Part the First and Only on this Friday Afternoon: One More Revolution of the Accelerating Doom Loop of Science. The following is an update to our previous discussion earlier this week. As everyone should know by now, the Secretary of Health and Human Services has fired the Director of the Centers for Disease Control, Dr. Susan Monarez, after less than one month on the job. If this is not a record, it should be. According to STAT News, RFKJr after asking “for her resignation, citing concerns about insubordination and her integrity (basically she stuck to the science and said “no”), including instances related to vaccine policy”. She refused and was offered another choice, “accept all recommendations from the agency’s vaccine advisory committee, whose members (the Secretary of Health and Human Services) had replaced with hand-picked allies (including Dr. Robert Malone, self-described inventor of mRNA vaccines, not) who shared his hostile views about childhood immunizations, and fire a number of high-level officials at the agency.”
Dr. Monarez’s lawyers argue that as the Senate-confirmed Director of CDC, only the president can fire her. This will not matter. The great and powerful X has spoken. And four high-level leaders at CDC have resigned anyway. All because, according to the Secretary who stated that “leadership changes were needed to bring Trump’s agenda to an agency that ‘has problems.’” Now, few would dispute that CDC has had problems, especially in senior leadership, during the past five years of a pandemic that is not over. But what is meant by the president’s “agenda”? One would think that any president’s agenda would be to support the best science and scientists instead of fire them by the thousands. After all, that was the ostensible purpose of President Trump’s Operation Warp Speed during his first term.
In any case it is not clear that Dr. Monarez has done anything except bring her expertise to a very difficult job in the current political environment. Who is Dr. Susan Monarez? She has a PhD from the University of Wisconsin and was a postdoctoral fellow at Stanford. She published her research as Susan P. Coller and then went into scientific administration where she has held important positions in government and elsewhere. She is well qualified for the position, as noted by the Secretary, who praised her “unimpeachable scientific credentials” while noting that he had “full confidence in her ability to restore the CDC’s role as the most trusted authority in public health and to strengthen our nation’s readiness to confront infectious diseases and biosecurity threats.”
Instead, it is clear that the primary goal of the Secretary to set back disease control and prevention while Making America Healthy Again by other means. RFKJr laments, on Fox & Friends:
“There is really a deeply, deeply embedded — I would say malaise (a word Jimmy Carter did not use in that speech) at the agency, and we need strong leadership that will go in there and that will be able to go in there and that will be able to execute on President Trump’s broad ambitions for this agency to [return] to the gold standard science and what it was when we were growing up, which was the most respected health agency in the world.”
“Gold-standard science” is nothing more than a trope, a fetish of the faux science of economics. When we (RFKJr and I are near contemporaries) were growing up the CDC was respected, and it has been until the various entanglements of public health with business and politics that characterized our responses to COVID-19. Some of us remember that it was CDC scientists who figured out AIDS in a matter of months and saved countless lives even though politics was a factor. They did the same with Ebola and other outbreaks of horrible diseases around the world. Without CDC, as it was and still is at the level of working scientists, the world would not be able to respond to emerging diseases and other treats to human health.
And the Secretary displays his goals thoroughly when he continues:
“Today, on the CDC’s website right now, they list the 10 top advances, the 10 greatest advances in medical science and one of them is abortion, another is fluoridation, and another is vaccines. So we need to look at the priorities of the agency.”
Or maybe we, all of us, need to look at his priorities for the agency? I found the Top-10 information on the CDC web site. There are actually two CDC documents that list a Top-10. They can be found here at a secondary site that refers to them. The first is from MMWR (Morbidity and Mortality Weekly Report) that is the flagship publication of CDC. The Ten Great Public Health Achievements in the United States, 1900 – 1999.
Vaccination
Motor-vehicle safety
Safer workplaces
Control of infectious diseases
Decline in deaths from coronary heart disease and stroke
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of drinking water
Recognition of tobacco use as a health hazard
There is not one family, in the United States and in most of the world, that has not been helped by these improvements. It can be argued that we could have done better on most of these, but that is always possible. Fluoridation works despite the merchants of doubt who follow the John Birch Society in their demonization of the practice. Vaccines also work. It should pain anyone to have to say this in the year 2025. From the CDC reference, during the 20th century decreases in morbidity for the following diseases ranged from 95.7% to 100%, because of vaccination: Smallpox, diphtheria, pertussis, tetanus, paralytic poliomyelitis, measles, mumps, rubella, and Haemophilus influenzae (the cause of bacterial pneumonia, sepsis, meningitis, and ear infections).
The list is much longer now. Vaccines will never be perfect or perfectly safe for everyone, but they have been essential in lessening the burden of severe disease. The newer HPV vaccines have the potential to prevent cervical cancer at 98%+ efficacy. It is simple-minded madness to deny this, but the Secretary persists in his enduring belief in the fraud that is (the former) Dr. Andrew Wakefield on the connection between the MMR vaccine and autism.
The second paper from CDC from MMWR (direct link here) lists Ten Great Public Health Achievements – Worldwide, 2001-2010:
Reductions in Child Mortality
Vaccine-Preventable Diseases (again)
Access to Safe Water and Sanitation
Malaria Prevention and Control
Prevention and Control of HIV/AIDS (a signal achievement with CDC contributions)
Tuberculosis Control
Control of Neglected Tropical Diseases
Tobacco Control
Increased Awareness and Response for Improving Global Road Safety
Improved Preparedness and Response to Global Health Threats
Moreover, as noted recently in MMWR, Health and Economic Benefits of Routine Childhood Immunizations in the Era of the Vaccines for Children Program — United States, 1994–2023 Weekly / August 8, 2024 / 73(31);682–685:
Broad access and availability of vaccines in critical for immunization programs to avert disease. Since 1994, the U.S. Vaccines for Children (VFC) program has covered the cost of vaccines for children whose families might not otherwise be able to afford them.
Among children born during 1994-2023, routine childhood vaccinations will have prevented approximately 508 million cases of illness, 32 million hospitalizations, and 1,129,000 deaths, resulting in direct savings of $540 billion and societal savings of $2.7 trillion.
During the VFC program era, routine childhood immunizations in the United States have been an important cost-saving public health strategy. Childhood immunizations continue to provide substantial health and economic benefits and promote health equity.
Again, no reasonable person can doubt any of this, except at the far margin (we can leave for another time a discussion of why affordability has anything to do with essential healthcare in the United States). But that is where dissemblers like to hide out. One might add that firearm deaths in the United States could have and should have been included on this list, but studying that was terminated with extreme prejudice because of the Second Amendment and the National Rifle Association. Does anyone remember when the NRA was all about gun safety and that the famous “well-regulated militia” was originally intended to eliminate Native Americans and enforce Slave Codes? I didn’t think so.
But getting back to RFKJr revealing himself on Fox & Friends, nowhere in these citations does the word abortion appear. The first paper includes this in Family Planning:
Access to family planning and contraceptive services has altered social and economic roles for women. Family planning has provided health benefits such as smaller family size and longer interval between the birth of children; increased opportunities for preconceptional counseling and screening; fewer infant, child, and maternal deaths; and the use of barrier contraceptives to prevent pregnancy and transmission of human immunodeficiency virus and other STDs.
No mention of abortion whatsoever. But as intended, the word does get the attention of an audience primed to hear it.
It is also worth looking at the four senior CDC employees who have left as a consequence of the defenestration of Susan Monarez. Demetre Daskalakis is an infectious disease physician who led HIV clinics in New York and later joined the NYC Health Department. He joined CDC in December 2020 to direct HIV prevention and subsequently worked on the mpox outbreak that affected gay and bisexual men. Dr. Daskalakis is gay and thus “a messenger that community would listen to.” Yes, he was. Up until this week he was Director of the National Center of Immunization and Respiratory Diseases, a position for which he is well qualified.
Deb Houry was a top CDC official who has been the public face of CDC on diabetes, mental illness among children, and recommendations on proper opioid use. She was second at CDC under Mandy Cohen and Acting Director before Susan Monarez was selected by the Current Administration. Houry began at CDC in 2014:
To lead the National Center for Injury Prevention and Control, which dealt with issues including gun violence, suicide, and opioid overdoses. It was one of the divisions at CDC rocked by mass layoffs this year, with the Trump administration saying it wanted to return the CDC’s focus to infectious diseases.
Aside from mass layoffs being a last refuge [1], this “return to focus” is an administration trope about CDC; they do try hard. Yes, the name of CDC was Communicable Disease Center (1946-1967) and National Communicable Disease Center (1967-1970; I have a discarded library book stamped to this effect). It became the Center for Disease Control in 1970 and was the Centers for Disease Control from 1980 to 1992, when CDC became the Centers for Disease Control and Prevention. This is a thoroughly natural evolution; there is nothing sacred about communicable or infectious disease in controlling and preventing disease in the 21st century.
Daniel Jernigan had worked at CDC for thirty years, most recently as Director of the National Center for Emerging and Zoonotic Infectious Diseases. He is a leading influenza expert. It is hard to imagine that his expertise will not be needed at the highest level at CDC, perhaps sooner rather than later. Jernigan has said that what sent him out the door was having to work with David Geier, whose “research” with his father on vaccines and autism has been “problematic” in its entirety.
Jennifer Layden led the Office of Public Health Data, Surveillance, and Technology while “spearheading the agency’s efforts to modernize its data strategy” to overcome health data systems that have been a wreck. But if the data are not available or are not usable, then there will be no health crisis or pandemic, by definition. The deterioration of the quality COVID-19 data was remarkable as pandemic fatigue progressed, perhaps never seen before at that level. On the other hand, data on HIV/AIDS and other reportable conditions are still quite good. For now.
Finally, this post was to end with the question of what will Senator Bill Cassidy, MD, R-Louisiana, have to say about this? Dr. Moneraz talked to the Senator as her termination was in the works because she would not toe an illegitimate line, and this apparently did not sit well with the Secretary. Remember, the Senator provided the slimmest of margins by which RFKJr was confirmed, because of assurances he received from nominee. By all accounts the President is all-in on RFKJr’s going “wild on health.”
The MAHA Movement lives, for the moment, but MAHA is mostly theatre for the majority, while giving the rich a feel-good experience that comes attached to their wearable continuous glucose monitors from Levels, of which RFKJr is so enamored. The company was founded by the future Surgeon General – after she gave up her medical career 80% through her ENT residency – and her brother. And no, continuous glucose monitoring for people without diabetes or another serious metabolic condition is superfluous. But the practice is lucrative for the provider of the monitor and the app and the add-ons loved by those with more money than sense.
We have heard from Senator Cassidy, naturally on the Great and Powerful X:
These high profile departures will require oversight by the HELP Committee.
The STAT News article continues:
Senator Cassidy later called for the next meeting of the CDC’s vaccine advisers, scheduled for mid-September, to be postponed indefinitely. (He called for a previous meeting of the vaccine advisory group, known as ACIP, to be postponed as well. Kennedy ignored his demand.)
“Serious allegations have been made about the meeting agenda, membership, and lack of scientific process being followed,” he said in a news release.
At one point, in response to questions about Kennedy stripping funding from mRNA research, Trump suggested that the two planned to meet about it but followed his comments with praise of Kennedy’s work. The White House has not confirmed whether a meeting ever took place, and no public reversal has emerged.
In the meantime, Kennedy, for his part, has continued to blow through promises he made to Cassidy and other senators that he would uphold vaccine science and publicly support immunization. HHS has de facto restricted access to Covid vaccines, for example. He has publicly questioned the value of certain vaccines and pharmaceutical treatments.
He’s also limited the ability of both his staff and the public to dissent: He recently moved to revoke recognition for the union that represents many HHS workers, and offers them a way to speak out against decisions they disagree with, and has made an effort to cut the public out of his decisions.
What a complete mess. One wonders if Senator Dr. Cassidy is having second thoughts. No one excuses (also a link from Conor this morning) the errors of omission and commission by CDC during COVID-19. Or the misses at NIH. Politics was mostly responsible, along with a general malaise caused by losing the plot. But we should remember that these agencies have previously served science and the people very well. Politics and science are always intertwined in the modern world, but as a good friend who is the Vice-President for Public Policy at a major organization of biological scientists, of which I have been a long-time member, puts it: “I don’t mind a fight, but a fight without rules has never been our problem, and at the moment there are no rules, only accusations and rage from critics who have never done the work and have agendas of their own.” That about sums it up, but then there is Hosea 8:7 to keep in mind. Or in the vernacular, what goes around comes around when people are not reasonable.
Nevertheless, it is difficult to see what is happening at CDC (plus NIH, NSF, NOAA, and other essential agencies) as anything but a revival of neo-Lysenkoism, a hundred years later. The outcomes for those scientists and administrators will not reach the severity of what happened in the Soviet Union (see Nikolai Vavilov, FRS), but the substitution of disinterested science for “administration priorities” will not end well this time either.
Note
[1] “Patriotism having become one of our topicks, (Samuel) Johnson suddenly uttered, in a strong determined tone, an apophthegm, at which many will start: ‘Patriotism is the last refuge of a scoundrel.’ But let it be considered, that he did not mean a real and generous love of our country, but that pretended patriotism which so many, in all ages and countries, have made a cloak for self-interest.”
