CDC’s crisis marks a dark moment for public health

Over the past nine months, I’ve heard the word “unprecedented” used again and again to describe this administration’s actions on public health. Often, that description has been warranted.

But what has happened at the Centers for Disease Control and Prevention on Wednesday is different. The firing of Susan Monarez, the first Senate-confirmed CDC director in history, was more than just unprecedented. It’s a watershed moment — one that may be unfixable under current health leadership.

Monarez’s firing has triggered a wave of resignations from CDC’s most trusted and capable leaders, including its chief medical officer, multiple center directors, and its top data scientist. Decades of experience, gone overnight. These were leaders with deep expertise, widely regarded across the public health community as the most capable and trusted voices still at the agency.

It’s a total implosion. To put it in context, think of the CDC as your local fire department. Most days, you don’t think about them. But when a fire breaks out, you need them there — fast, skilled, and organized. This administration has just fired the fire chief, pushed out the deputy chiefs, and scattered the battalion leaders. Many firefighters were let go months ago. What remains is a skeletal crew, leaderless, with no clear plan for the next alarm.

And the fires will keep coming. Just this week, the Hawaii Department of Health detected measles in wastewater. Under normal circumstances, CDC would be the first call. The agency would assess, coordinate, and help contain the threat. That is no longer guaranteed. If a child in a daycare starts showing signs of meningitis, if a cluster of foodborne illness emerges from a restaurant chain, if bird flu spreads among farm workers — states may now find themselves on their own. But our public health system was never designed for states to go it alone.

The collapse of this unseen shield affects all of us in ways we don’t always appreciate. It shapes whether your child’s school stays open during a flu surge. Whether a restaurant is shut down before contaminated food sickens dozens more. Whether programs that prevent youth suicide continue to run. When public health protections fail, we all feel it.

What makes this moment even more troubling is how it happened. STAT has reported that Monarez was dismissed after resisting orders to roll back vaccine guidance based on pseudoscience and to dismiss senior staff unlawfully. Her refusal was about integrity: CDC officials are not there to rubber-stamp political agendas. They are there to protect the health and safety of the American people. And when the political agenda actively harms Americans, it takes courage to push back. That’s what Monarez and her colleagues did.

This was precisely why many public health experts, including me, pushed for the CDC director role to require Senate confirmation. The goal was to insulate the position from political interference, ensuring that any ouster would have to come from the White House. That promise has now collapsed. Instead, the Department of Health and Human Services has boxed itself in, leaving both itself and the CDC in a state of paralyzed dysfunction.

Recruiting new leadership under these conditions will be nearly impossible. No credible public health expert will consider running a CDC center without knowing who the director will be, and whether that person can actually lead.

For the director role itself, the situation is even worse. It’s hard to imagine any respected candidate agreeing to take the job in such chaos, where they would be forced to compromise their integrity to sign on to falsehoods spread by the secretary. Those willing to serve will likely be so fringe that they cannot win Senate confirmation. Put simply: Good people won’t apply, bad people can’t get confirmed.

In the meantime, states will need to step up aggressively. They will have to invest in stronger health infrastructure, expand outbreak-response capacity, and even assume responsibilities like issuing vaccine recommendations — duties that have traditionally belonged to the federal government. That is an enormous burden for states, but until Washington demonstrates that it can once again be an effective partner, there is no alternative.

This amounts to a very dark moment for public health. There is no clear way out other than a new secretary of Health and Human Services — a change that more public health experts and lawmakers are beginning to demand. The department needs leadership that respects evidence and allows CDC to operate free from political interference. Without that, it is hard to see how the agency can recover.

The consequences will be tangible: more outbreaks, slower responses, and more people getting sick. Public health is our unseen shield. And right now, that shield lies shattered.

Ashish K. Jha is the dean of the Brown University School of Public Health and former White House Covid-19 response coordinator.