Who's in charge? CDC's leadership 'crisis' apparent amid new COVID-19 vaccine guidance

WASHINGTON — There was a notable absence last week when U.S. Health and Human Services Secretary Robert F. Kennedy Jr. announced in a 58-second video that the government would no longer endorse the COVID-19 vaccine for healthy children or pregnant women.

The director of the Centers for Disease Control and Prevention — the person who typically signs off on federal vaccine recommendations — was nowhere to be seen.

The CDC, a $9.2 billion-a-year agency tasked with reviewing life-saving vaccines, monitoring diseases and watching for budding threats to Americans' health, is without a clear leader.

''I've been disappointed that we haven't had an aggressive director since — February, March, April, May — fighting for the resources that CDC needs,'' said Dr. Robert Redfield, who served as CDC director under the first Trump administration and supported Kennedy's nomination as the nation's health secretary.

$9.2 billion-a-year agency without leader as nomination awaits

The leadership vacuum at a foremost federal public health agency has existed for months, after President Donald Trump suddenly withdrew his first pick for CDC director in March. A hearing for his new nominee — the agency's former acting director Susan Monarez — has not been scheduled because she has not submitted all the paperwork necessary to proceed, according to a spokesman for Sen. Bill Cassidy, R-La., who will oversee the nomination.

HHS did not answer written questions about Monarez's nomination, her current role at the CDC or her salary. An employee directory lists Monarez, a longtime government employee, as a staffer for the NIH under the Advanced Research Projects Agency for Health.

Redfield described Kennedy as ''very supportive'' of Monarez's nomination.

Instead, a lawyer and political appointee with no medical experience is ''carrying out some of the duties'' of director at the agency that for seven decades has been led by someone with a medical degree.

Matthew Buzzelli, who is also the chief of staff at the CDC, is ''surrounded by highly qualified medical professionals and advisors to help fulfill these duties as appropriate,'' Andrew Nixon, an HHS spokesperson said in a statement.

Adding to the confusion was an employee-wide email sent last week that thanked ''new acting directors who have stepped up to the plate." The email, signed by Monarez, listed her as the acting director. It was was sent just days after Kennedy said at a Senate hearing that Monarez had been replaced by Buzzelli.

The lack of a confirmed director will be a problem if a public health emergency such as the COVID-19 pandemic or a rapid uptick in measles cases hits, said Michael Osterholm, an epidemiologist at the University of Minnesota.

''CDC is a crisis, waiting for a crisis to happen,'' said Osterholm. ''At this point, I couldn't tell you for the life of me who was going to pull what trigger in a crisis situation."

An acting director rarely seen, and stalled decisions

At CDC headquarters in Atlanta, employees say Monarez was rarely heard from between late January – when she was appointed acting director – and late March, when Trump nominated her.

She also has not held any of the ''all hands'' meetings that were customary under previous CDC chiefs, according to several staffers.

One employee, who insisted on anonymity because they were not authorized to speak to the media and fears being fired if identified said Monarez has been almost invisible since her nomination, adding that her absence has been cited by other leaders as an excuse for delaying action.

The situation already has led to confusion.

In April, a 15-member CDC advisory panel of outside experts met to discuss vaccine policy. The panel makes recommendations to the CDC Director, who routinely signs off on them. But it was unclear during the meeting who would be reviewing the panel's recommendations, which included the expansion of RSV vaccinations for adults and a new combination shot as another option to protect teens against meningitis.

HHS officials said the recommendations were going to Buzzelli, but then weeks passed with no decision. A month after the meeting ended, the CDC posted on a web site that Kennedy had signed off on recommendations for travelers against chikungunya, a viral disease transmitted to humans by mosquitos. But there continues to be no word about a decision about the other vaccine recommendations.

Controversial COVID-19 vaccine recommendations bypassed CDC panel

The problem was accentuated again last week, when Kennedy rolled out recommendations for the COVID-19 vaccine saying they were no longer recommended for healthy children or pregnant women, even though expectant mothers are considered a high-risk group if they contract the virus. Kennedy made the surprise announcement without input from the CDC advisory panel that has historically made recommendations on the nation's vaccine schedule. The CDC days later posted revised guidance that said healthy kids and pregnant women may get the shots.

Nixon, the HHS spokesman, said CDC staff were consulted on the recommendations, but would not provide staffer's names or titles. He also did not provide the specific data or research that Kennedy reviewed to reach his conclusion on the new COVID-19 recommendations, just weeks after he said that he did not think ''people should be taking medical advice'' from him.

''As Secretary Kennedy said, there is a clear lack of data to support the repeat booster strategy in children,'' Nixon said in a statement.

Research shows that pregnant women are at higher risk of severe illness, mechanical ventilation and death, when they contract COVID-19 infections. During the height of the pandemic, deaths of women during pregnancy or shortly after childbirth soared to their highest level in 50 years. Vaccinations also have been recommended for pregnant women because it passes immunity to newborns who are too young for vaccines and also vulnerable to infections. Nixon did not address a written question about recommendations for pregnant women.

Kennedy's decision to bypass the the advisory panel and announce new COVID-19 recommendations on his own prompted a key CDC official who works with the committee – Dr. Lakshmi Panagiotakopoulos – to announce her resignation last Friday.

''My career in public health and vaccinology started with a deep-seated desire to help the most vulnerable members of our population, and that is not something I am able to continue doing in this role,'' she wrote in an email seen by an Associated Press reporter.

Signs are mounting that the CDC has been ''sidelined'' from key decision-making under Kennedy's watch, said Dr. Anand Parekh, the chief medical adviser for The Bipartisan Policy Center.

''It's difficult to ascertain how we will reverse the chronic disease epidemic or be prepared for myriad public health emergencies without a strong CDC and visible, empowered director,'' Parekh said. ''It's also worth noting that every community in the country is served by a local or state public health department that depends on the scientific expertise of the CDC and the leadership of the CDC director.''