‘Irreparably Damaged’: Former Senior Official Details the Darkest Days of the CDC Under RFK Jr.

To put it bluntly, the U.S. Centers for Disease Control and Prevention is in a complete freefall. Under the reign of Robert F. Kennedy Jr., the longtime crank turned U.S. Health and Human Services Secretary, thousands of people have lost their jobs, the organization’s policies have been hijacked by allies of the anti-vaccination movement, and workers there have endured a deadly shooting committed by a man whose motives were likely influenced by misinformation about the covid-19 vaccines. The most dramatic upheaval occurred in late August, when former CDC director Susan Monarez was fired just four weeks into taking the role. Monarez has since publicly testified that she was let go for refusing to sign off, without review, on the vaccine-related recommendations of RFK’s handpicked advisors, many of whom—like Kennedy himself—have a history of spreading misinformation about vaccines. Immediately after Monarez’s reported firing, in a coordinated act of protest, three senior staff members at the CDC turned in their resignation notice: Debra Houry, CDC’s former chief medical officer, Daniel Jernigan, former director of the National Center for Emerging and Zoonotic Infectious Diseases, and Demetre Daskalakis, former director of the National Center for Immunization and Respiratory Diseases (a fourth senior official, Jennifer Layden, former director of the CDC’s Office of Public Health Data, Surveillance, and Technology, also resigned). “We should practice detachment from the organizations and focus on the mission. And the mission is the health of the public.” Gizmodo reached out to Daskalakis to discuss the events within the CDC leading up to the resignation, the fallout since, and what the path forward might look like in a world where trust in the CDC has eroded. The following conversation has been lightly edited for clarity and grammar. Ed Cara, Gizmodo: Can you take us through the first days and weeks of the second Trump administration for you and others at the CDC? What was the general mood? Demetre Daskalakis: Soon after the election, when President Donald Trump announced that RFK Jr. was going to be his candidate for the Secretary of Health and Human Services—that was obviously the beginning red flag. Prior to the CDC, I had worked in New York City for many years in the Department of Health and Mental Hygiene. While there, I had been involved as the incident commander over the measles outbreak from 2018 to 2019. And that’s the first time that I had any awareness of the sort of anti-vaccine strategies of RFK Jr. and the organizations he participated in. So while we were running the measles response, one of his organizations, Children’s Health Defense, was working to undermine the work we were doing. It supported anti-vaccine messaging, and RFK Jr. would go on to sue the health department while we were in the middle of our response, trying to destabilize what we were doing. At that point, I was like, “There’s this kooky guy who’s a Kennedy who is really trying to interfere with this important work to prevent kids from getting sick.” So when they said his name as the candidate, I was like, “Oh boy.” Author’s note: Kennedy founded Children’s Health Defense and served as its chairman and chief litigation counsel before resigning ahead of his failed presidential run. But then I did research on it, and not just me, all the doctors at CDC who were in leadership. We all read books, we looked at papers, to figure out what we were up for. And also to see where there were opportunities for us to integrate our sort of science and strategy in public health with what will be the vision of the new secretary. It’s what you do as a civil servant: How do I work with the new leadership and still make sure that we’re protecting the health of the country? Before he was appointed, though, there were the confirmation hearings. Ahead of those hearings, his cousin [Carolyn Kennedy] came out, called him a predator and said that he was dangerous for American health. So that was something. And watching the hearings, I was not particularly impressed. He seemed not very well prepared, but that’s probably less his problem and more his teams. But we made it through that and then he got confirmed. The next thing that I did was, when he gave his big talk at HHS after he was sworn in, I made my whole team stop doing work so they could hear what he had to say. And honestly, it was good. He said gold standard science and radical transparency are things that he was going to uphold. And he made it seem like he was going to engage with the scientists and the experts across HHS to make sure that we’re going down the right scientific path. So we took copious notes, and we felt like we could do it—we’re going to figure out how to work with this guy. We prepared all these transition documents, all these plans, all these things to be ready to talk to him. Gizmodo: Then what happened? Daskalakis: Then he landed and we never, ever heard from him. We reached out to try to brief him. He never said yes. We talked to his teams. They never said yes. And the communications we were getting were some combination of dismantling CDC and doing really unhinged policy things. Around February 14th, we had our first CDC massacre where they fired a bunch of people who were newly hired staff. April 1st, we had our next CDC massacre where they literally deleted thousands of positions from CDC. And then just now, we had our third CDC massacre. We’re now about a quarter down of the staff that we had in CDC. “There’s no need to destroy public health to rebuild it.” And then there’s all the policy things. He changed the covid-19 vaccine recommendations for kids and pregnant women via a tweet [in late May]. We had heard nothing about it before that. He had never conferred with any scientists. When we asked him if we could get the documents underlying the data that support your decision, his staff said no. So CDC was directed to make changes and no one had ever seen the data underneath it. So we made it; we tried to mitigate that and made it a little bit not as bad. He then fired all of the experts on the Advisory Committee for Immunization Practices (ACIP), which is the body responsible for guiding CDC on what they should do for vaccine policy. And he replaced them mostly with people who were, frankly, political appointees who were ideologically aligned to his desire to dismantle and destroy vaccines. They’ve changed the way that the committee works. The entire agenda, the entire membership, all of the conversations are only driven by these people that he put in who are his ideological clones and the scientists are completely sidelined, only being able to provide data as requested rather than really engaging in the conversations. And then, of course, Susan Monarez was fired. There was this brief shining moment when we had a scientific leader who was going to help be a diplomat to build the bridge between us and the secretary. And then he basically told her that he didn’t want her science here; he just wanted her to sign off on these recommendations. And they fired her. Gizmodo: So the Monarez firing was the breaking point that led you and your senior colleagues to resign in protest? Daskalakis: That’s what led all of us to get together, and for me to say that it was time to go, because I can’t support something that’s not going to use good science, something that will potentially end up making terrible decisions for the country that could impact the health of people. But we had all been writing our resignation letters. I started my resignation letter when he fired ACIP because I was like, “I just need to have all this documentation for the moment when I have to get out of here, because I can’t do any good anymore.” RFK Jr. was dictating things in a way that wouldn’t let science get done or be reviewed adequately. But then I was very excited when Susan came aboard, when she had this moment of like, let’s try to work with this and make it better. She had a vision for how to do it. And he just threw it aside. She was like a trusted expert two months before, and now she’s absolutely a demon. So when we lost that scientific leadership, it was the end. “These are a bunch of rookies that don’t know even how to run a medium-sized organization, much less one that’s complex like CDC.” Bottom line, their office of the director at CDC only had one person other than Susan who was a scientist, and that was Debra Houry. So when that conversation began and she said she was also going to leave, that was the end of that. It’s like having a head and body but with no neck. Gizmodo: What do you say to the critiques made by RFK Jr. and his allies that all this chaos is needed? That the only way to “Make America Healthy Again,” as his saying goes, is to dismantle the status quo of the CDC and the country’s public health systems in general? Daskalakis: I call bullshit on it. It’s garbage. There’s no need to destroy public health to rebuild it. There is a rational way to do it. The CDC, especially since covid, has changed a lot. Could it change more? Yes, but do you do it by destroying CDC? That’s like flying a plane holding hundreds of people, thinking that the engine’s not so great, and trying to rebuild the engine while it’s flying. Even worse, it’s like blowing up a plane while it’s flying and hoping all the parts will land somewhere safe and the people will be fine. It’s beyond irrational. Tearing the CDC apart while saying that you’re going to make it better also means that we’re completely not prepared in the event that something disastrous happens. And frankly, we’re not really prepared for the routine work either, because it’s like an interconnected organism. We had already made proposals on how to make the CDC more efficient and how to do it quickly. But they wouldn’t take them. Instead, they’re taking this tech bro strategy of, “Let’s break it and then see how it goes.” And you don’t want your public health done that way. Gizmodo: How has the CDC been doing since your resignation, in your opinion? Daskalakis: It’s just getting worse, and they still don’t have any scientific leadership. The guy who they claim is the acting director of CDC, Jim O’Neill, has never met with the senior leadership at CDC—it’s now been about five weeks since he was appointed. And yet he feels comfortable, as a non-scientist, tweeting out things about separating the measles, mumps, rubella (MMR) vaccine and congratulating themselves for taking down websites that are important for people’s health because they have the word “equity” or talk about gender. And this latest reduction in force, it’s disastrous, even if some of those firings have been reversed. Right now, the CDC doesn’t have an ethics office; they don’t have an institutional review board; and they don’t have the organization that looks after the advisory committees. Author’s note: Some of the employees fired in this latest round were responsible for overseeing conflicts of interests in these committees, while the Trump administration has previously terminated several advisory committees. It’s supposed to be radical transparency, but they can’t communicate because they got rid of all their communicators. They can’t run a advisory committee because they got rid of the advisory committee groups. And they can’t review science to be able to go forward. Gizmodo: What about those still left behind at the CDC? How have they been faring through all this? Daskalakis: The staff is horribly traumatized. Two months ago, that place was shot with 500 bullets. My office has a giant hole in the window because of a bullet. And RFK Jr. came down, said thoughts and prayers, and then immediately went to an interview and said not to trust experts. Author’s note: During an August 11 interview three days after the shooting, RFK stated, “Trusting the experts is not a feature of either science or democracy.” No one seems to cares. When an ICE facility got shot up last month, the president ten minutes later had a statement about it. He has never said one word about the shooting at CDC; not one word about the police officer who died to protect us. So they do not value the workers, they do not value the work. For them, dismantling the CDC is no big deal and, frankly, it’s because they don’t understand the value that public health gives to the country and the world. Because these are a bunch of rookies that don’t know even how to run a medium-sized organization, much less one that’s complex like CDC. Gizmodo: Circling back a bit, it seems like breaking up the MMR vaccine—something that both acting CDC director O’Neill and President Trump have called for—would be the most dramatic change in vaccine policy seen yet. Just how realistic are the odds of that happening? Daskalakis: A year ago, I would have said it’s totally not possible. First of all, there’s no separate measles vaccine that’s produced and available in the U.S., and there’s no such thing as a separate mumps and rubella vaccine, either. But these people don’t follow any sort of political norms. And as we’ve seen with leucovorin, the drug that they approved for autism, they also don’t follow any sort of standard regulatory pathways. So I can’t predict if they’re going to do it. I don’t put anything past this administration’s ability to circumvent science and process. Gizmodo: Remarkably, we’re not even a full year into this second term. Given how dire the CDC’s situation is right now, what’s to be done, in your opinion? Is there a way to navigate ourselves out of this catastrophe in the making? Daskalakis: It’s a complicated question, but I have a simple answer. Right now, looking at CDC, it is pretty irreparably damaged. We can criticize the pandemic response, but CDC did a lot of important functions and did actually function very well for most of what it was doing. Post-pandemic, there were many changes to CDC, related to what the experience was during the pandemic. But now, with a quarter of the staff gone, with no strategic plan around why they’re gone, it’s all just patchwork. What CDC is like now is a smartphone with all of its apps but no operating system. So my simple answer is that federal public health has now been compromised—it has been taken over by ideology, it’s been weaponized. If you look at the CDC website, the “About” webpage is literally propaganda around extremely partisan views. My advice to the world is that we should practice detachment from the organizations and focus on the mission. And the mission is the health of the public. And so I think that focusing a lot of energy in trying to repair CDC is actually the wrong direction, because that damage has been done. And for me, the bottom line isn’t just that there’s no political will to fix it, it’s the opposite—there’s a strong political will to break it. There’s nothing that we’re going to be able to do at this moment to resist the breaking of CDC. But what we can do is turn to local jurisdictions, states, and other professional organizations outside the federal government. They’re going to have to be the renaissance that will follow after the dark ages. I don’t know what that renaissance will look like, but I know it’s not going to come from the feds down. It’s going to come from the states, the jurisdictions, the organizations, and the people on the ground. Because there will be something that can be rebuilt or built up, but it’s not going to be out of the minds of the people who are literally trying to destroy public health.