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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.
30 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.
With all due respect, the problem is not “imperfect covid recommendations.” The pandemic was a Chernobyl-level catastrophe for the CDC which exposed sloppy, arbitrary, and capricious decision-making, strong partisan political bias, and lack of scientific rigor. The botched rollout of testing in 2020, which put the US far behind other countries, was alone one of the greatest failures in the history of the US government – and not a single person has been held accountable. Add to that the massive economic and psychological damage done by lockdowns, the fabricated 6-foot distancing rule, school reopening guidance written by teachers’ unions, cloth masking toddlers, dishonesty on the safety and efficacy of the covid shots, rubber-stamping a covid-booster-for-everyone-forever policy in the absence of any data, and nakedly partisan policies such as suspension of evictions for 3 years masquerading as “public health” and you have the backlash that CDC is facing.
Add to this the fact that the CDC and other public health leaders declared that all this nonsense was “settled science” that we had to “follow” and that could not be challenged or questioned. They openly promoted censorship of those who disagreed and supported professional retribution to dissenters. And no one has apologized.
When good scientists are wrong, they acknowledge the errors and correct the scientific record. The US public health community has done nothing of the kind.
It is sad what is happening to the CDC, but it is not surprising to anyone who has been looking at the facts with an open mind. It is why a covid reconciliation is so important and why it was a mistake to just “move on.”
Thanks for your comment. We agree that CDC’s Covid actions were not all perfect, and that especially hindsight, some were now infamously wrong.
But they did their best under impossible circumstances, and to take down an entire organization with such dedicated practitioners for this is not only unjust, but it’s bad for them and for us.
I didn’t even mention the shooting, which one could argue the government’s actions have indirectly (if unintentionally) inspired.
So yes, I’m sad about it.
– Paul
Pretending that the alternative to the CDC was clear, compassionate, and evidence-based is revisionism. Many of the “solutions” promoted at the time, letting the virus spread under the banner of “freedom,” dismissing masks and vaccines, were also not science. They were ideology, and they have led to more preventable deaths, especially among the most vulnerable.
If we are going to talk about accountability, it has to apply across the board. Public health institutions must own their missteps, but so too must those who amplified pseudoscience and framed disregard for human life as a principled stance.
My interactions with the rank and file members of the CDC when I have reached out during Ebola, mpox and individual patients with rare parasitic infectious diseases showed their wide-open hearts and their knowledge–they cared so much for people they would never meet. My heart aches for this loss, and our patients will be worse for it.
Spot on, Dr. Sax. As well as devastating and, in reality, terrifying.
I agree. It is a scary era we are going back to. Our parents were relieved when Salk Vaccine was made available. We were very glad our children could have far more immunizations so they did not have to have most of the childhood illnesses. Having COVID vaccine not be recommended for children and healthy adults is horrible. We will have far more cases of COVID and risk another pandemic. Going back to the 1950s or earlier is not a good thing. It is sad a eulogy needs to be written for the CDC.
Thank you for writing this and all your comments over the years.
For decades, whenever the subject was infectious diseases, surveillance data, or vaccine applications and side effects, the CDC was the to-go global reference.
Will the situation get worse with more anti-science actions?
Joao Mauricio Campos
Brazil
Many thanks, Paul. Looking from abroad (Germany), many physicians and scientists are dismayed about the easiness with which this destruction of highly renowned structures occur. We are wondering, where the resistance against it remains. I am also wondering, how we would act if such things would happen in our country. I am not sure, that we would be more resistant, and I hope, that we learn from your experience that prevention is utmost important – as always in ID.
The CDC are now completely irrelevant and lost all its credibility over night. Not a single word coming out of the CDC can be trusted from now on. It’s shocking how quickly Trump and his cronies are tearing down world leading institutions.
SAD
CDC is a US institution with global reach. Although we are based in Europe, we were looking at CDC for all information Dr Sax describes. The scientific community in the US (and why not Europe?) must collectively react to what is happening in CDC in the strongest way.
Dr. Sax,
As usual, you provide a rigorous analysis of the present illness and an indisputable diagnosis. However, if one of your fellows were to stop there and offer absolutely nothing in the way of potential therapeutics, I suspect you would be deeply troubled. This is not a situation where your readers should be left in helpless partisan resentment. Strenuous activities are underway to save American public health, using exacting data-driven methods, and your readers should be aware how to support these efforts. See below for some examples. The patient may be in the ICU but there’s no reason for us, of all people, to declare DNR and walk away.
Charley (CDC 1988-2017)
https://www.cdcdataproject.org/
https://firedbutfighting.org/
https://www.msn.com/en-us/health/medical/15-photos-from-cdc-rally-for-officials-who-quit-over-rfk-policies/ar-AA1LrIyy
Dr. Sax, your post is spot on and, I fear, not alarmist enough. As you point out, nothing is perfect in science (one could say that about many things in many industries) and that responsible people making best efforts, using the most accurate information available, in trying to save as many people as possible has been the CDC’s mantra. Would the writer above feel better if the CDC apologized for the mistakes that were made? Does that solve the core problem with how this new version of HHS has systematically taken down all of the safeguards that have been so carefully and responsibly put in place over many decades. I was at a dinner party the other day and a 30-something year old jokingly said, he’s looking forward to getting the measles. Dark humor indeed. I don’t often agree with Bernie Sanders, but his most recent op-ed in the NY Times calling for Kennedy’s ouster was overdue. Shame on the Senate for confirming him in the first place.
This makes me think back to the 2011 film “Contagion,” a well-researched and scientifically plausible thriller in which a global respiratory virus pandemic far worse than COVID comes close to destroying humanity. It would have, had it not been for a strong public health infrastructure, vaccine research, and the CDC, all of which are now being destroyed by idiots and ideologues. Rewatch the movie (including the crucial scene after the credits). It will terrify you.
Thanks Paul. Agree with you. I just had a meeting with 1st year med students who are already excited about medicine and caring for patients. They are aware of the chaos emerging in health care with latest examples being the attacks on the CDC and mRNA therapeutics research. They are looking to us for help with advice and response. Best wishes,
We should not just eulogize the downfall of the CDC, but we all need to actively FIGHT against these atrocities. You can’t win unless you unify.
Paul is completely right here but understates the situation and malevolence of the people who have taken over HHS and our federal government. Read link below for the full resignation statement of Demetre Daskalakis MD MPH who was Director of the National Center for Immunization and Respiratory Diseases at CDC who “sees only harm coming”
https://x.com/dr_demetre/status/1960843433473376602
Great article. Unfortunately a lot of the problems with the CDC was inaction and politics that made policies seem worse. I find it interesting that the book “the great influenza” in its last chapter basically lists what would happen with a pandemic. Nails it so consistently and predicted the government in action b/c of politics. Played out just like they said. The voice of reason that was ignored was mostly the CDC. Then what happened? The CDC got the blame. Unfortunately, today alone my partners (PCPs) and I probably spent an hour each correcting misinformation coming out of the political establishment for which well intentioned and well educated people are leaving because political appointees and pressures. Hopefully we can reverse course. I find it sad that I have to download data and take screen shots of things before they disappear on the CDCs website and are replaced by political and uneducated opinion.
Reading this from Europe, the sadness you describe resonates — though perhaps with a different flavor. For decades, the CDC wasn’t just America’s public health compass; it was an international point of reference. When we in Europe needed quick surveillance data on HIV, influenza, dengue, or some obscure arbovirus, the CDC site was often the first stop. Even if we had our own agencies — ECDC in Stockholm, national health institutes in Paris, Berlin, London, Rome — the CDC was still a pillar, and its guidance carried global weight.
COVID changed that. From here, what we saw was not just the struggle of an institution dealing with a new virus, but an institution caught in the middle of America’s political and cultural civil wars. That’s what was most striking to European eyes: the way every shift in guidance became politicized, weaponized, and spun into accusations of betrayal. It was painful, because those of us working in medicine and public health understood that shifting recommendations are the nature of science. Still, we watched the CDC’s reputation unravel in real time, dragged down by forces far larger than virology.
At the same time, let’s be honest: the CDC did stumble. Messaging was inconsistent; airborne transmission was recognized late; mask guidance was muddled. That didn’t look much better from Europe than it did in the U.S. But many of us interpreted those changes as the messy but necessary process of science in crisis, not as proof of corruption. The real difference was that here, despite our own mistakes, the backlash never reached the same fever pitch. There was criticism, yes — but the wholesale dismantling of trust in public health institutions was uniquely American in scale and ferocity.
From a European perspective, the tragedy is double. First, America’s internal fights have weakened an institution that the world relied on. Second, the damage bleeds across borders. When the CDC is undermined, global public health is undermined — because diseases don’t stop at passport control. And while we have the European CDC and national agencies, the loss of a strong, credible CDC leaves a vacuum.
In the end, the pandemic reminded us all that perfection is impossible when navigating a new pathogen. No one — not the CDC, not the WHO, not our national institutes — got everything right. The difference lies in what happens afterward: do we use those failures to strengthen our systems, or do we punish them into paralysis? From Europe, the sight of America choosing the latter is not only heartbreaking, it’s dangerous for everyone!
IMO, the politicization of science has been one of the worst consequences of COVID. A large amount of people now believe that one’s acceptance (or not) of scientific theories depends on their political ideology, and not on how well-founded those theories are.
Between this and how political extremism is on the rise, with a very strong polarization between two sides who cannot accept each other, I have less and less hope for the future every day.
We have managed to go through a global pandemic and end less prepared for something similar in the future (as the destruction of CDC shows so well). This is both unbelievable and catastrophic.
The pandemic was just an excuse, Trump had the CDC in his crosshairs right after taking office.
June 2017 : The Centers for Disease Control and Prevention (CDC) would lose 17% of its budget, a cut of $1.2 billion. This news prompted former CDC Director Dr. Tom Frieden to take to Twitter and rebuke this “assault on science” that will “devastate” programs that protect Americans from many deadly conditions, including diabetes, heart attacks and strokes. He noted that the cuts would give the CDC its lowest budget in 20 years and lead to an increase in illness and deaths.
Making a mistake in biological science shouldn’t result in people being silenced, censored, outcasted and having their job taken away while being under attack from everyone including their own family because of propaganda and hysteria created by mainstream media collaborated with the government and CDC. Lives are ruined. This is literally a crime against humanity. To this day there is no justice.Those who were pro vax extremists got to move on as nothing happened just like the Nazis thought they could move on from the holocaust. All your good work CDC in the trash and that’s on you people. The institution needs to be undone and rebuilt from the ground up because a severe failure on society took place. A sorry means nothing because people with no special degree in medical science could easily discern what needed to be done but the ‘experts’ couldn’t figure it out that was a massive failure. It was so blatantly obvious and with such divisive hatred and dehumanization that the intentionality appeared sinister. If they just said whoever wants this vaccine and the elderly need it most then have it. But it was forced with the threat of punishment and people don’t trust world governments because they’re corrupt and evil misleading us with the media. The state of emergency was exaggerated to the point of collapsing the economy on purpose. I could go on and on and I’ll never forget about this ever.
I suppose you feel that > 1 million deaths in the USA over 2 years is an “exaggeration.” You were obviously nowhere near the packed EDs with gasping and dying people with no definitive approaches to treatment yet to be developed. And you should be ashamed of comparing vaccine mandates to the Nazis and the Holocaust, where there is no equivalence. You do understand the purpose of the Holocaust was to slaughter people, and the purpose of vaccination mandates was in the hope of saving lives from a never-before-seen virus causing a pandemic of devastating proportion. You owe readers an apology for your crassness.
Anyone who casually invokes Godwin’s law cannot be taken seriously.
It is wonderful to see that there are issues being brought up that we rarely see in the news or these forums such as the cutting of public health budgets and lack of attention to infection control in general. In addition, it should be noted that the CDC had no spokesperson early on that was allowed to comment on the pandemic and it was effectively muzzled despite the best efforts of Drs. Fauci and Birx. Members of professional societies like IDSA and SHEA were engaged to help get their message out.
At the time, most infection control and public health personnel were still consumed with developing pandemic planning related to Ebola. In late January 2020, many of us began to develop a potential plan for control of COVID-19 should it spread in the US based on the information what was available on pandemic influenza, human coronavirus, SARS-1 and MERS outbreaks. Those epidemics ended fairly promptly with respiratory isolation procedures.
Even so, implementing infection control procedures in March 2020 was like drinking from a fire hydrant. Decisions were made based on the information we had at the time. Many meetings were held, and recommendations changed on at least a daily basis. Staff sought advice about themselves, their families, and research proposals. Guidance documents, often conflicting, from government, institutions, and professional societies came later, much later. Alot of time was spent translating guidance into simple language that could be understood by all of our staff and consistently implemented. More meetings to explain why changes were made and input was sought.
Our goal was to keep our patients, staff, and families safe. Many patients and one staff member died; some staff became ill and never returned to work. After every holiday, we came to anticipate that staff hospital cases would increase 2 weeks later. Opening our family home-away from home facility and increasing inpatient visitation made decision making that much more complex.
Based on experience with human coronaviruses, who would have predicted that COVID-19 would mutate as rapidly as it did? Hopes that vaccination and herd immunity would rapidly end the pandemic were dashed. Surgical masks were shown to be as effective as N-95s with SARS-1, so why was airborne spread so prominent with COVID-19?
Needless to say, none 0f the measures that I anticipated using against COVID-19 in January 2020 were in place at the end of the pandemic. I had one infection control practitioner working with me through the worst of it and we were fortunate that we didn’t get ill despite being at the hospital M-F. When I look at these forums, images of those days, that I’d just as soon forget, come flashing back. I’ve been reluctant to put my experiences in writing knowing that some armchair quarterback will find something to criticize. I suspect there are others with similar experiences who don’t want to revisit those days, but it is time to speak out.
You are right. It is tragic and disheartening.
Baby and bathwater. I hope we learned something from the pandemic, but to use that unfortunate catastrophe to weaken and destroy its influence would be another catastrophic phenomenon. Correct and improve this valuable agency. Don’t listen to the witch doctors and shamans. And, for God’s sakes, DEPOLITICIZE!!