Questions and expectations swirl as Monarez steps into director's role at CDC

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4 days ago

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Dr. Susan Monarez will be sworn in as director of the US Centers for Disease Control and Prevention on Thursday, and she's taking the reins at a perilous time for the agency.
The CDC has lost nearly a quarter of its staff since January, thanks to massive workforce cuts at federal health agencies. The Trump administration's proposed budget for the fiscal year 2026 would slash the agency's funding by more than half. And under a proposed reorganization, the agency stands to lose more of its programs: Some are set to be moved to a new Administration for a Healthy America while others, such as the National Center for Chronic Disease and Health Promotion, would be eliminated altogether.
All this is playing out as US Health and Human Services Secretary Robert F. Kennedy Jr., who has long promoted misinformation about vaccines, has moved to undermine longstanding federal policies and processes that support vaccination in the United States.
Kennedy has also throttled communications coming out of federal health agencies, including the CDC, all but silencing its scientists amid the worst measles outbreak in the US in three decades.
Many at the agency and in the wider public health world are wondering whether Monarez will prove to be a savior or a sycophant.
Morale among agency staff is bleak, according to one CDC official who spoke on the condition that they not be named for fear of reprisals.
Staffers are feeling unsure about what Monarez's confirmation means, the official said. Many see her as a good scientist and someone with experience in leadership positions at federal agencies.
But they also wonder whether she'll be constrained by Kennedy, the official said.
Monarez's tenure in government spans Republican and Democratic administrations. Before coming to the CDC in January, she was deputy director for the Advance Research Projects Agency for Health, or ARPA-H, and was founding director of the Center for Innovation at the Health Resources and Services Administration. She held other leadership positions at the Department of Homeland Security and the Biomedical Advanced Research and Development Authority.
In her confirmation hearing, Monarez described herself as the daughter of a dairy farmer from rural Wisconsin who attended state schools and paid her own way through college, eventually earning a Ph.D. in microbiology and immunology. She said that her research was focused on two diseases, African sleeping sickness and toxoplasmosis, and that she was drawn to public health because treatments for those diseases remain limited but public health interventions have reduced the impact of the diseases.
Under questioning by senators, Monarez seemed to distance herself from Kennedy on two issues: vaccines and fluoride.
In response to questions from Sen. Bernie Sanders, an independent from Vermont, about the US ending its support for the Global Alliance for Vaccines and Immunization, Monarez said, 'I think vaccines save lives. I think that we need to continue to support the promotion and utilization of vaccines.'
When Sanders asked whether she agrees that there is no scientific proven link between vaccines and autism, Monarez said, 'I have not seen a causal link between vaccines and autism.'
Regarding fluoride, Monarez told Sen. Angela Alsobrooks that she considered it 'an important component to oral health. … The direct application can be very valuable.'
Alsobrooks asked about fluoridation of public drinking water, including in Monarez's own town. 'They have fluoridation there. Is it safe for families, the water in Potomac, Maryland?'
'I believe the water in Potomac, Maryland, is safe,' Monarez answered.
One staffer who worked under Monarez at ARPA-H described her as a quiet presence. She wasn't the type of manager who is an active presence on Slack or email, they said.
'We all respected her. She's been in government a long time,' said the staffer, who spoke on the condition that they not be named for fear of retaliation.
Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University's School of Public Health, has known Monarez for at least a decade.
'She's a lifelong government scientist who has risen through the ranks to become a very senior leader,' Nuzzo said. 'She's loyal to serving the American people.'
They worked together when Monarez was detailed to the White House, where she worked on the US National Action Plan for Combating Antibiotic-Resistant Bacteria.
'She got into the nitty-gritty of a complex policy issue, but she was also able to bring together a really diverse set of stakeholders to provide input into that strategy,' Nuzzo said. 'I think that's a great example of what Susan does.'
Monarez has said she has three priorities for the CDC.
First, she said, she wants to improve trust in the agency and its recommendations. Next, she will focus on strengthening public health infrastructure by investing in tools to prevent, detect and respond to threats in near real-time. She pledged to collaborate with state and local public health departments to build a nationwide public health network. Finally, she said, she will work to create rapid, evidence-based responses to public health emergencies, with timely communication that is consistent and grounded in facts.
While these are worthy goals, Nuzzo said, her biggest worry is whether Monarez will be able to act independently, without political interference.
'You can't run an organization as important and large as the CDC if you need to get permission for everything that needs to be done,' Nuzzo added.
Dr. Richard Besser, a former acting director of the CDC, said in a statement that he looked forward to meeting Monarez to better understand her plans to lead the agency. Besser is now president and CEO of the Robert Wood Johnson Foundation.
'Dr. Monarez must not only lead the CDC – she must fight for it. Our nation's entire public health system depends on CDC having the tools it needs to respond to pandemics, reduce chronic disease, and address health inequities that continue to leave too many communities behind. That starts with a director willing to speak the truth, defend science, and stand up for the health of every American,' Besser said.