In the six months since Robert F. Kennedy Jr. took office as the health secretary, the Centers for Disease Control and Prevention has withered, losing thousands of employees, about half of its budget and contracts, and much of its authority over the nation’s vaccine policies.
This week, as Mr. Kennedy ousted the agency’s new director and precipitated the resignation of four other leaders, experts in public health began asking questions unthinkable just a few months ago: Is the C.D.C. dying? And if so, what does that mean for Americans?
In interviews, a dozen public health experts, along with seven former high-ranking officials, described the C.D.C. as badly wounded and fast losing its legitimacy. It can still be salvaged, they said, but only if Mr. Kennedy listens to scientists and restores some of its crucial functions.
“It’s got, like, a heart rhythm that’s not viable at the moment,” said Dr. Demetre Daskalakis, who led the C.D.C.’s center for respiratory diseases until he resigned this week. “If it’s not shocked out of it now, it may not survive.”
Some experts acknowledged that the C.D.C. has its faults and needs serious reform. Its reputation was badly damaged during the pandemic, in part by its own missteps and in part because of misinformation spread by detractors.
But Mr. Kennedy “has not been reforming the C.D.C.,” said Dr. Ashish Jha, who served as the Covid czar during the Biden administration.
“He has been breaking it, and breaking it in a way that loses pretty much all the good people within it,” Dr. Jha said.
Asked for comment, Andrew Nixon, a spokesman for the Department of Health and Human Services, pointed to Mr. Kennedy’s message to C.D.C. employees on Thursday night.
“The C.D.C. must once again be the world’s leader in communicable disease prevention,” Mr. Kennedy said in the email. “Together, we will rebuild this institution into what it was always meant to be: a guardian of America’s health and security.”
On Thursday night, Mr. Kennedy announced that a longtime ally, James O’Neill, would be acting director of the agency. Mr. O’Neill is a former biotechnology executive who does not have medical or scientific training.
At this point, any candidate for the permanent job seems unlikely to please both Mr. Kennedy and senators who would have to confirm the nomination, critics noted.
Much of the recent turmoil at the C.D.C. has sprung from its role in establishing immunization standards for Americans. But the consequences are likely to be far more expansive.
Local and state health departments nationwide relied on the agency’s funding and expertise to cope with a wide range of health issues, from drownings to diabetes, lead poisoning to food safety.
“We are on the cusp of an imploding public health system,” said Dr. Jonathan Mermin, who served as director of the C.D.C.’s center for H.I.V. and sexually transmitted infections. He has been on administrative leave since April.
Some former officials said they hoped that the events of this week would serve as a warning, particularly to lawmakers, about the potential for long-term harm to the country. They feared it may take decades, even generations, to repair the nation’s public health infrastructure.
“There will be outbreaks that we miss and health care that’s not done with the best information,” said Dr. Anne Schuchat, the C.D.C.’s principal deputy director until her retirement in May 2021.
“It’s a dangerous time to be here, where you don’t know what to trust, who to trust,” she added. “I’m very scared for the people of the country.”
Mr. Kennedy has criticized the C.D.C. for decades, at times comparing its immunization policies to medical experiments committed in Nazi camps. He has continued after taking office as health secretary, calling the agency diseased and its employees and advisers corrupt.
He rebuked the agency even after it was attacked by a gunman earlier this month and after the resignations of several high-profile leaders.
Some experts said they agreed with many of the health goals Mr. Kennedy has outlined.
“We need to make America healthy again, we need to decrease health care costs, we have to look toward prevention,” said Dr. Anne Zink, a public health expert at Yale University and former chief medical officer of Alaska.
But Mr. Kennedy is a lawyer who’s trying to win an argument, and he picks facts to support it, she said: “There is a role for that in law, but that is not the role of science.”
Decisions From D.C.
About 20 of the C.D.C.’s leaders were gathered at a meeting on May 27 when their phones started pinging. Friends and family members were asking about Mr. Kennedy’s announcement on X that Covid vaccines would no longer be offered to healthy children and pregnant women.
That sort of decision would normally involve C.D.C. scientists analyzing data and presenting it in public meetings to independent advisers, who then would vote on how to proceed.
But it was clear that no one, including the director of the agency that oversees vaccine policies, had known about the announcement beforehand, said Dr. Deb Houry, who resigned this week as the agency’s chief medical officer.
“We thought it was probably real, because it was the secretary,” she said. But “we hadn’t seen anything in writing, so we didn’t quite know how we were going to implement it.”
That announcement, she and others said, was emblematic of the way Mr. Kennedy and the health department have treated the agency. On the rare occasions C.D.C. leaders were consulted, their input was largely disregarded.
Mr. Kennedy made decisions from Washington with far-reaching consequences: huge layoffs, severe restrictions on Covid vaccines, firing C.D.C.’s independent advisers en masse and canceling $500 million in mRNA research.
If the agency’s leaders had been asked which programs could be trimmed, Dr. Daskalakis said, “it would have been executed with at least something that was a modicum of order.”
Mr. Kennedy has said the C.D.C. should focus only on infectious diseases. Other functions, including chronic diseases, are to be moved to an as yet unformed entity called the Administration for a Healthy America, under his direct leadership.
That approach reveals a fundamental misunderstanding of public health practice and of the agency, Dr. Daskalakis said. Contending with infectious diseases, he noted, sometimes requires collaboration with experts in other areas such as maternal health, cancer and heart disease.
Changes to the C.D.C. are also directly hindering work on infectious diseases, including efforts to prevent H.I.V. and syphilis.
A round of cuts in February eliminated about 30 percent of the C.D.C.’s data center. Many were scientists brought in for “desperately needed” expertise in technology, said Dr. Jennifer Layden, director of the center until she resigned this week.
The center lost another 10 percent to resignations and early retirements in the weeks afterward, she said, hobbling its ability to maintain databases and help states with infectious disease surveillance.
Most of the C.D.C.’s budget goes to state and local departments, and cuts to the agency will curb their ability to care for residents, some officials said.
“If you chop off the heads of the agencies because they didn’t pledge to go along with you, despite what the science says, then you’re eroding public health from the foundation,” said Dr. David Margolius, director of public health in Cleveland.
Doctors, including those in emergency rooms, also rely on the C.D.C. for guidance, particularly about new diseases.
Now it is likely to be difficult, perhaps impossible, to get reliable, timely information from the agency, said Dr. Alison Haddock, president of the American College of Emergency Physicians.
In the absence of centralized advice, doctors and state and local departments may need to look to alternative sources. “Maybe that was the intent all along,” said Dr. Megan Ranney, an emergency physician and dean of the Yale School of Public Health.
Because of the C.D.C.’s isolation from the World Health Organization, the country has also lost much of its ability to track global threats like Ebola and Marburg viruses, and even such familiar foes as influenza. The C.D.C. received about 75 percent less data on influenza in other parts of the world this year, compared with previous years.
The information was used to make the seasonal flu vaccine. Now manufacturers will have to look somewhere other than the U.S. government for data on how to make the shots each year.
“Other countries are going to be deciding what goes in American arms,” Dr. Daskalakis said.
A few thousand people, including American citizens, bring malaria when traveling into the country, said Dr. Daniel Jernigan, who led the center for emerging diseases until this week.
Mosquitoes can then spread the disease, including drug-resistant versions. Yet $40 million for global malaria control has been cut from the agency’s budget.
“You have to know what’s happening outside the U.S. to make sure we can prevent it and control it here,” Dr. Jernigan said. “It’s all connected.”
Amid the bleak forecasts, some experts also maintained optimism that the C.D.C. would prevail in the long term.
“I think they’re trying to kill it — and it won’t die,” said Michael Osterholm, an infectious disease expert at the University of Minnesota. “It is fundamentally just far too important to the everyday lives of Americans as well as people around the world.”
But he and others said things are likely to become much worse before they get better.
“We’ve always been through periods of cataclysmic change and upset and disruption, and then we get through to the other side,” Dr. Ranney said. “I don’t know how long it will take, but we will come through this.”
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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