The only question for the new CDC Director nominee: Is she Marco or Monarez?

Her credentials and beliefs are not in question. It's her fortitude and her stamina.

Question 1: How do we know if Dr. Erica Schwartz, President Trump’s new nominee for Director of the CDC, is qualified?

Normally, I’d say it boils down to three things: résumé, reputation, and receipts. By those lights, Dr. Schwartz appears remarkably well-suited for the position. (I know, this is shocking in this administration, but we’ll come back to that later.)

• Dr. Schwartz appears to have substantial relevant experience. Notably, she served as Deputy Surgeon General under Surgeon General Dr. Jerome Adams (who remains respected) during the first Trump administration. Résumé?✅

• Along those lines, Dr. Adams recently voiced his support for her, as have others in the field. Reputation? ✅

• Finally, Dr. Schwartz clearly executed her duties appropriately in the past—including implementing standard policies that have now angered prominent anti-vaxxers. (Apparently anti-vaxxers don’t want our service members to vaccinate against smallpox, anthrax, and influenza.) Receipts? ✅

In fact, one of the strongest pieces of evidence that Dr. Schwartz is qualified to do the job is that one of HHS Secretary Robert F. Kennedy’s long-time anti-vaxxer associates, the vaccine injury lawyer Aaron Siri, lambasted Dr. Schwartz after news of her nomination broke. Siri said that Schwartz “would likely be a disaster.” While it’s sometimes unwise to conclude that “the enemy of your enemy is your friend,” when everything else lines up, it’s a pretty useful indicator.

A showdown is coming.

Asked during a Senate hearing if he would support Dr. Schwartz’s vaccine recommendations were she to be confirmed, Kennedy refused to commit. Ah, the symmetry. This precise premise—in reverse—is what led to CDC Director Dr. Susan Monarez’s atrocious ouster last year: she refused to go along with Kennedy’s dictates on vaccine policy. When she did that, she secured her legacy as someone who was willing to stand up, to speak truth to power, even at the expense of her own job.

For weeks, we’ve been hearing rumblings that the Trump administration wants Kennedy to start keeping a lower profile. CNN reported that a White House official admitted that when choosing a new nominee for CDC Director, they specifically “just need someone who’s not crazy.” It’s remarkable that this is the hurdle they had to clear.

Which leads to…

Question 2: Will Dr. Erica Schwartz ever be confirmed by the Senate?

The nature of this pick—the surprise that she’s simultaneously somebody that public health professionals respect and someone who President Trump nominated—would seem to portend an easy confirmation process. But I’m not so sure it’s going to be smooth sailing for Dr. Schwartz.

Here’s why…

Is she Marco or Monarez?

First, if Dr. Schwartz is confirmed, she may simply suffer the fate of her predecessor. That is, once the CDC’s Advisory Committee on Immunization Practices meets and votes, she will have the power to accept those recommendations or not. It was Dr. Monarez’s unwillingness to promise that she would bend to Secretary Kennedy’s will on these votes that cost her the job. So, will Dr. Schwartz do the same? In short, will she be more like Secretary of State Marco Rubio, who folded like a lawn chair when Elon Musk’s DOGE destroyed USAID in a matter of days? Or will she carry on the proud tradition inaugurated by Dr. Monarez, and stand up to Secretary Kennedy, even at great personal cost? Insiders tell me that it’s likely that Dr. Schwartz was either explicitly told that things would be different for her or that she’s been told nothing and is hoping that the news that President Trump wants RFK Jr. to tone things down means that she’ll have more independence.

But, if confirmed, many people think that Dr. Schwartz is doomed to fail. As Dr. Terry Adirim wrote in MedPage Today, “Women are very often elevated into leadership at exactly the moment an organization is broken. Handed the keys to a burning building and told to fix it. And when external forces make the fix impossible, the woman in the chair wears the failure. The ‘glass cliff’ isn’t a metaphor. It’s a pattern.”

Fates intertwined…

Second, there’s a chance that Dr. Schwartz will never be confirmed. That may sound surprising, given that I just told you that she appears to have broad, bipartisan support. But I’m wondering whether her nomination might get slow-walked. On May 16th, Louisiana is holding a primary for Senator Bill Cassidy’s seat. Currently, Senator Cassidy is the chair of the Senate HELP Committee, and is the key vote for this confirmation. This committee will determine whether or not Dr. Schwartz is confirmed. If she survives that vote, her nomination on the Senate floor will be assured. I firmly believe that Senator Cassidy would vote to confirm her. That’s important, because after he made the tragic mistake of voting to confirm Secretary Kennedy, it’s clear that he realized that he had been bamboozled, and that he should never again allow an anti-vaxxer to be confirmed to any important position in the government. That’s probably why there was not a nominee for CDC Director from August until April. Secretary Kennedy wanted an anti-vaxxer, and Senator Cassidy wouldn’t vote for one. From August until a few weeks ago, an official with absolutely zero qualifications or experience served as acting director. But under federal law, that could only go on for 210 days. After that, there could be no acting director. This is why the current so-called acting director of the CDC, Dr. Jay Bhattacharya, is not actually the acting director of the CDC. The CDC acknowledges as much, stating that he is “performing the delegable duties of the CDC director.”

This is not just some fine print. What this means is that Dr. Bhattacharya can perform a lot of important features of the role of acting or permanent director of the CDC; however, he cannot perform “non-delegable duties.” Chief among the non-delegable duties of the CDC Director is signing off on ACIP votes—votes that create mandates that insurers must cover recommended vaccines. The rules explicitly state that in the absence of an acting director, no one else at the agency can sign off on ACIP votes. The only person who can? The Secretary of Health and Human Services, Robert F. Kennedy Jr. As I’ve written before (A grand unified theory explaining the CDC power vacuum), this is precisely how Kennedy wants it.

Of note, Dr. Bhattacharya is not an anti-vaxxer to the core. He’s said all the right things, and I believe that he understands vaccine science. But he has also comported himself as a woeful sycophant of this administration. Serving as the top official in the CDC poses no moral threat to Dr. Bhattacharya. He just doesn’t care enough about this issue to stand up to RFK Jr. about it. Jay Bhattacharya is no Susan Monarez.

So, at the moment, the status quo suits President Trump and Secretary Kennedy just fine. The White House got some good headlines by surprising us with a CDC Director pick who appears to be qualified, and, again, in their own words, is “not crazy.” But until she’s confirmed, RFK Jr. still controls ACIP. Worse, he’s taking action to rewrite the committee charter, which would make it easier for him to pursue his agenda.

Will they just run out the clock?

I believe this all comes down to May 16th. If Senator Cassidy loses his primary—and despite sucking up to Trump for the last 16 months, President Trump threw his support behind a Republican opponent seeking to unseat Cassidy—the HELP Committee will have a new member, and very likely one who will go along with whatever Trump and RFK Jr. want. It’s possible that Senator Cassidy’s replacement as chair of the committee might be someone far more willing to promote anti-vaxxers—somebody like Senator Rand Paul. So if Cassidy loses, Trump may yank Schwartz’s nomination before she sails through what looks to be an easy, bipartisan vote.

It will be interesting to see when Dr. Schwartz begins to make visits to Capitol Hill to do the meet-and-greets required during the confirmation process. There’s ethics paperwork to sign and file, and there’s Senate review. All these things take time, and the summer recess looms. And nobody seems particularly hurried. In fact, Dr. Schwartz’s official nomination has not yet even been filed. Until that happens, Dr. Bhattacharya cannot serve as acting director. Although, as above, even when the paperwork gets filed, HHS may keep things as they are, with Bhattacharya doing some of the duties of the acting director, but not the key ones that RFK Jr. lusts after.

So, it’s possible that all this might play out after the midterms. At that point, RFK Jr. may be out as HHS Secretary. Why? Not because Trump will have suddenly grown tired of him, although polls matter and he is nothing if not mercurial. Rather, at some point, RFK Jr. is going to realize that his power is waning and that his best chance to ruin things for our country is to be at the helm. That’s right. He’ll be running for president. Remember, that’s how we got in this mess—Kennedy dropped out of the 2024 race, and threw his support behind Trump. I doubt that Secretary Kennedy’s presidential ambitions have abated.

This answers another question that we might have: Given all this, why on Earth would Dr. Schwartz subject herself to all of this? Perhaps the answer is simple: Maybe she believes she can outlast Secretary Kennedy.

• 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.

• Again, thanks to Professor Dorit Reiss, Professor Anne Joseph O’Connell, and HHS officials past and present for their input to this piece. Y’all are heroes.

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