The U.S. Centers for Disease Control and Prevention (CDC) stands at a crossroads. After years of pandemic fallout, opioid deaths, and declining public trust, the agency needs bold, decisive leadership. What it doesn’t require is another physician at the helm.
In recent years, the CDC has almost exclusively been led by physicians, clinicians whose primary training, instincts, and oath revolve around caring for individual patients. But medicine and public health, though deeply related, are fundamentally different. Medicine treats individuals. Public health protects populations. Leading the CDC is less about diagnosis and more about infrastructure, logistics, and prevention. It is a job that requires not just clinical insight but engineering—designing robust systems that stop crises before they begin.
That’s what makes the nomination of the agency’s acting director, Susan Monarez so significant. She isn’t a medical doctor, and that’s a good thing because, instead, she has spent those decades developing the skills and known-how to operate with the population first. In lieu of spending years focusing on the individual patient, she has vast experience within the scientific and strategic core of public health and government. She has helped stand up national biodefense policy at the Department of Homeland Security, guided innovation at the White House Office of Science and Technology Policy, and most recently, helped to launch and lead as Deputy Director President Biden’s high-risk, high-reward health initiative, the Advanced Research Projects Agency for Health or ARPA-H.
Not only does she have deep scientific expertise, but she has a relatively rare experience coordinating across agencies, managing complex systems, and translating public health ideas into operational outcomes, exactly the kind of leadership the CDC needs now. Where her background lacks the rigor of caring for a patient in a hospital, her experience is more apt to skills needed for running the premier public health agency of the United States.
Monarez holds a Ph.D. in microbiology and immunology, and has spent two decades leading innovation and strategy across federal agencies including the Department of Homeland Security, the White House Office of Science and Technology Policy, and most recently, ARPA-H. Her work has spanned pandemic preparedness, antimicrobial resistance, maternal and mental health, digital privacy, and more. But what sets her apart isn’t just the breadth of her resume. It’s the systems-level way she approaches health.
For much of its history, the CDC excelled at this kind of work. It wasn’t just a hub for disease surveillance, it was operational. It helped eradicate smallpox, built national immunization infrastructure, and improved water safety through engineering-driven programs. And though these accomplishments were largely achieved under the leadership of previous CDC Directors who were medical doctors, in recent decades, the agency’s posture has drifted toward analysis and communication, and away from implementation.
Dr. Monarez has the experience to bring the CDC back to those roots. She has led high-impact programs at ARPA-H, including efforts to transform mental health care through scalable, tech-enabled solutions and to redesign maternal health systems to address disparities in outcomes. At the Health Resources and Services Administration (HRSA), she launched the Center for Innovation to improve care delivery across the nation’s safety-net providers and oversaw development of tools to better allocate resources and expand access in underserved areas. And at the Biomedical Advanced Research and Development Authority (BARDA), she played a key role in strengthening the nation’s preparedness for health emergencies, including accelerating diagnostics and medical countermeasures for pandemic threats. Her career has been about building – not just understanding problems – but designing and implementing solutions that scale specifically to improve population health.
We saw the consequences of a too-clinical mindset during the COVID-19 pandemic. Early on, the U.S. regulated tests for their diagnostic accuracy in individual patients, rather than their utility in mitigating community transmission and distinguishing who needed to isolate from those who could safely continue working, a distinction that could have helped keep the economy open. Later, the vaccine rollout emphasized two-dose regimens for each person, even when a single dose conferred most of the protection. That meant for every 100 people who received their second shot, 100 others got none at all. It was a medically sound strategy for those lucky enough to receive both doses—but a public health failure for everyone else.
These decisions weren’t made out of malice. They reflected a framework centered on patients, not populations. But leading the CDC today requires the opposite. It demands someone who understands the nuances of population-level data, policy tradeoffs, and systems design, which Monarez does. Her work has consistently focused on operational solutions to population level health problems. She has navigated multiple federal administrations, helped build programs from scratch, and championed scalable innovation. That is exactly what the CDC needs right now—not just to restore its credibility, but to address complex challenges like antimicrobial resistance, mental health, and the opioid epidemic.
Her background could prove especially vital in the months ahead. If confirmed, Monarez will report to Health and Human Services Secretary Robert F. Kennedy Jr., whose controversial vaccine skepticism has alarmed public health experts. Steering the CDC in this political climate will require more than clinical expertise. It will require scientific rigor, diplomatic skill, and unshakeable integrity.
Clinical perspectives will always be essential to public health, but they can be sourced through advisors. What cannot be outsourced is strategic, systems-level leadership.
Monarez brings exactly that. She is a public health engineer for a moment that demands nothing less.
The post Why Susan Monarez is the Right Choice to Lead the CDC appeared first on TIME.
