Public health experts monitoring the lack of leadership at the Centers for Disease Control and Prevention have long predicted that finding someone to lead the agency would be a daunting task.
In the first 15 months of the second Trump administration, the agency had a Senate-confirmed director for just four weeks — Susan Monales, who was fired last August after clashing with Health Secretary Robert F. Kennedy Jr. over vaccine policy.
The administration had indicated last week that it would recommend a new candidate, but that did not happen. National Institutes of Health Director Jay Bhattacharyya now runs his own nearly $49 billion business and serves as part-time director of the CDC hundreds of miles away.
Once a new candidate for CDC director is nominated, and if he or she wins confirmation from the Senate, which is increasingly willing to follow the president’s lead, the hard work is just beginning.
Whoever takes over the Atlanta-based CDC will face major immediate challenges. Here are a few:
Convincing angry and distrustful staff
A key moment occurred during an all-hands meeting that Mr. Bhattacharya convened last week. A conference room at CDC headquarters’ Roybal campus in Atlanta was packed with agency staff. Some watched online from their offices.
Following Mr. Bhattacharyya’s opening remarks, the Q&A included the following pointed questions: “There’s been a lot of talk about rebuilding the public’s trust in us, and I’d like to know what you’re going to do to rebuild your trust,” one woman asked, to loud cheers and thunderous applause.
Mr Bhattacharyya’s response focused on the need to “moderate differences”.
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Staff say trust is lost for a variety of reasons. In particular, many are deeply upset that President Trump never mentioned the gunman’s attack on the CDC campus, even though President Kennedy’s first public comments were slow to come. (He made the comments the day after the attack and after posting a photo of himself salmon fishing in Alaska on social media.)
The attack was so shocking that windows cracked by the gunman’s barrage of bullets at authorities have yet to be replaced.
Fiona Havers was a medical epidemiologist in the CDC’s coronavirus division, but she left last year because her staff didn’t want to be involved in President Kennedy’s vaccine policies, which they believed were harming public health. Kennedy’s key role in selecting a new CDC leader would make him immediately suspect to CDC staff, she said.
“The very fact that they were appointed by this administration is going to be a credibility issue for them,” said Havers, now an adjunct associate professor of infectious diseases at Emory University.
Abby Tighe, a former CDC employee who was laid off in February 2025 during CDC’s first round of layoffs, agreed.
“The biggest challenge that any secretary, or any acting secretary, has right now is that there is a lack of trust between CDC staff and leadership. So they need to make the case for why both the CDC (staff) and the American public should trust them,” said Tai, one of the founders of what is now known as the National Public Health Coalition. (Formerly known as Fired But Fighting.)
Take a position on vaccines or not
The administration’s political polls show a majority of Americans support vaccines and disapprove of President Kennedy’s efforts to undermine long-held vaccination policies. President Kennedy has reportedly been told to focus on other health issues ahead of the November midterm elections.
But given Kennedy’s role in selecting the next CDC director and the reasons for firing Monares, the new director will need to quickly make his position on vaccines clear to staff. And there’s only one valid answer here.
“The only standard that staff can refer to at this point under this administration is what happened to Dr. Monares, and that is that she stood up for vaccine integrity and was fired,” Tai said.
The administration maintains that Kennedy is not opposed to vaccines, but if he shows some level of support, it generally means some form of approval. We clearly recognize that within the CDC. In a meeting with staff last week, Ms. Bhattacharyya said, “It’s extremely important that every child in this country gets the measles vaccine,” before adding, “Bobby doesn’t care if I say that.”
Convince staff that you actually have decision-making power
For decades, the director was the only political appointee at the CDC. In the past, even a director could weather changes in Washington, but over the past quarter century it has been common for a new CDC director to take over when a new administration takes office. Still, they were never political figures. CDC directors have not previously spoken at the Conservative Political Action Conference (CPAC). (Though Bhattacharya did so.)
However, this administration currently has about 18 political appointees at the CDC, particularly in the Office of the Director. Most of them have no medical qualifications or public health experience. Many of them worked for Republican campaigns or were previously unsuccessful Republican political candidates. The appointees include Sam Beyda, a recent college graduate who previously worked for Elon Musk’s US Department of State Services and appears to have a significant role in running the CDC.
In most cases, their roles are unclear, but it is clear that many exist to fulfill President Kennedy’s efforts to rewrite vaccination policy in ways that downplay the importance of these key public health tools and sow mistrust.
STAT Plus: Inside the delicate, high-stakes search for a new CDC director
In an oral history of what happened at the CDC in the New York Times, former chief medical officer Debra Hawley said Monares was told she couldn’t make important decisions unless they came from her chief of staff (not of her choice) or the Department of Health and Human Services’ general counsel.
“Certainly, that would really hinder the CDC director’s job if he had to approve staffing and policy decisions with the approval of an aviation lawyer… or 24-year-old Sam or someone else. Then they could put anyone there,” Woolley, who resigned in protest of Monares’ firing, told STAT.
Daniel Jernigan, former director of the National Center for Emerging and Zoonotic Infectious Diseases, who resigned with Mr. Awry, said the size of political appointees and, at least, the autonomy of the CDC sends a clear message to staff.
“This shows that the secretary has all the decision-making power, and it doesn’t really matter who the secretary is,” he said.
Restore trust in agencies that have been tattered
The CDC has long been the world’s premier public health agency. Government agencies around the world have modeled it. Many companies use the acronym CDC in their names, even though the letters do not have the same meaning in the local language.
The agency’s website was once a repository of public health information and science. It’s now a resource that even former staffers say should be treated with caution, with the understanding that some pages remain valid while others have been rewritten. Many of these updates were driven not by new research results but by Kennedy’s distrust of vaccines. In other cases, governments have sought to remove all references to health equity and transgender people from government websites, or have chosen to revert to using the term monkeypox for a disease currently called mpox in other parts of the world.
Richard Besser, CEO of the Robert Wood Johnson Foundation, has worked at the CDC for years, including serving as acting director at the beginning of the H1N1 influenza pandemic in 2009. He currently does not recommend people refer to the CDC website.
“A site only works if the public can trust that every page has the most relevant, evidence-based information out there. And that’s no longer the case,” Besser said.
Following President Kennedy’s repeated attempts to revise vaccine recommendations, public health experts are advising people to use the websites of professional societies such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists to find out which vaccines to give and when.
Awry noted that many state health departments have unlinked their websites from the CDC.
Restoring public trust in government institutions is critical, but it will not be easy to achieve.
Return to work fighting chronic illness
Over the past year, the CDC has been through several waves of layoffs. Chronic disease programs are particularly poorly treated, even those focused on oral health and tobacco control, to name a few. The administration argued that, despite additional functions assigned to the CDC by Congress, the agency had grown too large and sprawling, taking on too many issues far removed from its original mission of fighting infectious diseases.
President Kennedy announced plans to move much of the CDC’s chronic disease efforts to a new agency, which he proposed calling the Agency for a Healthier America. However, AHA is just an aspiration at this point.
Meanwhile, many of the CDC’s chronic disease programs are still fully funded by Congress but are not functioning because they lack staff, said Tai, who previously worked in the field of overdose prevention.
“There are people who have been completely laid off, but those programs are still funded. There are also people who have been off for more than a year and could come back and work, but they can’t,” she said.
Regain your gaze on what’s happening around the world
Infectious diseases don’t care about borders – a lesson the world should have learned by now from the 2014-2016 Ebola outbreak in West Africa, the coronavirus pandemic, and the global spread of mpox.
Knowing what’s happening elsewhere — knowing when a problem occurs before it becomes a disaster — is an important job for the nation’s public health agencies, especially the CDC. Historically, this is the institution that has uncovered the causes of new diseases. Other countries often seek its guidance and send samples to verify what they think their labs are observing. Or so it used to be.
But the Trump administration withdrew the United States from the World Health Organization, severing many scientific ties in the process. It destroyed the United States Agency for International Development, which not only helped many countries implement their own disease control programs, but also gave the United States the opportunity to monitor what was happening in every corner of the globe.
The administration said bilateral agreements with other countries could provide a basis for important intelligence sharing.
But Havers, Hooley, Jernigan and others are very concerned that the U.S. withdrawal from the WHO and international aid is limiting the U.S. ability to continue to address the threat of the disease. “I think that’s a big concern,” said Havers, who spent a significant amount of time in China when the H7N9 avian influenza outbreak began. “There’s always the threat of new pathogens emerging. I think by withdrawing from the WHO, CDC has less visibility in that area.”
stop the drain of talent
This agency has traditionally been the type of place where people with an interest in public health work for years, often their entire careers.
However, an estimated 20% of CDC employees have lost their jobs in the past year. Many of the centers and major programs are run by interim directors. “Since President Trump took office, 21 out of 25 centers, institutes, and offices have lost their leaders. This is a tremendous instability,” Awry said.
Since being appointed interim leader of the CDC, Mr. Bhattacharya has filled some of these posts and issued job circulars for several more. He told staff at the all-hands meeting that he was aware there were no plans for further cuts at the agency, but promised to oppose the idea if it was brought up.
Jernigan said the next CDC director will need to figure out a way to stop the bleeding.
“If you talk to the staff, they’re all paying attention,” he says. “So the best thing the next coach can do is give the staff something to stick with.”
