The purge at the top of the US Centers for Disease Control and Prevention crystalizes the dilemma facing many professional officials across the US government.
Is their duty to medical science, economic data, or the best possible conclusions to be drawn from intelligence?
Or should they reflect the world as President Donald Trump wants it to be?
The White House on Thursday laid out the choice after the firing of CDC Director Dr. Susan Monarez after she clashed with Health and Human Services Secretary Robert F. Kennedy Jr. over vaccine policy and declined to dismiss top agency officials.
“It was President Trump who was overwhelmingly reelected on November 5. This woman has never received a vote in her life,” White House press secretary Karoline Leavitt said. “If people are not aligned with the president’s vision and the secretary’s vision to make our country healthy again, then we will gladly show them the door.”
Every president deserves some level of loyalty and for officials to honor the mandate of an administration chosen in a democratic election. And Republican presidents have long complained that what they see as a liberal bureaucracy has thwarted them. But any government that interpreted the world only according to the whims and hunches of a president would provide a poor service to the American people.
The question of whether to follow the data or follow the president is especially acute for those charged with keeping Americans safe — from foreign threats, economic crises and diseases — in the age of Trump.
The CDC is being ‘shredded’: Top health expert
Monarez is a respected scientist, as are several other top CDC officials who quit after her ouster. And the CDC has long been viewed as the world leader in fighting disease because of its rigorous adherence to science, ethical standards and state-of-the-art clinical trials that have saved millions of lives with vaccinations.
But the “vision” they are accused of failing to follow is that of Kennedy, a longtime vaccine skeptic who falsely claims the childhood vaccination schedules he is threatening to disrupt have not been subject to “gold-standard science.” And RFK Jr. was selected by a president who suggested early in the Covid-19 pandemic that one way to fight the spread of the novel coronavirus was to stop testing people for it.
It’s one thing for the administration to demand adherence to its policies on education, housing or agriculture. But the scientists at the CDC know that their decisions really are life and death. Those who are qualified doctors are sworn to an ethical obligation to study, apply and advance scientific knowledge for the good of patients.
But this traditional code of professional behavior puts them at odds with the politics of the moment.
Four officials in the CDC’s top echelon resigned to highlight the politicization of science by the administration after Monarez was ousted. Their departure effectively left the agency leaderless.
One of those officials, Dr. Demetre Daskalakis, the former CDC chief of vaccines and respiratory diseases, disputed Kennedy’s characterization of the agency as “very troubled.”
“I think that if — if CDC is being characterized as troubled by Secretary Kennedy, I think we have to turn the mirror back to him, because I think that the trouble is emanating mainly from him,” Daskalakis told CNN’s Kaitlan Collins on “The Source” Thursday.
Trump came to power for a second term riding a tide of skepticism among his voters about the public officials and institutions that provided medical guidance during the pandemic, often on unpopular measures such as masking and school closures. Some recommendations were later overtaken by science. Some later seemed wrong or misguided. And several infringed on the personal freedoms millions of citizens took for granted and caused a political backlash. But the evidence is that they also saved lives, along with the vaccines first rolled out in Trump’s first term.
Some Trump voters also view the public health establishment as part of a massive, secretive “deep state” made up of elite liberal establishment types dedicated to undermining Trump and his mission.
Kennedy, a former independent presidential candidate, brought a valuable coalition to Trump’s campaign, as he’s popular among many voters concerned about the influence of big food and pharmaceutical companies on Americans’ health. Many of his views on the perils of ultraprocessed food are in line with those of many mainstream health experts — who are nevertheless horrified by his vaccine stance. Supporters of Trump’s “Make America Healthy Again” agenda, epitomized by RFK Jr., sometimes cut across traditional political, gender and ethnic divides.
So the suspicion among Trump’s critics is that decisions at the top of America’s public health community — previously rooted in the best available science — are now being made to satisfy the agendas of two powerful men who lack medical qualifications and hold anti-scientific views.
“Medicine and public health have added three decades to the human lifespan. Vaccination alone produced 40% of the reduction in child deaths,” Dr. Atul Gawande, a surgeon and renowned writer, posted Thursday on X. “And now a disturbed and unqualified man driven by crackpot theories is destroying the foundations of this work, including CDC,” he wrote, referring to RFK Jr.
Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said on “CNN News Central” Thursday that Kennedy had been an anti-vaccine conspiracy theorist for 20 years and pushed back on the HHS secretary’s criticisms of the agency. “The CDC is a stellar organization, but now it is being shredded — by him — and so it is not the stellar organization it was anymore,” Offit said.
The experts at the CDC are not alone in the dilemma over loyalties. Officials who differ with the dictated wisdom of the president have been losing their jobs in droves or coming under pressure to do his bidding or face the sack.
Federal Reserve Chairman Jerome Powell has faced months of rhetorical attacks by the president for refusing to bow to his demands to slash interest rates, a decision that would fly in the face of a conventional reading of data on employment and inflation and economic history.
And there’ve been multiple purges in intelligence agencies of career analysts and officers who are regarded as denizens of the anti-Trump deep state. CNN reported Thursday that Tulsi Gabbard, the director of national intelligence, ousted a CIA Russia expert who helped brief Trump’s team before his summit with President Vladimir Putin. The US leader left that meeting two weeks ago adopting many of Putin’s positions.
CDC drama will have serious political consequences
The chaos at the CDC left the administration with a mounting political problem.
Monarez had been in her post for less than a month. Her departure focused attention back on some of Kennedy’s most extreme goals and was the latest sign that he’s undermining vaccinations.
Already, RFK Jr. has terminated investments in 22 mRNA vaccine projects, claiming they “fail to protect effectively against upper respiratory infections like Covid and flu” even though it was a dose of this type that helped end the pandemic. He fired the 17-member panel of outside vaccine experts who sit on the CDC’s Advisory Committee on Immunization Practices, which reviews vaccine data. Some of his selections to replace those experts have expressed anti-vaccine views in the past. And this week, Kennedy seemed to indicate to Trump that he would soon point to a link between vaccines and autism, despite overwhelming research showing none.
Perhaps even the White House knows Kennedy is a loose cannon. CNN reported Thursday that Deputy Secretary of Health and Human Services Jim O’Neill was expected to be named acting CDC director. O’Neill is a Silicon Valley-based technology and biotech investor who also worked in the George W. Bush administration and is not seen as being in RFK Jr.’s orbit.
The chances of confirming a permanent replacement for Monarez look daunting. A candidate acceptable to the Senate Health, Education, Labor, and Pensions committee that managed Monarez’s confirmation last month might be unacceptable to RFK Jr. and the MAHA wing of the Republican Party. The role of committee Chairman Sen. Bill Cassidy could be crucial. The Louisiana Republican, who is a physician, has already pledged to carry out oversight into Monarez’s firing.
It seems possible that the administration might have to try to fill the position through a recess appointment or might even be forced to keep interim leaders in place. And anyone with credible medical and scientific qualifications might soon find themselves faced with the same dilemma as Monarez and other officials over whether to go along with Kennedy’s counter-scientific ideas.
But the White House is unlikely to return to a more conventional, science-based approach to public health. Kennedy is too valuable for that — one reason the White House is fighting attempts by Democrats to build political pressure for his dismissal.
RFK Jr. and his clear-out of the so-called public health deep state is hugely popular on conservative media. The purges strengthen Trump’s image as an outsider dedicated to the destruction of the Washington establishment. And American politics has a case of long Covid: Ideological divisions left over from the pandemic are still a potent organizing force for conservative voters and political leaders keen to tap into them.
The unique MAHA coalition of voters — spanning libertarians, conservatives, and some liberals and independents — is hugely important for Trump in the 2026 midterms. Its influence will grow if the Republican base lacks energy ahead of an election that could hand Democrats the power to constrain his presidency and even impeach him again if they win back the House.
The controversy over the CDC might have grave implications for the nation’s health. But ultimately, it comes down to something at least as important to the White House: Trump’s political health.
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