Susan Monarez, confirmed as director of the Centers for Disease Control and Prevention on Tuesday night, now faces challenges unlike any ever confronted by a leader of the troubled agency.
Dr. Monarez, 50, has more than 20 years of government experience, and in that sense is more qualified than some recent C.D.C. directors — even if she’s the first non-physician to be handed the role.
But it’s not clear that decades in government will help her resist the unscientific policies and organizational chaos set in motion by her new bosses.
The Trump administration is dismembering the agency, firing thousands of employees and moving many of its core functions to a new entity, the Administration for a Healthy America, in Washington.
A leading vaccine skeptic, Robert F. Kennedy Jr., is now the nation’s health secretary. He has been voluble about what he sees as collusion between federal regulators, like those at the C.D.C., and the drug industry to hide the harms of vaccines from the public.
He has repeatedly undermined vaccines and has replaced members of an influential advisory committee on immunization policy with people whose skeptical views align with his own.
“I’m concerned for her — I hope she’s going to be OK,” said Gigi Gronvall, a biosecurity expert at the Johns Hopkins Center for Health Security, who has known Dr. Monarez for nearly 20 years.
“I wish I could celebrate this without the known challenges of dealing with somebody who is an anti-vaxxer as secretary,” Dr. Gronvall added. “When you have an original sin like that, it’s really hard for people, no matter how well intentioned, to succeed.”
Dr. Monarez and the Department of Health and Human Services did not immediately respond to requests for comment.
Many current and former C.D.C. employees said on Wednesday that they were relieved to have a permanent director who could steer the agency and promote its priorities in the administration, but worried that Dr. Monarez might become a figurehead.
“It’s probably better than not that there’s an acting director, but I’m not super optimistic that she’s going to be a strong advocate for the agency, given this political climate,” said Dr. Fiona Havers, who resigned from the C.D.C. last month.
Dr. Monarez, who is registered as a Republican in Maryland, served as the C.D.C.’s acting director earlier this year, as the Department of Government Efficiency laid off agency personnel and President Trump signed executive orders forbidding initiatives focused on diversity, equity and inclusion and on “gender ideology.”
In March, Mr. Trump abruptly withdrew the nomination of Dr. Dave Weldon, a former Republican congressman, to be the agency’s director. Dr. Monarez was nominated instead.
By law, once she was nominated she could no longer serve as acting director. Mr. Kennedy assumed greater control over some C.D.C. decisions, including a few regarding vaccines.
How Dr. Monarez will choose to lead the agency is a question with enormous public health consequences.
“It remains to be seen whether or not she will actually push back, and if she does, whether or not she’ll be able to remain in her position,” Dr. Havers said.
In her confirmation hearing in June, Dr. Monarez affirmed her belief in vaccines as crucial to public health. Her work on biosecurity over decades is respected by her peers.
“She is very committed to public health and science — she’s very committed to vaccines and the importance of vaccines in the world.” said Dr. Tom Inglesby, the director of the Johns Hopkins Center for Health Security, who has known Dr. Monarez well for 15 years.
“As long as she is given the leeway to make critical decisions about vaccines and about public health, I think she will be a very strong leader for C.D.C.,” he said.
But some employees of the C.D.C.’s chronic disease center, the agency’s largest arm, were dismayed that she had agreed with the Trump administration’s decision to refocus the agency only on infectious diseases.
Mr. Kennedy plans to shut down the chronic disease center and move some of its functions to the as-yet unformed Administration for a Healthy America.
At her confirmation hearing, Dr. Monarez told senators she would “make sure that any of the activities that were supported under C.D.C. in the previous models are successfully transitioned to other parts” of the government.
Much of Dr. Monarez’s work has been on biosecurity and pandemic preparedness. But she was not widely known outside her field, and her work did not intersect with the C.D.C.’s, which collaborates with state and local public health departments.
That may not matter in her new role, said Dawn O’Connell, who was assistant secretary for pandemic preparedness at the H.H.S. under President Joseph R. Biden Jr.
“Even if she’s not a subject matter expert in C.D.C. issues, she can maneuver within the government,” Dr. O’Connell said. “Whether that holds up in this current administration and the structure that exists under R.F.K., I don’t know.”
As acting director, Dr. Monarez mostly acquiesced to the administration’s demands and did not try to shield the C.D.C., according to several current and former agency employees.
She also did not hold agencywide meetings, nor offer reassurance to the C.D.C. staff through the turbulent time, the employees said.
Dr. Richard Besser and Dr. Anne Schuchat, both of whom served as acting directors of the agency, said they had treated the role like that of a permanent director, holding meetings, setting agendas and working closely with staff.
But Dr. Monarez may have been explicitly instructed by the White House not to do the same in her role as acting director, Dr. Schuchat said.
With a permanent leader in place, “there’s an ability for staff to support that leader, make the case for particular things and hopefully protect some of the most important things,” she added. “I like to give people a chance to prove their leadership.”
Apoorva Mandavilli reports on science and global health for The Times, with a focus on infectious diseases and pandemics and the public health agencies that try to manage them.
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