A director for an agency without a spine

THE SENATE is set to vote on confirming Dr Erica Schwartz as director of the Centers for Disease Control and Prevention. The vote is expected to mark an end to a revolving-door vacancy that left America's top public-health agency without a permanent leader for almost all of Donald Trump's second term. Dr Schwartz is a career civil servant with a distinguished record in the United States Public Health Service. She is, by most accounts, the right person for the job. That does not make the job easy. What makes it harder is the agency she would lead.

Since Mr Trump took office in January 2025, the CDC has been systematically hollowed out. Approximately 1,300 employees-roughly 10% of the workforce-were fired on February 14th 2025 in a government-wide purge of probationary staff. A further round of layoff notices in October 2025 targeted another 1,300 workers, though more than half were subsequently reinstated after legal challenge. Between cuts, resignations, retirements and contract non-renewals, the CDC has lost between a quarter and 30% of its workforce. About 80% of its senior leadership positions remain without permanent appointees. A survey of more than 600 current and former CDC employees conducted by researchers at Michigan State University found that 99% said the administration's changes had reduced the agency's capacity to respond to a public health emergency. Among current workers, 85% reported burning out.

The damage is not merely bureaucratic. It is showing up in disease counts. The CDC confirmed 2,318 cases of measles in America through July 24th this year, surpassing the total for all of 2025-when 2,289 cases represented the worst outbreak since 1991. The country is on course to lose its measles-elimination status, which it achieved in 2000. The vast majority of cases involve the unvaccinated; 93% of patients this year have unknown vaccine status or have not been vaccinated. Two doses of the MMR vaccine are 97% effective. The arithmetic is straightforward. At the same time, 6,707 laboratory-confirmed domestic cases of cyclosporiasis-a gastrointestinal illness caused by a food-borne parasite-have been reported since May 1st, affecting 45 states, with more than 11,500 additional cases under investigation. The CDC has identified one multistate outbreak cluster linked to iceberg lettuce, but the source of the broader increase in cases remains under investigation. An Ebola outbreak in Central Africa is expanding, at a time when the CDC's deployable roster of infectious-disease experts has been sharply reduced.

Dr Schwartz's confirmation, if it occurs, would do nothing to reverse these trends. It would give the agency a face. It would not restore its capacity, or its authority.

The constraint is political as much as demographic. Dr Schwartz will work under Robert F. Kennedy Jr, the health secretary, whose tenure has been defined by a campaign to dismantle decades of vaccine policy. Mr Kennedy proposed spending $5bn-more than a tenth of the National Institutes of Health's annual budget-studying a link between vaccines and autism that has been comprehensively refuted by every major study. He attempted to remove vaccines for six out of 17 diseases from the recommended childhood immunisation schedule. He replaced the entire Advisory Committee on Immunization Practices, the CDC's principal vaccine-advisory body, with members who shared his scepticism.

To be sure, Mr Kennedy has not succeeded in everything he has tried. A federal judge in Boston blocked his changes to the vaccine schedule and his replacement of the advisory committee in March 2026, ruling that the decisions were arbitrary and capricious and that the government had "disregarded" established scientific methods, thereby "undermining the integrity of its actions". The administration has said it will appeal. Mr Kennedy also reportedly agreed to avoid talking publicly about vaccines after senior White House aides warned that his rhetoric was creating political damage. But behind the scenes he has continued to push his agenda, and the political interference with the CDC's scientific mission has not ceased. Internal emails obtained by Senator Bernie Sanders show that senior officials at HHS told CDC leaders to require "political review of major policy decisions" and to "err on the side of caution." The previous CDC director, Susan Monarez, was fired in August 2025 after refusing to accept this interference. Multiple senior leaders resigned in protest.

This is the structure Dr Schwartz would inhabit. She is qualified. She is a retired rear admiral with degrees in medicine, law and public health. She served as chief medical officer of the Coast Guard and as deputy surgeon general in Mr Trump's first term. Public-health veterans say she has the credentials, the integrity and the communication skills for the role. Dr Georges Benjamin, head of the American Public Health Association, welcomed the nomination. But competence at the top does not compensate for a decimated workforce, a political boss whose agenda contradicts the agency's scientific mission, and an organisation whose decision-making is subject to political review from an office whose leader has shown no interest in evidence-based public health.

The real question is not whether Dr Schwartz is the right person. It is whether the CDC can function as a public-health agency when its chain of command leads to someone who regards its core mission-promoting vaccination, tracking disease, advising the public on the basis of epidemiological evidence-as something to be curtailed. The courts have provided a partial brake. They cannot rebuild an organisation. That requires staffing, leadership, autonomy and trust. None of those are being restored.

The better answer would be to separate the CDC from political interference by statute. Congress could insulate the agency's scientific advisory bodies from appointment-and-removal power at the secretary's discretion. It could require that major public-health communications be based on peer-reviewed evidence and not subject to political review. These are not radical ideas. They are the kind of institutional safeguards that keep public-health agencies functioning across administrations. The fact that they have not been proposed suggests that no one in power particularly wants them.

Dr Schwartz's confirmation would be a step. It would not be the step that matters. An agency with three-quarters of its original staff, little senior leadership and a boss who distrusts its foundational science needs more than a director. It needs a spine. That would have to come from Congress. Whether Congress has the will is another question altogether.