The Lancet Declares U.S. CDC "On the Brink" After a Year of Mass Layoffs, Leadership Turmoil, and Severance from the WHO

Details

On April 24, 2026, The Lancet published an editorial titled "The US CDC on the brink," arguing that the U.S. Centers for Disease Control and Prevention — long regarded as the gold standard in public health — is "struggling to maintain scientific excellence, trustworthiness, and relevance" as a result of actions by the Trump administration and the Department of Health and Human Services (HHS) under Secretary Robert F. Kennedy Jr. The editorial synthesizes roughly 15 months of cascading changes: a mass-casualty attack on the Atlanta headquarters motivated by vaccine misinformation, the firing of the agency's Senate-confirmed director, the departure of most of its senior scientific leadership, the suspension of dozens of surveillance databases, and an executive order severing formal ties with the World Health Organization.

The August 2025 Shooting at CDC Headquarters

On August 8, 2025, a gunman opened fire on the CDC's Roybal Campus in Atlanta, striking at least six buildings and firing more than 180 rounds. (The Lancet editorial gives the date as August 11; contemporaneous reporting from NBC News, CNN, and the Georgia Recorder places it on Friday, August 8.) The Georgia Bureau of Investigation identified the shooter as 30-year-old Patrick Joseph White of Kennesaw, Georgia. According to PBS NewsHour, investigators concluded White believed the COVID-19 mRNA vaccine had made him ill and suicidal.

DeKalb County Police Officer David Rose, 33, was killed while responding to the scene. Rose was a married father of two with a third child on the way, and had been on the force for less than a year. No CDC employees or the roughly 90 children in the campus day care were physically injured, though four people were treated for stress. The Lancet notes that eight months after the shooting, the 150 windows damaged in the attack had still not been repaired.

The attack came the same week HHS announced the cancellation of nearly half a billion dollars in mRNA vaccine research funding. Former U.S. Surgeon General Jerome Adams, who served in the first Trump administration, wrote in STAT that the shooting was "not an isolated event" but "a dire reflection of ever-escalating threats public health workers face in a climate increasingly shaped by misinformation, politicization, and inflammatory rhetoric." The American Federation of Government Employees, which represents CDC workers, called on HHS to condemn the vaccine misinformation that had motivated the attacker.

Firing of the Senate-Confirmed Director

Susan Monarez was sworn in as CDC director on July 31, 2025, following a 51–47 party-line Senate confirmation. She was the first CDC director to go through Senate confirmation after a 2023 law added that requirement. Less than a month later, on August 27, 2025, the White House announced she had been fired.

In September 2025 testimony before the Senate Health, Education, Labor and Pensions Committee, Monarez said Kennedy had directed her on August 25 to commit in advance to approving every recommendation from the Advisory Committee on Immunization Practices (ACIP) — which Kennedy had reconstituted with vaccine-critical appointees — and to dismiss career vaccine-policy officials without cause. She said she refused because she "could not pre-approve recommendations without reviewing the evidence" and had "no basis to fire scientific experts." Monarez told senators that Kennedy called the CDC "the most corrupt federal agency in the world" and said CDC employees "were killing children and they don't care."

Kennedy offered a different account, telling a separate Senate panel that Monarez had admitted she was not "trustworthy." Monarez directly rejected that version under oath. Several Republicans, including HELP Committee Chairman Bill Cassidy (R-LA), raised pointed questions about Kennedy's account; Senator Tim Kaine (D-VA), who had voted against Monarez's confirmation, told her: "I owe you an apology. I had concern about your backbone and I was wrong."

Several senior CDC officials — including Chief Medical Officer Debra Houry and National Center for Immunization and Respiratory Diseases Director Demetre Daskalakis — resigned in protest. Daskalakis wrote in his resignation letter that the changes put "people of dubious intent and more dubious scientific rigor in charge of recommending vaccine policy."

Internal Emails Reveal the Pressure Campaign

In June 2026, a cache of internal CDC emails offered a granular, contemporaneous record of the pressure agency leaders faced from Kennedy and his aides during the administration's first months. Dr. Debra Houry — a party to all the messages, and the CDC's chief medical officer until she resigned in the wake of Monarez's firing — provided more than 250 pages to the Senate Health, Education, Labor and Pensions Committee in response to written questions after her September 2025 testimony. Senator Bernie Sanders (I-VT), the panel's ranking member, published the emails online and posted a staff memo on June 23, 2026, and called for Kennedy's resignation; the full email cache and committee memo were released alongside it. The messages, first reported in detail by The New York Times, span January to mid-August 2025 — beginning before Kennedy's confirmation and ending about a week before Monarez was fired.

The flu-vaccine ad campaign. Less than 24 hours after Kennedy was sworn in, his office ordered the CDC to take down its advertising campaign promoting flu vaccines. On February 14, 2025 — with flu season in full swing — HHS spokesman Andrew Nixon called communications official Nicole Coffin and, she wrote to her supervisor Kevin Griffis, "asked that we pull out of circulation all campaign ad buys related to flu or anything encouraging shots or vaccinations." Coffin noted the request "came directly from the Secretary" and that the plan was "to transform to an informed consent campaign." That same day, the CDC reported that influenza had killed 68 children and 16,000 people overall, amid 29 million reported cases and 370,000 hospitalizations that season. Griffis warned Monarez that halting the campaign in the middle of an outbreak "presents significant reputational risk to the agency" and could raise "legal issues."

Scrubbing and restoring the website. Trump's first-day executive order ending "radical and wasteful government D.E.I. programs" prompted the CDC to pull hundreds of web pages — including the data.cdc.gov public-health data repository — that might reference race or gender. At 10:30 p.m. on January 31, 2025, the day after Kennedy wrapped up his confirmation hearings, Monarez sent an urgent late-night plea to get the ACIP vaccine-adviser website "up and functioning," noting links had broken "likely due to language modifications." Former employees told the Times that Kennedy's aides feared removing vaccine pages could endanger his confirmation. In an 8:30 a.m. negotiating session the next morning with Kennedy's closest adviser, Stefanie Spear, CDC leaders devised a color-coded spreadsheet — green for pages restored, red for pages to stay down, yellow for pages HHS wanted back up. The ACIP pages went back up; the exception was information on the mpox vaccine, which stayed down and, when later restored, reverted to calling the disease "monkeypox," a term the World Health Organization abandoned in 2022 as stigmatizing.

Digging up ACIP's history. As Kennedy prepared to remake ACIP, Stuart Burns — the secretary's point man inside the director's office — dispatched staff to compile 60 years of historical material on the committee, including its 1964 charter and past conflict-of-interest policies, to "inform his understanding of... the historical glide path that brought us here." The research stretched over several weeks and included a search of the CDC's museum and a trip to the National Archives facility in Morrow, Georgia. Afterward, Houry pressed Burns that it would be "helpful to prioritize" such requests given how many staff had been laid off: "Staff had to pull 28 boxes for this request." When Burns separately asked for 10 years of measles data as the CDC deployed "disease detectives" to the Texas outbreak, Houry replied that "the active measles response has to take priority."

Installing allies and pursuing vaccine data. The emails show political leaders tried to use Title 42 — a provision allowing scientific experts to bypass the normal civil-service process — to install Mark Blaxill, a Harvard Business School graduate and founder of the anti-vaccine group SafeMinds, atop the CDC's National Center on Birth Defects and Developmental Disabilities. CDC human-resources officials concluded he lacked the scientific qualifications to be a "distinguished consultant" under the law; he now works at the agency in another capacity. The messages also confirm Kennedy's push to gain control over the Vaccine Safety Datalink (VSD), a database of millions of confidential medical records he believes could prove a vaccine-autism link that studies have repeatedly debunked. His senior counselor, Reyn Archer, wrote that Kennedy "wants to buy all the VSD data and put it in the office of the Secretary." The Sanders memo adds that researcher David Geier — previously barred for misusing the data — was granted VSD access despite lacking required ethics verification and training as of April 2025.

Kennedy's direct involvement. Kennedy gave direct instructions to William Thompson, a CDC scientist working under whistle-blower protections who has challenged a 2004 agency study finding no link between the measles vaccine and autism. Thompson described compiling data sources for future autism studies as a "high priority for Secretary Kennedy." The secretary's own words appear just once in the collection — a one-line July 10, 2025 message weighing in on a two-decade-old data set: "Bill. I'm assuming this is the verstratten original data," a reference to former CDC researcher Thomas Verstraeten. The emails close in mid-August with a message from Kennedy's chief of staff, Matthew Buckham, to Monarez on August 19: "I wanted to elevate the absolute need for political review of major policy decisions at CDC," ensuring "political leadership all have eyes" on major decisions and that personnel changes be run past the White House. He signed off, "Make America Great! Matt." Eight days later, the White House fired Monarez.

Workforce and Leadership Collapse

The Lancet cites an estimated 2,000 CDC staff fired — roughly one in five — with about 300 on administrative leave, and with 20 of 25 CDC center directors having departed. The cuts came in multiple waves:

• In April 2025, an HHS-wide reduction in force cut approximately 2,400 CDC positions as part of a 10,000-person layoff across the department, with notices sent at 5 a.m. telling staff they had lost building access effective immediately.
• On the night of October 10, 2025 — during the second week of a federal government shutdown — HHS sent another round of more than 1,000 termination notices, with the CDC "especially acute[ly]" affected. CNN reported the cuts wiped out entire offices, including the full staff of the Morbidity and Mortality Weekly Report, a surveillance publication continuously produced for more than a century.
• Many of the October notices were later rescinded, but sources told MSNBC the director's office of the National Center for Immunization and Respiratory Diseases — meaning all of that center's leadership — was eliminated outright.

Demetre Daskalakis, the former NCIRD director, told MSNBC bluntly: "CDC is over. It was killed." Government Executive reported that CDC had shed roughly one-quarter of its staff since Trump took office.

Halted Disease Surveillance

A peer-reviewed audit published in Annals of Internal Medicine on January 26, 2026 found that, of 82 CDC public databases that had previously been updated at least monthly, 38 (46%) had stopped or substantially delayed updates in 2025. Among the paused databases:

• 33 of 38 (87%) tracked vaccination — including 14 on influenza, 11 on COVID-19, and 6 on RSV
• 4 tracked respiratory disease burden or emergency department visits
• 1 was the Provisional Overdose Death Counts dataset

According to Scientific American, 34 of the 38 paused databases had received no new entries in more than six months; a follow-up check on December 2, 2025 found that only one had resumed updates. The pauses "started predominantly in March and April 2025, shortly after Mr. Trump assumed the presidency and Mr. Kennedy was confirmed." HHS spokesperson Andrew Nixon told NBC News that "changes to individual dashboards or update schedules reflect routine data quality and system management decisions, not political direction."

Robert Hopkins Jr., medical director of the National Foundation for Infectious Diseases, told Medscape that in infectious disease and vaccines, "there are not a whole lot of other complementary systems that can give us that information," and that the gaps mean the country cannot tell whether low-case regions are genuinely disease-free or simply under-surveilled. Jeanne Marrazzo — the former director of the National Institute of Allergy and Infectious Diseases, fired by Kennedy in 2025 — wrote in an accompanying editorial that the pattern demonstrated "a profound disregard for human life."

Severance from the World Health Organization

On his first day in office, Trump signed Executive Order 14155, withdrawing the United States from the WHO. The order paused transfers of U.S. funds to the organization, recalled U.S. personnel working with it, and directed agencies to identify alternative partners. On January 27, 2025, CDC Deputy Director for Global Health John Nkengasong sent an internal memo — obtained by CNN — instructing all CDC staff to immediately cease engagement with the WHO "through technical working groups, coordinating centers, advisory boards, cooperative agreements or other means — in person or virtual."

The United States formally left the WHO on January 22, 2026. Shortly afterward, the administration proposed spending roughly $2 billion per year to duplicate global disease-surveillance systems the U.S. previously accessed at a fraction of the cost through its WHO membership. The Lancet notes that CDC staff secondments to foreign governments and UN agencies — long-standing instruments of disease-elimination work on measles, polio, and hepatitis B — have been cancelled, and that international candidates are no longer eligible for the CDC's Epidemic Intelligence Service, a fellowship that has trained more than 4,100 public-health responders worldwide.

Georgetown University law professor Lawrence Gostin told NPR that the communication halt was "not only reckless" but potentially "lawless," given U.S. obligations under the legally binding International Health Regulations.

Vaccine Policy Changes and Measles Deaths

In June 2025, Kennedy dismissed all 17 members of the Advisory Committee on Immunization Practices (ACIP) and replaced them with appointees — several of whom have publicly criticized vaccines. The reconstituted committee has since narrowed CDC recommendations for the COVID-19 vaccine and stopped recommending the birth dose of the hepatitis B vaccine for all infants.

During the same period, the United States experienced its first measles deaths in a decade. A West Texas outbreak that began in January 2025 grew to over 500 cases by April, killing two unvaccinated school-age children. Kennedy repeatedly emphasized vitamin A and other treatments over vaccination; infectious-disease physicians told NPR his messaging was "missing the mark" and risked creating the impression that supplements could substitute for the MMR vaccine.

New Nominee: Erica Schwartz

On April 16, 2026, Trump nominated Dr. Erica Schwartz to serve as the next CDC director. Schwartz, a retired rear admiral in the U.S. Public Health Service Commissioned Corps, is a board-certified preventive medicine physician who served as deputy surgeon general during the first Trump administration. She holds MD (Brown), JD (Maryland), and MPH (Uniformed Services University) degrees. According to STAT, she has no discernible public record opposing vaccination — a shift from Kennedy's earlier preferences.

The nomination came after the 210-day statutory limit on acting directors under the Vacancies Act had expired, leaving the role formally unoccupied. Since Monarez's firing, the role has been held in acting capacity by HHS Deputy Secretary Jim O'Neill and NIH Director Jay Bhattacharya. CNN reported that the White House — concerned about political fallout ahead of the 2026 midterms — took a more active role in the search and explicitly did not require that a nominee share Kennedy's vaccine skepticism.

Reactions split along predictable lines. Former Surgeon General Jerome Adams, who personally selected Schwartz as his deputy, called her pick encouraging, saying she has "the expertise, credibility, and integrity to lead the CDC effectively" if allowed to follow the science. Conversely, Aaron Siri — a vaccine-injury attorney close to Kennedy — called the choice a "disaster" on X, writing that "this agency does not need another cheerleader for industry."

State-Level Responses

As federal public-health capacity contracted, coalitions of states began forming regional alternatives:

• On September 3, 2025, the governors of California, Oregon, and Washington launched the West Coast Health Alliance to "uphold the scientific integrity of public health" as a regional response to CDC changes. Hawaii joined the next day.
• A parallel Northeast Public Health Collaborative formed during the same period, according to Scientific American.
• Both alliances have issued their own respiratory-season immunization recommendations, aligning with guidance from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists rather than the reconstituted ACIP.

The Lancet warns that while stronger state-level coordination is welcome, the current alliances are "concentrated in Democratic states," raising the risk of "further fracturing public health along political lines."

Proposed FY2027 Budget

On April 3, 2026, the White House released its fiscal year 2027 budget request, which proposes a 41% cut to CDC — from $8.9 billion to $5.3 billion — with much of the reduction achieved by shifting programs to a newly proposed Administration for a Healthy America. According to the Association of State and Territorial Health Officials, the request represents roughly a $3 billion cut to CDC programs, including $1.4 billion for chronic disease prevention and $1 billion for HIV/AIDS activities. Congress rejected similar cuts in the FY2026 cycle, but the budget signals the administration's continued priorities.

The same budget states that CDC "will play a key role in implementing an America First approach to global health to replace the functions of the World Health Organization," a mission the Lancet editorial argues is incompatible with the agency's drastically reduced international footprint: "CDC cannot gather epidemic intelligence and mount an outbreak response without international partners in other countries."

Public Trust

A February 2026 KFF poll found trust in federal health agencies has declined across the political spectrum during Kennedy's tenure. Monarez and Houry both testified that political appointees were playing an unprecedented role in agency decisions; Houry told senators that "for the next type of pandemic, a novel pathogen, some of the staff cuts we have faced, we have less ready responders. We have less visibility into global pathogens at this time."

Kennedy, in April 2026 House testimony, defended the changes as "absolutely necessary adjustments to restore the agency to its role as the world's gold standard public health agency" and said morale was "much better than it was a year ago." He acknowledged that proposed NIH cuts were "painful" but said fiscal pressures required them.

Additional Context

The Lancet closes by noting that despite the value of stronger state-level public health and regional alliances, "the USA still needs a strong federal-level agency that has the capacity, mandate, trust, expertise, and broad political support to protect health across the country" — and that whether such an agency can be reconstructed from the current institution remains an open question.