Health – Earlybirds Invest

The simmering showdown between US Health Secretary Robert F. Kennedy Jr. and the leadership of the Centers for Disease Control and Prevention has finally boiled over.

The White House said on Wednesday that CDC director Susan Monarez was fired — and Monarez’s representatives quickly responded that she wouldn’t leave her post without a fight. In protest of the ousting and Kennedy’s leadership, four senior CDC leaders resigned.

The tension had been building for months. Once Kennedy took the helm of the US Department of Health and Human Services, he laid off thousands of workers at the CDC and other health agencies. He has rolled back longstanding vaccine policies over the objections of many experts inside and outside of the CDC. Then, earlier this month, a man angry about the Covid-19 vaccines fired nearly 200 bullets into a CDC office building. Although no one was hurt, CDC workers criticized Kennedy and others for stoking anti-CDC sentiment and for not speaking out after the incident. President Donald Trump has still not publicly commented on the shooting.

The final straw came yesterday when the Food and Drug Administration announced limited approval of new Covid vaccines updated to better match the variants currently circulating. The FDA approved the new shots — but only for the elderly and people who are at higher risk because of underlying health conditions. The vaccines had previously been approved for all Americans 6 months of age and older. The CDC would have been expected to make new Covid vaccine recommendations that matched the FDA’s narrower approval, excluding healthy adults, pregnant women, and children — but, according to the New York Times, Monarez refused to commit to that policy in a private meeting with Kennedy

What happened next was chaos. National news outlets reported Wednesday afternoon that Monarez had been fired, less than a month after her Senate confirmation. Over the next few hours, Monarez’s representatives responded that she was refusing to step down (her attorney suggests that her firing had been illegal), but the White House insisted she had, in fact, been terminated. And so began an exodus of more CDC leaders.

One of those officials — Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases — explained why he was leaving the agency in a post on X. He portrayed the CDC situation as an existential battle between science and anti-science, noting in his post that no one on his team had ever even briefed Kennedy since he was sworn in as US health secretary in April.

“I am unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health,” Daskalakis wrote. “Public health is not merely about the health of the individual, but it is about the health of the community, the nation, the world. The nation’s health security is at risk and is in the hands of people focusing on ideological self-interest.”

The CDC that will be left behind will be less science-driven and more beholden to Kennedy and his agenda — precisely the warning that the departing CDC officials are trying to send and a sentiment echoed by other public health organizations. “THE SUSTAINED ATTACKS ON PUBLIC HEALTH IN THE U.S. MUST END NOW,” read an all-caps statement sent by the Infectious Disease Society of America to the media.

But there’s a bigger story here than just the latest drama under Kennedy’s leadership: What’s unfolding is a fight over the narrative of public health in America — and for the public’s trust.

The American public is still unmoored after the Covid-19 pandemic, and two sides are trying to win out: Kennedy’s Make America Healthy Again movement along with the critics who attacked the public health establishment during that emergency, and the public health experts aligned with America’s scientific institutions. The outcome will determine the future of collective health in the US.

Kennedy argues that the public health establishment of the previous generation has failed the public and must be razed and replaced. If you look at the recent CDC personnel issues through this lens, then dismissing public health officials with decades of experience in their field is in service of that goal. On the other side, most scientists, public health experts, and CDC officials would argue that public health largely has a record of success — though with some mistakes and failures along the way.

America’s public health institutions did lose some trust during the pandemic amid confusing and often inconsistent guidance. But a longer record of vaccinations driving down disease and other public health campaigns yielding major gains in people’s well-being is clear from historical data and decades of peer-reviewed research.

Science may be on the CDC officials’ side, but we’re still learning exactly how the public actually feels about public health. How average people react to this drama and the conflicting messages that Kennedy and CDC officials are sending will determine the long-term consequences of this fight.

How does the public really feel about public health?

This parade of firings and principled resignations is in part a performance — and the audience is the American public.

As I have written before, 25 years ago, there was a pretty clear public health consensus in America. The federal government and major medical organizations were usually aligned on the major questions — questions like which vaccines to get. And the public was widely in support. In 2001, around the time the US declared measles had been eradicated, more than 90 percent of US adults said it was “extremely” or “very important” for people to get childhood vaccinations.

It is difficult to imagine such unanimity about any public health-related issue today.

Right now, the percentage of Americans who think childhood immunizations are important is below 70 percent. According to a 2024 Pew Research Center survey, only 26 percent of Americans have a great deal of faith in scientists to act in the best interests of the public, about the same percentage as those who say they have not too much or none at all (23 percent). That is much lower than in 2019, the pre-pandemic era, when 36 percent of Americans said they had a great deal of faith in science being in the public’s best interest and only 12 percent had none or little.

Most Americans are stuck in the middle; 50 percent say they have a “fair” amount of trust in scientists. One way to think about this group is that they are up for grabs.

Kennedy’s Make America Healthy Again movement has gained steam because many Americans desire a fresh approach to health and wellness; Kennedy remains one of the more popular active political figures in the country, despite criticism from all corners of the public health establishment. As the country’s top health official, Kennedy argues he has a mandate to overhaul public health policy on everything from vaccines, to the food supply, to fluoride in public water systems.

But the health risks of Kennedy’s policy agenda are real, and that is the message that public health experts, including the resigning CDC leaders, are trying to deliver to the public.

The US has already seen what happens when childhood vaccination rates drop, with the worst measles outbreak in 30 years taking hold this year in a poorly vaccinated Texas community. Dentists in Utah, where Kennedy helped herald the removal of fluoride from local water systems in April, are preparing for a surge in cavities. The introduction of fluoride into US water systems led to a large decline in cavities over many years; now, Kennedy’s policy agenda could move the country backward.

And now, the new restrictions on Covid vaccines announced yesterday could make it more difficult for many people to get them. Vaccines may not be as widely available at pharmacies, and insurers may not be willing to cover the vaccine without government approval. That could make it harder for both vulnerable people and their loved ones to get Covid shots. The science is clear on the relative safety of the Covid shots, and Kennedy has been criticized for the weak evidence that he has cited to justify the changes to the Covid vaccine guidance. People could get sick if these shots are harder to come by because of Kennedy’s policies.

This is always a challenge in public health.

Short of emergency lockdowns and mandates, public health has always been about soft power: Can you persuade the public to take certain precautions in the best interest of not only themselves but the people around them? And that authority is always fluctuating. Around 90 percent of Americans get their childhood shots, but less than 50 percent usually get their flu shot in a given year.

Now, the headwinds facing good public health policy are stronger than ever, with Kennedy and his movement representing an active opponent of many well-supported public health interventions in charge of US health policy. For a while, Monerez, Daskalakis, and others seemed prepared to try to work within the system that Kennedy controlled. But they no longer believe that is possible, so they are taking the fight to the public.

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