You Serve at the Pleasure of the President: As Such You are No Longer Wanted or Needed

Throughout my career, I have chaired and been a member of countless scientific and health policy advisory committees for the federal government—from AIDS and tuberculosis to cancer, biomedical research, and food and drug regulation. It is because of the high quality of scientists who serve the federal government (intramural as well as external advisors) that America boasts the most venerable scientific agencies in the world—the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Food and Drug Administration (FDA). In my roles advising all of these federal agencies and the White House, I have served both Republican and Democratic presidents—until now.

I have been proud to serve on the Fogarty International Center Advisory Board. The Fogarty Center supports global health research by building partnerships and training scientists, with a vision for a world where the frontiers of health research span the globe, and scientific advances reduce disease and extend longevity for all. International collaborative research is good for America and for our partners, especially in Africa, where the proportion of health researchers is the lowest and access to top-quality training opportunities—like experienced mentors and research centers of excellence—is limited. Biomedical research is the engine of our economy and a global public good. As such, it should be the highest priority of a “Make America Healthy Again” (MAHA) agenda. The recently published MAHA Strategy claims to promote policies like good nutrition to prevent chronic diseases, especially among children. But this is in deep tension with the Trump administration’s slashing of the NIH’s research budget and its proposal to eliminate the CDC’s National Center for Chronic Disease Prevention and Health Promotion.

Recently, NIH Director Jay Bhattacharya sent me a letter saying, simply, “you serve at the pleasure of the Secretary of Health and Human Services. As such your appointment has been rescinded effective immediately.” The letter came shortly after a Fogarty Center dinner with the NIH Director, where I advocated strongly for robust ongoing NIH research funding. I hasten to add that, unlike many senior appointments at the Department of Health and Human Services (HHS), Dr. Bhattacharya is a highly respected scientist and health researcher.

There was no reason given for the dismissal. We know that tens of thousands of career civil servants and expert advisors have received similar letters. Over the course of 2025, HHS has undergone multiple rounds of staffing cuts, resulting in more than 20,000 employees being laid off. A compliant Supreme Court allowed the staff firings using its “shadow” docket. The current federal government shutdown has seen additional staff terminations. Not only were the new firings harmful, but they also demonstrated gross incompetence—firing over 1,300 CDC employees, including staff responsible for surveilling and responding to measles outbreaks, only to rescind 700 terminations the next day, stating it was a coding error.

In August, HHS Secretary Robert F. Kennedy, Jr. fired CDC Director Susan Monarez just weeks after the Senate confirmed her nomination. She said her firing stemmed from her refusal to back unscientific recommendations by CDC’s Advisory Committee on Immunization Practices (ACIP). At least four senior scientists resigned in protest. The Secretary appointed Jim O’Neill, a fierce MAHA loyalist, as acting director.

Mass firings have hollowed out domestic public health agencies, leaving vast deficits in leadership, expertise, and experience. While domestic public health capabilities have been severely weakened, the impacts on global health have been even more devastating. The president withdrew from the World Health Organization, rejected the amendments to one of its core treaties (the International Health Regulations), and withdrew from negotiations on another (the Pandemic Agreement). The administration decimated USAID, upended PEPFAR, cut a host of other global health programs, including canceling funding for Gavi, the Vaccine Alliance, and slashed humanitarian assistance.

On June 9, 2025, Secretary Kennedy fired all 17 members of ACIP, saying he was “restoring public trust” and removing conflicts of interest. Kennedy replaced them with handpicked appointees closely aligned with his vaccine-skeptical views. Yet, a JAMA study documented that those ACIP members had few conflicts, but the new appointees were riddled with conflicts. There was no notice or deliberative process in either the firings or the new appointments. Consequently, the new ACIP members and acting CDC director rubber stamped unscientific changes to both MMRV vaccines as well as COVID-19 vaccines for pregnant women and children. The whole childhood immunization schedule is at risk.

The Trump administration has taken aim at scientific advisors beyond ACIP. For example, the administration abruptly shuttered the Healthcare Infection Control Practices Advisory Committee, a federal advisory committee that provides guidance on infection control practices. Meanwhile, the Acting Environmental Protection Agency (EPA) Administrator James Payne dismissed all members of the Clean Air Scientific Advisory Committee and the Science Advisory Board, calling the dismissals a “reset.”

Summary dismissals of scientific advisors are harmful to public health and the environment. Long-serving committee members accumulate deep subject matter knowledge, historical context, and relationships across agencies. Most of the administration’s new appointees have little expertise in vaccines, immunology, epidemiology, or public health, and many of them have alarming records of vaccine denial. Scientific advisory committees typically work through rigorous and transparent data review and peer discussions. But now, ACIP is failing to publish its agenda, neglecting scientific review, and even limiting CDC scientific input. This is all unlawful, but don’t expect the Supreme Court to defend science and the rule of law.

Overall, we have seen an erosion of credibility and public trust in scientific recommendations. Never before, for example, have major medical organizations and consortia of states issued vaccine recommendations at odds with ACIP and CDC. Advisory committees serve as independent checks on agency decisions. Removing committee members en masse concentrates power in the HHS Secretary, who is using it for political ends.

There is, of course, a political dimension in all health policy, but decisions should be based on scientific and other evidence of public benefit. Political leaders are not free to make up their own facts and then claim to have restored trust in science. Or to put the politicization of public health more succinctly, “you serve at the pleasure of the president, and as such, you are no longer wanted or needed.”

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