Why the collapse of the wall between science and ideology at the US Centers for Disease Control and Prevention (CDC) threatens national health security, and vulnerable communities.

I have spent most of my professional life in public health, from my work in HIV and meningitis prevention in commercial sex venues in New York City to my roles in leading emergency operations in national and global outbreaks. 

I have seen what happens when misinformation fills the space where science should be–people’s health is put at risk. And today, as partisan political forces reshape what Americans are told about vaccines, infectious disease, and community health, I fear we are watching the same dangerous pattern unfold, and the health and safety of our nation will suffer.

The wall that once protected scientific evidence from political interference did not fall on its own. Its foundation was damaged by miscalculations and miscommunication during extreme threats like the COVID-19 pandemic.  

This damaged wall was then easily pushed down by nefarious actors who moved from the fringes to the top of national health leadership, facilitated by elected officials distracted by politics rather than focused on health. Unless we build a new, stronger wall, resistant to such attack, the consequences will be measured in preventable illness, permanent disability, and lives cut short.

From marginalization to manufactured confusion

For decades, the CDC has been a global gold standard in disease surveillance and immunization guidance. That work relies on a simple principle: CDC and external scientists generate and evaluate evidence. Policy follows the data after close consideration of all the domains to make sure that it supports the optimal health of people. Clear communications express the policy for public health and healthcare professionals and the general public

Over the last year, that sequence has been toppled. Instead of scientific review guiding recommendations, ideological preferences have dictated the conclusions while scientists were either not consulted or told to “find the proof” to support a pre-formulated conclusion.  

CDC subject matter experts have been excluded from substantive briefings with leadership at the Department of Health and Human Services (HHS). Repeated requests for data to support the major changes to the immunization schedule made by secretarial decree have never been delivered. Sweeping changes to scientific documents have been announced without process, review, or the knowledge of the involved agencies.  

The result is not only dysfunction. It is distortion. The changes to immunization policy and science released under the CDC moniker were not produced through the normal, rigorous, transparent process.

They relied on analyses the agency never saw. They contained interpretations of research that the original authors themselves would not support. In some cases, they advanced ideas that have long been rejected by pediatricians, immunologists, virologists, and epidemiologists.

When science is forced to serve ideology, the public receives neither science nor ideology. They receive confusion.

Direct threat to vulnerable communities 

When I entered public health, I did so as a gay physician who watched too many friends suffer and die in a system that decided their lives were expendable. That experience shaped my entire career. It taught me that public health is not an abstraction. It is an obligation.

Today, that obligation has been broken. Ideological rhetoric has elevated intuition above science, denying the benefit of vaccines that have saved millions of children from disability and death and focusing on unproven or debunked risks of these vaccines or their components. 

This pivot toward a pre-vaccine worldview is not theoretical. It directly threatens infants, pregnant people, older adults, and immunocompromised individuals who depend on evidence-based recommendations and population immunity.

The consequences do not stop there. The current administration’s dismissal of transgender health, its efforts to halt domestic and international HIV programs, and its disregard for the expertise needed to manage respiratory viruses reveal a worldview centered on survival of the strong rather than protection of the vulnerable.

Eugenics is not a word I use lightly. Yet elements of that thinking are echoed in policies that promote natural infection over prevention provided by vaccines; confound health equity with diversity-focused hiring practices, and pit personal choice against community.

For people who already face barriers to care, such an approach is not only negligent. It is dangerous.  We cannot support systems where only the strong should survive or thrive. Not everyone has the luxury of choice in the circumstances that put them at risk for poor health.

A government that claims to care about the health of its citizens cannot choose which citizens deserve the opportunity to achieve their best health.  

Collapse of trust and credibility

Trust is the currency of public health. Without it, guidance becomes noise. Recommendations become suspicion. Data becomes propaganda.

The recent firing of scientists from the Advisory Committee on Immunization Practices (ACIP) through a social media post instead of direct communication was not just unprofessional. 

It was a public signal that expertise is now secondary to optics and key staffing decisions are being driven by loyalty to an ideology rather than competence.  It is unfathomable that the executive leadership of CDC does not include any career scientists and is staffed entirely by political appointees with little or no public health experience. 

When leaders announce major shifts in COVID recommendations in hastily produced videos or rambling online posts that bypass the agency entirely, the public does not see innovation. They see chaos.

Once trust is broken, earning it back is not easy. It requires honesty, transparency, and humility. It requires acknowledging mistakes and inviting scrutiny. It requires remembering that the CDC’s credibility comes not from politics but from the dedication of thousands of career scientists who wake up every morning committed to protecting the public.  

CDC scientists continue to work to protect our health, but they are being held hostage in a hijacked agency being manipulated for the political and personal gain of its leadership. 

Where agencies like the CDC go from here

I resigned as Director of the National Center for Immunization and Respiratory Diseases, not because the work was unimportant, but because the work was being undermined at its core. 

As long as scientific staff cannot brief leadership, review data, or provide recommendations free from interference, the CDC cannot fulfill its mission.  

We have come to a point in the history of CDC where we cannot trust its communications.  It has become a wolf in sheep’s clothing: thinly disguising ideology and partisan politics in the garb of CDC-endorsed science and communication.

The path forward requires more than restoring old structures. It requires building a durable firewall between science and political ideology that is strong enough to withstand future attacks.

Three principles must guide that reconstruction:

First: Transparency must be non-negotiable. Data informing national recommendations must be publicly available, subject to peer review, reproducible, and accessible to CDC scientists. No policy should be finalized without the agency scientists responsible for it participating in the analysis

Second: Expertise must be valued, not vilified. Advisory committees like ACIP must be staffed with qualified, vetted experts who are selected based on competence, not ideological alignment with HHS leadership. Their guidance must be generated through a structured scientific process to ensure their recommendations optimize the health of people rather than serve ideology or the personal gain of HHS leaders and their associates. 

Third: Public health must return to its purpose. The goal is not political positioning. It is the protection of people. That includes members of  LGBTQ communities, immigrant communities, rural communities, Indigenous communities, and all who have historically been told their lives matter less.

Public health cannot thrive in secrecy. It cannot operate in fear. And it cannot function when science is treated as an inconvenient truth that can simply be edited out of existence with a tweet or revision of a website. 

Building a new system

 We are not witnessing a disagreement over data or a generative scientific debate. We are experiencing the intentional collapsing of the systems that protects the health of our nation. We are beyond the point of no return with CDC.  

Rather than hoping to rebuild a shattered agency, our effort should focus on building a new public health system that is better equipped to withstand the ideological blows that have damaged trust in the current federal public health system. 

It must be responsive to the needs of the people it serves on the ground rather than the whims of disconnected partisan leaders. Building these systems will require courage, clarity, and commitment from jurisdictional public health, academic, and business leaders who understand that public health science is not a threat to democracy. It is the foundation for the health and economic security of our nation.

The question is not whether we have the knowledge to create the new public health. It is whether we have the will and the courage to leave the past behind and move into the future.

As I wrote in my resignation letter, public health is not merely about the health of the individual. It is about the health of the community, the nation, and the world. The stakes could not be higher.

If ideology continues to replace evidence, we risk returning to an era where only the strong survive. If we choose science, transparency, and compassion, we can build a healthier future for everyone. The choice is ours, the time to act is now.

Dr Demetre Daskalakis, MD, MPH is senior public health advisor for the Wellness Equity Alliance. He is the former Director of the US CDC’s The National Center for Immunizations and Respiratory Diseases, and nationally recognized in the US as an expert in infectious disease, immunization policy, and LGBTQ health.