Demetre Daskalakis, MPH ’12, resigned from the Centers for Disease Control and Prevention (CDC) in August. Daskalakis, an infectious disease doctor, had led the agency’s National Center for Immunization and Respiratory Diseases. Here, he discusses what led to his decision, his concerns over recent policy changes, and why he believes the nation’s—and the world’s—health is at risk.
Let’s start out with a little bit about your background. How did you decide on a career in public health and what brought you to the CDC?
Early in my academic career, when I was in college, I started doing volunteer work in HIV. This was in 1991 in New York City, and I had friends who I lost to the disease. I decided I wanted to do something that would prevent people from suffering or dying from infectious diseases, specifically at that time, HIV.
My first public health job was working for the New York City Department of Health and Mental Hygiene, which I joined in 2014. I was hired by Mary Bassett [François Xavier Bagnoud Professor of the Practice of Health and Human Rights at Harvard Chan School], who was the city’s Health Commissioner at the time, to be the head of the Bureau of HIV and AIDS Prevention. In 2017, I was promoted to Deputy Commissioner for Disease Control overseeing the infectious disease portfolio at the Department of Health. During that time I served as incident commander for two notable large emergency responses: the measles outbreak in 2018-2019 and the COVID-19 pandemic from January 2020 through November 2020. Later that year I was recruited to the CDC to be the head of the Division of HIV Prevention. After working in a number of areas, including as head of the CDC COVID-19 vaccine task force and deputy coordinator of the White House mpox response, I was named head of the CDC’s National Center for Immunization and Respiratory Diseases in 2023.
When the new administration came to power, what was your expectation? When did you start to have concerns about the direction the administration was taking?
I can work in any kind of administration as long as I have someone who values public health. When the new administration came to office, I thought, the track record for the president in public health was actually pretty great. I got to see the tail end of Operation Warp Speed when it was known as the Countermeasures Acceleration Group. I worked very closely with them when I was on the CDC COVID-19 vaccine task force.
Ending the HIV Epidemic (EHE) was another Trump initiative that was a game changer. So, frankly, I was optimistic that I and my colleagues could work well with the new administration.
After Secretary Kennedy was confirmed, he talked about gold standard science and radical transparency and not having preconceived notions of how we’re going to get to a healthier America. And my team and I thought, we can work with that. We had a number of meetings about how to fit our science and public health strategy into the Make America Healthy Again (MAHA) framework. Subsequently, all of my optimism was dashed when I saw that the Secretary was doing things in the vaccine space, such as putting information out about measles vaccines that wasn’t based on data or any interaction with measles experts at CDC.
He said he was going to be radically transparent. I’m not used to radical transparency meaning that I find out about major policy changes on Twitter [X] that no scientist from CDC had been consulted on.
We always did gold standard science at CDC, but what I saw happening was an attempt to retrofit and cherry-pick science to a desired outcome and to limit what the American people could see in terms of decision-making.
In your resignation letter, you described the changes to the adult and children’s immunization schedule, which removed the recommendation that healthy children and healthy pregnant women get the COVID-19 vaccine, as one example of policies that “do not reflect scientific reality and are designed to hurt rather than improve the public’s health.” Could you elaborate?
The data tell us that pregnancy is a risk factor for adverse outcomes of COVID-19. You vaccinate a pregnant person for two reasons: because pregnancy is a risk for an adverse COVID-19 outcome for that human, but also for the pregnancy—if that person gets sick, the pregnancy could be at risk. Also, the transfer of antibodies after a vaccine from the mother to the child means that the child has more protection against COVID-19, and when you look at the age group that has the highest hospitalization rate in kids, it is 0-6 months.
Following the initial announcement, we [the CDC] were able, through some negotiation, to get the immunization schedule for children to include shared clinical decision making [families who want a child to be vaccinated may be able to do so after talking with a health care provider].
But the strategy is flawed, in my opinion, backed by the data that I know. When you look at the data in the U.S. for hospitalization using the COVID-NET platform, a surveillance system [that monitors COVID-associated hospitalizations], just under 60% of the kids who were admitted to the hospital or to the intensive care unit for COVID-19 didn’t have underlying risk factors. So that blanket statement that only kids who have underlying conditions should be getting the vaccine isn’t supported by data, and I think could potentially result in harm. And the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics agree.
You said you learned about that vaccine schedule change on X. What was your reaction when you saw that? You also noted issues with how HHS leadership arrived at that decision and how you found out about it. Could you elaborate?
I was in a meeting with all of the senior leaders at CDC and I was presenting on outbreaks and my phone blew up. I was worried something was happening, so I looked and the messages were asking if we [the CDC] had changed the vaccine schedule.
I asked the group if anybody had heard about any changes to the vaccine schedule and people said no. After wrapping up, I left the room and watched the tweet of the video of Dr. Makary, Dr. Bhattacharya, and Secretary Kennedy—and no one from CDC—telling us that that CDC had just changed the childhood schedule.
I have no idea how they arrived at that decision because they wouldn’t share any of the documents that the Secretary used to make it. There are allegedly a couple of memos that exist. Maybe someone’s seen them at CDC, maybe a political appointee, but no science folks, including those at CDC directed to implement the vaccine schedule change, had ever seen such a document.
HHS released a “frequently asked questions” (FAQ) document to members of Congress, however, that was unvetted by any subject matter experts at CDC and was full of purposeful misinterpretation of science. When I saw the document I checked the references, and there were instances where things were said in the FAQ that did not accurately represent the conclusion of the papers [being referenced].
What are some of the other things that concern you about recent policy changes?
I think the COVID vaccine policy changes are kind of testing the system. I’m worried that where they can’t destabilize vaccine recommendations, they’re going to try to undermine the quality of CDC data and say that we don’t have the data that we need to be able to make decisions. This may be starting with vaccines, but it’s unclear where it will end.
I’m also worried about things that aren’t in the CDC space, such as trying to destabilize trust in vaccines. As a clinician, I see that confused patients usually give up because it’s too hard to figure out what to do, and confused doctors are even worse. When people ask me, where do you point people for data and for guidance now, I don’t know the answer, so I can’t imagine what a primary care doctor would say.
The effort to create lack of confidence in vaccines is also going to impact us if we have a situation where we need to relaunch a vaccine in an emergency or pandemic situation. There’s a lot of misinformation around mRNA vaccines—RFK Jr. had said that COVID-19 vaccines didn’t help end the pandemic and that “they were the deadliest vaccines ever made.” That’s wrong. We saw that the vaccines were really important in bringing the pandemic under control.
Every year, we see that individuals who don’t get vaccinated, especially if they’re older or younger, are way more likely to be hospitalized and have adverse events. In terms of the side effects of the vaccine, I definitely have a lot of empathy for folks who believe that they may be vaccine injured, but what we see empirically in the data is that there are consequential adverse events, but they are rare. The risk-benefit profile supports maintaining access to this vaccine.
What happens if we’ve undermined COVID vaccines? And cut $500 million of funding to mRNA development? And we have a reason to need a nimble onboarding of a vaccine to control an outbreak or a pandemic?
Hundreds of employees have been let go from the CDC since April. What do you think the impact of those cuts will be?
They seem to have taken the approach that we’ll cut people out of CDC that are doing chronic disease or “woke” things, such as gun violence or health equity.
What they don’t get is that when you activate for an emergency response, people come from all parts of the agency. There are responses that require other skill sets other than being, say, a smart virologist or bacteriologist. What’s going to happen if the next Zika virus comes and there’s no one who has experience in maternal fetal medicine at CDC, an area decimated by staff cuts?
We are looking at a decimation of public health that will take decades, if not more, to rebuild, if there ever comes a time that we can.
We’re entering flu season in the U.S. With our upcoming withdrawal from the World Health Organization (WHO), do you have concerns about how we’ll collaborate with other countries around public health?
I do have a lot of thoughts. The CDC has laboratories that are really important, not just to do interesting science, but that are critical in being prepared for outbreaks and vaccine-preventable disease threats.
CDC has the best influenza lab in the world. But since January, the number of countries that are submitting specimens to CDC for flu—to design candidate vaccine viruses so that we’re prepared for a regular flu season or a pandemic flu—has decreased by around 75%. WHO even released a letter to other countries saying, don’t send things to Atlanta [CDC headquarters]. That means we as a nation are flying blind.
We’ve gotten exactly zero polio specimens since February from external countries. We’ve done exactly zero measles technical assistance trainings to laboratories around the world to make sure that they’re able to do the measles diagnostics necessary to understand what’s happening globally.
We’ve had over a 60% decrease in COVID sequences that have been shared by other countries since January, so we’re flying blind on that one, too. We don’t know if there’s going to be a new variant that’s going to escape immunity. No clue. Or we’ll have a clue, but we’ll have it after it’s already on our shores.
What other things scare you?
I worry about a lot of things. I’m worried about vaccine-preventable diseases, I’m worried about polio, as global and domestic vaccine programs are threatened. I’m obviously worried about measles, because that’s not going well—I think the [Western] hemisphere is going to lose measles elimination status and the U.S. is going to be next.
And I worry about the thing that we don’t know about yet. We are less prepared because of this “break things and see how it goes” strategy.
How are you holding up since your resignation?
I haven’t gotten lots of sleep and have had long days with constant interviews because I feel that this is the time to speak up and say that something is horribly wrong and America’s health is at risk, and by extension, so is the globe’s.