After CDC Director Is Ousted, More Senior Officials Resign

FLORA LICHTMAN: Hey, I’m Flora Lichtman, and you’re listening to Science Friday. Before we get going, we are kicking off one of our favorite “cephalobrations” of the year. You got it, Cephalopod Week. And you can get in on the party by sponsoring virtual cephalopods. When you donate $8 or more– that is a tentacle shout-out– you’ll have the opportunity to choose from eight beautifully illustrated sea creatures, which we’ll post on our Sea of Support web page along with your first name.

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Today on the show, checking in on the CDC.

DEMETRE DASKALAKIS: When you see that folks aren’t listening to scientists, not listening to experts, but are rather trying to make decisions without science, that’s when harm begins.

FLORA LICHTMAN: We’re checking in on the Centers for Disease Control and Prevention. Last week, Secretary Kennedy and the White House fired the CDC director after only a month in the job. Right after, several other senior leaders resigned from the agency, including Dr. Demetre Daskalakis, an infectious disease physician and former director of the National Center for Immunization and Respiratory Diseases at the CDC.

Demetre, welcome to Science Friday.

DEMETRE DASKALAKIS: Thank you so much for having me.

FLORA LICHTMAN: OK, so you spent five years at CDC. You led the COVID vaccine task force. You became the head of immunizations. You were a civil servant for most of your career. You resigned a week ago. Was it a difficult decision?

DEMETRE DASKALAKIS: Yeah, I mean, I think that the actual action of resigning was one of the hardest decisions I’ve made in my life. I’ll say, however, my justification for resigning, that wasn’t ambiguous.

FLORA LICHTMAN: Tell us a little more.

DEMETRE DASKALAKIS: Yeah, I mean, I worked in local public health during probably one of the most consequential moments in public health history, was in New York City during the beginning of COVID-19 in January 2020, where I was the incident commander. That meant being in charge of the public health response for the Department of Health and Mental Hygiene. I’ve run responses for Legionella, which is so complicated; for measles. And I’ve worked with folks who are politically appointed or elected.

It’s always one of the most amazing parts of a job of a public health person, to be someone who’s a scientist who’s able to discuss things with folks who are non-scientists, to get them to the place where they understand what you’re saying. And so that tends to mean bidirectional interaction. But I was never able to brief Secretary Kennedy. I’ve never met the man. I never knew what was coming.

I hear about directives that have no material to back them up. I hear one thing being said in the media that doesn’t correlate with what the science says, like use vitamin A to prevent measles as opposed to vaccine, all that stuff. Eventually, you get to the place where you’re like, I just can’t– I can’t really function. And then when you see that folks aren’t listening to scientists, not working with them to meld where science and policy meet, but are rather trying to make decisions without science, that’s when harm begins, and I couldn’t be there anymore.

FLORA LICHTMAN: What is the state of the agency now?

DEMETRE DASKALAKIS: I’m going to use exactly the terminology that Secretary Kennedy used. I think that CDC is in trouble. He cites the trouble being on the inside, and I cite the trouble being on the outside. So I think that CDC is in trouble because it’s been stripped of scientific leadership.

Like, forget me, that was my choice to leave. But with no CDC director for Lord knows how long, or potentially a CDC director with no scientific background, I think that we’re in a dire strait as long as we continue to dehumanize experts, say don’t listen to the experts, and continue to run the agency as if though it’s a hedge fund or a battery company.

FLORA LICHTMAN: I mean, you were the former head of immunizations. In your opinion, can we trust CDC guidance now?

DEMETRE DASKALAKIS: I fear to say that. Unless something changes radically, I would question all of the recommendations coming out of CDC, especially in vaccine space. Go to your trusted source, which, in my opinion at this point, needs to be your medical provider, your pediatrician, your internist, your pharmacist, whoever takes care of you or you can access to ask questions because I don’t know what’s going to come out of the agency in this space.

FLORA LICHTMAN: That’s a shocking thing to hear.

DEMETRE DASKALAKIS: But I’m not the only one who said it. I mean–

FLORA LICHTMAN: No, I know.

DEMETRE DASKALAKIS: –this Is not a commentary on the science or the scientists, it’s the commentary on the political leadership that seemingly would prefer to wrestle ideology onto the American people rather than science-based recommendations.

FLORA LICHTMAN: I want to talk about how these changes at the CDC are going to impact and are impacting Americans.

DEMETRE DASKALAKIS: Yeah.

FLORA LICHTMAN: In your view, what are the risks or dangers to people listening to this show right now because of these bureaucratic changes?

DEMETRE DASKALAKIS: Right now, what the risk is, is that if there are people who have no specific expertise in pediatrics, public health, immunization, who are influencing decisions around vaccines, those decisions have ramifications for how people could access vaccine. Just in the last week, we saw that, based on the regulatory actions at FDA, people aren’t going to be able to get vaccines easily in their pharmacies for COVID-19. More of that is coming.

These aren’t pointy-headed policy decisions. If the Advisory Committee on Immunization Practices– it’s the vaccine committee that advises the director of CDC on how to make policy for vaccines– if they say the vaccine should no longer be administered to children, and if the CDC director or their equivalent signs off on that, that means that insurance will no longer cover that vaccine. It means that there may be implications for the manufacturers, in terms of the market, to be able to keep making it. It means that there may be some problems with providers feeling comfortable providing the vaccine, from the perspective of liability.

With one swipe of the pen, what would happen is that you would limit access to people. So what this should read to people is not that we are potentially increasing freedom by making vaccine recommendations more constricted, but in fact, the opposite is happening, where you’re going to limit access so people have no choice. I believe in the science behind vaccines. I am a skeptic of vaccines, which is why I ask all the questions that I do in the spaces that I’ve been in. But I really think that if there’s no access, there’s no choice. And that’s really what’s at stake.

The other part of that, though, as well, is that even if there’s not a problem with access, all of this chaos that’s being created by the secretary is going to mean that people won’t know what to do. Doctors won’t what to do; they won’t where to look for guidance. Patients will be confused. And, both from the perspective of destabilizing confidence in vaccines and destabilizing access, for people on the ground, that means more diseases that could be prevented; more times where a kid is going to end up in the hospital instead of spending time with their parents on a holiday; more opportunities for an older adult to be admitted to the hospital because of something that could have been prevented.

FLORA LICHTMAN: Where do we go from here? Is it now the job of local governments of states to step in?

DEMETRE DASKALAKIS: So I think they have no choice. The states are going to have to step up. And I think we’ve seen a coalition of states on the West Coast and a coalition of states in the Northeast already forming because they’re starting to not have trust in federal public health to be able to execute on what they think is important for public health.

FLORA LICHTMAN: These are states who are getting together and saying, OK, we’re going to come up with our own immunization guidelines and we’ll protect vaccine access in our states.

DEMETRE DASKALAKIS: And even like, and we’re going to figure out how to purchase our own vaccine separately. They’re doing all of these things. And what that is going to do is, for the states that have elected to do that, great. The states that are resourced to be able to do their own thing, great. But there are going to be states that are not resourced in the same way, that may not have the political will to join in alliances.

And that’s going to mean have and have-not in the United States from the perspective of equity. And by equity, I don’t mean buzzword; I mean equity with a capital E, which is what all public health is. And that means making sure that people are able to achieve their maximum health despite where they live in society.

FLORA LICHTMAN: Well, you’re also seeing states, on the other hand, like Florida, who said this week that they are going to work to eliminate all vaccine mandates.

DEMETRE DASKALAKIS: Yeah.

FLORA LICHTMAN: And the argument is that the government should not tell you what you have to put in your body. What do you make of that?

DEMETRE DASKALAKIS: Yeah, really important to say that states make their own decisions. Also important to say that a sort of announcement from a podium does not then mean implementation is happening tomorrow. I think that there’s a lot of steps to get that recommendation over the finish line, or that plan over the finish line. So this is an example of a policy that, no matter how you cut it, is going to potentially mean that fewer people are vaccinated. And that’s going to manifest itself as more disease.

It’s up to Florida. Like, being a federal government person, you can’t really tell people what to do in the state. So this is their decision. It’s not the decision I would recommend, and it is also a decision that will undoubtedly result in vaccine-preventable diseases. Measles may become an everyday part of life in Florida; polio may as well. And so this policy decision will likely mean fewer people will be vaccinated, especially kids, and that opens them up to vaccine-preventable diseases that could lead to illness at best, disability, death at worst.

FLORA LICHTMAN: This is a big question, and I apologize in advance. But there was a shooting at CDC last month. I understand that the bullets went through your window. You weren’t there, fortunately.

DEMETRE DASKALAKIS: Yep.

FLORA LICHTMAN: Demetre, how did we get to a place where science and scientists are quite literally under attack?

DEMETRE DASKALAKIS: I think that the dehumanization of scientists that’s occurring in the rhetoric that’s coming from leadership in science in the US, that’s gone into this sort of mass consciousness of America. And the people that I work with at CDC, they live and breathe just to make sure that the health of the people they serve is protected. That’s all they do.

Public health folks that do applied public health, they’re the ones that make sure that there’s vaccines in your pharmacy, vaccines in your doctor’s office. They’re the ones that make sure that there’s Narcan available in your jurisdiction so you can not have people dying of overdose. It’s the things, the invisible things that you never know are happening unless you need them. And that’s the thrill that everyone gets in working in public health. So vilifying and dehumanizing the people means that you don’t realize that people just like you next door are doing the work to keep you healthy.

FLORA LICHTMAN: Do you see a path out? Do you see a way to restore trust in science?

DEMETRE DASKALAKIS: I think that this is where a leader steps up and says, mistakes have been made, there are things that we need to improve, and let’s do this by building and not destroying. The opportunity for leadership is to stop the rhetoric and focus on the science and redirect this back to what it’s supposed to be, which is to protect the health of American people, rather than be a tool to please a base.

FLORA LICHTMAN: And presumably there are things to fix and change, right?

DEMETRE DASKALAKIS: 100%. Everybody agrees. Oh my gosh, everybody in public health wants to make it better. You can’t do it for free. You can’t make it better for free and cut 2,000 staff, right? You can’t slash and burn and then expect for it to function. There needs to be more rationality, and there needs to be a plan.

And so, where’s the plan– That’s a great question for HHS, like, where is your big plan? Other than gold standard science rhetoric, radical transparency rhetoric. It’s a lot of words and no plan.

FLORA LICHTMAN: Dr. Demetre Daskalakis is the former director of the National Center for Immunization and Respiratory Diseases at the CDC.

Today’s episode was produced by Rasha Aridi. But a lot of folks help make this show happen every single week, including–

SPEAKER 1: Annie Nero.

SPEAKER 2: Jason Rosenberg.

SPEAKER 3: Shoshannah Buxbaum.

SPEAKER 4: Sandy Roberts.

FLORA LICHTMAN: I’m Flora Lichtman. Thanks for listening.

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