An ongoing dialogue on HIV/AIDS, infectious diseases,
August 29th, 2025
Watching the Chaos at the CDC — with Sadness and Alarm
Image by Jackson Moccelin from Pixabay
Throughout my career as an infectious diseases doctor, the CDC has been a rock-solid source.
- Need reliable data on an outbreak? The CDC.
- Need thoughtful, evidence-based guidelines? The CDC.
- Need an authoritative reference for a consult question or to steer a colleague or trainee to the right place? The CDC.
- Need the latest, most accurate surveillance information on HIV or influenza or dengue or you-name-it? The CDC.
- Need advice for your friend doing anthropology research in rural Bolivia and wondering whether they should take malaria prophylaxis (yes), and what it should be (multiple options)? The CDC.
Did I always agree with every word? Of course not. Show me an ID doctor who always agrees with every guideline, and I’ll show you a cephalosporin that covers enterococcus.
For example, for years I’ve thought we’re too aggressive with “bat in bedroom, no bite” postexposure prophylaxis, preferring the Canadian approach. But I never doubted the people making the U.S. guidelines had done their homework with integrity; they weren’t part of some sinister rabies vaccine/immunoglobulin cabal. It was a difference in opinion, that’s all.
And I trusted the people. The ones I’ve known who have worked at the CDC are mission-driven and incredibly hard-working. They’re not looking for fame or fortune, to cultivate a brand, or to make a splash in the media. You don’t expect to see a TikTok video from a CDC official. They’re the kind of colleagues who disappear into data sets, surveillance reports, and fieldwork, all in the service of preventing disease and saving lives.
So what happened?
In a word: COVID. The pandemic was the public health earthquake of our lives, and the aftershocks continue. The CDC is one of its casualties. Instead of learning from missteps and strengthening the institution, we’re watching it be weakened — deliberately, in some cases, and it seems with pointless vengeance. The critics who scream the loudest treat it as if every imperfect COVID recommendation, every adjustment of guidance in real time, every policy now viewed as incorrect with 20-20 hindsight, was a betrayal and not a best effort to help us cope with this new, tricky virus.
Let’s acknowledge that perfection was impossible in the face of an unprecedented global crisis. Guidance had to evolve, sometimes rapidly. To punish the agency now is like telling tennis star Carlos Alcaraz he can’t compete in the U.S. Open because he lost in the Wimbledon finals.
Yes, the stakes were high during COVID, but nobody — NOBODY — got it 100% right.
The result? One of our most reliable public health institutions is being destroyed by non-experts in medicine and public health. People with disturbing beliefs about infectious diseases in general and vaccines in particular. And who knows what the next year or years will bring? Who will we turn to then?
For those of us who have leaned on the CDC our entire careers, watching its destruction at the hands of non-experts is not just disorienting — it’s heartbreaking, and makes me very, very sad.
5 Responses to “Watching the Chaos at the CDC — with Sadness and Alarm”
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Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
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Thank you for a eulogy. It needed to be said. But COVID is just a pretext.
We European physicians are astonished by the destruction of the CDC, which we used frequently for rapid scientific orientation. We fear it will happen in many European countries as well, albeit with some delay. I hope that at least some countries in the EU will save their scientific integrity.
Pter Kardos MD
Germany
Mimi Breed is exactly right about the COVID pretext. As much as COVID illustrates and is emblematic, the real problem is the whole anti-intellectual milieu pervading the country. We now live under an evil dictatorial kakistocracy, divorced from reality.
I meant that Covid gave license to all their anger. Gives them a “justification” for acting on their worst anti-intellectual impulses, because they can point to things that the agency “got wrong” and claim it validates all their cruel and destructive actions.
-Paul
I agree. Thank you for writing this and for all you do. I fear we are hurtling towards a major resurgence in the incidence & prevalence of preventable infectious diseases and the harms they cause. It does not have to be this way. Alas.