In the wake of departures last week at the CDC, state governments moved in opposite directions around vaccine policy, and a coalition called on Secretary Kennedy to resign.

One week after Health and Human Services Secretary Robert F. Kennedy Jr. forced Susan Monarez, Ph.D. out as Director of the federal Centers for Medicare & Medicaid Services (CDC), several different vaccine policy-related developments took center stage on Wednesday, September 3.

First, on Wednesday, as Kirby Wilson and Romy Ellenbogen of the Tampa Bay Times reported, “Florida is set to end all state vaccine mandates, state Surgeon General Joseph Ladapo announced at a news conference Wednesday. For decades, the state has required numerous vaccines for kids attending school, including shots that protect against Measles-mumps-rubella, polio, chickenpox and Hepatitis B. But Ladapo on Wednesday compared these mandates to ‘slavery,’ and promised that they all will soon end. He did not immediately provide specifics. Vaccines have saved at least 154 million lives in the last 50 years, according to the World Health Organization. The vast majority of the lives saved were infants. Until recently, the DeSantis administration’s criticism of vaccines had been reserved for COVID-19 shots. In 2022, against the recommendation of American Academy of Pediatrics, Ladapo’s Department of Health recommended health children not take mRNA COVID vaccines. The department has since recommended against the shots for all populations,” they wrote.

Further, they noted, “Wednesday’s announcement marks a new moment in the administration’s break with the public health community over vaccines. Health experts have long maintained that vaccines are most effective at stopping the spread of disease when they’re widely adopted. In the 20th century, vaccine were used to eradicate diseases such as smallpox. Florida already allowed parents to object to vaccines on religious grounds, a practice which has been criticized by public health officials. Now, vaccine exemptions are set to be expanded in the state.”

Also on Wednesday, on the opposite coast, Emily Baumgaertner Nunn of the New York Times reported that “Three Democratic-controlled West Coast states announced plans on Wednesday to form a ‘health alliance’ that would review scientific data and make vaccine recommendations for their residents, saying that the federal agency responsible for issuing such guidance for the country had become ‘a political tool that increasingly peddles ideology instead of science.’ The move, which comes at a time of unparalleled turmoil at the agency, the Centers for Disease Control and Prevention, is an effort by California, Oregon and Washington to take scientific stewardship into their own hands after Health Secretary Robert F. Kennedy Jr., a vaccine skeptic, has taken control of the C.D.C.’s vaccine decisions. Other states, including several in the Northeast, are considering joining in a similar effort,” Baumgeartner Nun noted.

Indeed, she wrote, “Hours after the Western states’ announcement, Florida announced it was going in a starkly different direction: The surgeon general said the state would end all vaccine mandates, including for children to attend schools, claiming in a news conference that each mandate ‘drips with disdain and slavery.’ Florida’s governor, Ron DeSantis, a Republican, endorsed the plan, though it was not immediately clear whether it would require legislative input. The differing state moves underscored the increasingly disjointed nature of vaccine policy across the country. States have always set their own vaccine policy and mandates for schoolchildren, but those rules were based upon national recommendations put forth by the C.D.C. Now that all 17 experts on the agency’s advisory panel have been dismissed by Mr. Kennedy — several of them replaced by vaccine skeptics — the opaque federal landscape has led to a hodgepodge of state moves.”

Richard E. Besser, M.D., currently president and CEO of the Robert Wood Johnson Foundation, and a physician who served as President Barack Obama’s Acting CDC Director from January through April 2009,  told ABC News’s Mary Kekatos on Wednesday afternoon that, “As a pediatrician, and as a parent, it’s absolutely frightening, the idea that children could go to school and be unvaccinated.

That puts them at risk and others around them who may have underlying medical conditions. That’s not what America’s about. In America, there are things we do to be part of a community."

The step that the leaders of California, Washington, and Oregon took on Wednesday was the polar opposite of the approach that the Governor and Surgeon General of Florida took on the same day. Indeed, California Governor Gavin Newsom, Oregon Governor Tina Kotek, and Washington Governor Bob Ferguson, referenced the turmoil at the CDC in their announcement. A press release posted to Governor Newsom’s office’s website began thus: “Today, California Governor Gavin Newsom, Oregon Governor Tina Kotek, and Washington Governor Bob Ferguson announced they will launch a new West Coast Health Alliance to ensure residents remain protected by science, not politics. The alliance represents a unified regional response to the Trump Administration’s destruction of the U.S. CDC’s credibility and scientific integrity.”

And it quoted the three governors as stating that “President Trump’s mass firing of CDC doctors and scientists — and his blatant politicization of the agency — is a direct assault on the health and safety of the American people. The CDC has become a political tool that increasingly peddles ideology instead of science, ideology that will lead to severe health consequences. California, Oregon, and Washington will not allow the people of our states to be put at risk.”

Writing about the tri-state announcement, the Los Angeles Times’s Melody Gutierrez, Michael Wilner, and Susanne Rust wrote on Wednesday afternoon that “The rebuke from the West Coast states reveals the escalating concerns about the life-and-death consequences of the Trump administration’s healthcare agenda. For decades, the CDC has been the nation’s trusted authority on vaccines — setting childhood immunization schedules, guiding which shots adults should receive and shaping state health policies across the country. The states said the focus of their health alliance will be on providing evidence-based recommendations about who should receive immunizations while ensuring the public has access to credible information about the safety and efficacy of vaccines,” the Los Angeles Times reporters wrote.

Collaborative of healthcare associations calls on RFK Jr. to resign

With regard to everything happening in terms of the CDC’s leadership and the turmoil around vaccine policy at the federal and state levels, a coalition of 22 organizations on Wednesday evening called on Secretary Kennedy to resign. The statement was posted to the website of the Washington, D.C.-based Infectious Diseases Society of America (IDSA), a leading national association of clinical and scientific leaders in the infectious diseases sphere.

The statement began, “As national medical, scientific, public health and patient organizations, we call for the resignation of HHS Secretary Robert F. Kennedy Jr. to ensure the health of the American people. Forcing high-level CDC expert leaders to turn their back on decades of sound science to meet Kennedy’s agenda puts us all at risk. This final exclamation point on a term defined by repeated efforts to undermine science and public health definitively leaves Americans less safe in a multitude of ways.”

And the organizations cited the following issues:

•            Food safety: Reduced capacity to protect the public from foodborne illness, including a drastic reduction in the number of infections monitored and a resulting increased risk of foodborne illness.

•            Diagnostic testing and expert consultation: Limited testing capacity and consultation for less common infections where expertise, testing or medications may only be available at CDC.

•            Infection tracking and surveillance: Lack of information about what infections are circulating in local communities, which health care providers rely upon to evaluate and protect patients. 

•            Public and provider education: Loss of expertise and trust in what was once the premier source of information to support clinicians and empower patients to make the best decisions to protect themselves and their families.

•            Chronic disease prevention and management: Weakened initiatives that promote healthy behaviors, preventive care and community-based projects to prevent and manage chronic conditions like heart disease, diabetes and cancer.

•            Emergency response: Diminished leadership and capacity to detect and mount effective responses to emerging infectious diseases and bioterror attacks. 

•            Longstanding epidemics: Reversal of progress made in ending the HIV epidemic, eliminating viral hepatitis and addressing sexually transmitted infections.

•            Health and safety throughout the lifespan: Loss of expertise and information to support healthy pregnancy, child development and injury prevention.

•            Vaccination: Decimated capacity to make evidence-based vaccine recommendations and objectively oversee vaccine safety.

•            State and local health departments: Loss of expert guidance, technical support and resources to protect communities from routine health threats. 

The leaders of the 22 organizations went on to state that “We are gravely concerned that American people will needlessly suffer and die as a result of policies that turn away from sound interventions. After careful consideration, we insist on Kennedy’s resignation to restore the integrity, credibility and science-driven mission of HHS and all its agencies. Our country needs leadership that will promote open, honest dialogue, not disregard decades of lifesaving science, spread misinformation, reverse medical progress and decimate programs that keep us safe. We are speaking out because protecting public health is our responsibility as physicians, scientists and patient advocates. It is also the responsibility of our elected officials, and we call for their support at this critical moment to protect the health of the nation. It is time to reverse course and begin rebuilding the public health infrastructure overseen by CDC. Kennedy has proven himself unwilling and ill-prepared to lead that effort.”

The coalition of 22 organizations represents a very broad swath of organizations focused on public health, including the IDSA itself, as well as the American Public Health Association, the American Association of Immunologists, the American Society for Virology, and the Association for Professionals in Infection Control and Epidemiology, among numerous others.

That coalition’s call on Secretary Kennedy was echoed by Senator John Osoff of Georgia, who on Wednesday evening told Jen Psaki on MSNBC that “What he is doing at the CDC is gross mismanagement. The CDC right now is in a state of total crisis. The workforce has been systematically demoralized; more than a quarter of the staff has been fired or pushed out. There was a gunman who sprayed hundreds of rounds at the CDC headquarters, a very sensitive building, and a DeKalb County sheriff was killed, apparently inspired by conspiracy theories. And Secretary Kennedy was too busy salmon-fishing to immediately respond to it.” And, asked whether Kennedy had been a driver of conspiracy theories, he said, “He has been obsessed with these conspiracy theories for a long time,” adding that “Secretary Kennedy is demolishing our entire public health infrastructure. He must resign.”

The CDC’s former CMO speaks out

Meanwhile, also on Wednesday, Debra Houry, M.D., M.P.H., who had been the CDC’s Chief Medical Officer and Deputy Director for Program and Science, but who joined three other senior CDC leaders in resigning to protest the firing of Dr. Monarez last week, published an op-ed in the Washington Post on Wednesday morning entitled “I resigned from the CDC. Here are three questions for RFK Jr.”

Dr. Houry wrote that, “[U]nder the current administration, public health data and lab infrastructure are eroding, making Americans less prepared for all health threats. With the United States separating from the World Health Organization, flu sample submissions from abroad have decreased by more than 70 percent — meaning we don’t know which viruses should be targeted in the next flu shot. Data about covid-19 has decreased by over 60 percent — so we might not know if a threatening new variant is emerging. Polio lab submissions have completely stopped: We will not be able to stop polio at its source before it lands on American soil. We are not ready for emerging health threats, and it’s only getting worse.”

Further, Dr. Houry noted that, “With recent terminations, reorganizations and reductions in force, the CDC anticipates 750 fewer ‘ready responders’ among its workforce to immediately support communities in a crisis. Building the local public health workforce and systems that can respond to threats is the difference between being caught off guard and being ready.”

And, she wrote, “At the most recent CDC Advisory Committee on Immunization Practices meeting, presentations were delivered that had not been vetted by the agency, including one that had fabricated references on thimerosal. And the agency’s own document was pulled from the CDC website. The Morbidity and Mortality Weekly Report — long considered the gold standard of public health reporting — was paused for two weeks without explanation. Although it has resumed publication, there are no longer news media materials or public summaries to make findings accessible to practitioners and patients alike. These changes weaken the transparency and rigor that Americans deserve.”

Houry insisted that “The public must know that CDC guidance is grounded in the best available science and communicated openly and honestly, even when the science evolves. That means data must be shared quickly, uncertainty acknowledged directly and political pressure resisted. Without that, trust erodes — and with it, the ability to save lives in moments of crisis.” And, she wrote, “These three questions — about health, preparedness and transparency — are not abstract. They are the test by which history will judge us. If the answer is yes to all three, America will be a healthier, safer and stronger nation. If not, trust will continue to erode, and more lives will be lost.”