After three director changes since July and a wave of significant staff departures, the CDC faces growing questions about its capacity to deliver the outbreak coordination, surveillance and public health guidance hospitals have relied on for decades.
Jay Bhattacharya, MD, director of the National Institutes of Health, was named acting CDC director Feb. 18. He replaced HHS Deputy Secretary Jim O’Neill, who stepped down earlier this month. He had been appointed acting director in August after the ouster of Susan Monarez, PhD, who had held the role for about one month.
Just five days after Dr. Bhattacharya was selected to helm the agency, its Principal Deputy Director Ralph Abraham, MD, resigned after three months in the No. 2 role due to “unforeseen family obligations” according to a Feb. 23 CDC statement.
Several public health experts have voiced concerns about Dr. Bhattacharya’s ability to concurrently run the NIH and CDC, The New York Times reported Feb. 18. Dr. Bhattacharya is a physician and medical economist who researches the well-being of populations, but has no formal public health training, according to the Times.
The concerns extend beyond just Dr. Bhattacharya’s lack of public health expertise. Geography alone will be a challenge, the publication noted, as the CDC is based on Atlanta and NIH is headquartered in Bethesda, Md.
Debra Houry, MD, former chief medical officer and deputy director for program and science at the CDC, said her hesitations go beyond any one person’s expertise or leadership ability to the fundamental argument that it is not a “reasonable or responsible structure” to have one individual lead both agencies.
“Placing one person in charge of running two agencies at once raises serious questions about feasibility, governance, and risk to our communities,” she wrote in a Feb. 24 op-ed for MedPage Today.
Michael Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, was more direct in remarks to the Times, calling Dr. Bhattacharya’s joint appointment “a recipe for disaster.”
President Donald Trump has not yet named a permanent nominee for the top CDC role. Once that nomination has been identified, it could take several months for Senate confirmation, meaning the CDC will likely operate without a full-time executive leader for an indefinite period. What’s more, the agency has undergone significant workforce changes through a series of firings and resignations, including that of many career leaders.
The CDC defended Dr. Bhattacharya’s joint appointment, saying he is committed to serving the American people in a Feb. 25 statement to Becker’s.
“The director has empowered the NIH leadership team to ensure the agency’s priorities continue moving forward until the President nominates and the Senate confirms a permanent CDC director,” an HHS spokesperson said. “The CDC leadership team will work closely with Dr. Bhattacharya during this acting period to continue protecting and serving the American people. The director is solely focused on ensuring a seamless transition for both agencies while maintaining continuity of leadership and advancing their core public health missions.”
The leadership and workforce churn raises questions about the agency’s capacity to fulfill core functions hospitals depend on.
As the main coordinating body for infectious disease outbreaks and public health emergencies, healthcare leaders face uncertainty about what federal support would look like during the next health crisis. Dr. Osterholm spoke to the Times of this risk, saying the agency is “[o]ne disaster away from being a disaster itself.”
As institutional knowledge leaves the agency, clinical and compliance leaders also face a practical question: whether the guidance they rely on — from infection control protocols to antimicrobial stewardship to vaccine guidance — will remain current, and whether updates will arrive on expected timelines. That concern is already materializing. On Feb. 20, a federal spokesperson confirmed to Becker’s that the CDC’s Advisory Committee on Immunization Practices canceled its February meeting, which was expected to review COVID-19 vaccine recommendations.
Questions have also arisen about the national disease surveillance systems that hospitals report data to and review. About 46% of public CDC health surveillance databases were paused or faced delayed updates last year, according to a Jan. 27 study published in Annals of Internal Medicine. Weaker surveillance efforts can cloud visibility on community-level disease activity for hospitals, which is often valuable information to inform staffing, surge planning and isolation protocols.
The agency’s operational challenges are compounded by ongoing legal battles over CDC funding cuts to states and vaccine policy, including a Feb. 24 lawsuit filed by 15 states to block recent changes to the childhood immunization schedule. These legal challenges add another layer of unpredictability for healthcare leaders and state officials trying to plan around federal guidance and funding streams.
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