President-elect Donald Trump’s choice to lead the U.S. Centers for Disease Control and Prevention (CDC), announced on 22 November, is another sign that on public health, the new administration is veering away from tradition. David Weldon, a 71-year-old physician and former Republican representative from Florida, has questioned vaccine safety, and scientists worry about his potential impact on the long-venerated agency. But several also acknowledged CDC has lost some of its shine and some public trust, and that new approaches may be worth considering.
“I don’t think I agree with almost anything the new president says,” admits Michael Mina, an epidemiologist and former Harvard University faculty member. “But what I do agree with is there is a lot of room to change and improve” CDC. “We need a jolt.”
What kind of jolt Weldon would bring isn’t yet clear. He is an internist who practices in Malabar, Florida, where his physician page notes interests in managing hypertension and high cholesterol, treating diabetes, and providing preventive care, among others. That focus on chronic disease echoes interests of his potential new boss, Robert F. Kennedy Jr., who is Trump’s nominee to lead the Department of Health and Human Services.
During his time in Congress, from 1995 to 2009, Weldon spoke out on several lightning-rod issues. He attempted to force a federal review of the case of Terri Schiavo, a young woman in Florida who doctors determined was in a persistent vegetative state, and objected on the floor of the House of Representatives to the removal of her feeding tube. He questioned the safety of thimerosal, a common vaccine preservative, advancing the debunked claim it could lead to autism. He also challenged Gardasil, the vaccine that protects against human papillomavirus and is credited with slashing rates of cervical cancer in young women. He’s been a frequent commenter on Fox News, and Kennedy has praised Weldon for his vaccine-skeptical views.
If confirmed, Weldon will take the helm of a roughly $9 billion agency facing a variety of challenges. Tasked with stemming infectious diseases, promoting smoking cessation programs, and making childhood vaccine recommendations, among other priorities, CDC “has been under the budget gun” for years, says Nicole Lurie, who worked in pandemic preparedness during former President Barack Obama’s administration. CDC’s budget has been largely flat for a decade, when adjusted for inflation. The agency is in dire need of upgraded data analysis systems, Lurie says, which would help it more nimbly manage the brush fire of a contagious disease before it gets out of control. “The more we starve” CDC on funding, she says, “the more it will fail.”
Some scientists familiar with the agency also worry it has become increasingly politicized and less effective and open in its communications. “I know it’s very difficult for the press to speak with people at CDC,” says David Heymann, who spent years working at the agency and the World Health Organization and is now at the London School of Hygiene & Tropical Medicine.
James Curran, dean emeritus of the Rollins School of Public Health at Emory University, remembers speaking to the media without permission while working at CDC in the 1980s, as he chased down what became recognized as HIV/AIDS. When he shared his fears about this new and catastrophic virus, he was reprimanded, but “I didn’t get fired,” he says. Curran contrasts his experience with that of senior CDC official Nancy Messonnier, whose dire early warnings about COVID-19 led to her abrupt disappearance from press briefings in the first Trump administration and her departure from CDC soon after.
CDC’s own communication about COVID-19 was often flawed, Mina says. One example was messaging that vaccination for COVID-19 would halt transmission of the virus, which proved to be incorrect. “There was a real fear that if they were to say anything not completely positive about the vaccine, it would erode trust” in the shots, Mina says. “We’ve taken this approach that the average American cannot hear any nuance.”
Gillian SteelFisher of the Harvard School of Public Health thinks the agency at times adopted a counterproductive, moralizing tone during the pandemic. “[It] became, ‘If you’re a good person you’re going to get vaccinated,’” she says.
Assessing and communicating about vaccine safety has also been complicated for the agency. Work to develop safer vaccines and clarify vaccine risks—which are overwhelmingly rare—could help counter antivaccine sentiment, says Robert Chen, scientific director of the Brighton Collaboration and a prior director of CDC’s vaccine safety program. He and some other public health researchers support an independent vaccine safety entity—separate from CDC and the U.S. Food and Drug Administration, which are jointly tasked with overseeing U.S. vaccine safety. But to some, such views are often deemed antivaccine themselves, he says. That’s partly because of fears that any questioning of vaccines will lead the public to abandon them; it’s also because such views do sometimes dovetail with unscientific ones.
While in Congress, Weldon similarly advocated for removing vaccine safety monitoring from CDC’s purview, but also diverges from Chen in public comments on vaccines. Vaccine-skeptical Trump nominees “lose credibility … when they insist autism is caused by vaccines when we have shown it isn’t,” Chen says.
Although he believes there’s room for reform, Curran warns that Weldon should avoid a “tear-it-all-down” approach. That, he says, would endanger public health and harm agency morale. “We can’t just find worldwide cholera experts” anywhere else, Curran says of CDC’s staff. Heymann echoes that point, calling the agency “a safety net” for the country and the world when it comes to infectious disease.
Whatever Weldon’s priorities, if he is confirmed to lead CDC, he and his staff will share one challenge with their predecessors: reaching a sometimes-skeptical public. In a 2023 Health Affairs paper that surveyed 4208 U.S. adults, SteelFisher and her colleagues found that among the 42% of respondents who said they trusted CDC “a great deal,” a top reason was their belief that the agency “followed scientifically valid research.” A common reason not to trust its guidance was “concerns about political interest on policies and recommendations.” A frequent worry is, “do they have your best interests at heart?” SteelFisher says. And “it’s superhard to show that as an institution.”
