Making sense of the showdown at the CDC

The nation’s top public health agency was thrown into uncertainty Wednesday night when the head of the Centers for Disease Control and Prevention was abruptly fired, only for her lawyers to insist that she was staying in the role. Four other top CDC officials did resign, with one of them alleging, in a sharply worded statement, that Health and Human Services Secretary Robert F. Kennedy Jr. is carrying out the “weaponization of public health” from within the government.

A new acting director for the CDC was named Thursday night, even though the previous director has not yet publicly acknowledged that her tenure has ended.

The announcements, legal challenges and accusations came in such a flurry that it can be hard to keep track of it all. Here’s a rundown of what happened, where things stand right now and where they might go from here.

What happened?

On Wednesday evening, the HHS announced via social media that CDC Director Susan Monarez, who was sworn into the job less than a month ago, was no longer leading the agency.

Less than two hours later, Monarez’s lawyers responded by saying that she had not, in fact, been fired and would also refuse to resign. They argued that Kennedy, though the CDC falls under his purview as HHS secretary, does not have the authority to terminate her. Only President Trump has that power, they said.

“When CDC Director Susan Monarez refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts, she chose protecting the public over serving a political agenda. For that, she has been targeted,” Monarez’s lawyers wrote in a statement.

The White House released its own statement late Wednesday night saying that Monorez had been let go because she was “not aligned with the President’s agenda of Making America Healthy Again.” Monarez’s lawyers said that still wasn’t enough because it came from a White House spokesman, rather than Trump himself.

“As a presidential appointee, senate confirmed officer, only the president himself can fire her,” Mark Zaid, one of Monarez’s attorneys, wrote on social media.

White House press secretary Karoline Leavitt told reporters Thursday morning that Trump himself had fired Monarez, but Zaid said that was still not enough.

“[Leavitt] can say whatever she wants. … But it doesn’t make her comments factually true, even when from a White House podium,” he wrote on social media.

Four other top CDC officials did leave the agency on Wednesday night over frustration with the direction of the agency under RFK’s leadership.

“I am not able to serve in this role any longer because of the ongoing weaponization of public health,” Demetre Daskalakis, who was in charge of the center that oversees national vaccination strategies, wrote in an email to colleagues that was shared with the media.

The CDC’s Chief Medical Officer Debra Houry, its Director of Public Health Data Jennifer Layden and the director of the National Center for Immunization and Respiratory Diseases Daniel Jernigan also resigned.

During an interview on Fox News on Thursday morning, Kennedy said it would be inappropriate for him to comment on personnel issues. But he levied heavy criticism at the CDC, arguing that the agency is “in trouble” and adding that “it may be that some people should not be working there anymore.”

Kennedy specifically called out the CDC’s actions during the coronavirus pandemic.

“President Trump has very, very ambitious hopes for CDC right now, and CDC has problems,” he said. “We saw the misinformation coming out of COVID. They got the testing wrong. They got the social distancing, the masks, the school closures that did so much harm to the American people today.”

Trump has yet to publicly comment on Monarez’s firing, which would likely end the uncertainty about her status.

HHS is moving forward as if the matter is settled, however. Jim O’Neill, Kennedy’s top deputy in the department, was named acting director of the CDC Thursday night. O’Neill, a former health official turned Silicon Valley investor, was also a frequent critic of the CDC during the pandemic, though he described himself as “very strongly pro-vaccine” during a confirmation hearing for his previous position in May.

How did we get here?

Kennedy was a controversial pick to lead HHS because of his long history of health claims that run counter to scientific consensus, particularly when it comes to the safety and effectiveness of vaccines. He was confirmed by a narrow margin in the Senate, with all Democrats voting against his confirmation and all but one Republican voting in favor.

Earlier this year, Kennedy announced mass layoffs within HHS, including hundreds of staff let go from the CDC. During his tenure, he has realigned much of the department around his Make America Healthy Again agenda, which centers around solutions for chronic disease that often conflict with medical consensus. He also fired all members of the CDC’s vaccine advisory board, replacing them with allies who have a history of vaccine skepticism, and brought in a researcher whose work has been widely criticized by medical experts to lead a study into the causes of autism.

Monarez, a career infectious disease researcher, was Trump’s second pick for CDC director. She was chosen after Trump’s first nominee, Dave Weldon, was withdrawn over apparent concerns that Weldon couldn’t get enough votes in the Senate to be confirmed because of his own past comments about vaccines.

Monarez reportedly butted heads with Kennedy throughout her brief tenure as CDC director. Tensions within the agency escalated earlier this month after a gunman — motivated by extreme anti-vaccine beliefs — opened fire on the CDC’s headquarters in Atlanta, shattering hundreds of windows and killing a police officer. In the wake of the attack, more than 750 HHS employees published a letter to Kennedy asking him to stop spreading vaccine misinformation. Monarez had previously sent a note to CDC employees lamenting the “deadly consequences” of vaccine conspiracies, though she did not place any blame on Kennedy directly.

The situation came to a head on Wednesday, hours after the Food and Drug Administration announced new guidelines for COVID-19 vaccines that make it harder for adults under 65 without an underlying medical condition to access the shots.

What happens next?

Trump can formally end Monarez’s tenure with the CDC at any point by personally firing her.

The scandal may not end when Monarez is ultimately ousted, however. Republican Sen. Bill Cassidy, who leads the Senate committee that handles health-related issues, said that the high-profile departures at the CDC will require oversight from Congress.

Cassidy also called for an upcoming meeting of the HHS’s vaccine advisory committee to be postponed until the allegations made by the departed CDC staffers have been fully investigated.

“These decisions directly impact children’s health and the meeting should not occur until significant oversight has been conducted,” he wrote in a statement. “If the meeting proceeds, any recommendations made should be rejected as lacking legitimacy given the seriousness of the allegations and the current turmoil in CDC leadership.”.

A permanent director for the CDC will also need to be named. It’s unclear if O’Neill, who is expected to keep his job with HHS while also serving as acting director, will be nominated to fill the position for the long term. Any new director would have to be confirmed by the Senate.