Public health experts have long anticipated that appointing a new leader for the Centers for Disease Control and Prevention (CDC) would be an enormous challenge due to the existing leadership void.
During the initial 15 months of Trump’s second term, the CDC had a Senate-confirmed director for just four weeks. Susan Monarez, the previous director, was dismissed last August following a disagreement over vaccination policies with Health Secretary Robert F. Kennedy Jr.
Although the administration intended to propose a new candidate last week, this did not occur. Meanwhile, Jay Bhattacharya, the director of the National Institutes of Health, is managing his own substantial $49 billion operation while also acting as the part-time head of the CDC, despite being located hundreds of miles away.
If a new nominee for the CDC director position is announced and successfully confirmed by a Senate increasingly resistant to presidential appointments, the real challenges will commence. The new leader will face significant hurdles from the outset. Here are some of the main challenges:
Winning Over a Distrustful and Frustrated Staff
In a recent all-hands meeting convened by Bhattacharya at the Roybal campus of the CDC headquarters in Atlanta, staff members filled the meeting room while others participated remotely. During the session, a staff member posed a critical question: “There’s been a lot of conversation about rebuilding the public trust in us, but I would like to know what you’re planning to do to rebuild our trust in all of you?” This question was met with loud cheers and applause.
Bhattacharya responded by emphasizing the importance of “de-escalating disagreement.”
According to staff, trust has eroded for various reasons. Many are particularly upset that President Trump did not address a gunman’s attack on the CDC campus, and that Kennedy’s initial response was delayed. He commented only a day after the incident and only after posting pictures of himself salmon fishing in Alaska on social media.
The attack was traumatic, and the windows damaged by gunfire have yet to be replaced.
Fiona Havers, a medical epidemiologist in the CDC’s coronavirus division, resigned last year due to disagreements with Kennedy’s vaccine policies, which she believed would harm public health. She noted that Kennedy’s involvement in selecting the new CDC leader would make any appointee suspect to the staff.
“The very fact that they’re appointed by this administration is going to be a credibility issue for them,” said Havers, who now teaches infectious diseases at Emory University.
Abby Tighe, a former CDC employee who was laid off in February 2025 during the first wave of job cuts, shared similar sentiments.
“The biggest challenge any director at this point has, and that even the acting director has, is there’s no trust between the workers at CDC and leadership. And so they need to make the case for why anybody should trust them, both [workers] at the CDC and the American people,” said Tighe, a founder of the National Public Health Coalition, previously known as Fired But Fighting.
Taking a Stand on Vaccines
Political polling by the administration indicates that the public generally supports vaccines and disapproves of Kennedy’s efforts to undermine established vaccination policies. Kennedy has reportedly been advised to concentrate on other health issues before the November midterm elections.
Given Kennedy’s role in selecting the next CDC director and the circumstances surrounding Monarez’s dismissal, the new director will need to quickly clarify their stance on vaccines to the staff. There’s only one acceptable position here.
“The only point of reference staff have at this point under this administration is what happened with Dr. Monarez. And that’s that she stood up for vaccine integrity and she was fired,” Tighe explained.
Although the administration claims Kennedy is not against vaccines, his support often comes with caveats. This understanding is prevalent within the CDC. In a recent staff meeting, Bhattacharya stated, “it is vital that every kid in this country get the measles vaccine,” adding that “Bobby’s fine with me saying that.”
Convincing Staff of Authority
Historically, the CDC’s only political appointee was the director, a role that remained stable even amid political changes. However, in recent decades, a new administration typically brings in a new CDC head, although these leaders were not politically affiliated. CDC directors did not traditionally address the Conservative Political Action Conference (CPAC), as Bhattacharya has done.
This administration has filled the CDC’s Office of the Director with around 18 political appointees, many lacking medical or public health expertise, and often having backgrounds in Republican campaigns or as unsuccessful political candidates. One notable appointee is Sam Beyda, a recent graduate who previously worked for Elon Musk’s U.S. DOGE Service and now plays a significant role in managing the CDC.
Their roles are largely undefined, though many are clearly there to support Kennedy’s efforts to reshape vaccination policy in ways that undermine trust in these critical public health measures.
In a New York Times oral history on the CDC’s recent changes, former chief medical officer Debra Houry mentioned that Monarez was instructed to have all major decisions approved by her chief of staff or the Department of Health and Human Services legal counsel, neither of whom she chose.
“Certainly if the CDC director has to have staffing and policy decisions signed off on by an aviation attorney … or 24-year-old Sam or someone else now, that will really hamper a CDC director. Then you could put anybody there,” said Houry, who resigned in protest over Monarez’s firing.
The presence of numerous political appointees and their autonomous operation, at least from the CDC’s perspective, sends a clear message, according to Daniel Jernigan, former director of the National Center for Emerging and Zoonotic Infectious Diseases, who resigned alongside Houry.
“It demonstrates that the secretary is the one that’s been calling all the shots, and it doesn’t really matter who the director will be,” he stated.
Repairing the Agency’s Damaged Credibility
The CDC has long been considered the world’s leading public health agency, with many global agencies modeled after it. However, its website, once a trusted source of public health information, is now viewed with skepticism, even by former employees. While some pages remain accurate, others have been altered, driven by Kennedy’s vaccine mistrust or efforts to remove references to health equity and transgender individuals. The administration has also reverted to using the term monkeypox instead of mpox.
Richard Besser, CEO of the Robert Wood Johnson Foundation, who spent years at the CDC and served as acting director during the H1N1 flu pandemic in 2009, no longer advises people to consult the CDC’s website.
“It only works as a site if the public can trust that every single page is the most relevant, evidence-based information that there is. And that’s no longer the case,” Besser explained.
Kennedy’s various attempts to modify vaccine recommendations have led public health experts to recommend consulting the websites of professional organizations like the American Academy of Pediatrics or the American College of Obstetricians and Gynecologists for vaccine schedules.
Houry noted that several state health departments have removed links to the CDC’s website.
Restoring public trust in the agency is essential, but it will be a formidable task.
Refocusing on Combatting Chronic Diseases
In the past year, the CDC has endured multiple rounds of job cuts, significantly impacting chronic disease programs, including those targeting oral health and tobacco control. The administration argued that the CDC had become too large, handling issues beyond its original mission of infectious disease control, despite Congress assigning these additional functions.
Kennedy announced plans to transfer many of the CDC’s chronic disease efforts to a new agency, the Administration for a Healthy America (AHA), which remains an unfulfilled goal.
Meanwhile, many CDC chronic disease programs are fully funded by Congress but are inactive due to lack of staff, according to Tighe, who worked in overdose prevention.
“There are people who have been totally fired and those programs are still funded. And there are people who have been on administrative leave for over a year who could go back and do their jobs, but are not able to,” she said.
Restoring Global Monitoring
Infectious diseases do not respect borders, a lesson underscored by events like the West African Ebola outbreak, the Covid pandemic, and the global spread of mpox. Monitoring global health issues is crucial for the CDC, traditionally a leader in identifying new diseases. Other countries frequently sought its expertise and sent samples for validation, though this has changed.
The Trump administration withdrew the U.S. from the World Health Organization (WHO), severing numerous scientific connections, and dismantled the U.S. Agency for International Development, which assisted other nations in disease control and provided the U.S. with insight into global health issues.
The administration claims that bilateral agreements with other countries could underpin vital information-sharing.
However, Havers, Houry, Jernigan, and others express concern that the U.S. withdrawal from the WHO and international aid hampers the nation’s ability to address disease threats. “I think that’s a huge concern,” remarked Havers, who spent considerable time in China during the H7N9 bird flu outbreak. “There’s always a threat of novel pathogens emerging, and with the withdrawal from the WHO, I think CDC has reduced visibility in that space.”
Halting the Loss of Talent
The CDC has traditionally attracted public health professionals dedicated to long-term careers. However, an estimated 20% of CDC staff have lost their jobs in the past year, and many centers and major programs are managed by interim leaders. “Twenty-one of 25 centers, institutes, and offices lost their leaders since President Trump took office. That is gross instability,” Houry highlighted.
Since taking on the interim leadership role, Bhattacharya has filled some positions and posted job openings for others. He assured staff at the all-hands meeting that he was unaware of any plans for further cuts and promised to oppose the idea if it arises.
Jernigan emphasized that the incoming CDC director must find ways to retain staff.
“If you talk with the staff, they’re all looking,” he noted. “So the best thing that the incoming director can do is to give the staff something to stay for.”
