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Trump has yet to nominate a permanent CDC director and the Senate confirmation of his pick for top doctor is in limbo
The Trump administration’s “Make America healthy again” (Maha) agenda appears to be stalled as two of the government’s most influential public health positions sit empty
Donald Trump has yet to nominate a permanent director for the Centers for Disease Control and Prevention (CDC), leaving an agency that has been plagued by turmoil for the past year without a leader. At the same time, the president’s controversial pick for surgeon general, Casey Means, remains in limbo as her nomination stalls in the Senate
The CDC has now been without a Senate-confirmed director for more than 210 days, the maximum length of time an acting head can manage an agency under federal law
Jay Bhattacharya – who also runs the National Institutes of Health (NIH) – has served as interim chief of the CDC since February, and is expected to continue overseeing the agency through a delegation of authority by the health secretary, Robert F Kennedy Jr, according to statements from both the Department of Health and Human Services (HHS) and White House
In a statement, the HHS said that Kennedy and Chris Klomp, who serves as the director of Medicare and deputy administrator of the Centers for Medicare and Medicaid Services (CMS), were “working with the White House on the CDC director search by evaluating candidates that can further the Trump administration’s objective of restoring the CDC to its original mission of fighting infectious disease”.
The agency’s last Senate‑confirmed director, Susan Monarez, took over in July but was fired less than a month laterafter clashing with Kennedy over his vaccine agenda. Since then, the CDC has seen an exodus of senior public health officials, many of whom accused the health secretary of politicizing the agency and stripping leaders of their independence. The upheaval followed a shooting at CDC headquarters in Atlanta, where a gunman – who blamed the Covid vaccine for making him depressed and suicidal – killed a police officer.
Most recently, a federal judge ruledearlier this month that Kennedy’s handpicked vaccine advisory panel was unlawfully appointed, and voided many of their recent decisions on vaccines, which included no longer recommending the latest version of the flu and Covid shots and the inclusion of the RSV shot for infants
Since only the CDC director can formally approve vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP), the absence of a permanent director effectively shifts that authority to Kennedy as health and human services secretary, according to the Stanford law professor Anne Joseph O’Connell
On Wednesday, the New York Times reported that the administration is struggling to find a nominee who both aligns with its agenda and can withstand Senate scrutiny, according to a person familiar with the search
As the White House searches for a permanent CDC director, its nominee for the nation’s top doctor remains stuck in limbo. Casey Means testified more than a month ago, but the Senate health committee has yet to schedule a vote – leaving the post unfilled more than 320 days after Trump first nominated Means last May. Her initial hearing was postponed when she went into labor hours before she was set to appear.
Means, 38, who is neither a board-certified doctor nor holds an active medical license, graduated from the Stanford School of Medicine, but did not complete her head and neck surgical residency at Oregon Health and Science University. Her scientific experience is mainly focused around her work as an influencer and leader within the Maha space – the key pillar of the Trump administration’s health policy.
During her confirmation hearing, Means evaded questions about vaccine guidance, argued that many of the country’s chronic health problems stemmed from lifestyle and environmental factors, brushed off concerns about her limited medical experience and faced criticism over potential conflicts of interest tied to her wellness product promotions on social media
As Means’s appointment remains hampered, all eyes remain on the key Republican votes on the health committee that she will need to advance – namely Bill Cassidy of Louisiana, and two GOP moderates, Susan Collins of Maine and Lisa Murkowski of Alaska
All three lawmakers expressed skepticism with various aspects of Means’s public health perspective during her confirmation hearing. Shortly after Means testified, both Collins and Murkowski told Politicothey were undecided about how they plan to vote
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“These issues are important to me,” Murkowski said at the time. “Last year when the secretary was going through his confirmations, he made certain assurances about vaccines that in fairness I am not seeing have been kept.”
Cassidy, who cast the pivotal vote to confirm Kennedy as Trump’s health secretary last year, did so despite concerns about Kennedy’s anti‑vaccine history. Kennedy assured him he would not interfere with the ACIP’s membership. He subsequently reversed course, reshaping the department and sidelining career public health experts
Both Cassidy and Collins are also up for re‑election this year, adding political pressure as Republicans warn Kennedy’s shifts on vaccine policy could damage the party in the midterms. Cassidy – a former physician who chairs the health committee – is facing a primary challenge from Julia Letlow, a Louisiana congresswoman. Letlow is endorsed by Trump and backed by Maha Pac, which has pledged $1m to defeat Cassidy.
On Thursday, Letlow urged the two‑term incumbent to “stop blocking” Means’s nomination in a post on X, writing that “for too long, Washington has protected a healthcare system that waits until people are sick, cashes in on chronic disease, and leaves families to pay the price. President Trump is trying to change that, and Casey Means is a major part of that fight.”
Collins, meanwhile, is expected to face a competitive race against whichever Democrat emerges from Maine’s primary
Allies of the Maha movement have since tried to apply pressure onRepublican holdouts to confirm Means. On Wednesday, during a weekly organizing call with the political advocacy group Maha Action, the Republican senator Rand Paul, also a member of the health committee, told attenders to contact Cassidy, Collins and Murkowski. “We should have voted long ago,” Paul said during the call. He added that the three senators he named “have not been vocal in their support for her nomination”.
On the call, which the Guardian joined, Paul added that if Means’s nomination for surgeon general could not get the support it needs, then members who oppose her “should at least be on record as opposing her”
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