After months weathering staffing cuts and disease outbreaks without an official leader, the Centers for Disease Control and Prevention finally has a new director.
The Senate confirmed Susan Monarez, a health scientist and longtime civil servant, to run the public health agency. She is the first CDC director to be confirmed by the Senate under a law passed in 2023, and the first to serve in the role without a medical degree in more than 70 years. The vote was 51-47, along party lines.
Monarez takes over an agency in chaos, according to employees who have spoken to NPR. Thousands of workers have left in recent months and support for many programs has been cut. President Trump has proposed slashing CDC's funding for fiscal year 2026.
"We really need her in this role," says Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, who has known Monarez professionally for more than a decade. "She's a loyal, hardworking civil servant who leads with evidence and pragmatism, and has been dedicated to improving the health of Americans for the entirety of her career."
Monarez, a microbiologist and immunologist by training, served as CDC's acting director from January through March this year, stepping down as required when Trump chose her for the director role. Previously, she was deputy director for the Advanced Research Projects Agency for Health, or ARPA-H, a governmental agency that funds cutting-edge biomedical and health research.
Monarez nominated after Weldon was withdrawn
She was nominated as CDC director after Trump withdrew his first pick, Florida physician Dave Weldon, when senators raised concerns about his stance on vaccines, including previously debunked claims about vaccine safety, and signaled that he did not have the votes to pass.
Dr. Georges Benjamin, executive director of the American Public Health Association, who previously described Weldon as "not the right guy for the job," was sanguine about Monarez. "She values science, is a solid researcher, and has a history of being a good manager," Benjamin says, "We're looking forward to working with her."
In a June confirmation hearing before the Senate Health, Education, Labor and Pensions committee, Monarez said restoring trust in the CDC was one of her top priorities. "I will rebuild credibility by making CDC leadership more public-facing and accountable…[and] ensure all recommendations are backed by publicly available, gold-standard science," she said.
Monarez also listed modernizing public health infrastructure and responding rapidly to disease outbreaks as additional priorities. "We know the next outbreak is not a matter of if, but when," she said, "I will implement tested, evidence-informed predefined protocols to avoid confusion and delays, and strengthen risk communication so the public receives timely, consistent guidance based on facts, not fear," she said, adding "These priorities support the President's and the Secretary's vision of a healthier America."
Tension between public health norms and administration's agenda
In the hearing, Monarez walked a fine line between traditional public health perspectives and those of her boss, Secretary of Health and Human Services Robert F. Kennedy Jr., who has long questioned the safety of vaccines. He now oversees federal health agencies that include CDC, the Food and Drug Administration and the National Institutes of Health.
In response to a question from Sen. Lisa Blunt Rochester, a Delaware Democrat, about whether she would commit to keeping routine vaccines free for U.S. children, Monarez said, "Vaccines absolutely save lives, and if I'm confirmed as CDC director, I will commit to making sure that we continue to prioritize vaccine availability."
Monarez also said she believes fluoride is an important component to oral health, and that the fluoridated tap water in her community is safe. For decades, low levels of fluoride have been added to many community drinking water systems to prevent cavities, though Health Secretary Kennedy has directed the CDC to change its guidance on the practice, alleging health harms that have not been found at the recommended fluoride levels.
At the hearing, Monarez repeatedly defended the Trump administration's vision for the CDC, which she described as "getting back to its core mission of preventing, detecting and responding to infectious diseases and emerging threats." She said programs that focus on other health issues that she described as "important public health concerns," such as chronic diseases, obesity, depression, drug addiction and overdose, would be transitioned to other parts of HHS. Kennedy has announced that he is creating a new Administration for a Healthy America, which may focus on primary care, mental health, environmental health and more.
"The Secretary has laid out a very clear vision for making America healthy again," Monarez said, in response to a question on Kennedy's performance as health secretary, "I think he has prioritized key public health activities for preventing chronic diseases, for reducing maternal morbidity and mortality. … I think the Secretary is doing the important work of leading a very complex agency through a number of different transitions."
A scientific balancing act
Monarez will be balancing core scientific values with her new boss' mistrust of the scientific and medical establishment, observers say. For instance, Kennedy has replaced the CDC's bench of vaccine advisers with his own picks, many of whom lack expertise in vaccines. "My biggest anxiety for her is whether she will be able to lead with the independence and the commitment to letting the evidence drive the strategy approach that she's known for," says Nuzzo at Brown University.
Monarez inherits an agency reeling from deep staffing cuts, funding clawbacks and a clampdown on communications. "Morale is very low," says Benjamin from APHA, "CDC has always been the gold standard of public health organizations in the world, and it's been paralyzed."
The CDC has lost about a third of its staff since January, according to numbers provided by Representative Rosa DeLauro's (D-CT) office.
More changes – including budget cuts – are anticipated in an ongoing reorganization effort that aims to remove noninfectious diseases from the CDC's responsibilities.
That's shortsighted, says Dr. Nirav Shah, former principal deputy director at CDC who left the agency in February.
"Health is multifaceted," Shah says, "It's not just the mosquitoes and viruses that we are exposed to, but it's also the exercise we get, the foods we eat and the environment in which we live. A true public health agency should, as CDC currently does, take into account all of those risks and balance them."
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