Former CDC Director, Rochelle Walensky: “Here’s What to Know About What’s Happening to Our U.S. Health Agencies—and Why Doctors and Scientists Are Worried”

It happens every week. An unexpected phone call or email from a family member, colleague, friend, and even friends of friends telling me some version of this: “My enter name of loved one has just been diagnosed with enter name of terrible disease.” What follows is a plea for help—an urgent request for a referral to the best specialist, an appeal to find the leading scientist who might offer hope based on a newest discovery or therapeutic. 

Whether you’re the one making the call or the one answering it, in that moment, your only wish is that medicine and science have advanced far enough to save a life. With the current changes happening at our nation’s premier health agencies, I fear we are taking steps in the wrong direction, ultimately destabilizing US science and demoralizing its dedicated talent pool.

I am an infectious disease clinician, drawn to this field by what I witnessed during my training in the mid 1990s: A generation dying of AIDS. Over time, my research turned to HIV-related policies on drug costs, access to care, and the value of treatment. As a professor at Massachusetts General Hospital and Harvard Medical School, I never imagined I would be called to become the 19th Director of the US Centers for Disease Control and Prevention (CDC). And I certainly did not anticipate seeing myself serving in that role during the largest pandemic of our lifetime.

When I received my CDC business cards, the numbers “24/7” appeared boldly on the back—a stark reminder of the CDC’s never-ending mission to safeguard the health, safety, and security of all Americans and, by extension, people around the world. Though I was deeply familiar with the CDC’s infectious disease work, I quickly came to understand the agency’s vast scope—from tracking rabies in imported dogs and the health of miners and fisherfolk to the surveillance of emerging outbreaks in over 60 countries.

The paradox of public health is that when it works as it should, it remains invisible. No headlines, no crises, just silent prevention. Most of the time, that’s exactly what happens. 

As the Director of the CDC from 2021 to 2023, I had a front row seat to the US public health agencies. Now, from the sidelines, I am witnessing the world’s premier US public health agencies in the news once again. This time, the news is not predominantly about the next crisis they are heroically tackling, but instead it is about their undoing. Like so many of my peers who have devoted their entire careers to science and medicine, I am distressed every time I see a headline about the indiscriminate undermining and dismantling of our public health agencies. Doctors and scientists are profoundly worried. Here are just a few reasons why.  

Our health agencies study and recommend vaccines to prevent infection and even eliminate diseases.

In my 25 years of clinical practice, I have encountered only one case of measles. The patient was exposed in an airport terminal two hours after the “index patient”—the first identified case who had measles—had departed. The two never encountered one another. That is how contagious measles is. 

We know this disease requires vaccination rates (or immunity from prior infection) exceeding 95 percent to maintain robust and reliable community protection—what’s referred to as “herd immunity.” The CDC is in the vaccine business; the agency evaluates their benefits and risks, determines the populations in whom to deploy them, and rolls out campaigns for their implementation.  

In recent years, vaccination rates among US kindergartners have declined, with national coverage falling below 93 percent—a fall from 95 percent pre-pandemic. Even this modest drop results in consequences that are becoming alarmingly clear.

The epicenter of the current measles outbreak is Gaines County, Texas, which has the lowest kindergarten vaccination rate in west Texas, hovering around 82 percent. As I write this, there are 90 confirmed cases, and some estimates suggest as many as 200 to 300 additional infections. Notably, most of those affected were unvaccinated. This is a big deal: Beyond the serious infectious complications that can result from measles, such as pneumonia, brain inflammation and death, contracting the disease can result in a weakened immune system and, for pregnant women, birth defects in an unborn child. Prior to a widely available vaccine, measles resulted in 400-500 deaths in the US annually, mostly children, which is more than twice the current number of annual pediatric deaths due to influenza. 

For decades, Americans have had the privilege of debating vaccine safety, not because they faced the horrors of these diseases, but because vaccines had made them nearly disappear. Tragically, that tide is turning, and we are becoming reacquainted with the morbidity and mortality resulting from those very diseases vaccines have the capacity to prevent.

Public health servants dedicate their careers to tracking deadly diseases. Firing them leaves all of us exposed.

Over the past year, one of the most alarming health threats has been the evolution of H5N1—commonly known as “bird flu” or “highly pathogenic avian influenza (HPAI).” This strain of the flu remains largely unfamiliar to the human immune system, and many experts are saying H5N1 has significant pandemic potential.

Since 2022, the virus has increasingly been detected in wild birds and has since spread to commercial poultry, nearly 1,000 dairy cattle herds across the country, and an expanding array of other animal and human hosts across the country. The outbreak has had wide-ranging consequences, from soaring egg prices to the first reported death of a patient in Louisiana, who was exposed to H5N1 by a backyard flock.

Our federal health agencies work together to prevent bird flu and control outbreaks when they occur. This is just one of many examples of the work performed tirelessly by federal agency employees—work that doesn’t end at the U.S. border. 

 Take Ebola, for example, a deadly virus that belongs to a family of viral hemorrhagic fevers, alongside similarly lethal diseases like Marburg, Rift Valley Fever, and Lassa Fever. Thanks to the vigilance of trained local communities and the tireless work of many dedicated employees at the CDC, the WHO, and other US and international partners, these diseases are largely contained within Africa. Yet outbreaks continue to occur and remain one flight away from spreading diseases across the globe. During my tenure as CDC Director, we faced at least two Marburg outbreaks and one Ebola outbreak, the latter claiming 77 lives.

As we all learned from HIV/AIDS in the ’90s, a threat anywhere is a threat everywhere. In an interconnected world, no country can tackle these dangers alone. Right now, an Ebola outbreak in Uganda and Marburg outbreak in Tanzania are resolving, thanks in part to the WHO, which allocated $5 million so that these contagious diseases can be rapidly contained and do not reach us here in the US or anywhere else around the world.

This is what partnership looks like. This is what global solidarity demands. 

Deep funding and staffing cuts threaten the next generation of scientific leaders—and the big breakthroughs they’re working on.

The National Institutes of Health (NIH) boasts 174 Nobel Laureates among its investigators and grantees. Its work has transformed medicine. Today, a person with HIV can expect a normal lifespan—an unthinkable reality when I was in training. Pediatric leukemia, once a near-certain death sentence, now has a cure rate exceeding 90 percent, which is a dramatic leap from its cure rate of less than 10 percent just decades ago.

Throughout my entire research career, I was funded by the NIH. Make no mistake, the grant process is brutally competitive. Funding rates at some institutes hover below 10 percent, which means that on average, a researcher must write 10 grants—each totaling 100 to 200 pages—just to be awarded one. Even then, securing funding can take more than 1.5 years from the submission of the initial application.

These odds are not for the faint of heart. They are for the scientifically determined, the relentless seekers of discovery, the ones who strive to have the answer when a loved one makes that desperate call about a terrifying diagnosis.

 A weakened NIH is not just a threat to the pipeline—it is a threat to discovery itself. The scientific ecosystem is delicate. To drive groundbreaking discoveries and transform them into tangible individual and population benefits, the nation must sustain a robust NIH alongside a flourishing, well-resourced network of US scientists and research institutions. When those closest to us have serious questions about their health, it is the results of this science that will enable those of us in the medical field to provide answers. 

As the foundations of global partnerships, infrastructure, funding, and expertise falter at the federal level, scientists, epidemiologists, and public health experts are sounding the alarm. 

The enemies are not the people, they are the pathogens. And the threat is not distant, it’s right here.

Rochelle Walensky, MD, MPH is the Bayer Fellow in Health and Biotech at the American Academy in Berlin, and a physician scientist. She served as the 19th Director of the Centers for Disease Control and Prevention, Professor of Medicine at Harvard Medical School (2012-2020), an Infectious Diseases (HIV) clinician. She is mother of three boys (her proudest title), and wife.