. Kennedy’s leadership.”

They went on to write that, “Because Dr. Monarez had been confirmed by the Senate — previous C.D.C. directors were not subject to such confirmation — she served at the pleasure of the president. Mr. Kennedy likely did not have the authority to dismiss her,” the New York Times reporters wrote. But they also noted that a statement was posted by a spokesperson for President Trump, Kush Desai, stating that the President had terminated her. Desai stated that, “As her attorney’s statement makes abundantly clear, Susan Monarez is not aligned with the President’s agenda of Making America Healthy Again. Since Susan Monarez refused to resign despite informing HHS leadership of her intent to do so, the White House has terminated Monarez from her position with the C.D.C.”

Alec Schemmel and Lorraine Taylor of Fox News wrote on Wednesday evening that, “Prior to Monarez's Senate confirmation, CDC directors did not typically require Senate approval, but that changed in 2022 when Congress passed a law making it necessary. Monarez was the first-ever Senate-confirmed CDC director in the agency's history. Monarez was also the first CDC director without a medical degree in more than seven decades. However, she does hold a Ph.D. in microbiology and immunology. After getting her doctorate, Monarez entered the federal government, where she found herself in roles at the White House's Office of Science and Technology Policy, the National Security Council, the Department of Homeland Security and the Advanced Research Projects Agency for Health (ARPA-H). Her biography on the CDC's website says she worked on ‘leading efforts to enhance the nation's biomedical innovation capabilities, including combating antimicrobial resistance, expanding the use of wearables to promote patient health, ensuring personal health data privacy, and improving pandemic preparedness,’” they added.

Following the White House’s actions, Mark Zaid and Abbe Lowell, attorneys representing Monarez, issued a statement that included this statement: “When CDC Director Susan Monarez refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts, she chose protecting the public over serving a political agenda,” the lawyers, Mark S. Zaid and Abbe Lowell, wrote in a statement. “For that reason, she has been targeted. First it was independent advisory committees and career experts. Then it was the dismissal of seasoned scientists. Now, Secretary Kennedy and HHS have set their sights on weaponizing public health for political gain and putting millions of American lives at risk.”

The battle over Monarez’s status was only one element in the drama, as several senior CDC officials announced their resignations. As the Washington Post’s Lena H. Sun, Dan Diamond, and Lauren Weber reported late on Wednesday evening, “After news of efforts to oust Monarez, at least three top CDC officials announced their resignations Wednesday, citing lost funding, the political climate and a broader attack on public health, according to their emails to staff obtained by The Washington Post. Demetre Daskalakis, M.D., the CDC’s top respiratory illness and immunization official, posted his scathing resignation letter on X where he blasted Kennedy and his appointees for unraveling coronavirus vaccine recommendations, which he said ‘threaten the lives of the youngest Americans and pregnant people.’”

They quoted him as stating further that “I am not sure who the Secretary is listening to, but it is quite certainly not to us. Unvetted and conflicted outside organizations seem to be the sources HHS use over the gold standard science of CDC and other reputable sources. At a hearing, Secretary Kennedy said that Americans should not take medical advice from him. To the contrary, an appropriately briefed and inquisitive Secretary should be a source of health information for the people he serves. As it stands now, I must agree with him, that he should not be considered a source of accurate information.”

Then, the Post reporters wrote, “The CDC’s chief medical officer, Debra Houry, M.D., M.P.H., told staff that ‘ongoing changes’ prevent her from continuing in her job. ‘Vaccines save lives — this is an indisputable, well-established, scientific fact,’ Houry wrote. ‘Recently, the overstating of risks 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.’”

Further, they wrote that Daniel Jernigan, M.D., M.P.H., “a longtime official who helped oversee the CDC’s infectious-disease response, also announced his resignation.” Dr. Jernigan has served for several years as Director for the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), where he has overseen “the CDC’s work with foodborne, waterborne, fungal, vector-borne, healthcare-associated antimicrobial-resistant and high-consequence (e.g., Ebola, anthrax) infectious diseases,” according to Dr. Jernigan’s Linked in profile description.

The Post reporters noted that “Public health advocates had hoped Monarez would be a check on Kennedy and block him from limiting access to vaccines. Kennedy on Wednesday announced that the health agency signed off on new coronavirus vaccines but that the agency limited approval to people 65 and older or who have risk factors for severe coronavirus disease, instead of everyone 6 months and older.

What’s more, NBC News’s Erika Edwards and Berkeley Lovelace Jr. reported on Wednesday evening, “Dr. Jen Layden, director of the Office of Public Health Data, Surveillance and Technology,” also resigned. And they  quoted her as stating that, “Recently, the overstating of risks [of vaccines] and the rise of misinformation have cost lives, as demonstrated by the highest number of US measles cases in 30 years and the violent attack on our agency,”

The NBC News reporters wrote that “CDC staffers said they were shocked by the developments. ‘These guys are the best in the business. They know their stuff,’ said a CDC staffer who requested anonymity for fear of retaliation. ‘I’m stunned how fast this all happened.’”

Dr. Mandy Cohen, a former CDC director under President Joe Biden, issued a statement Wednesday evening, saying that “We lost exceptional leaders who have served over many decades and many administrations. The weakening of the CDC leaves us less safe and more vulnerable as a country.” And Michael Osterholm, an infectious disease expert and the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said in a statement that the “departures are a serious loss for America. The loss of experienced, world-class infectious disease experts at CDC is directly related to the failed leadership of extremists currently in charge of the Department of Health and Human Services,” he said.

Osterholm is launching the Vaccine Integrity Project as a potential alternative to the CDC’s Advisory Committee on Immunization Practices. In June, Kennedy fired all 17 ACIP members and replaced them with his own picks, including several Covid vaccine skeptics.

The dramatic developments on Wednesday evening had followed a series of unprecedented developments, as Government Executive’s Carten Cordell noted on Wednesday evening. “The resignations come less than three weeks after a gunman fired hundreds of bullets into the CDC’s Atlanta headquarters over what police said was opposition to the COVID-19 vaccine shot,” he wrote. “After the shooting, CDC employees told Government Executive that before Monarez arrived as director, they had received “almost no communication from leadership, basically since the beginning of the year” and that she had been working to improve on that. In June, CDC officials said the agency had lost nearly a quarter of its staff, some 3,000 employees, since President Donald Trump took office, through reductions in force, retirement incentives, deferred resignation, and firings. Some layoffs have been reversed. The CDC has also been at the center of controversy related to policy actions by HHS Secretary Robert F. Kennedy, Jr. Since his confirmation in February, Kennedy, a noted vaccine critic, has replaced the members of a vaccine advisory board and terminated $500 million in research funding for mRNA vaccines,” he wrote.

Dramatic confrontations preceded firing

The Times reporters, in their report, wrote that a federal official, “who spoke on condition of anonymity for fear of retribution, said Mr. Kennedy summoned Dr. Monarez to his office on Monday and demanded that she resign. When she refused, Mr. Kennedy demanded that she remove the agency’s top leadership by the end of the week. Dr. Monarez then called Senator Bill Cassidy, the Republican chairman of the Senate health committee, who in turn called Mr. Kennedy, according to the official. Mr. Kennedy, furious, summoned Dr. Monarez to a second meeting on Tuesday and accused her of “being a leaker,” according to the official, and told her she would be fired. The official said Dr. Monarez spoke to other senators as well. On Wednesday, a White House official told Dr. Monarez that if she did not resign by the end of the day, Mr. Trump would terminate her. Dr. Monarez then called Senator Bill Cassidy, the Republican chairman of the Senate health committee, who in turn called Mr. Kennedy, according to the official. Mr. Kennedy, furious, summoned Dr. Monarez to a second meeting on Tuesday and accused her of “being a leaker,” according to the official, and told her she would be fired. The official said Dr. Monarez spoke to other senators as well.”

On MSNBC on Wednesday evening, Georges C. Benjamin, M.D., executive director of the Washington, D.C.-based American Public Health Association, told Jan Psaki in an interview that “This is an example of failed leadership and administrative incompetence on the part of the Secretary. What it means for the rest of us is that we’re all going to be at risk, because people who want to be vaccinated, won’t be.” And, asked about the possible weaponization of public health issues, Dr. Benjamin said that “Public health works on trust, and the minute you break that trust, you lose the public. The public has been confused.” Ultimately, he said, the result of all of this instability at the CDC is that “There will be more deaths.”

Also on MSNBC, Ashish Jha, M.D., currently the dean of the Brown University School of Public Health in Providence, Rhode Island, and President Joe Biden’s White House Coronavirus Response Coordinator from April 2022 through June 2023, told Ali Velshi that “What you’re seeing is the wholesale destruction of the CDC; scientists standing up for some very basic scientific facts like vaccines work, not signing onto an anti-vaccine agenda. CDC is enormous important when you have disease outbreaks, lead poisoning in the water. We are far more vulnerable now because of the actions of this administration and the actions of this health secretary,” he added.

This is a developing story. Healthcare Innovation will update readers as new developments emerge.

Key Takeaways:

Ø  > In a complex series of developments on Wednesday, August 27, the White House fired Susan Monarez, Ph.D., the Director of the Centers for Disease Control and Prevention (CDC).

Ø  > Demestre Daskalakis, M.D., Debra Houry, M.D., M.P.H., Daniel Jernigan, M.D., M.P.H., and Jen Layden, M.D., Ph.D., four leaders in very senior positions inside the CDC, protested the White House’s move, and all resigned yesterday, making public statements criticizing HHS Secretary Robert F. Kennedy Jr. and the White House.

Ø  > Public health leaders nationwide have been criticizing what happened on Wednesday, and expressing concern over public health leadership going forward.