RFK Jr.'s Ongoing Overhaul of CDC Adds Risk to Crisis Response

US Health Secretary Robert F. Kennedy Jr.'s dismantling of the CDC is being criticized by former officials who warn his actions are crippling the ability to grapple with health crises and at odds with his pledge to restore public trust in the agency.

Disease surveillance, response to major health crises, conflict-of-interest checks—these are among the roles of a top federal public health entity that are said to be in crisis after a tumultuous year.

With around a third of the agency’s civil service workforce lost, Centers for Disease Control and Prevention employees face an uncertain future, where firings feel around the corner and the ability to manage disease outbreaks is in peril.

The Trump administration is “going to keep breaking it until there’s a point where they have to fix it,” said Demetre Daskalakis, the former director of the CDC’s National Center for Immunization and Respiratory Diseases who resigned this summer.

Kennedy wrote in the Wall Street Journal that he would restore trust in the CDC, with more focus on infectious disease, enhanced respiratory-disease surveillance, and investment in the workforce. He blamed agency dysfunction for Covid-19 lockdowns, long school closings, and more.

Yet sweeping firings and other actions cut against Kennedy’s proposal to improve the CDC, former agency officials say.

“It’s very important to distinguish what he says from what he does, because they bear very little relationship to one another,” said Tom Frieden, CDC director during the Obama administration.

Refocused Agency

Kennedy’s plan to restore the CDC’s focus on infectious diseases is misguided, Frieden said, as the agency’s “core mission is to protect Americans from all health threats, including both infectious and non-infectious conditions.”

When threats emerge, it’s often unclear whether they’re infectious, he said, and outbreak response requires multiple CDC divisions.

Daskalakis thinks what Kennedy is “heading toward is making CDC like a block grant organization that also somehow aggregates data.” The administration could trim CDC to “what they think is an infectious disease response element,” made up of “some labs, some surveillance and then potentially some of the response pieces.”

“What they’re going to head toward is, here’s a bunch of money, go at it yourselves, because they don’t value the fact that you actually need expertise to implement public health,” Daskalakis said.

The Department of Health and Human Services denies CDC functions are at risk.

“The goal is not to shrink CDC, it’s to sharpen its mission. By refocusing on essentials, HHS is ensuring the agency delivers real, measurable public health impact,” said Andrew Nixon, HHS communications director.

Kennedy claimed to want to support local health departments with outbreaks. The HHS’ approach to doing so “empowers states by cutting red tape, increasing flexibility, and prioritizing funding for outcomes rather than bureaucracy,” Nixon said.

But “states and locals aren’t getting increased funding,” said Debra Houry, CDC chief medical officer who resigned in August. If the Trump administration’s proposed budget cuts happen, there will be less, she said.

Without a strong, centralized federal health force like the CDC, Houry is concerned about a “have and have nots” situation, where those outside of regions coordinating policy have less access.

Some say Kennedy’s criticisms are valid. A former CDC leadership official during the Covid-19 pandemic said the agency wasn’t always clear about how it came to decisions.

Also weighing in was Jeffrey Tucker, founder of Brownstone Institute who helped organize the Great Barrington Declaration—an open letter against pandemic lockdowns co-authored by now-National Institutes of Health Director Jayanta Bhattacharya— who said “the CDC needed shock therapy.”

“There’s no way you can understand what’s going on right now without understanding the central role that the CDC played in being the front face for the pandemic calamity,” Tucker said.

Firing Frenzy

New political leadership has also moved in as former staff who clashed with Kennedy were removed or left, including Daskalakis, Houry, and brief CDC Director Susan Monarez.

Deputy HHS Secretary Jim O’Neill has served as acting CDC director since Monarez was fired over disagreements on vaccines.

At a November Milken Institute conference, O’Neill said the HHS is “eager to hire wonderful scientists and data engineers and AI engineers and researchers and drug reviewers.”

“We’re going to keep improving the organization, keep trying to combine functions and reduce redundancy. We’ll continue to recruit. We have a lot of vacancies. We really need a lot of talent, and we’re constantly hiring,” O’Neill said.

Kennedy’s plan to consolidate CDC functions on HIV, maternal and child health, and more into the new $20.6 billion Administration for a Healthy America agency has also been controversial.

Bob Moffit, a former senior HHS official now at the Heritage Foundation, said consolidating programs under AHA was Kennedy’s “best proposal” for a restructuring plan.

But Houry said it’s unclear whether some of the groups that survived the firings will be moved to AHA. Nixon declined to comment on the status of consolidating functions under AHA, pointing to ongoing litigation.

The HHS has seen sustained reduction-in-force efforts throughout the year, with the Trump administration aiming to cut around 20,000 staffers through early retirements, other elective departures, and reductions-in-force.

The former leadership official said the firings look like the HHS was trying to clear out a critical layer of leadership and scientific oversight.

A current CDC employee said 100-plus employees in respiratory diseases received layoff notices in October, only to have them reversed shortly after, a move they say seemed as if the greater HHS didn’t understand their function.

The HHS takes issue with those claims. Regarding the firings, Nixon said the department was “strengthening oversight” by “removing leadership with ideological bias.” As for the respiratory disease cuts and reversals, Nixon called this account a mischaracterization of routine personnel review processes.

Overall, the cuts sparked concern of the removal of institutional knowledge, expertise, and experience.

“I don’t know how they’re going to function,” Houry said.