\n<\/p>\n
Rachel Feltman: For Scientific American\u2019s Science Quickly, I\u2019m Rachel Feltman.<\/p>\n
In recent weeks several prominent public health experts have resigned from the Centers for Disease Control and Prevention, citing concerns about the agency\u2019s shift away from science-based decision-making.<\/p>\n
Among them was Demetre Daskalakis, who until recently directed the CDC\u2019s National Center for Immunization and Respiratory Diseases. He\u2019s here today to tell us more about what\u2019s going on at the CDC\u2014and what concerned experts are doing to try to keep America healthy.<\/p>\n
If you’re enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.<\/p>\n
Thanks so much for, for joining us today.<\/p>\n
Demetre Daskalakis: Thanks for having me.<\/p>\n
Feltman: So to start could you tell me a bit about your former role at the CDC and what you did there?<\/p>\n
Daskalakis: I, actually, in my five years at CDC had seven separate roles …<\/p>\n
Feltman: Mm.<\/p>\n
Daskalakis: So I will just focus on the last two years, where I was the center director for the National Center for Immunization and Respiratory Diseases.<\/p>\n
So, you know, CDC is made out of centers\u2014that\u2019s what Centers for Disease Control and Prevention mean\u2014and so the National Center for Immunization Respiratory Diseases, which we\u2019ll call NCIRD for short, is the center that is responsible for a lot of vaccine policy and vaccine-preventable diseases for the country, as well as the jurisdictional immunization programs and the very important Vaccines for Children Program.<\/p>\n
Feltman: And how have things been changing there over the last year or so?<\/p>\n
Daskalakis: I mean, not for the good. I think that with the installation of the new secretary of health, Robert F. Kennedy Jr., I was seeing a pretty significant shift away from sort of science-based work more toward this ideologic, almost authoritarian-style leadership coming from the Health and Human Services secretary that didn\u2019t really value or listen to any expert information or advice.<\/p>\n
Feltman: You recently resigned, as did several other prominent experts at the CDC. And the feeling in, in a lot of your resignation statements was that you felt that the CDC had become something so different from what it was supposed to be that you could do more work from the outside. What do you think that\u2019s going to look like?<\/p>\n
Daskalakis: I mean, unfortunately, I think my resignation letter was a little bit prophetic because, I mean, literally right after I resigned, you know, CDC put up a political manifesto as their mission statement that really, again, was all ideology and very light on science or public health. And then, you know, we\u2019ve seen the Advisory Committee [on] Immunization Practices, where the fire wall between science and ideology and politics completely broke down, and I feel like I\u2019m sort of in a unique position: I really understand what is supposed to happen and what the normal process is. And so I feel like one of my main roles outside of CDC is going to be to sort of identify when there are glitches in the Matrix and when there are things happening that are atypical and things that aren\u2019t sort of going through a process that value science before sweeping statements and policies are made. And so I will have that utility for as long as I sort of have the awareness; I can point at the chaos.<\/p>\n
Feltman: Yeah, and what do you think some of the solutions look like for public health organizations outside of the CDC to keep America actually healthy [laughs]?<\/p>\n
Daskalakis: Yeah, I think that this is, like, the key moment where, as someone who\u2019s worked in governmental public health for over a decade and in health care for two decades-plus, it hurts me to say that I don\u2019t trust what\u2019s coming out of the CDC. And as an infectious disease doctor, when I see patients and I have a question, that\u2019s where I go. And so, unfortunately, I think that we\u2019re seeing the decay of the quality of information, and it\u2019s not, like, a random decay; it is a specifically targeted decay to create an ideology propaganda machine that\u2019s Orwellian, as opposed to a trusted health source …<\/p>\n
Feltman: Hmm.<\/p>\n
Daskalakis: So I think that the first is that this won\u2019t last forever, but it\u2019s what has to happen for now because of the way leadership is at HHS. So I think that, really, a lot of the onus and responsibility now falls on\u2014I\u2019m gonna call them \u201cpara-public health\u201d\u2014paragovernmental organizations that are actually using process and data to sort of generate sort of recommendations and, you know, in effect, replacement policies to make sure that the health machine of the U.S. continues to function even as people are trying to destroy it. I think that the answer is that those organizations are going to have to carry the water for a lot of this. They\u2019re going to need to be the trusted voices for the folks at the front line, whether they\u2019re public health practitioners or medical providers.<\/p>\n
And what I hope is that they are forming deeper and stronger alliances so that they are gonna be more unified in what they say, because one of the scary parts is these states that are putting together coalitions, they\u2019re doing the right thing, right\u2014let\u2019s just be clear. But it\u2019s gonna create a tapestry across the U.S. that is about have and have-nots. So your California-Hawaii axis and your, like, Northeast axis, you know, they\u2019re doing great. The question\u2019s gonna be: Is there going to be something for the South and parts of the Midwest that may not have that political will that\u2019s necessary to lift up [that works] to make sure that folks are protected? And if government funding\u2014which could be taken away at any minute, and they have really created some levers where they\u2019re going to be able to potentially pull funding with not a good reason from a lot of jurisdictions\u2014like, how is that gonna play out in places that don\u2019t have tax base to be able to cover what the federal government normally provides?<\/p>\n
Feltman: Absolutely. So as you\u2019ve alluded to there are a lot of things going on at the CDC that do not align with the science and that are troubling, so it can be, I think, kind of hard for people to keep up and know what to pay attention to. So I\u2019m curious: What are your sort of biggest concerns about issues that the CDC is mishandling?<\/p>\n
Daskalakis: I\u2019m worried that the sort of ongoing effort to sort of identify programs that are somehow not ideologically aligned to the administration are going to be yanked and that\u2019s going to mean safety nets for people in the community are gonna be taken away. But even bigger, they\u2019re dismantling what CDC does, and CDC, one of the most important things that it does is it pumps out 80 percent of its money to [state and] local jurisdictions. So if that starts to falter, then that means that when CDC starts to fail there, local jurisdictions are also going to fail, and that\u2019s going to mean people are going to suffer, people are gonna get diseases, and forget about infectious diseases\u2014what\u2019s gonna happen with overdose prevention?<\/p>\n
Feltman: Mm.<\/p>\n
Daskalakis: What\u2019s gonna happen with syringe-availability programs? It\u2019s not ideologically aligned. And going back to infectious diseases, like, we know what happens in environments where those services go away: Disease outbreaks happen. There\u2019re gonna be HIV outbreaks. There\u2019re gonna be hepatitis C outbreaks. There\u2019s gonna be, like, increased overdose. So, you know, what I\u2019m worried about is what\u2019s years and years of progress is gonna get pulled back because people just wanna break stuff.<\/p>\n
And then, on the other side, vaccines\u2014I think that the Advisory Committee [on] Immunization Practices has now become completely irrelevant. The problem is that it is still relevant to the people who need vaccines for children through that program …<\/p>\n
Feltman: Right.<\/p>\n
Daskalakis: So, you know, the good news is that they tried to break stuff during the ACIP meeting; what they broke was scientific process, and so you can\u2019t trust anything that they\u2019re doing. But the output of what they did could\u2019ve been way, way worse. But it still means that they now are able to flex the muscle and say, \u201cI don\u2019t like this vaccine, and with no data I\u2019m gonna remove it from the childhood schedule,\u201d like they did with measles, mumps, rubella, varicella\u2014or chicken pox\u2014combination. Like, there was no public health problem for which they were solving, and they decided to just take that off.<\/p>\n
I think the other part is that the only person briefing the president is RFK Jr. …<\/p>\n
Feltman: Mm.<\/p>\n
Daskalakis: And I think what we saw, in the most recent press conference, where they were talking about acetaminophen and autism, since there\u2019s no data that supports the assertions that they\u2019re making\u2014but what we saw was, I think, a terrifying preview of what RFK Jr. wants to do with the vaccine schedule. I feel like what President Trump said was at least based on something that was briefed to him by RFK Jr., so are we looking at spreading out a vaccine schedule in a way that doesn\u2019t protect children based on no data or based on RFK Jr.\u2019s decades-old ideology that has not been proven by any science? I think we have a dark future coming; it won\u2019t be forever, but I think it\u2019s gonna be dark for now.<\/p>\n
Feltman: What advice do you have for individuals in America who are feeling really anxious and fearful, for themselves, for their children and also for their neighbors and loved ones in general in terms of keeping people healthy? You know, what can people do?<\/p>\n
Daskalakis: So first, I think one of the things that we do in public health all the time is say how important it is to practice trauma-informed care. So we very often don\u2019t turn that light back on ourselves, and that includes the people that we serve sometimes. And so I think, as a public health leader, I\u2019m gonna start with some trauma-informed leadership for people and say: it is okay to be scared because it\u2019s scary. There are things happening that are not good for your kids\u2019 health and not good for your health and, frankly, not good for the public health security of this country.<\/p>\n
So my advice, other than that your feelings are valid, is: I know that not everybody has a health care provider, but where you do have a health care provider you need to connect with them because they\u2019re going to have better advice than what CDC and HHS are putting out.<\/p>\n
Feltman: Mm.<\/p>\n
Daskalakis: So if you\u2019re pregnant and don\u2019t know what to do with acetaminophen, talk to your ob-gyn. If you don\u2019t know what to do with vaccines for your kids, talk to your pediatrician. If you don\u2019t know what to do for vaccines\u2014with vaccines for yourself, talk to your primary care doctor. If you don\u2019t have a primary care doctor, talk to your public health department, see what they\u2019re recommending. If that\u2019s not something that you wanna do, talk to your pharmacist. Really think about the people who are smart and know what they\u2019re doing and approach them.<\/p>\n
And I guess one really important thing to say, which is, like, for people a red flag: I\u2019m a doctor; I take care of patients. Even through a lot of public health emergencies I was able to still see patients. And one of the things that I know is that the relationship between doctor and patient or any health care provider and patient is a sacred one.<\/p>\n
Whenever you hear anyone trying to destabilize that relationship, as the secretary is doing, you need to say that \u201cI don\u2019t trust that person …\u201d<\/p>\n
Feltman: Mm.<\/p>\n
Daskalakis: Because that relationship is really what makes public health and personal health in the U.S. work, even though it\u2019s an imperfect system.<\/p>\n
Feltman: Yeah, you know, you were at the CDC through some pretty serious public health crises. The Mpox outbreak comes to mind as one that you\u2019ve been credited with handling really beautifully. So I\u2019m curious if you could, using that outbreak as sort of a benchmark for comparison, could you walk us through how you think that the current CDC is set up to handle a serious disease threat?<\/p>\n
Daskalakis: I\u2019ll start by just saying that my last few weeks were pretty hard, but the last eight months at CDC were awful. And the reason that they were awful was because people who have no idea about public health were using, like, a \u201cbreak it\u201d strategy to do what they think is sort of refashioning CDC into some kind of different organization.<\/p>\n
Outbreak response isn\u2019t just about the infectious disease. So my Mpox response is something that I think is a great example of why this plan at CDC isn\u2019t good. When I started working on the Mpox response one of the things that I did was try to weave together different pieces of the U.S. government\u2019s work to create what I called a syndemic response.<\/p>\n
So Mpox is a syndemic\u2014that means interacting epidemics that when they touch each other make themselves much worse. And so Mpox is an epidemic, HIV is an epidemic, homelessness is an epidemic, drug use is an epidemic, so all of those things converged to actually create a really bad Mpox outbreak. So what I was able to do in Mpox was bring together mental health providers, housing providers, HIV prevention, HIV treatment in a way that generated an effective response.<\/p>\n
So these people who are pulling CDC and the federal government apart don\u2019t understand that. What you\u2019re doing is taking away, like, the limbs of a response. So maybe the infectious disease sort of work is, like, the heart or the brain, but it\u2019s not the arms and legs. The arms and legs means you need all of those things to work together.<\/p>\n
And so as you see CDC being torn apart, 2,000 people who are no longer there, years of experience, centers that are being demolished, we are sorely unprepared for the next thing, even if it\u2019s not so big. And I\u2019m sitting here as an expert not only in infectious diseases but in outbreak and emergency response, I\u2019m looking at this saying, like, \u201cThe people who are tearing apart your public health endeavor have no idea how to do this.\u201d<\/p>\n
Feltman: Mm.<\/p>\n
Daskalakis: It seems as if they\u2019ve never responded to anything\u2014which is true. All of the people who are making these decisions are not responders. They don\u2019t know how to do it. And so breaking it without knowing anything about it is gonna mean that the next Mpox is just not gonna go as well.<\/p>\n
Feltman: Well, thank you so much for coming on to, to talk with us today. This has been really enlightening.<\/p>\n
Daskalakis: Thank you so much. Thanks for having me.<\/p>\n
Feltman: That\u2019s all for today\u2019s episode. Tune in on Friday for a special field-trip: we\u2019re spending some time in one of the quietest rooms on the planet.<\/p>\n
In the meantime, don\u2019t forget Science Quickly is up for a Signal Listeners Choice Award and we definitely need your vote. You can find a link to do that in our show notes. Thank you in advance.<\/p>\n
Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi and Jeff DelViscio. This episode was edited by Alex Sugiura. Shayna Posses and Aaron Shattuck fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news.<\/p>\n
For Scientific American, this is Rachel Feltman. See you next time!<\/p>\n","protected":false},"excerpt":{"rendered":"
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