Ever since Robert F Kennedy (RFK) Jr was appointed United States Secretary of Health and Human Services, the Centers for Disease Control and Prevention (CDC) has been under pressure to abandon its traditional evidence-based approach to public health in America and across the world.
That pressure came to a head last week with the sacking of recently appointed CDC director Susan Monarez. According to her lawyers, the longtime government scientist, who had been in the role less than a month, was targeted after she refused to “rubber-stamp unscientific, reckless directives”.
Monarez will be replaced by Jim O'Neill, deputy director of the Department of Health and Human Services. Critics note he has no medical or scientific training.
On the same day as Monarez’s firing, three senior officials resigned. They included the CDC’s chief medical officer, and two others with leadership roles in areas including vaccines and emerging diseases.
I worked at the CDC between 1986 and 1995. Almost all of my work was with activities overseas.
While the CDC is a key institution overseeing and funding public health in the US, it’s also instrumental in global health. Consequently, turmoil at the CDC could have an impact not just in the US, but around the world.
Vaccine scepticism: a threat to public health
Soon after the inauguration of US President Donald Trump for the second time in January 2025, threats to American public health became clear. RFK Jr was confirmed as the Secretary of Health and Human Services in February, with authority over the CDC.
By April, 25% of CDC staff had been fired and its contract spending was cut by 35%. Cancelled CDC programs included those focused on the prevention of lead poisoning in children, environmental health, and sexually transmitted infections including HIV.
Notably, RFK Jr has a long history of vaccine scepticism.
In 2019–20, more than 5,700 people became infected when a measles outbreak ravaged the island nation of Samoa. Some 83 people died, most of them children.
In the lead up, a number of ads spread vaccine misinformation on Facebook, sowing doubt about safety of the measles vaccine. Some were found to have been funded by the Children’s Defense Fund, an organisation founded by RFK Jr.
RFK Jr’s department has dismissed and replaced the 17 expert members of the Advisory Committee on Immunization Practices with eight new people – a number of whom have reportedly expressed anti-vaccination views.
During RFK Jr’s tenure so far, his department has:
RFK Jr is arguably the most important figure overseeing health in the US. It’s difficult to underestimate the harm his actions will do to vaccine confidence and uptake in America and around the world.
A long history of international aid
While the CDC had long provided advice to the World Health Organization (WHO) on malaria control, the first major overseas initiative was as an active partner in the WHO’s successful global smallpox eradication program. Along with the Soviet Union, the CDC initially focused on West Africa in the 1960s and then India and Bangladesh in the 1970s.
The CDC’s first international emergency health response occurred during the Biafra conflict, which led to widespread famine in the Eastern part of Nigeria. In 1968, at the request of the International Committee of the Red Cross, the CDC mobilised staff to monitor nutrition and design programs to combat malnutrition.
The agency’s largest ever overseas intervention began in March 2014 when an Ebola outbreak occurred in Guinea, Sierra Leone and Liberia. By July 2015, the CDC had allocated 3,000 staff to Ebola, with 1,200 on the ground in West Africa, including neighbouring countries such as Nigeria and Senegal. CDC staff provided technical advice on strengthening laboratory diagnosis, contact tracing and surveillance.
Following the Ebola outbreak, the Global Health Security Agenda was established as a coordinated epidemic preparedness initiative with members from more than 60 countries, United Nations agencies and non-governmental organisations. The Obama administration funded US involvement generously with the CDC leading US contributions.
Threats to global health
The first sign of a US withdrawal from global health came soon after Trump’s inauguration when he signed executive orders cancelling US membership of the WHO and suspending all US foreign development assistance.
This led to the cancellation of large programs to prevent and treat HIV and AIDS, malaria, tuberculosis and hepatitis.
Soon after, CDC officials were ordered to cease all communications with the WHO, leading to CDC experts leaving global advisory committees, among other things.
The dismantling of the US Agency for International Development (USAID) has led to a loss of 83% of its programs and the cancellation of 5,200 contracts. This has stymied its ability to effectively deliver lifesaving aid, including in countries devastated by conflict and famine, such as Sudan. One study predicted the cuts in USAID funding could lead to 14 million extra deaths by 2030.
Budget and staff cuts have seriously reduced the CDC’s capacity to engage in global initiatives. For example, the Maternal and Child Health Branch was shut down and all 22 staff terminated. This branch helped low- and middle-income countries implement programs to prevent HIV in pregnant women and their babies.
The loss of financial resources and a large number of expert staff means the agency faces an uncertain future. Interference in its procedures to develop science-based health policies will gravely affect its ability to carry out its mandate both domestically and globally. The CDC has lost the trust of the American people and is no longer regarded as the preeminent public health agency in the world.
Governments, research institutes and health development agencies around the world must unite to decry this loss of global health expertise. Millions of lives depend on forceful action.
Michael Toole receives funding from the National Health and Medical Research Council. He worked for the US CDC between 1986 and 1995. The content of this article represents the views of the author and not those of the Burnet Institute.
