Exclusive: The Trump administration dismantled the CDC’s peer review system. Staffers scrambled to salvage it.

The CDC sends hundreds of millions of dollars to outside researchers each year. Would the Trump administration let that happen in 2025?

Dear Readers, I’ve been reporting this story for several weeks. It features on-the-record quotes from prominent CDC/NIH alumni, legal experts, and input from more than a dozen additional sources whose identities are protected here. It’s a 3,700-word deep dive into how the Trump administration tried to dismantle the CDC’s peer review process for external grants—and how career staff worked to save the system that ensures rigor and fairness in its decision making.

If you find this valuable, please share it and consider upgrading to support Inside Medicine. Thank you so much! —Jeremy Faust

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You can’t just call a meeting of outside experts.

You need a FACA charter.

What am I talking about and why do you care?

The CDC is responsible for creating unified federal responses to countless public health problems. For the CDC to fulfill its duties, knowledge gaps like these—known unknowns—must be filled. How many American kids have epilepsy? Are men being asked the right questions when considering whether to receive prostate cancer screening? The answers guide national priorities and policies.

Answering these questions takes research, research that CDC scientists cannot perform, owing to lack of in-house expertise, sufficient resources, or both. So, a simple solution has long been in place: outsourcing.

The CDC sends around 80% of all the money it receives back out the door, including to state and local health departments. Around 10-20% of this goes toward competitive external research grants, amounting to hundreds of millions of dollars every year, funding that supports research into chronic diseases, birth defects, injury, global health, and infectious diseases.

Inside Medicine has learned that earlier this year, the Trump administration quietly dismantled the external peer review procedure that assured that CDC-funded extramural research reflected the “most meritorious ideas and projects,” and maintained public accountability.

Interviews with more than a dozen current and former HHS employees and legal experts reveal what appears to be another retreat from the venerable systems that safeguard transparency and fairness in federal science—only to be replaced by a looser framework prone to political influence and cronyism.

Even so, CDC scientific officers identified a workaround, and attempted to get these grants funded before the 2025 fiscal year ended on September 30. They wouldn’t know until the last minute if they had succeeded.

A system designed to ensure quality and fairness is scrapped.

Since 2003, CDC policy has required that outside (“extramural”) research funding decisions hinge on competitive peer review processes performed by external experts, rather than on its own internal deliberations, similar to how the NIH decides which outside research to support. Engaging external experts provides accountability by guarding against internal cronyism or groupthink. It also protects against internal conflicts of interest, because unlike NIH grants, CDC grants are close collaborations between CDC employees and the outside researchers they support, meaning that agency scientists often end up designing aspects of the research and eventually co-authoring the resulting studies.

It makes sense, then, that CDC research staffers tasked with deciding how millions of taxpayer dollars would be spent couldn’t just call in whomever they pleased, willy-nilly, to adjudicate all of this. Instead, “special emphasis panel” members had to be recruited and carefully vetted. The overall goal was to ensure the right expertise was brought to bear, conflicts of interest were identified, and even equitable geographic distribution among the members was considered. Every year, the CDC’s extramural research staffers sought out experts, but center directors made the final calls, taking all of these factors into account.

But well before experts were selected, CDC officers needed permission to create a panel in the first place. Like I said, you couldn’t just call a meeting of outside experts—you being a CDC employee looking to fund extramural research pertaining to your center, division, or branch’s work.

That’s right. If you were a CDC staffer trying to fund research on, say, eliminating parasitic threats to impoverished Americans, your project needed an active FACA charter.

Federal Advisory Committee Act (FACA) charters provide federal officials with the legal permission to assemble and convene panels of outside experts for input. Without a FACA charter, the external peer review process that the CDC has long insisted upon—that is, until earlier this year—couldn’t proceed.

Shortly after President Trump took office, CDC officials were notified that virtually all active FACA charters covering CDC projects and programs would be revoked, effective immediately. Dr. Debra Houry, then the agency’s chief medical officer, advocated for at least some of these to be maintained. “None came through,” she told Inside Medicine. “They canceled everything that was not statutorily required.” That meant that at least two—the Advisory Committee on Immunization Practices, whose membership was fired and replaced by a crew mostly composed of Robert F. Kennedy Jr. allies, and the Advisory Committee to the Director—had to remain in place, by law. Most of the other FACAs covering the CDC’s work, however, have since been terminated. (Nobody at the CDC even knew the rules governing the terminations of FACA charters, though it’s likely that the actions were legal, even without public notice, I learned from law professors Dorit Reiss of UC Law San Francisco and Lawrence O. Gostin of Georgetown Law). Until this year, there were hundreds of active FACA charters within HHS. It’s unclear how many remain.

CDC staffers respond.

Once word went out that the FACA charters had been revoked, the CDC research staffers had a choice. Do nothing—meaning that no external research would get funded this year—or find a workaround. If you’ve been reading this newsletter for the past 10 months, you know which option they took. They found a way.

While the formal external peer review process could not be conducted, some fine print in the CDC’s policy was unearthed by alert staffers. It indicated that “field reviews” could still occur in certain situations. This would adhere to the spirit of the CDC’s original policy—seeking external expertise to guide funding decisions—without convening the usual expert panels that require FACA charters.

The question was, would it fly? The power to greenlight this rested with one person: Dr. Sam Posner. Until this spring, Dr. Sam Posner ran the Office of Science at the CDC. Posner now describes himself as “very retired.” (You can tell this is authentic because he’s willing to speak his mind about the Trump appointees with whom he briefly worked while on the record. Words like “haphazard” and “sloppy” came up at times. Also, unlike other recently retired federal leaders, he’s seemingly uninterested in finding a way to remain involved, which in part explains why he has given no media interviews until now. He still cares deeply, but he’s done. This seems to have freed him from worries over losing behind-the-scenes influence. When we first spoke, he had just finished some woodworking, a hobby he has quietly immersed himself in over the last seven months.)

Some at the CDC thought that Posner’s signoff would not be adequate and that HHS approval of the field review plan was needed. That would have meant more scrutiny from DOGE. Fortunately, other agency staffers knew the policies well enough to realize this was not the case. Posner agreed and he greenlit the plan himself.

Suddenly, hundreds of millions of dollars in grants were back on the table.

Posner’s decision surprised some insiders. Posner was respected, but known as a “by the book” guy. Some even speculated that his decision was influenced by the fact that he had recently announced that he would retire later in the spring. That was an overread, though.

“My retirement had no bearing on the decision,” Dr. Posner told Inside Medicine. “My interest was ensuring that we did everything we could to carry out the mission of the agency.”

Indeed, his decision was by the book. It was just in the fine print of that book.

A race against the fiscal year clock.

Posner’s signoff was welcome news to CDC staffers, but they had to act fast. Normally, the peer review process would have been underway weeks or months earlier. The staffers quickly sent the languishing proposals out to external experts for review—in many instances to the very same experts who would have served on FACA-compliant “special emphasis panels.”

Those experts were happy to do the work, but time was limited compared to the typical cycle. “I felt bad that the people did not get the kind of review that they usually get, and should get,” one of those experts, a faculty member at a major research university in the northeast, told Inside Medicine. But it was a lot better than nothing. (In fact, some viewed at least some of the steps in the usual process as superfluous.)

Just how different “external peer review” (which requires a FACA charter) and a “field review” (which does not) are depends on your point of view. In both cases, submitted research proposals are sent to experts outside the CDC for peer review. But with field review, there could not be an actual meeting (either virtual or in person) convening all the experts. Those meetings were seen as an important part of the old process. They gave the panelists a chance to hear summaries of other experts’ opinions (which were always prepared by a designated CDC officer after receiving the initial external reviews), and to have rich discussions on all of the proposals. Ultimately, each proposal was voted on and scored. From there, the final decisions would be made by CDC officers.

On the other hand, the field review workaround engaged the same experts who would normally have filled the usual panels. But without the meeting and the voting, CDC officers had less guidance than they had in the past, though ironically, more freedom. That freedom was not something that CDC staffers sought. Rather, the workaround was seen as “a rarely used mechanism that would abide by the federal laws and be as close as possible to a FACA committee,” one CDC staffer told me.

Ultimately, the CDC staffers got what they wanted—expertise and input to help determine which outside researchers to fund this year.

A final barrier. (Spoiler: It’s DOGE.)

Over the course of the summer, the funding decisions were made by CDC staffers as the reviews came in. But Project 2025 architect (and White House Office of Management and Budget Director) Russell Vought had, in July, again frozen some CDC funds, adding more stress and uncertainty. Researchers began asking CDC staffers for updates. They needed to know if they could afford to keep their staff on payroll, for example. But CDC program officers didn’t have any news for them. Everyone knew that if the grants were not approved by the end of the fiscal year, September 30, the money would vanish. (What would happen after is unclear; Congress legally mandates that the CDC must spend the money allocated to it, and usually that is done, though some exceptions exist.)

By September, that latest OMB freeze was over and all of the recommended grants could be sent up the chain for approval. But, a new step, final signatures from DOGE, was still needed. Prior experience suggested that DOGE decisions would trickle out over a week or two. Instead, there was radio silence, even with just a few days remaining in the fiscal year. Then, at last, just a few days before October 1, a flurry of updates appeared in the grants management system. All (or nearly all) of the CDC’s recommended awards had been approved by DOGE. For the most part, it happened in a single day. To my knowledge, none of the recommended grants were rejected by DOGE.

The CDC staffers were thrilled, if surprised. “We were happy that we could get money out to these meritorious programs and continue funding the science,” one recently RIF’d CDC staffer said. They were also incensed. “They literally killed the programs that ensure transparency, objectivity, and fair review without conflicts of interest,” the staffer pointed out to me, only for DOGE to quickly rubber-stamp everything at the last possible minute, which calls the rationale for DOGE’s very existence into question. “And they have the audacity to claim they are defending the spend,” the RIF’d CDC staffer added.

Why are they doing this?

While reporting this story, I kept coming back to one question: Why did the Trump administration revoke the FACA charters only to then allow the grant proposals that those charters helped evaluate to proceed with a workaround?

Back in March, Politico reported that the administration had been considering terminating these FACA charters. But at that time, nothing had happened. Still, when asked, HHS officials justified the potential move as part of the Trump administration’s goal of reducing the federal bureaucracy.

But that’s not really how it worked out at the CDC. Once the FACA charters were axed, very little actually changed with respect to the extramural grants. The field review workaround was effective. (The field review framework has also been approved for next year’s cycle.)

Then, on October 10, most of the remaining CDC staffers who work on these extramural grants were RIF’d. Some programs’ staffers were completely gutted, meaning that even if the agency wanted to use the field review workarounds next year, there would be nobody left to run them.

That money, however, will have to be spent—unless Russell Vought convinces the courts that the administration can claw back research funding, something he has not successfully achieved.

So, in hindsight DOGE’s quick signoff on the CDC’s 2025 extramural grants may have been strategic: After the administration RIF’d CDC employees this spring, a handful of states (led by New York Attorney General Letitia James) sued the Trump administration. Part of that lawsuit addressed these grants. “If you get rid of CDC staff, there is nobody to process the awards. That means states wouldn’t get their funding,” a former senior leader in CDC’s chronic disease center told Inside Medicine. That was one of the named injuries in the lawsuit. This summer, a court agreed. And, despite speculation that the administration might ignore judicial rulings, largely that has not been the case. So, with the allocated money for 2025 now spent (at least on paper), the administration can now argue that there was no injury after all, rendering the case moot and ripe for dismissal. (The injunction is still in place, as the case has not been formally decided.)

Enter cronyism.

Looming large is the specter of cronyism. Once the government reopens, there is nothing stopping the administration from deciding to scrap the field review plan for next year’s CDC grant cycle. All of these decisions could simply be assigned to a Trump appointee at the CDC.

There are signs that this is where things are headed, including new policies that allow grants to be terminated when they don’t align with administration “priorities.” (It’s worth noting that while that policy was recently enacted, some of the proposed changes originated during the Biden years.)

And while the administration has, so far, not taken to routine cronyism in its competitive grant-making decisions (including at the NIH), it has shown that willingness in other areas. When HHS Secretary Robert F. Kennedy Jr. said—out loud—that his agency would “make the proof” needed to link autism and Tylenol, he was likely thinking about grants like these. Without pesky CDC scientists in the way to make research grant decisions, Kennedy could simply fork over millions of dollars to his allies, including people who specialize in conducting shady research that looks like science but isn’t. For example, he hired David Geier, a discredited vaccine skeptic, to lead an HHS-funded study on vaccines and autism. In another glaring example, this spring the NIH awarded $500 million in funding to internal research being carried out by Dr. Matthew Memoli, a virtual unknown at the agency until 2025 when he was plucked from obscurity to serve as Acting Director in the early days of the Trump administration. Having done the administration’s bidding until the permanent director was confirmed by the Senate, the quid pro quo influx of cash to his pet project—a universal flu vaccine using an old platform seen as not particularly promising or innovative—couldn’t have been less subtle. An award that size was completely unprecedented, even for projects deemed far more important, I was told.

Dr. Jeanne Marrazzo, one of two former NIH officials who has filed a whistleblower complaint against the administration after being fired as the Director of the National Institute of Allergy and Infectious Diseases earlier this year (she succeeded Dr. Anthony Fauci in the role in 2023), told Inside Medicine that cronyism in this administration is a major concern. When informed about the FACA charter terminations at the CDC, Dr. Marrazzo linked it to what she sees as the “wholesale dismantling of all guardrails that could potentially get in the way of their giving money to the people and places that are loyal to their ideology.”

The meritocracy, she believes, will only become easier to dismantle as the administration continues to remove career officials and replace them with friends, like at the NIH last month when a new Director of the National Institute of Environmental Health Sciences, a friend of Vice President JD Vance, was installed without the usual national search. Meanwhile, at the CDC, the Office of the Director has been entirely cleansed of career officials (leaving only Trump appointees) while, throughout the agency, there are far more political appointees than in the past.

Marrazzo worries that actions like these are largely flying under the radar. “It functions as a way to make the process opaque, so there’s less pushback. People likely won’t even know it happened until it’s a done deal—and then it’s much harder to reverse,” she said.

“Under the radar” may have another upside for the administration. While hundreds of millions of dollars in research funding is nothing compared to the billions awarded by the NIH each year, that’s precisely what makes extramural CDC grants a perfect opportunity for cronyism: the sums in play are too small to make major media headlines, but adequate to line the pockets of loyalists handsomely.

But Dr. Sam Posner—the CDC official who greenlit the field review workaround—isn’t convinced that the Trump administration is consciously playing a long game with cronyism in mind. “They’re clueless,” he told me. “I don’t think the people who signed off on this even knew what they were doing. They don’t even talk to each other.” What about CDC leadership installed by Trump, like Chief of Staff Matthew Buzzelli? Would he have been aware of this or objected, I wanted to know. “He does not, by his own admission, as I recall, read his email,” Posner said. “And I’m not sure that he would understand what all of it meant.”

According to Posner’s interpretation, it wasn’t that the administration didn’t want the grants to go out, but, rather, it was the genuine outside expertise that the FACA charters recruited that was the target. All of this wasn’t an attempt to impound funds, then, but a way for the administration to flush out experts that may disagree with its ideology.

That begs the question, then: Is this not ultimately about replacing expertise with cronyism?

What will happen in 2026?

The federal government fiscal year for 2026 began October 1. In most years, the CDC would have already published dozens of Notices of Funding Opportunities (NOFOs) over the course of the year. In 2025, scarcely over a dozen have gone out. And the ones that were publicized were “forecasts,” meaning they were not actionable; forecasts are notices that there will be a NOFO for a particular project, and contain only basic information, a preview of sorts. (Unlike at the NIH, CDC NOFOs are highly specific, because the CDC uses extramural research to answer precise questions it has that would help guide national policies and unified federal responses to various health threats, rather than choosing creative investigations proposed by the researchers themselves.) The NOFO slowdown reflects several factors: a communications freeze during the early days of the administration, the April 1 RIFs, and leadership vacuums at the CDC (recall that there was no Acting Director for months, for example, spreading other leaders thin).

Overall, it’s clear that nowhere near the usual number of NOFOs will be posted for the 2026 cycle, even after the government shutdown ends.

“With the processes they are setting up, the number of NOFOs will be few,” the former CDC official in the chronic diseases center told me. “That’s where they will really exert their influence.”

Meanwhile, the few NOFOs that have gone out are not unusual. But next year is when the administration could let its freak flag fly, canceling long-term projects that get renewed at routine intervals, while possibly announcing new ones of questionable value that address Secretary Kennedy’s priorities. For example, the Secretary recently directed the CDC to study the harms of offshore windmills, including assessing their impact on commercial fishing.

Other projects, however, may vanish. “They won’t even announce ones they don’t like,” the former official said. Nor will the public have any idea that anything is amiss, as deliberations on which NOFOs are and are not posted each year have never been public. Dr. Posner agrees. “Because they are so specific, they’ll be able to say these very specific activities don’t align” with administration priorities, allowing them to exert more control.

So, while it’s impossible to know what the agency will fund next year, it’s likely to deviate from past priorites. In the last decade, there has been an emphasis on social equity and social determinants of health in the kinds of questions that the CDC has sought to answer via extramural research. That won’t fly in the current environment. “They’re probably going to take a shift in what they are looking to fund,” the former official told me.

And even the holdover grants that remain funded (including continuations that DOGE just signed off on), might soon begin to deteriorate. That’s because after the money goes out, there’s upkeep—work that CDC program staff carries out as part of these grants, which are actually “cooperative agreements” between the agency and the outside researchers—including intense involvement in data collection and analysis, and even collaborating on scientific manuscripts. That means the already-spent taxpayer dollars won’t yield the valuable information the grants were intended to gather.

Why? Because for many projects, virtually every CDC employee involved in this process has, as of the October round of RIFs, been terminated. Even if CDC employees wanted to do this work—whenever it is that the federal government finally reopens—there will be virtually nobody left to do it.

If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.