Departures roil the CDC leadership. What’s next for the agency?

The firing of the director of the U.S. Centers for Disease Control and Prevention and the resignation of several high-profile agency leaders pose immediate challenges to the operations of the nation’s premiere public health agency, experts said.

It could take “several months” to identify and confirm a replacement for CDC Director Susan Monarez, who was terminated Wednesday after less than a month on the job, said Dr. Georges Benjamin, director of the American Public Health Association. And it could take more time to fill at least four key vacated positions that oversee disease outbreaks, vaccines and public health data.

“The whole chain of command has just been disrupted,” Benjamin told The Associated Press. “It’s like getting rid of your generals in the middle of a war.”

Health experts said Americans could see immediate effects, from confusion over the availability of COVID-19 vaccines to delayed responses to outbreaks of infectious diseases such as measles or foodborne illnesses caused by germs such as E. coli or listeria.

“The average American should worry about their safety and their health and whether information coming out of Health and Human Services is reliable or trustworthy,” said Dr. Anne Schuchat, former principal deputy director of the CDC, who left the agency in 2021.

Here’s what you need to know about the sudden changes at the CDC.

What happened this week?

The White House ousted Monarez on Wednesday after apparent clashes between the CDC director and Health Secretary Robert F. Kennedy Jr. over changes to the nation’s vaccine policy.

Officials at the White House said Monarez was dismissed because she was not aligned with President Donald Trump’s agenda and refused to resign.

That action coincided with the resignation this week of at least four top CDC agency leaders: Dr. Debra Houry, the agency’s deputy director; Dr. Daniel Jernigan, leader of the agency’s work on emerging infectious diseases; Dr. Demetre Daskalakis, a top vaccine official; and Dr. Jennifer Layden, who led public health data efforts.

What happens next?

Monarez was the first CDC director to require Senate confirmation under a law that took effect in 2023. Replacing her would require Trump to nominate a new director, who would then need to be considered and confirmed by the Senate. On Thursday, Republican Sen. Bill Cassidy said the high-profile departures will “require oversight” of the Senate Health, Education, Labor and Pensions Committee, which he chairs.

In the meantime, the president could name an acting CDC director, Benjamin noted.

Replacing the leaders in the other positions, including those who held the jobs for years, will be difficult, Schuchat said.

“The four people who resigned led important parts of the agency and had the respect of the nation and the world,” she said.

In an appearance on “Fox & Friends,” Kennedy declined to directly comment on the CDC shake-up. But he said he is concerned about CDC officials adhering to the administration’s view of health policies.

“So we need to look at the priorities of the agency, if there’s really a deeply, deeply embedded, I would say, malaise at the agency,” Kennedy said. “And we need strong leadership that will go in there and that will be able to execute on President Trump’s broad ambitions.”

How could the changes affect average Americans?

The clash at CDC was apparently triggered by conflict over changes in policy regarding recommendations for COVID-19 vaccinations that could make getting a shot more complicated for people.

The Food and Drug Administration approved updated COVID-19 shots on Wednesday but limited their use for many Americans — and removed one of the two vaccines available for young children. The new jabs from three manufacturers are approved for all seniors, but the FDA narrowed their use for adults and children to those with high-risk health conditions, such as asthma or obesity.

The FDA approval is typically reviewed by a CDC vaccine advisory committee, which makes recommendations for use. Monarez said she would not automatically sign off on recommendations of the committee, which was handpicked by Kennedy, according to Dr. Richard Besser, a former CDC acting director. (Besser is now president of the Robert Wood Johnson Foundation, which helps support The Associated Press Health and Science Department.)

The changes present new barriers to access for millions of Americans, who would have to prove their risk, and others who may want the shots but suddenly no longer qualify. The vaccines were previously recommended for Americans 6 months and older.

“These decisions, made without supporting evidence, reflect a troubling pattern by HHS of interfering in the relationship between patients and their healthcare providers and limiting access to vaccines — public health tools proven to save lives and reduce costs,” said Michael Osterholm, a University of Minnesota infectious disease researcher.

In addition, the disruption at the CDC could jeopardize many local health services undergirded by the agency’s support and expertise, Schuchat noted. That could mean tracking a simmering infectious disease outbreak, such as measles, or outbreaks of foodborne illness.

“It’s the water that you drink, the lead in your pipes. Look around your community,” she said. “If people are doing well and healthy, it’s probably partly because of the CDC.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.