It's been a week of turmoil at the Centers for Disease Control and Prevention. For employees at the public health agency headquartered in Atlanta, the first inkling that something was amiss came on Monday when a planned all-staff meeting was cancelled.
Here's how events unfolded from there.
1. CDC Director Susan Monarez is out.
CDC Director Susan Monarez led the agency for less than a month. She was confirmed by the Senate in late July, sworn in on July 31, led the agency through a gunman's attack on Aug. 8, and was forced out of the job this week.
Her attorneys, Mark Zaid and Abbe Lowell, said in a statement that she was targeted because she "refused to rubber-stamp unscientific, reckless directives and fire dedicated health experts."
Sources who were not authorized to speak publicly on the matter told NPR that Monarez had a meeting that went very badly last week with Health and Human Services Secretary Robert F. Kennedy Jr. That kicked off the drama that played out this week.
The Washington Post broke the story, then HHS confirmed Monarez was out in a social media post on the agency's X feed. Later, White House press secretary Karoline Leavitt said that she had been fired.
Monarez's attorneys say that the firing has not been communicated to her by President Trump, and that is necessary because it is a position confirmed by the Senate.
2. Meet CDC Acting Director Jim O'Neill.
Kennedy tapped one of his top advisors to be acting director of the CDC. Jim O'Neill will continue in his role at HHS, while leading CDC. Kennedy announced the move on Thursday in an email to staff obtained by NPR.
O'Neill previously served various roles at HHS under President George W. Bush. Since then he's mostly run investment funds for billionaire tech investor Peter Thiel. He had a senate hearing for his current role in HHS.
O'Neill was an early supporter of Kennedy's Make America Healthy Again movement and a vocal critic on social media of the CDC's role during the pandemic. His social media handle on X is @HHS_Jim.
In the past, he has expressed very strong libertarian views. For instance, he has said he thinks people should be able to be compensated for donating human organs to help incentivize more supply. He made that point in a speech to The Seasteading Institute in 2009: "Eleven people every day die while waiting for a kidney that could save their life. And there are plenty of healthy spare kidneys walking around, unused."
It's notable that he's not a physician or a scientist. Monarez, who held other roles in government, has a doctorate in microbiology, and most CDC directors have had medical degrees. O'Neill's background concerns Dr. Deb Houry, the chief medical officer of the CDC who resigned this week.
"You can be a great administrator but you do need to at least have a knowledge of how you'd handle an outbreak or an emerging pathogen," Houry told NPR.
HHS did not immediately respond to NPR's request for comment.
3. More CDC leaders resigned in protest.
Besides Houry, two other top CDC leaders resigned this week. Dr. Demetre Daskalakis led the National Center for Immunization and Respiratory Diseases, and Dr. Dan Jernigan led the National Center for Emerging and Zoonotic Infectious Disease.
Houry says it became clear very quickly after Monarez was sworn in that she wasn't going to be able to implement her policy ideas on vaccines.
A key issue for Houry, Daskalakis and Jernigan are the actions Kennedy has taken that align with the views of anti-science activists. Houry told NPR that ethically they couldn't abide the direction the agency is taking, and she said they wanted to time their departures for impact after the news broke that Monarez was being fired.
"We said, 'OK, this is our time,'" Houry says. "And we decided to do it together because when a single senior leader leaves, you know, it gets a little blip. But for us, we care about the agency and the people. And this is the way we could make that strong statement."
4. Rank-and-file CDC employees have been through the wringer.
On August 8, a gunman fired more than 500 rounds of ammunition into the buildings of the CDC and killed Dekalb County Police Officer David Rose. The gunman was motivated by "discontent" with the mRNA covid vaccine and died by a self-inflicted gunshot wound, authorities said. The incident happened after Kennedy's action on Aug. 6 suspending $500 million in mRNA research grants.
The gunman's attack also came on the heels of a chaotic and confusing layoff process at CDC, and a radical change in philosophical direction for the agency to focus solely on infectious disease. Kennedy reiterated that change in direction in an email to all CDC staff obtained by NPR.
While infectious disease has always been a priority for the agency, CDC has also tried to mitigate other things that kill Americans, such as injuries and chronic diseases. Kennedy is changing that without a clear explanation of how the federal health infrastructure will address these issues in the future.
5. Eyes are on congress next.
The Senate HELP Committee gave Monarez her hearing, and that committee is chaired by Republican Sen. Bill Cassidy of Louisiana.
Cassidy is a physician who spoke about his personal experiences seeing the devastating illnesses that can happen to unvaccinated children during Kennedy's confirmation hearing. He said he voted to confirm Kennedy after Kennedy promised to maintain federal vaccine policies — which is not what Kennedy has done.
Cassidy said this week that his committee will conduct oversight of these CDC resignations. The ranking Democrat on the same committee, Sen. Bernie Sanders of Vermont, has called for a hearing on the leadership shakeup. Cassidy has yet to confirm whether that will happen.
Cassidy has, however, called for an important meeting on vaccines to be postponed. The Advisory Committee on Immunization Practices, known as ACIP, announced Thursday that its fall meeting would be Sept. 18-19. Cassidy asked for that to be pushed back.
Kennedy fired all members of the ACIP committee and replaced them with his own roster of people who do not have the same expertise as the fired panel.
Gisele Grayson contributed to this report.
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