A grand unified theory on what the hell is going on with the CDC's power vacuum.
Secretary Kennedy has the agency right as he wants it: Under his power and increasingly unable to function properly.
I’m coming in hot today. Let’s get to it. Thanks for supporting Inside Medicine.
It has been over three months since President Trump’s first nomination for CDC Director, Dr. Dave Weldon, crashed and burned on the eve of his Senate confirmation hearing. Everything had been proceeding normally until March 13, when Weldon’s chances suddenly evaporated.
Weldon didn’t go quietly. Reasonable minds disagreed about why his star had fallen so quickly. Was the problem his substance or his style? For anyone left unsure, Weldon promptly released a floridly unhinged public statement that settled the debate swiftly: It was both.
A couple of weeks later, on March 31, then-acting CDC Director Susan Monarez was officially nominated for the permanent gig. Monarez had been in the acting CDC Director position since the earliest days of the Trump administration. By late March, she had demonstrated that she had, for this curséd timeline, the ideal credentials to run the place indefinitely. On one hand, she had been absolutely feckless in the face of DOGE-initiated censorship and mass terminations of CDC workers, and Trump world liked that. (They like anyone they can easily bulldoze into compliance.) On the other hand, Monarez was seen by sciency types as, well, actually sciency. Given the options (and other newly-installed Star Wars bar characters pushing pens at HHS), Monarez seemed by comparison like the second coming of Marie Curie.
Nowadays, we don’t know exactly how Susan Monarez spends her days, but it ain’t as acting CDC Director. That’s because under the Vacancies Act, the acting CDC Director and the nominee for the permanent position may not be the same person. And Monarez has been abiding by the law, I’ve been repeatedly told by CDC insiders. Once nominated for the permanent position, she immediately stopped attending leadership meetings and also stopped making whatever independent decisions DOGE had permitted until that point.
Have you noticed that her confirmation process is taking an awfully long time, especially for a person who ran the agency for a couple of months?
In fact, I’ve learned that it was not until the last couple of weeks that Dr. Monarez began making the rounds on Capitol Hill as expected of high-level nominees, meeting with Senators to secure the votes needed for confirmation. But I was also told that with the Senate’s summer schedule, it’s unlikely that Monarez will be confirmed soon, and perhaps not until August or September.
This all suits HHS Secretary Robert F. Kennedy smashingly, in case you’re wondering.
So what do we think happened and why?
Where things stand: The CDC has no Director, neither permanent nor acting. Secretary Kennedy said otherwise, but this is blatantly false. Not even HHS spokesman Andrew Nixon thinks that it’s true.
Here’s what I think has happened and why:
Back in January and early February, Senator Bill Cassidy, a physician (and the ranking member of the Senate HELP committee which handles nominations) expresses fears that RFK Jr. will attack vaccines if he is confirmed as HHS Secretary.
RFK Jr. tells him he won’t.
Cassidy says he believes this. (Shaka, when the walls fell.)
Cassidy votes for RFK Jr.’s confirmation to survive the HELP committee. (The other Senate Republicans who might have become no votes if Cassidy opposed the nomination stand down, in deference).
On February 13, RFK Jr. becomes HHS Secretary Kennedy, and his tenure begins.
Secretary Kennedy quickly demonstrates that his assurances to Cassidy were empty.
On February 20, a late February meeting of the CDC’s Advisory Committee on Immunization Practices (ACIP) is postponed, without explanation. The claim was that a longer public comment period was needed. (This came around the same time that Secretary Kennedy moved to eliminate comment periods from many rules and regulation processes.)
During a major measles outbreak, Secretary Kennedy initially downplays its severity, promotes Vitamin A, and talks out of both sides of his mouth on vaccine in a March 3, Fox News opinion.
On March 11, we learn that NIH grants on improving vaccine trust have been canceled.
On March 13, the nomination of Dr. Dave Weldon as CDC Director is withdrawn because it’s clear he doesn’t have the votes.
Dr. Susan Monarez is named as the replacement nomination for CDC Director on March 31.
This leaves the acting CDC Director position open, something nobody seemed to notice until it was reported here in Inside Medicine on April 9. (Some members of Congress did not seem to realize it, even weeks later.)
ACIP meets on April 15-16. The committee votes in favor of some expanded recommendations for RSV, meningococcus, and Chikungunya virus vaccines.
On May 13, Secretary Kennedy signs off on the Chikungunya vaccine votes, but not the other ones. The CDC’s website says, “With pending confirmation of a new CDC Director, these recommendations were adopted by the HHS Secretary on May 13, 2025 and are now official recommendations of the CDC.” In other words, the CDC says there’s no acting CDC Director—which its leadership website confirms.
On May 14, in a Senate HELP committee hearing, Senator Lisa Blunt Rochester asks Secretary Kennedy who the acting CDC Director is? (She holds up a copy of Inside Medicine, which is subsequently entered into the Senate record). Kennedy says the acting Director of the CDC is Matt Buzzelli, owing to the fact that Susan Monarez could no longer serve. This is, by all accounts, false. (Buzzelli is the chief of staff, a Trump-supporting lawyer installed to babysit Monarez et al.)
At this point, Secretary Kennedy seems to realize the power of not having a CDC Director. Since only a CDC Director or the HHS Secretary can make vaccine policy official, he now runs the entire vaccine establishment of the United States. This is a crowning moment of the anti-vaccine movement. Kennedy seizes the opportunity.
On May 20, two HHS officials write that they will unilaterally change FDA policy on vaccines, making it harder for vaccines to reach the market. They also imply that HHS would be better off not recommending Covid-19 vaccines to as many people as it has until now. (The merits of this aside, this was neither in the FDA’s purview, nor is evidence or adherence to any of the required transparent processes by which CDC vaccine recommendations must abide presented.)
On May 27, Secretary Kennedy announces on Twitter/X that the CDC will no longer include Covid-19 vaccines on its list of recommended vaccines. Again, merits aside, the announcement comes without any process. No new data. No public votes. Just announcements on social media.
By Friday, May 30, it is reported that CDC’s ACIP charts had been updated with most of the changes that Kennedy had outlined on May 27.
At this point, Kennedy and his acolytes are having an absolute bonanza—the time of their lives, really.
June 9. Realizing that nobody can or will stop him, Secretary Kennedy announces that he has fired all seventeen members of ACIP, a body of respected experts who had been carefully vetted. (All seventeen of them published a Viewpoint in JAMA on June 16 which is worth reading.) The agenda for the June 25-27 ACIP meeting is sorta posted in the Federal Register, but specifics are vague. (I guess comment periods are not that important after all.)
June 11. Secretary Kennedy names eight new members to ACIP, including some blatant anti-vaxxers, and those who have been paid as expert witnesses in lawsuits against vaccine manufacturers. (Conflicts of interest seem to only count in one direction.)
At some point during the last couple of weeks, our would-be nominee for the permanent CDC position, Dr. Susan Monarez, starts making the rounds on Capitol Hill, in advance of her confirmation hearings. But due to the summer schedule, it’s unlikely that Monarez will be confirmed for weeks, if not months, I’m told. This leaves Kennedy in full control of US vaccine recommendations for adults (for pediatric policy, his newly installed octet of voting ACIP members make those decisions without need for further sign-off by Kennedy; a simple majority vote is needed.)
It’s good to be the king.
All to say, that given what happened in March and April, Secretary Kennedy seems to have figured out that not having a permanent CDC Director was a boon for him and his MAHA movement. In fact, not having even an acting CDC Director turns out to be tons of fun for him and his acolytes. The patients are running the asylum, and every day is Taco Tuesday.
Bottom line, it’s distinctly possible that, realizing their mistake in confirming Kennedy, Senator Cassidy (or perhaps Senator Lisa Murkowski or Senator Susan Collins) killed Dave Weldon’s CDC nomination on March 13. Their hope and intent was to get a better replacement—and not a florid anti-vaxxer. To punish them for that (and realizing the opportunity), Secretary Kennedy had Monarez’s confirmation slow-walked so that he and his pals could just run ACIP into the goddamned ground for as long as possible. Cause and effect. Serve and volley. Crime and punishment.
Now, it’s likely that Dr. Monarez has had no say in these matters. It’s also possible that, like her time as acting CDC Director, she’s doing precisely as ordered—albeit that may be a distinction without a difference. In any case, apparently her paperwork had not been completely filed as recently as June 5, over two months after her official nomination, which explains the delay in her confirmation. This is great for Secretary Kennedy. What’s the rush, as far as he’s concerned? He’s the king of HHS, and he’s loving every minute.
2D chess versus checkers.
I’ve been watching a lot of chess videos lately. I’ve learned that people really can think ahead, when it suits their interests. I’ve also learned that some simple and devastating moves can be humiliating. It’s clear that Secretary Kennedy outplayed Senator Cassidy. Each day brings a new degradation to Cassidy’s reputation who, in the words of The Atlantic, “blew it.” It’s not that Kennedy’s moves were so brilliant. It’s just that, compared to Senator Cassidy, he starts to look like Magnus Carlson.
So: Could the power vacuum at the CDC be the result of a stalemate initially created by Senator Cassidy and crew? Having realized their horrible mistake confirming Secretary Kennedy, they killed the Weldon nomination for permanent CDC Director, making it known that they would not repeat their mistake of promoting an anti-vaxxer. However, Secretary Kennedy shrewdly realized that the stalemate—a snail’s pace confirmation process for Susan Monarez—ridiculously favors him and has allowed him to coup the whole damn thing for a few months?
I’m starting to think so. In this instance, a stalemate favors the king.
Your move, Senator Cassidy.
That’s all for now. Thanks for reading and supporting science, facts, and the actual American way!
If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.
It is infuriating to think about what is happening at HHS, FDA and CDC; and important to be aware of it all. If we don’t know what is going on, we have no hope of stopping the runaway train of incompetence. Thank you Dr. Faust.
The potential devastation caused by this unethical maneuvering on the chessboard of power grabs is unthinkable. Thinking of the possible inconsistent administration of childhood vaccines, and knowing how many school districts are heavily populated by people from all over the world and staffed by many pregnant teachers at any given time, I wonder: what could possibly go wrong??? Will share your email (which explains things so well).