Sowing distrust in the science behind CDC guidance.

The turmoil roiling the Centers for Disease Control and Prevention (CDC) was on full view last Thursday at the Senate hearing convened to review the Trump administration’s health care agenda. The proceedings quickly descended into a shouting match as senators, both Republican and Democrat, challenged health secretary Robert F. Kennedy Jr. on his policies and recent actions, particularly regarding vaccines and the firing of CDC director Susan Monarez. Kennedy defended his positions while attacking the agency, as he has done repeatedly, accusing its medical experts and scientists of corruption and collusion with the pharmaceutical industry.

In late August, Kennedy called Monarez into his office and pressured her to resign, a mere 29 days after appointing her. At the time of her appointment, Kennedy lauded Monarez as “a public health expert with unimpeachable scientific credentials,” stating that he had “full confidence in her ability.”

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According to White House press secretary Karoline Leavitt, Monarez was fired because she was “not aligned with the President’s mission to make America healthy again.” At the Senate hearing, Kennedy claimed that he had told her to resign “because I asked her, ‘are you a trustworthy person?’ and she said, ‘no.’”

However, in an editorial published in the Wall Street Journal, Monarez described being told “to preapprove the recommendations of a vaccine advisory panel newly filled with people who have publicly expressed antivaccine rhetoric.” When she refused to do so, because, as she stated in the editorial, “It is imperative that the panel’s recommendations aren’t rubber-stamped but instead are rigorously and scientifically reviewed before being accepted or rejected,” Kennedy threatened her with termination. Three days later the White House fired her.

Further resignations of key experts.

Fallout from the firing of Monarez exposed the extent of dysfunction within the agency since  Kennedy assumed leadership. Four of its top officials resigned in protest: Dr. Debra Houry, the chief medical officer; Dr. Jennifer Layden, head of the office of public health data, and Dr. Demetre Daskalakis and Dr. Daniel Jernigan, who each ran a center related to vaccine recommendations and safety. All four stated that they resigned because changes in the agency had made it impossible for them to do their job.

In his resignation letter, Daskalakis wrote that the policies and materials being produced under the new administration “do not reflect scientific reality and are designed to hurt rather than to improve the public’s health.” In an interview with The Hill, he noted that in the seven months of Kennedy’s leadership, “no CDC subject expert from my center has ever briefed the Secretary.” In interviews reported in Time, Jernigan and Houry also described how they and other top experts had been sidelined during Kennedy’s tenure, neither consulted as experts or invited to scientific meetings, and their offers to brief Kennedy ignored. They only learned of changes in the CDC’s vaccine recommendations when it was announced on social media.

Fueling public mistrust.

Monarez’s firing came within weeks of the attack of a gunman who shot hundreds of rounds of bullets into the CDC headquarters in Atlanta, killing a police officer. The gunman was apparently motivated by his belief that the COVID vaccine had caused his mental health problems. Many CDC staff feel that Kennedy’s rhetoric disparaging vaccines contributed to the shooting. More than 750 current and former CDC employees sent a letter to Kennedy, claiming that the growing mistrust in public institutions, fueled by “dangerous and deceitful statements and actions” by him and his administration, have turned “public health professionals from trusted experts into targets of villainization—and now, violence.” They asked Kennedy to end the “spread of inaccurate health information,” to “affirm CDC’s scientific integrity,” and to “guarantee the safety of the HHS workforce.”

A replacement lacking scientific training or credibility.

Kennedy’s choice to replace Monarez suggests that the rhetoric is unlikely to change. Jim O’Neill, deputy to Kennedy and the new acting director, is a former biotechnology executive and has no medical or infectious disease scientific training. According to a report in the Guardian, during the COVID pandemic, O’Neill promoted support for ivermectin and hydroxychloroquine, treatments that were not supported by scientific evidence, and has posted conspiracy theories regarding COVID on social media.

All of this upheaval comes on top of funding and staff cuts that have hollowed out entire agencies within the CDC. Proposed budget cuts could slash its budget by as much as half, a move that will likely lead to severe funding cuts to state and local health departments. The White House has already blocked millions in funding for the agency’s public health programs focused on chronic diseases including diabetes, chronic kidney disease, and tobacco use.

Overall the agency has lost thousands of employees, including scientists working on blood disorders, violence prevention, sexually transmitted diseases, environmental health, asthma, injuries, lead poisoning, and smoking. According to the New York Times, most of the Division of Reproductive Health was dissolved, this despite the disproportionately high maternal and infant mortality rate in the U.S. About 40% of data center staff have been cut or resigned, hampering the center’s ability to maintain surveillance of infectious diseases, a critical function already compromised with the loss of global data. And last week, on what one scientist called “a bad day for science” Kennedy canceled $500 million in funding for mRNA research, the technology used to rapidly develop life-saving COVID vaccines and considered the best hope for countering future pandemics.

Public health experts are sounding the alarm. “We are on the cusp of an imploding public health system,” said Dr. Jonathan Mermin, former director of the CDC.’s center for HIV and sexually transmitted infections. Nine former CDC directors wrote an editorial in the New York Times outlining the many ways that Kennedy is “endangering every American’s health.” Many public health experts and organizations have called on him to step down or on the government to oust him. That does not appear likely though, as Kennedy still has the support of President Trump.

In the meantime, some states are coming together to form coalitions of experts to make their own recommendations on vaccines based on rigorous science, rather than rely on what is coming out of the CDC. Clinicians need to help patients cut through the misinformation and confusion as they make health decisions for themselves and their families.

By AJN news director Karen Roush, PhD, RN, FNP