However, her lawyers—Mark Zaid and Abbe Lowell—disagreed. In their words, she was asked to resign because she “refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts,” and she did not resign. They further argued that only the president can terminate a sitting CDC director, not Kennedy or any other HHS official. White House personnel notified Monarez in a phone call on Wednesday that she, indeed, had been fired by the president, but her legal team still disagrees, with Zaid noting on social media that being notified by White House staff is not the same as being informed by the president himself.
At a press conference the following day, White House press secretary Karoline Leavitt publicly addressed the matter, stating that Monarez “said she would [resign], and then she said she wouldn’t, so the president fired her, which he has every right to do.” Trump has yet to comment on Monarez’s firing but he alluded to the turmoil in a social media post on Monday that speculated on the effectiveness of COVID-19 vaccines: “With [the] CDC being ripped apart over this question, I want the answer, and I want it NOW.”
Monarez is not the only top official leaving the nation’s public health agency. Three senior officials resigned on Wednesday in protest of her ouster: CDC chief science and medical officer Debra Houry, director of the National Center for Immunization and Respiratory Diseases Demetre Daskalakis, and director of the National Center for Emerging and Zoonotic Infectious Diseases Dan Jernigan. (Jennifer Layden—director of the Office of Public Health Data, Surveillance, and Technology—also left the agency on Thursday, though it’s unclear whether her departure was connected to that of Monarez, and whether Layden was fired or resigned.)
Until this point, CDC leadership had not found Kennedy, who took office aiming to shake up an agency that he said had lost the nation’s trust, impossible to work with. As Daskalakis told the New York Times on Thursday, the secretary and CDC officials were largely aligned in “managing the measles outbreak in Texas” by educating local communities on possible warning signs of a measles infection and emphasizing this rather than just inoculation. “We shifted the message from being like an only-vaccine drumbeat, to including vaccine prominently,” he said, “but also talking about what the signs were, where you should get in the car and drive to [the hospital] because it’s an hour away.”
However, when Daskalakis made repeated attempts to open up dialogue between researchers and Kennedy, he found his efforts consistently rebuffed. “We offered to do briefings when he first started, I think some people were able to brief some lower-level staff, but not staff that were Secretary Kennedy’s staff,” he said Friday. “So, no one from my center has ever briefed the secretary”
Tension within federal departments has been present in previous administrations, but this situation is particularly “unsettling,” Dr. Joshua Sharfstein, a public health professor at Johns Hopkins’ Bloomberg School of Public Health and a former Food and Drug Administration (FDA) principal deputy commissioner, told TMD. “I used to work at [the] FDA, so I had a little bit of tension on different issues [with other federal regulatory agencies],” he said. “But the idea that the CDC director isn’t going to be able to look at the evidence and actually make a decision based on the evidence, that’s unsettling.”
Due to its importance for public health, the CDC has been largely insulated from sweeping changes or reforms introduced by new presidential administrations. But under the Trump administration, more than 2,000 CDC employees have been laid off, and other long-serving officials had resigned in frustration.
As Lawrence O. Gostin, distinguished university professor at Georgetown Law and faculty director of the university’s O’Neill Institute for National and Global Health Law, told TMD, “I’ve worked with CDC directors appointed by Republicans and Democrats—always thought that the CDC was a shining star of science and public health in the federal government.” He continued, “All of that is unraveling right before our eyes. The CDC is weakened beyond recognition.”
Gostin worked closely with the Biden administration on issues involving the CDC and public health, and he explained that while the White House “sometimes sought to interfere with CDC,” its involvement in the federal agency pales in comparison to the current administration. “Never, ever had they demanded blind loyalty or fealty to the White House, or to the president, or to the [HHS] secretary,” Gostin said. “The disputes have always been: Did you really get the science right? Did you really explain this properly to the American public?”
The ACIP is scheduled to meet on September 18, and its recommendations for COVID and other vaccines could be an early indicator of changes to come at the CDC; particularly if the panel stops recommending a wide swath of vaccines. But delaying the meeting—as GOP Sen. Bill Cassidy of Louisiana proposed on Thursday—also comes with consequences. As Wendy Parmet, a law professor at Northeastern University and director of the school’s Center for Health Policy and Law, told TMD, rescheduling the ACIP meeting “actually makes things worse in terms of accessibility for vaccines right now.” On Thursday, CVS Pharmacy announced the COVID-19 vaccine would be unavailable in 16 states with laws prohibiting pharmacies from doling out vaccines that have not received ACIP’s recommendation for approval. In 13 of those states, people can still obtain the vaccine with a doctor’s prescription, but receiving a vaccine at a doctor’s office is usually more expensive than going to a pharmacy.
Kennedy named Monarez’s temporary replacement on Friday, choosing deputy HHS secretary Jim O’Neill to serve as acting CDC director until Trump submits a new nominee for Senate confirmation. While Monarez was the first CDC director in more than 50 years not to hold a medical degree—she received a doctorate degree in microbiology and immunology—O’Neill has a significantly less traditional résumé, having received both his bachelor’s and master’s degrees in humanities. He served as principal associate deputy secretary at HHS under President George W. Bush, and in the years since, has worked closely with billionaire tech entrepreneur and right-wing donor Peter Thiel, serving as managing director of his hedge fund, Clarium Capital. O’Neill was also CEO of SENS Research Foundation: a Thiel-funded nonprofit that researches experimental anti-aging medication.
“I’m very strongly pro-vaccine,” O’Neill said at his Senate confirmation hearing for deputy HHS secretary in May, adding, “I support the CDC vaccine schedule.”
During a Fox News interview on Thursday, Kennedy said the CDC was a “troubled” body that he would be “fixing,” and added “it may be that some people should not be working there anymore.” However, as Gostin emphasized, the decision to fire Monarez was motivated by considerations far outside the scientific field. “He fired [Monarez] because she was doing her job,” he said. “He fired her because she wouldn’t comply with a blind political orthodoxy, and that’s why she had to leave.”
