The firing of the Centers for Disease Control and Prevention director Dr. Susan Monarez, less than a month after she was confirmed by the United States Senate, should worry those who care about public health and American science.
But the move should not be a surprise. It comes at the end of a tumultuous summer that included budget cuts, firings and resignations, a shooting near the agency’s headquarters and a raft of bewildering changes to process and protocol. And while it may well signal an alarming new turn in the steady dismantling of American public health, that demolition was already well underway.
An official statement from the White House said that Dr. Monarez was “not aligned with the president’s agenda of Making America Healthy Again.” News reports indicate that it was her clashes with the health secretary, Robert F. Kennedy Jr., over vaccine policy that did her in.
In his confirmation hearings, Mr. Kennedy insisted that he was not an anti-vaxxer and that he just wanted to set the highest possible bar for which studies were used to inform health policy. He wanted “gold standard science,” he said. He also took pains to reassure his interlocutors that he was comfortable with being challenged, and with accepting data that contradicted his own views.
In the weeks that followed, some onlookers breathed a sigh of relief as Dr. Marty Makary, a surgeon, and Dr. Jay Bhattacharya, a medical doctor and health economist, were appointed to lead the Food and Drug Administration and the National Institutes of Health. If their views on Covid-19 had been deemed controversial, these were still men of science and medicine. Surely that ethos would prevail, the thinking went, and would temper some of the more bombastic instincts that seemed to govern the health secretary.
But it’s clear now that neither leader was appointed for his credentials so much as his willingness to flout the basic principles of sound science and good public health. Dr. Bhattacharya has defended the termination of mRNA research; Dr. Makary has allowed officials to override his agency’s scientists on vaccine approval decisions. Neither leader has raised any meaningful objection to the broader dismantling of the agency he has been put in charge of. And when Dr. Monarez, their C.D.C. counterpart, stood her ground, she was fired.
Senator Bill Cassidy of Louisiana, a doctor who by all accounts cares about preserving Americans’ access to vaccines, does not seem to be keeping a wary or watchful eye on these shifting tides, or preparing to intervene with any kind of resolve. He expressed concern about Mr. Kennedy’s views on vaccination, but whatever promises he extracted from Mr. Kennedy before voting to confirm him have proved hollow. As the secretary has gutted the committee that helps set vaccine recommendations, undermined access to Covid boosters, poured resources into a self-serving attempt to link vaccines to autism and canceled nearly $500 million in federal contracts for mRNA vaccine development (our best bet for beating the next pandemic), Dr. Cassidy has remained largely, embarrassingly silent.
Despite his assurances in January, Mr. Kennedy is not simply trying to ensure that the best science is used to guide the nation’s health policies or demanding greater transparency into health policy decision making or insisting that disenfranchised groups be heard out. He is trying to fully dismantle the nation’s vaccination apparatus, regardless of what science says or what most people want. And less than a year into his tenure as health secretary, he is succeeding brilliantly.
At least four of the C.D.C.’s top officials have resigned in protest of Dr. Monarez’s firing. More departures, voluntary or forced, are rumored to be afoot. In a resignation letter, one official noted that the data used to justify recent changes in immunization schedules was never shared with the agency, despite requests. This opacity is offensive and alarming, but again, in light of all we have seen these several months, it is hardly shocking at this point.
Neither are the departures; scientists and civil servants have been leaving the nation’s federal health institutions in droves all year, taking decades of knowledge and expertise with them. But the reverberations of such a serious and sustained exodus will be felt for a generation at least.
Meanwhile, as the institutions he was charged with leading crumble around him, Mr. Kennedy has been speculating about the link between antidepressants and school shooters and pontificating about what he sees as the obvious “mitochondrial challenges” plaguing so many American children. “You can tell from their faces, from their body movements and from their lack of social connection,” he said recently.
What is he talking about? How on earth did we get here, and where do we go next? Whatever the answers, it’s clear that the nation’s leading public health official does not have any real interest in — or possibly any real understanding of — public health.
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Jeneen Interlandi, a staff writer at The New York Times Magazine and the Opinion section of The Times, writes about public health. @JInterlandi
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