The Trump administration’s flagship “Make America Healthy Again” agenda is being held back by a critical leadership vacuum, with two of the nation’s most prominent public health posts remaining unfilled and key initiatives stalling as a result.
A CDC in turmoil without permanent leadership
At the heart of the impasse is the Centers for Disease Control and Prevention, which has now been without a Senate-confirmed director for over 210 days, exceeding the federal legal limit for an acting head. Dr Jay Bhattacharya, who also leads the National Institutes of Health, has been serving as interim chief since February. Although his official acting title expired on 25 March, statements from the Department of Health and Human Services (HHS) and the White House indicate he continues to oversee the agency through authority delegated by Health Secretary Robert F Kennedy Jr.
The agency’s last confirmed director, Dr Susan Monarez—the first non-physician to hold the role in 70 years—was fired less than a month into her tenure in August 2025 after clashing with Kennedy over vaccine policy. Her dismissal triggered what some employees termed a “Valentine’s Day Massacre,” part of an exodus of over 3,000 public health workers from the CDC. Senior officials who departed have accused the Health Secretary of politicising the agency and stripping leaders of their independence, concerns echoed by nine former CDC directors who have warned of increasing threats to public health from political interference.
The turmoil has been compounded by a shooting at the CDC’s Atlanta campus in August 2025, where a gunman who blamed the Covid vaccine for his depression killed a police officer. According to HHS, Secretary Kennedy and CMS deputy administrator Chris Klomp are “working with the White House on the CDC director search by evaluating candidates that can further the Trump administration’s objective of restoring the CDC to its original mission of fighting infectious disease”. However, reporting suggests the administration is struggling to find a nominee who both aligns with its agenda and can withstand Senate scrutiny, with political risks ahead of the midterm elections also cited as a reason for delay.
The stalled nomination of a controversial surgeon general
Parallel to the CDC’s leadership crisis, the nomination of Casey Means for Surgeon General remains stuck in the Senate health committee more than 320 days after she was first nominated. Means, a 38-year-old wellness influencer and leader within the Maha movement, graduated from Stanford School of Medicine but did not complete her surgical residency. She is neither a board-certified doctor nor holds an active medical licence, having voluntarily made her Oregon licence inactive.
During her confirmation hearing, Means evaded questions on vaccine guidance, argued that chronic diseases stem from lifestyle and environmental factors, and brushed off concerns about her limited medical experience. She also faced criticism over potential conflicts of interest tied to her promotions of wellness products on social media. Her nomination has drawn criticism from both anti-vaccination campaigners and proponents of evidence-based medicine.
Bill Cassidy needs to stop blocking President Trump’s Make America Healthy Again agenda and move Dr. Casey Means’ nomination forward now.
For too long, Washington has protected a healthcare system that waits until people are sick, cashes in on chronic disease, and leaves…
— Julia B Letlow, Ph.D. (@jbletlow) March 26, 2026
Political hurdles and a Republican impasse
The fate of Means’s nomination hinges on key Republican votes on the Senate health committee, namely Bill Cassidy of Louisiana, Susan Collins of Maine, and Lisa Murkowski of Alaska. All three expressed scepticism during her hearing. Senator Murkowski stated that Kennedy had made assurances about vaccines during his own confirmation “that in fairness I am not seeing have been kept.”
The political calculus is particularly acute for Senators Cassidy and Collins, who face re-election this year. Cassidy, a former physician who chairs the health committee, is facing a primary challenge from Trump-endorsed congresswoman Julia Letlow, who is backed by the pro-Maha PAC which has pledged $1m to defeat him. Letlow has publicly urged Cassidy to “stop blocking” Means’s nomination. Collins, meanwhile, is expected to face a competitive race from Maine’s Democratic nominee.
Cassidy cast the pivotal vote to confirm Kennedy as Health Secretary last year despite concerns about Kennedy’s anti-vaccine history, after receiving assurances Kennedy would not interfere with the CDC’s vaccine advisory panel (ACIP). Kennedy subsequently fired all 17 members of the ACIP, replacing them with individuals who have questioned established vaccine research—a move a federal judge ruled was unlawful, voiding the panel’s recent decisions on flu, Covid, and RSV vaccines. A separate ruling temporarily blocked Kennedy’s scaled-back childhood vaccine recommendations, finding he likely violated federal law.
Allies of the Maha movement are applying pressure. Senator Rand Paul, a committee member, told attendees of a Maha Action advocacy call to contact the three holdout senators, stating “We should have voted long ago,” and noting they “have not been vocal in their support for her nomination.” Paul added that if the nomination cannot proceed, those opposing it “should at least be on record as opposing her.”
The leadership vacuum has tangible consequences. With no permanent CDC director, the authority to formally approve vaccine recommendations effectively shifts to Secretary Kennedy, according to legal expert Professor Anne Joseph O’Connell. The broader Maha agenda—which includes initiatives on regenerative agriculture, removing petroleum-based dyes from food, revising federal nutrition policy, and establishing a commission on childhood chronic disease—remains hampered by the instability at the top of the nation’s public health institutions.