The White House and the director of the Centers for Disease Control and Prevention were engaged in a tense standoff on Thursday after Health Secretary Robert F. Kennedy Jr. tried to fire the director, Susan Monarez, and multiple high-ranking agency officials resigned.
The White House said that she had been dismissed. But her lawyers, who said she had chosen “protecting the public over serving a political agenda,” insisted that she remained C.D.C. director until President Trump fired her personally.
The dispute now appears to be in the hands of Mr. Trump, who has not weighed in publicly. A spokesman for the White House did not respond to an inquiry about whether the president would fire Dr. Monarez.
The Republican-led Senate voted only last month to confirm her; she is the first C.D.C. director to be subject to Senate confirmation. As such, she works at the pleasure of the president, not Mr. Kennedy.
Senators from both parties expressed dismay at the events unfolding at the C.D.C.
The chairman of the Senate health committee, Senator Bill Cassidy, a Louisiana Republican and physician who voted for Mr. Kennedy, said on social media late Wednesday that the “high profile departures will require oversight” by his panel. He did not elaborate.
Senator Bernie Sanders, the Vermont independent and ranking member of the panel, called for a hearing with Mr. Kennedy and Dr. Monarez and said the attempt to fire her was “outrageous.”
Senator Patty Murray, Democrat of Washington and a former chairwoman of the committee, called for Mr. Kennedy’s “immediate termination.”
Ms. Murray, who voted against Dr. Monarez’s confirmation, said in a statement that she had “serious doubts about Director Monarez’s willingness to stand up against R.F.K. Jr.’s personal mission to destroy public health in America.” She added: “I’m glad to say that I was wrong.”
Appearing on Fox News on Thursday morning, Mr. Kennedy said, “The agency is in trouble, and we need to fix it, and we are fixing it, and it may be that some people should not be working there anymore.”
The agency and its employees are still reeling from a deadly shooting there earlier this month. A gunman fired hundreds of rounds at the agency’s headquarters in Atlanta, killing a police officer, shattering windows and terrifying employees.
According to people familiar with the events, the relationship between Mr. Kennedy and Dr. Monarez, an infectious disease researcher and a government scientist who has worked for administrations of both parties over 20 years, splintered over vaccine policy.
Mr. Kennedy’s decisions on vaccine policy also prompted the coordinated departure of three high-ranking agency officials on Wednesday; a fourth left separately on Tuesday.
In meetings this week, Mr. Kennedy demanded that Dr. Monarez fire top agency officials. He also insisted that she agree to accept recommendations of the Advisory Committee on Immunization Policy, or A.C.I.P., an expert panel that has recently been reconstituted by Mr. Kennedy with some members who have opposed current vaccines.
The committee is scheduled to meet again on Sept. 18 and 19, and may consider recommendations for a wide array of vaccines, including those for hepatitis B, Covid, respiratory syncytial virus (RSV) and measles, mumps and rubella, according to an agenda posted on the Federal Register.
After Dr. Monarez refused Mr. Kennedy’s demands, she called Senator Cassidy, who in turn called Mr. Kennedy, which angered the health secretary, according to an administration official familiar with the events.
Dr. Richard Besser, a former acting director of the agency, said that he spoke to Dr. Monarez on Wednesday and that she told him there were two things she would not do in her job.
“One was anything that was deemed illegal, and the second was anything that she felt flew in the face of science,” Dr. Besser said. “And she said she was asked to do both of those, one in terms of firing her leadership, who are talented civil servants like herself, and the other was to rubber stamp A.C.I.P. recommendations that flew in the face of science. And she was not going to do either of those things.”
The three officials who coordinated their resignations on Wednesday had decades of government experience and all had a hand, one way or another, in vaccine policy.
Dr. Debra Houry, the C.D.C.’s chief medical officer, coordinated the various arms of the agency. Dr. Demetre Daskalakis ran the center that oversees respiratory illnesses and issues vaccine recommendations. Dr. Daniel Jernigan supervised the center that oversees emerging diseases and vaccine safety. The fourth official, Dr. Jennifer Layden, who resigned a day earlier, led the office of public health data.
In an interview on Thursday morning, Dr. Houry and Dr. Daskalakis said there was no single move that pushed them to resign.
Rather, it was “death by a thousand paper cuts,” Dr. Houry said. “We had so many of these instances where we just couldn’t take it.”
The three had been contemplating leaving the agency for weeks, they said, but their distress escalated sharply after the new members of the advisory panel said that they would revisit the childhood and adolescent vaccination schedules when they met again in the fall. One vaccine that protects against hepatitis B was added to the committee’s agenda for its next meeting in September.
Other recent moves also influenced the resignations.
Last week, Mr. Kennedy named Retsef Levi, a health analytics expert at the Massachusetts Institute of Technology, to lead the Covid vaccine work group, which was given a broad mandate. Mr. Levi has called for the Covid vaccines to be pulled from the market. Last week, a spokesman for the Health and Human Services Department defended the choice of Dr. Levi, saying the group’s members would work with federal experts and be receptive to diverse perspectives.
Dr. Daskalakis criticized the selection of Dr. Levi, saying he had no expertise in vaccines, “ is frankly riddled with bias” and was assigned specifically to prevent the C.D.C.’s input to the discussion.
“That was, for me, one of the brightest red lines,” he said.
Mr. Kennedy signaled his intention to transform immunization policies when he fired all 17 independent scientific advisers to the C.D.C. and replaced them with eight people of his own choosing. (One later dropped out because of financial conflicts of interest.)
This week’s high-profile resignations are only the latest in a series of exits at the agency since Mr. Kennedy took office. In April, as the C.D.C. and other agencies were sharply pared down, some C.D.C. leaders were placed on administrative leave and a few took early retirement.
Two experts in vaccine policy left the agency in June, saying they feared for the lives of Americans if Mr. Kennedy were to continue unchecked.
Dr. Lakshmi Panagiotakopoulos oversaw the Covid vaccine working group before she resigned in June. “It’s heartbreaking to witness such important, nuanced work being led by someone who has shown publicly at the A.C.I.P. meeting that he not only doesn’t understand the data, but is also dedicated to baseless conspiracy theories,” she said about Dr. Levi on Thursday.
The newest resignations are a sign of “how dire things are at the agency,” she said.
Sheryl Gay Stolberg covers health policy for The Times from Washington. A former congressional and White House correspondent, she focuses on the intersection of health policy and politics.
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.
Christina Jewett covers the Food and Drug Administration, which means keeping a close eye on drugs, medical devices, food safety and tobacco policy.
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