Senate committee advances Susan Monarez to be Trump's CDC director
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The committee's action comes after months of turmoil with no leader at the helm of the Atlanta-based federal agency tasked with tracking diseases and responding to health threats.
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The CDC has been hit by widespread staff cuts, resignations of key officials and heated controversy over longstanding CDC vaccine policies upended by Health Secretary Robert F. Kennedy Jr.
Last month, Monarez told senators that she values vaccines, public health interventions and rigorous scientific evidence, but she largely dodged questions about whether those positions put her at odds with Kennedy, a longtime vaccine skeptic who has criticized and sought to dismantle some of the agency's previous protocols and decisions.
'Unfortunately, Dr. Monarez — who has served as Trump's acting CDC director — has done nothing to stand in the way" of Kennedy's actions, Sen. Bernie Sanders, the Vermont independent, said Wednesday.
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The CDC was created nearly 80 years ago to prevent the spread of malaria in the U.S. Its mission was later expanded, and it gradually became a global leader on infectious and chronic diseases and a go-to source of health information.
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HHS further constrains certain vaccine advisers to the CDC, limiting their input in evidence reviews
In a further jolt to the process of reviewing and recommending vaccines at the US Centers for Disease Control and Prevention, another group of outside advisers to the agency was abruptly sidelined this week. In an email sent late Thursday evening, which was obtained by CNN, members of roughly 30 medical and public health organizations who serve as liaison members of the CDC's Advisory Committee on Immunization Practices, or ACIP, were told they could no longer participate in the committee's crucial workgroups. Liaison members don't vote at ACIP's public meetings on vaccine recommendations, but they can participate by asking questions and commenting on presentations. Behind the scenes, they have also historically done important work undertaking detailed evidence reviews of the safety and effectiveness of vaccines that helps to inform the group's votes. Those reviews happen in subcommittees called workgroups. As of late last year, ACIP had 11 active workgroups. In addition to studying scientific research, workgroups consider issues of public health importance like what age groups might get the most benefit from a vaccine, what an immunization costs and whether it will be accessible to people who should get it. Workgroups also help craft the language of the recommendations that are voted on by the full committee. Votes are typically held during ACIP's three public meetings each year. If ACIP approves a recommendation, it's forwarded to the CDC director for consideration. The director isn't bound by the committee's recommendation but usually follows it. Liaisons include groups like the American Medical Association, the American Academy of Pediatrics and the American Pharmacists Association. Members also represent nurses and public health officials, typically groups that play a significant role in delivering vaccinations. The latest move comes more than a month after US Health and Human Services Secretary Robert F. Kennedy Jr. removed all 17 voting members of ACIP, replacing them days later with eight of his own picks, many of whom have cast doubt on the safety of vaccines and public policy around vaccination. One member later dropped out during the required financial review. The email sent Thursday called the liaison members 'special interest groups' that are 'expected to have a 'bias' based on their constituency and/or population they represent.' 'It is important that the ACIP workgroup activities remain free of any influence from any special interest groups so ACIP workgroups will no longer include Liaison organizations,' the email said. Andrew Nixon, director of communications for HHS, said in a statement Friday that 'Under the old ACIP, outside pressure to align with vaccine orthodoxy limited asking the hard questions. The old ACIP members were plagued by conflicts of interest, influence and bias. We are fulfilling our promise to the American people to never again allow those conflicts to taint vaccine recommendations.' Dr. William Schaffner, an infectious disease expert at Vanderbilt University who has been participating in ACIP for 40 years as both a voting member and a liaison member, said the move to exclude professional organizations from the process of making vaccine recommendations was shortsighted. 'The organizations have a certain ownership in the recommendations because they participate,' Schaffner said. That participation increases buy-in from different stakeholder groups, which helps ACIP recommendations become the accepted standards of medical practice. Without that participation, Schaffner said, there's a risk that groups will make their own vaccine recommendations, which could lead to conflicting and confusing advice. In fact, some outside organizations, including the Vaccine Integrity Project, have already started the process of making independent vaccination recommendations. Shaffner said he also takes issue with the idea that liaison representatives are biased, which he says implies a conflict of interest. 'Every work group member, no matter who they are, is vetted for a conflict of interest,' he said, and that vetting process has only become more stringent over time as society has become more attuned to the problem. 'I have to turn down opportunities because they would interfere with my being on a work group, and that's something I do, or did,' he said. ACIP's charter spells out that some 30 specific groups should hold non-voting seats on the committee. It also allows the HHS secretary to appoint other liaison members as necessary to carry out the functions of the committee. On Friday, eight organizations that are liaisons to the committee said in a joint statement that they were 'deeply disappointed' and 'alarmed' to be barred from reviewing scientific data and informing the development of vaccine recommendations. 'To remove our deep medical expertise from this vital and once transparent process is irresponsible, dangerous to our nation's health, and will further undermine public and clinician trust in vaccines,' said the statement, which was sent by the American Medical Association. New outside experts may be invited to participate in the workgroups as needed based on their expertise, according to an HHS official who spoke on the condition that they not be named because they had not been authorized to share the information, but such inclusion will no longer be based on organizational affiliation. 'Many of these groups don't like us,' the official said. 'They've publicly attacked us.'
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