Losing trust in an instant: a public health emergency of the administration's making

I read with sadness and anger the events of these last few weeks.

We have witnessed premier public health organizations that are respected around the world being twisted into ideological standard bearers for politicians, far from the science for which they were established and have stood for decades.

It is reported that Dr. Susan Monarez was fired as head of the CDC because she refused to bow to the pressure of supporting non-science-based recommendations for vaccines, as promulgated by our current HHS Secretary, RFK Jr. 

I was wary when Kennedy was nominated to lead HHS, but there was also tentative reason for optimism, which I wrote about at the time.

Today, I can only say this: in my 35-year career as a physician, I have held recommendations from the CDC in high esteem, as well as research findings emanating from the NIH. My first wife, when she had Stage 4 colon cancer, was treated by an exceptional surgeon at the NIH campus in Bethesda, Maryland. Those institutions are not perfect, but what's the saying? Building trust takes years, but it can be lost in an instant—and that instant is now.

As most of us well know, science is about the constant questioning of established norms and the ongoing search for truth. Every good scientific researcher tries to disprove his/her own assumptions about their field of study. Many will never see the fruits of their labors, only living to pass on their knowledge to the next generation, who may build on their life’s work. 

I’ve seen a lot in my career:

• As an emergency physician during the first part of my career, I witnessed with sadness the profit-driven motives of "Big Pharma," the rise of the opioid epidemic, and the millions of lives impacted by a narrative sold to physicians about pain as the "fifth vital sign."

• I’ve also witnessed pharmaceutical success with the rise of thrombolytic therapies for heart disease and stroke, which save millions of lives and reduce the rising curve of cardiovascular disease deaths.

• I've also seen great advances in targeted cancer therapies using messenger RNA vaccines (the same technology used for the COVID vaccines). 

How we have arrived at a place where vaccines are seen as dangerous or harmful is puzzling.

Do I believe that patients were harmed from COVID vaccines? Yes, they were, in a small number of cases. This should be studied with the same intention and open-mindedness as all medical research. But I also believe, based on the extensive scientific evidence available, that millions of lives were saved in the U.S. and many more worldwide because of these vaccines—and the rapidity with which they were produced and distributed.

Throughout my life, the CDC, NIH, and their associated research institutions have rightly been held up as among the world’s premier public health and research institutions. Here are just a few of the accomplishments in which the NIH played a key role over the past quarter-century:

1. Human Genome Project → the genomics era (completed 2003; followed by the gap-free “telomere-to-telomere” reference in 2022). Led by NHGRI/NIH, this unlocked modern genetics, diagnostics, and precision medicine. (Genome.gov, ViiV Healthcare)

2. Structure-based vaccines & mRNA platforms (COVID-19 as the proof point, 2020). The NIAID Vaccine Research Center’s spike “2P” design and prototype-pathogen work underpinned the rapid NIH–Moderna vaccine. (Genome.gov, National Institutes of Health (NIH))

3. HPV vaccines (first U.S. approvals 2006). NCI scientists Douglas Lowy & John Schiller’s virus-like-particle (VLP) breakthrough led directly to today’s cancer-preventing HPV shots. (Cancer.gov)

4. Immune checkpoint inhibitors (CTLA-4, PD-1/PD-L1) transform cancer care (2011→). NCI-funded/basic work enabled therapies that now treat dozens of tumor types. (Cancer.gov)

5. CAR-T cell therapy (first approvals 2017). Building on decades at NCI (Rosenberg et al.), engineered T-cells now induce durable remissions in refractory leukemias and lymphomas. (Cancer.gov, NIH Intramural Research Program)

6. Genetic medicines: from AAV gene therapy to the first CRISPR treatment (SCD, 2023). NIH-supported pipelines culminated in gene therapies like Luxturna (vision) and the first FDA-approved CRISPR edit (CASGEVY) for sickle cell disease. (Genome.gov, NHLBI, NIH)

7. Curative hepatitis C antivirals (DAAs, 2011–2014→). NIH-backed virology paved the way for drugs that now cure >95% of infections, altering liver-disease and transplant trajectories. (NIDDK)

8. HIV prevention at scale: PrEP, including long-acting cabotegravir (2020 trials; FDA 2021). NIH-funded HPTN-083/084 trials showed CAB-LA’s superiority in key populations, leading to approval. (PubMed Central)

9. Alzheimer’s biomarkers to disease-modifying therapy (ADNI launched 2004; lecanemab traditional approval 2023; donanemab 2024). NIA’s ADNI reshaped trials/diagnosis and helped enable the first agents that slow decline in early AD. (National Institutes of Health (NIH), National Institute on Aging)

10. The Human Microbiome Project (2007–2016). NIH’s Common Fund HMP mapped “normal” microbiota and seeded today’s microbiome-driven diagnostics and therapeutics. (NIH Common Fund, BioMed Central)

As you can see, many of these have changed the trajectory of millions of lives, both here in the U.S. and worldwide.

The Trump administration’s FY 2026 budget proposal, released in May 2025, would have slashed NIH funding from roughly $47 billion to about $27 billion, a dramatic 40% reduction. This plan also aimed to consolidate NIH’s structure, eliminating several institutes and consolidating others.

Thankfully, the Senate Appropriations Committee, in a bipartisan move last month, rejected those deep cuts, opting instead to increase NIH funding by $400 million—around a 1% boost over FY 2025 levels—and preserved all 27 institutes. 

While the list above is impressive, the CDC's public health accomplishments are just as important to note, even though they may appear less dramatic. Public health doesn't get the same headlines as dramatic cancer breakthroughs or groundbreaking vaccine developments, but they are nonetheless critical to our health and safety.

The former makes headlines, the latter saves many more lives. These are all CDC-led or co-led programs from the last 25 years:

1. Faster foodborne-outbreak detection. Advanced Molecular Detection (AMD) + PulseNet’s WGS makeover CDC’s AMD program modernized public-health genomics; PulseNet switched to whole-genome sequencing, making foodborne-outbreak detection faster, more precise, and more preventative (with large modeled health and cost benefits). (CDC Travelers' Health, CDC)

2. National Wastewater Surveillance System (NWSS) Launched in 2020, NWSS turned wastewater into an early-warning platform now tracking multiple pathogens (beyond COVID-19) and giving communities trend insight before clinical data catches up. (CDC Stacks, CDC)

3. Accelerating contagious outbreak response. SPHERES: the national viral genomics consortium CDC created and leads SPHERES to coordinate U.S. pathogen sequencing, accelerating real-time genomic data use for outbreak response (e.g., SARS-CoV-2 variant tracking). (CDC)

4. V-safe: smartphone-based, active vaccine safety monitoring. Stood up in Dec 2020 and later expanded (e.g., mpox, RSV), v-safe added rapid, at-scale post-vaccination safety signal detection via millions of check-ins. (CDC, CDC Blogs)

5. Containing Ebola in Africa, the largest deployment in CDC history: West Africa Ebola (2014–2016) CDC activated its EOC, deployed ~1,400–1,900 responders, stood up labs and incident-management systems, and helped halt international spread—work that also built long-term emergency management capacity. (CDC)

6. Pandemic influenza preparedness (H1N1 + ongoing systems). During 2009 H1N1, CDC’s rRT-PCR received FDA EUA within days; CDC is a WHO Collaborating Center for influenza and built the Influenza Risk Assessment Tool (IRAT) to prioritize pandemic threats and inform vaccine/stockpile planning. (CDC Archive, CDC)

7. Combating antimicrobial resistance (AR Solutions Initiative & AR Lab Network). Since 2016, the AR Lab Network has provided nationwide capacity to detect and contain resistant threats; CDC’s 2019 AR Threats Report documented progress (e.g., pre-pandemic reductions in AR deaths). (CDC, CDC Archive)

8. Anti-smoking campaign. “Tips From Former Smokers” (national media campaign) Launched in 2012, Tips drove millions of quit attempts and sustained calls to quitlines—one of the most evaluated, effective tobacco-control mass-media efforts in the U.S. (CDC)

9. Curbing the HIV Epidemic (EHE) & measurable declines CDC’s EHE work (with partners) helped drive a 12% drop in estimated new HIV infections from 2018→2022, with especially large declines among adolescents and young adults. (CDC)

10. Global polio eradication support (GPEI core partner) Continuing CDC’s leadership, global wild-polio cases have fallen by >99% since 1988; during the past 25 years CDC’s surveillance and field operations helped push toward eradication in all but two countries. (CDC, Global Polio Eradication Initiative)

The CDC’s FY-2025 funding is essentially flat with a slight overall increase to HHS. Five hundred million dollars for opioid surveillance was shifted to SAMHSA (Substance Abuse and Mental Health Services Admin)—reducing CDC’s direct role in overdose data coordination.

Going forward, the Senate’s FY-2026 draft would keep CDC roughly level (a small decrease of ~$50–70 million), which preserves core infectious disease and lab capacity but leaves little margin for modernization or workforce growth.

In contrast, the House proposal seeks a 19% cut and major program “streamlining,” while the Administration has floated a structural reorganization that would move large swaths of CDC’s chronic and environmental health work into a new agency. Unless Congress aligns on stable funding and resists fragmentation, the CDC could lose effectiveness in chronic disease, overdose, and cross-cutting data systems even as outbreaks and health threats continue to demand a unified, well-resourced public health agency. 

Meanwhile, this past week has seen a wholesale change at the CDC in leadership, including:

• Susan Monarez, PhD: Appointed and confirmed by the Senate as CDC director in July 2025, she was removed from office by the White House after refusing to implement unscientific directives and not endorsing controversial vaccine guidance favored by HHS Secretary Robert F. Kennedy Jr.

• Debra Houry: CDC Chief Medical Officer, resigned, citing loss of scientific independence and deepening politicization within the agency.

• Demetre Daskalakis: Director of the National Center for Immunization and Respiratory Diseases, resigned in protest.

• Daniel Jernigan: Director of the National Center for Emerging and Zoonotic Infectious Diseases, resigned, expressing dissatisfaction about vaccine policies and the agency's direction.

• Jennifer Layden: Director of the Office of Public Health Data, Surveillance, and Technology, stepped down amid turmoil.

When I see wholesale changeover of leadership, in any organization, it means there is a high probability of either 1., widespread corruption involving multiple individuals or 2., external pressure seeking to dramatically alter the mission and values of the organization.

The narrative from the White House is that "the CDC needs to change." While I agree, all institutions need to be challenged to change, I also believe that those forcing the changes are not using rigorous scientific evidence to propose new recommendations to the public.

When major medical organizations start putting out their own recommended guidelines, in some cases different from the CDC, the evidence builds that the CDC is moving in the wrong direction in protecting public health.

Here are the U.S. national medical associations that have publicly issued guidance that differs from recent CDC recommendations (as of Sept 2, 2025), with the topic of divergence:

• American Academy of Pediatrics (AAP) — now recommends COVID-19 vaccination for all children 6–23 months (and permissive for older kids), departing from CDC’s current stance for healthy children. AP NewsCIDRAPPBS

• American College of Obstetricians and Gynecologists (ACOG) — continues to recommend COVID-19, influenza, and RSV vaccination during pregnancy, explicitly breaking with CDC’s recent changes. ACOGKFF Health NewsCIDRAP

• Society for Maternal-Fetal Medicine (SMFM) — reaffirms COVID-19 vaccination in pregnancy to protect pregnant patients and infants, contrary to current CDC positioning. SMFM

• Infectious Diseases Society of America (IDSA) — warns that rolling back CDC recommendations for healthy children and pregnant people will harm access, and maintains a pro-vaccination position at odds with CDC’s shift. Infectious Diseases Society of America

• American Academy of Family Physicians (AAFP) — leadership joined other major societies in publicly opposing CDC/ACIP upheavals and advocating for evidence-based vaccination guidance (a stance diverging from CDC’s new posture). STAT

• American College of Nurse-Midwives (ACNM) — issued a 2025 call-to-action recommending four vaccines in pregnancy (flu, Tdap, COVID-19, RSV), departing from CDC’s current recommendations. American College of Nurse Midwives

  
  

The complete picture of what is happening to our country's scientific and medical research institutions is more troubling the more you look at it.

I’m realistic that a single voice being raised in concern about what we are seeing may not amount to much. I realize my audience is small and some would say insignificant enough to make a difference. In the end, we each need to take a stand on where we stand. The ability to choose to do something brings with it its own risks and threats. But the choice to do nothing also has its own expected result, even if we do not care to admit it. 

I’ll finish with a quote from Martin Luther King Jr., which, as an integrative medicine physician,\ is resonating particularly strongly at this moment: There is a time when silence is betrayal.