She blew it. CDC Director nominee tanks in Senate hearing.

She was supposed to be good. But Senator Bill Cassidy lost his mind in real time as Dr. Erica Schwartz crashed and burned before the Senate HELP Committee yesterday.

• Editor’s Note: This article includes an editor’s note at the end regarding a post-publication change.¹

Wait, what’s the catch? That was the prevailing reaction in public health circles when President Trump announced this spring that Dr. Erica Schwartz would be nominated to lead the CDC.

She had the right training. She had the right experience. She had the right support.

Even better, anti-vaccine allies of HHS Secretary Robert F. Kennedy Jr. were vocally displeased with the choice. Sounded great.

Her nomination was so normal, the journey so drama-free, that my primary concern of late was that her nomination would be pulled, especially since Senate HELP Committee Chair Bill Cassidy (R-LA) lost his re-election primary to a pro-Trump challenger.

Just how worried was I? Well, I signed up for an auto-alert for changes to her nomination status on Congress.gov, if that gives you a sense.

For a while, we heard nothing. But the delay didn’t amount to anything unusual for a typical confirmation process. The logistics just take some time. Then, in June, I heard that Dr. Schwartz had started making the rounds on Capitol Hill, a sure sign of progress. Finally, news broke that she would appear before the Senate HELP Committee on July 15. That was an important step in her road to confirmation.

As recently as Tuesday, my main worry was that Dr. Schwartz’s nomination would be pulled, or that if confirmed, she would suffer the fate of her predecessor, Dr. Susan Monarez, who lasted 29 days as CDC Director before being canned by Secretary Kennedy because she stood up to him on vaccines. (We admire Dr. Monarez for this.)

So, yesterday’s hearing was to be a breeze. Senator Cassidy and others would ask simple questions, and they’d get clear answers. She would then get the committee votes necessary to advance to a successful full Senate vote. Easy.

Uh oh.

That’s not what happened. As the hearing proceeded, I began to hear rumblings in my public health group chats. The hearing was not going well. Schwartz was failing to give straightforward answers to lay-ups. Clips began appearing on my social media feeds. It was not good. Before long, it looked like a complete implosion. (For a full rundown, visit Rasmussen Retorts, by Dr. Angela Rasmussen.)

Dr. Schwartz would not give clear statements debunking links between vaccines and autism. Ouch.

She did not know that the CDC’s Office on Smoking and Health is, for all practical purposes, closed. (This is despite smoking cessation being the “number one thing” she focused on while serving the Navy.) Ouch.

She claimed to be unaware of a relatively recent HHS policy spurning mRNA vaccine research. Ouch.

Asked if she would carry out an order to stop promoting the flu vaccine during a deadly flu season, Dr. Schwartz would not answer directly. Ouch.

Worst, when asked if she would report to Congress if she received any directive from Secretary Kennedy or others that was anti-scientific or that could harm the health and well-being of the American people, her answer was shockingly feeble. Instead of simply saying yes—that was indeed an available option—she said that she did not believe that would happen. Ouch. Ouch. Ouch.

Together, these were incredibly poor answers to toddler questions. Her answers indicated some combination of incompetence, ignorance, and subservience. Given the current state of the CDC, and HHS overall, that simply will not do.

Let me be clear: until yesterday, I supported President Trump’s nominee for CDC Director, Dr. Erica Schwartz. Yesterday, Dr. Erica Schwartz lost my support.

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What’s a bozo to do?

Senator Cassidy saw what was happening during the hearing, and seemingly lost his mind, in real time. As CNN’s Dana Bash said, it’s not often that a Senate hearing goes differently than expected. But that’s what occurred.

She blew it.

Now, one could understand that a nominee might have to be cagey behind closed doors with the likes of Secretary Kennedy or President Trump. After all, getting the nomination for CDC Director from them whilst fulfilling an HHS mandate that she not be crazy, was probably its own mine field. But in the Senate hearing, Schwartz had a small—and scientifically sane—audience, perhaps of just one: Bill Cassidy.

Unfortunately, based on yesterday’s hearing, Cassidy has reason to believe that Schwartz is not another Susan Monarez. That is, under pressure from Kennedy, she’ll fold like a Creutzfeldt-Jakob protein. By the end of the day, Cassidy’s words could not be mistaken. He was sorely, sorely disappointed.

You could see his blood boiling. He also knew he had himself, in large part, to blame. Cassidy, of course, was bamboozled during Secretary Kennedy’s confirmation process. In a now classic blunder, he bargained that a vote for Kennedy in 2025 would prevent a pro-Trump primary challenge in 2026. Of course, he was wrong and will go down as one of the great losers in modern Senate history—having sold out the health of American children in exchange for a doomed re-election campaign. (If you’re ever having a really bad day, just read that sentence back and you’ll feel comparatively accomplished.)

This leaves the senator in a difficult position. If he kills Schwartz’s nomination, Trump will sooner or later nominate a replacement (or else install an Acting Director, or let Jay Bhattacharya continue to cosplay the role for the duration). By the time another official nominee comes to the Senate HELP Committee, likely next year, Senator Cassidy will be back in Louisiana, I dunno, mainlining crawdaddies.

Make no mistake, yesterday’s train wreck was fabulous news for Secretary Kennedy. With Cassidy a goner come January, Trump and Kennedy may be able to nominate someone truly awful. They know that with someone other than Cassidy running the Senate HELP Committee in 2027—possibly someone more MAGA/MAHA coded—the HHS “just find someone who isn’t crazy” mandate may be very 2026.

Insider reactions.

Coming into Wednesday’s hearing, most of my colleagues were Schwartz supporters. Former CDC Chief Medical Officer and Principal Deputy Director Dr. Debra Houry told Inside Medicine that Dr. Schwartz has the qualifications to be a CDC Director. But, given the past year at the agency, she was looking for more direct responses about how she would handle political interference. “I do not have concerns about her scientific or technical expertise,” Houry said to me on Wednesday. “But this role should be non-partisan and focused on protecting the health of Americans regardless of who is in the administration.”

Others had been less optimistic. One CDC scientist, who requested anonymity for job protection, told me that many didn’t have such high hopes. “It was disappointing and surprising that Dr. Schwartz did not seem to be aware of many of the problems we’ve faced over the past year and a half, including the 90% RIF [of NIOSH employees]. She will have a lot to learn about what the CDC looks like now.”

Ambition without a mission.

During a conversation with a friend and colleague recently, I observed that genuinely qualified professionals who are asked to take a role in the Trump administration must confront a troubling reality: they will, at some point, likely be forced to choose between service and careerism, mission and ambition.

Serving in the federal government should be undertaken because of the opportunity to make a difference, not for titles, prestige, or the occasional ride on Air Force One.

If someone cares more about their own professional prospects than doing what’s right, it’s a recipe for decay. When Dr. Susan Monarez stood up to Secretary Kennedy’s anti-vaccine pressure, she showed that she was mission-driven.

After yesterday’s hearing, I’m forced to conclude the opposite about Dr. Erica Schwartz. She embodied ambition without a mission. That’s a shame, because I had had high hopes for her.

But I’m equally worried that if she fails to survive the Senate HELP Committee confirmation vote, whoever comes next will be worse.

Comments? Questions? Ideas? Venting? Please share your views in the Comments section.

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

1. Editor's Note/Correction: After publication, I changed the lead image for this article. The original image paired a quote from Senator Bill Cassidy with a photo of the CDC Director nominee, but the quote was made during a different Senate hearing. To correct this and avoid any potential confusion, I replaced the image with a standalone photo of the nominee. The text of the article is otherwise unchanged. My thanks to Helen Branswell of STAT News for bringing this to my attention.