RFK Jr. is bad for your health

Public servants are trying to warn us that state capacity is being undermined

The Centers for Disease Control shitshow is a microcosm of the mismanagement of the Trump era. It also demonstrated some extraordinary courage among principled public servants, who were willing to lose their jobs to draw attention to damage being done to public health.

What is happening at CDC is not a one-off. I have studied the federal bureaucracy for a quarter century and am not aware of any comparable period in American history where so many public service professionals across different policy domains are sending out SOS signals to the public. If you care about state capacity, the ability of government to get things done, you should be very worried.

If you are skeptic of government bureaucrats and their claims, I invite you to consider whether you would want the medical professionals at CDC or RFK Jr to treat your family if they got sick. Because right now, Trump is empowering RFK Jr to determine of your family’s health.

Let’s walk through it bit by bit.

RFK Jr. wanted Monarez to fire competent public health officials and lend her credibility to bad policy

The Secretary of Health and Human Services, Robert F. Kennedy Jr. is an anti-vax crank. He should never have been confirmed to any sort of public health position. He lied to the Senate about how he would manage vaccines if confirmed, and most Republican Senators, including physician Dr. Bill Cassidy, chose to believe him and ignore his record.

While much of RFK Jr.’s work at HHS is meaningless photo-ops with food providers promising to remove food dyes here, or add beef tallow there, he has invested real effort in exactly the place his record suggested: targeting vaccines. He has fired all members of the CDC vaccine advisory committee, baselessly accusing them of conflicts-of-interest, and replacing them with fellow vaccine skeptics.

This goes beyond Covid vaccines: childhood vaccines to stop the spread of preventable diseases are now in the crosshairs, even after Kennedy assured Senator Cassidy that they would not be touched. Kennedy has defunded research on mRNA vaccines, ensuring that the world will less ready for the next pandemic. He is encouraging states to weaken vaccine requirements.

On Monday, RFK Jr. told the CDC Director, Susan Monarez, in place for just over a month, to accept two conditions if she wanted to keep her job.

First, he wanted her public support for his policies to limit access to vaccines. Monarez is an infectious disease scientist who has served in government for a long time. In effect, RFK Jr. was asking that she lend her personal credibility as a scientist, and the credibility of CDC, to his anti-vax policies. She demurred, saying she needed to talk to senior staff at CDC.

Second, Kennedy ordered her to fire those staff. Since they are career civil servants, it would be illegal to fire them without cause, although this has become the norm now in the Trump administration. For example, career officials at FBI were fired for refusing to fire their fellow civil servants without cause.

Monarez refused both requests.

To be clear, RFK Jr. can implement these vaccine policies without the blessing of Monarez. What he wanted is for public health officials to lie to the public. What he wanted was to purge medical doctors and infectious disease researchers with decades of public health experience if they don’t go along with his woo-woo medical theories.

RFK Jr. wanted an agency head to not communicate to Congress

The second reason that Monarez was fired was because she reached out to a US Senator.

Monarez is a Senate-confirmed appointee. She has every right to talk to members of Congress who care about the mission of her agency. After all, Congress establishes that mission in statute and via appropriations. If you want a government where RFK Jr. is the only official allowed to talk to Congress about public health, then you have settled for a government where Congress can’t fulfill it’s oversight function.

After the Monday meeting, Monarez spoke with Senator Cassidy about the threats to a policy he cares intensely about: access to vaccines. Cassidy, in turn, called RFK Jr. to share his concerns. RFK Jr. was furious with Monarez, labeling her a leaker. He simply does not want Congress to know or interfere with his anti-vax crusade to the greatest degree possible.

The White House and HHS leadership is dysfunctional

HHS announced the ouster of Monarez in a tweet on Wednesday. Note the passive voice.

Then a very strange thing happened, something I can never recall seeing before. Monarez’s lawyer said a) she was not resigning, and b) had not actually been fired.

So lets unpack this. Monarez is a Trump appointee. Only Trump can fire her, not Kennedy, even though CDC is part of HHS. Even after the White House personnel office sent a message saying Monarez was fired, her lawyers were still demanding an actual letter from Trump.

What *may* have happened is that RFK Jr. wanted Monarez out, and told her to resign or be fired but either did not clear it with the White House, or with Trump.

By demanding that Trump fire her, Monarez refused the go quietly. She brought a "fuck you, make me” energy to the table. In doing so, she also brought attention to the looming public health crisis. As it is, Trump still has not explained why the person he nominated just a month ago is unfit to serve. White House spokespeople said that Monarez was fired for not supporting the President’s Make America Healthy Again agenda without explaining how her actions contradicted this agenda.

Federal employees really want you to know how bad things are

As soon as the HHS announced Monarez was gone, other widely respected CDC leaders, Dr. Deb Houry, Dr. Demetre Daskalakis, Dr Jennifer Layden, and Dr. Daniel Jernigan, emailed colleagues to say that they too were exiting. You can read their resignation letters here. These are not the first resignations. Other CDC officials had already left, with one vaccine expert warning: “C.D.C. processes are being corrupted in a way that I haven’t seen before.”

The great political economist Albert Hirschman offers a simple typology for how people deal with troubled organizations: exit, voice, and loyalty. In this context, the employees appear to have combined voice and loyalty — staying with the organization, but raising concerns — until it was not longer viable, and then combined voice and exit. Houry, the former CDC deputy directory and chief medical officer, described their resignation as “bat signal” to Congress.

We agreed to do this together. We’ve been talking about it for months, and the past few days, it was just escalating. If one of us retired, it would have been a blip. When the three of us do it together, it’s more powerful and just shows the state of our agency.

I am going to share the letter from Dr. Daskalakis in full. It is long, so I have highlighted some sections, but it is worth your time, since it details a pattern of manipulating the reputation of the CDC to justify decisions that will endanger Americans. If you are going to write a resignation letter, this is how you go out with all guns blazing:

I am writing to formally resign from my position as Director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), effective August 28, 2025, close of business. I am happy to stay on for two weeks to provide transition, if requested.

This decision has not come easily, as I deeply value the work that the CDC does in safeguarding public health and am proud of my contributions to that critical mission. However, after much contemplation and reflection on recent developments and perspectives brought to light by Secretary Robert F. Kennedy Jr., I find that the views he and his staff have shared challenge my ability to continue in my current role at the agency and in the service of the health of the American people. Enough is enough.

While I hold immense respect for the institution and my colleagues, I believe that it is imperative to align my professional responsibilities to my system of ethics and my understanding of the science of infectious disease, immunology, and my promise to serve the American people. This step is necessary to ensure that I can contribute effectively in a capacity that allows me to remain true to my principles.

I am unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health. The recent change in the adult and children’s immunization schedule threaten the lives of the youngest Americans and pregnant people. The data analyses that supported this decision have never been shared with CDC despite my respectful requests to HHS and other leadership. This lack of meaningful engagement was further compounded by a “frequently asked questions” document written to support the Secretary’s directive that was circulated by HHS without input from CDC subject matter experts and that cited studies that did not support the conclusions that were attributed to these authors. Having worked in local and national public health for years, I have never experienced such radical non-transparency, nor have I seen such unskilled manipulation of data to achieve a political end rather than the good of the American people.

It is untenable to serve in an organization that is not afforded the opportunity to discuss decisions of scientific and public health importance released under the moniker of CDC. The lack of communication by HHS and other CDC political leadership that culminates in social media posts announcing major policy changes without prior notice demonstrate a disregard of normal communication channels and common sense. Having to retrofit analyses and policy actions to match inadequately thought-out announcements in poorly scripted videos or page long X posts should not be how organizations responsible for the health of people should function. Some examples include the announcement of the change in the COVID-19 recommendations for children and pregnant people, the firing of scientists from ACIP by X post and an op-ed rather than direct communication with these valuable experts, the announcement of new ACIP members by X before onboarding and vetting have completed, and the release of term of reference for an ACIP workgroup that ignored all feedback from career staff at CDC.

The recent term of reference for the COVID vaccine work group created by this ACIP puts people of dubious intent and more dubious scientific rigor in charge of recommending vaccine policy to a director hamstrung and sidelined by an authoritarian leader. Their desire to please a political base will result in death and disability of vulnerable children and adults. Their base should be the people they serve not a political voting bloc.

I have always been first to challenge scientific and public health dogma in my career and was excited by the opportunity to do so again. I was optimistic that there would be an opportunity to brief the Secretary about key topics such as measles, avian influenza, and the highly coordinated approach to the respiratory virus season. Such briefings would allow exchange of ideas and a shared path to support the vision of “Making America Healthy Again.” We are seven months into the new administration, and no CDC subject matter expert from my Center has ever briefed the Secretary. I am not sure who the Secretary is listening to, but it is quite certainly not to us. Unvetted and conflicted outside organizations seem to be the sources HHS use over the gold standard science of CDC and other reputable sources. At a hearing, Secretary Kennedy said that Americans should not take medical advice from him. To the contrary, an appropriately briefed and inquisitive Secretary should be a source of health information for the people he serves. As it stands now, I must agree with him, that he should not be considered a source of accurate information.

The intentional eroding of trust in low-risk vaccines favoring natural infection and unproven remedies will bring us to a pre-vaccine era where only the strong will survive and many if not all will suffer. I believe in nutrition and exercise. I believe in making our food supply healthier, and I also believe in using vaccines to prevent death and disability. Eugenics plays prominently in the rhetoric being generated and is derivative of a legacy that good medicine and science should continue to shun.

The recent shooting at CDC is not why I am resigning. My grandfather, who I am named after, stood up to fascist forces in Greece and lost his life doing so. I am resigning to make him and his legacy proud. I am resigning because of the cowardice of a leader that cannot admit that HIS and his minions’ words over decades created an environment where violence like this can occur. I reject his and his colleagues’ thoughts and prayers, and advise they direct those to people that they have not actively harmed.

For decades, I have been a trusted voice for the LGBTQ community when it comes to critical health topics. I must also cite the recklessness of the administration in their efforts to erase transgender populations, cease critical domestic and international HIV programming, and terminate key research to support equity as part of my decision.

Public health is not merely about the health of the individual, but it is about the health of the community, the nation, the world. The nation’s health security is at risk and is in the hands of people focusing on ideological self-interest.

I want to express my heartfelt gratitude for the opportunities for growth, learning, and collaboration that I have been afforded during my time at the CDC. It has been a privilege to work alongside such dedicated professionals who are committed to improving the health and well-being of communities across the nation even when under attack from within both physically and psychologically.

Thank you once again for the support and guidance I have received from you and previous CDC leadership throughout my tenure. I wish the CDC continued success in its vital mission and that HHS reverse its dangerous course to dismantle public health as a practice and as an institution. If they continue the current path, they risk our personal well-being and the security of the United States.

On Thursday, CDC scientists walked out of their headquarters in Atlanta to salute the three departing CDC leaders as they were escorted from their offices by security. This was an extraordinary display for three reasons.

First, these are public health officials. They are doctors and scientists. They are not, by their nature, activists who seek the limelight.

Second, these employees who are visibly supporting dissent, chanting “USA not RFK”, are risking their jobs. Federal employees in places like FEMA and EPA who have raised concerns publicly about the mismanagement occurring within the Trump administration have been put on administrative leave, and can reasonably expect to be fired. (Such punitive actions are illegal, but no-one seems to care about that any longer). While critics like RFK Jr. present public health employees as venal beneficiaries of a corrupt system, the opposite is true: they are putting their livelihood on the line for the sake of their principles.

Third, these employees joined together in front of a building that was the subject of a terrorist attack just a couple of weeks earlier. A man fired more than 500 rounds at the CDC building, and the resulting damage was still visible in the background of the protests. One police officer was killed, and it is a miracle that the attack did not result in mass casualties.

The terrorist was motivated by the same anti-vax conspiracy theories as RFK Jr. RFK Jr. previously labeled CDC as “a cesspool of corruption.” It is hard to imagine how demoralizing this is, but this quote from a reporter trying to interview CDC employees gives you a sense:

No one affiliated with the CDC would allow themselves to be identified while speaking to the media. They are terrified of losing their jobs, they said. But one said the administration’s response severed their final thread of loyalty to the organization. They are loyal to their colleagues now. But not the government agency that employs them. And they are bewildered and betrayed by the silence.

As much as you should feel appalled by the actions of RFK Jr. you should feel deeply proud of the courage of the public employees who stuck with their principles, even at the cost of their careers.

If RFK Jr. stays, the attack on public health will escalate

The head of CDC has typically been a physician with deep public health experience. Monarez was not Trump’s first pick. This was Dave Weldon, a former Republican Congressman and Army doctor. Weldon did not have the type of public health experience normal of CDC directors, but RFK Jr. pushed the nomination. Why? Weldon shares the same doubts about vaccines that RFK Jr. does, embracing the widely-debunked idea that vaccines cause autism.

As Weldon’s record became clear it also became clear that the Senate would not confirm him, and so Trump turned to Monarez. In effect, RFK Jr. wanted Monarez to adopt the views of the CDC nominee that even Senate Republicans could not support.

The new acting head of CDC faces an incredibly tough job. Agency leadership has been decimated, morale is low, and employees no longer believe that the administration respects their mission of protecting public health.

So who did RFK Jr. turn to?

Well, its not good. Jim O’ Neill is not a physician, scientist, or someone with the public health credentials normally associated with CDC director. He is currently the Deputy Director of HHS. He did work in the domain of public health during the Bush administration, but is more recently an employee of Peter Thiel, the Trump-supporting tech billionaire libertarian. Those libertarian views extend to public health. For example, O’ Neill has said:

• On non-FDA approved drugs: “We should reform FDA so that it is approving drugs after their sponsors have demonstrated safety and let people start using them at their own risk.”

• On paying people for their body-parts: “There are plenty of healthy spare kidneys walking around, unused.”

• On letting Covid spread: “Is omicron the best vaccine? Remember, CDC can redefine the word vaccine at will.”

On news of O’Neill taking over as acting head of CDC, Atul Gawande, perhaps the best known public health voice in America, responded:

I am skeptical that O’ Neill will use his limited political capital to stand up for the scientists working at CDC, or basic public health principles. The fact that RFK Jr picked him is a signal that O’ Neill will serve as a the type of rubber stamp that Monarez refused to be.

Public health is not something that Trump cares much about. Indeed, he has distanced himself from his most impressive achievement of his first term: the Warp Speed production of vaccines. He has delegated oversight of public health to an anti-vaxxer because of this indifference. This delegation gives RFK Jr. a great deal of power to pursue his agenda. But it also makes him vulnerable. As a newcomer, he is more dispensable than others in Trumpworld. If the political costs of MAHA become too high, RFK Jr. could go the way of Elon Musk.

Congress has been absent

None of this is normal. Richard Besser, a former CDC official who is now CEO of the Robert Wood Johnson Foundation, said he was “dumbstruck by how little oversight Congress has shown to the devastating moves that this administration has taken when it comes to public health.”

But this is basically the story of Congress right now. With a Republican majority, they have offered no check on the Trump administration.

All eyes are on Cassidy, the physician who ultimately provided the vote to confirm RFK Jr. Cassidy has said that hearings will follow because of the CDC departures. He has also said that any recommendations from RFK Jr.’s vaccine advisory committee will be “lacking legitimacy” given that “Serious allegations have been made about the meeting agenda, membership, and lack of scientific process being followed.”

These are good first steps, but what RFK Jr. has shown us time and again that if given the chance he will absolutely implement his anti-vax agenda, even if it means lying to Congress or ignoring the science. Congress will not be able to finger-wag him back to sanity. Radical conspiracy theorists have real convictions, even if those convictions mean kneecapping American state capacity. Far from being cowed by the growing scandal, RFK Jr. seemed emboldened, saying: “There’s a lot of trouble at C.D.C., and it’s going to require getting rid of some people over the long term in order for us to change the institutional culture."

As long as he stays in office, the American public has to assume that their public health is being actively threatened. A current CDC employee put it starkly:

People will die because of this. We won’t be able to get out guidance or get out funding for public health departments or get out vaccines. We’re going to be sicker as a country, not as effective, waste resources. And for what? I don’t understand.