Makary’s resignation as head of the Food and Drug Administration widened a leadership gap across the U.S. health system that had already begun the week with several senior posts empty or filled by temporary leaders. The FDA chief’s departure came Tuesday, leaving the agency without a permanent top official while HHS remains in a period of rotating interim leadership, according to an Associated Press report.
The reshuffling compounds criticism that the scale of upheaval at HHS is unusually high, with concerns centered on whether the agencies can coordinate science and public communication effectively. Critics also pointed to the broader disruption they associate with Kennedy’s approach to health policy and staffing, describing a series of cuts and firings that they say have further weakened stability.
The report said that, even before Makary stepped down, some HHS-linked leadership roles were already unfilled or acting. It described no Senate-confirmed U.S. surgeon general, the National Institutes of Health director doubling as acting head of the Centers for Disease Control and Prevention, and the FDA lacking a permanent vaccine chief after that official was ousted a second time in a year.
“It’s a sign that something is not right in this department,” said Dr. Daniel Jernigan, a former senior employee at the CDC. In the same account, Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania, said most Americans do not pay attention to federal agency leadership until a public health concern arrives, and she framed moments like outbreaks as opportunities to build public trust that has eroded in recent years.
At the FDA, the report said Makary leaves behind ongoing reviews and unfinished initiatives under scrutiny, including work tied to ultra-processed foods, food dyes, antidepressants and COVID-19 shots. It said the FDA is developing a first-of-its-kind definition of “ultra-processed foods,” an issue Kennedy has blamed for elevated rates of diabetes, obesity and other chronic conditions, and that the task has fallen to the agency’s deputy commissioner for foods, Kyle Diamantas.
Diamantas was tapped by Trump to lead the FDA on an acting basis, the report said, and he is also serving as a chief counselor to Kennedy. Dr. Peter Lurie, a former FDA official now at the Center for Science in the Public Interest, said in the report that Diamantas now has a “nearly impossible charge” and criticized what he described as leadership by someone without a medicine or science degree at a science-based agency under an “unqualified secretary” whose focus, in Lurie’s view, centers on personal medical and nutritional “pet peeves” rather than evidence-based public health.
For the CDC, the report described a cycle of short-term directors. It said Trump’s first choice to run the agency, former Florida Rep. Dr. David Weldon, had a Senate confirmation hearing canceled in March 2025 after about an hour before it was to begin. The report said Weldon at the time said he had been told that not enough senators were willing to vote for him.
The account said the White House then moved to Susan Monarez, who was confirmed by the Senate but ousted in less than a month after disagreements over the administration’s agenda, with several scientific leaders resigning in protest. Since then, multiple HHS officials have served as acting director, and the report said NIH Director Jay Bhattacharya has been overseeing the CDC since February; it also said Trump nominated Dr. Erica Schwartz, a former deputy surgeon general, to be the next CDC director for Senate confirmation.
Current and former CDC employees told the report that there is a void in experienced public health leadership and that Kennedy’s aides have slowed and sometimes blocked the agency’s ability to communicate with the public and conduct the full range of science-based work it had done previously. HHS officials told the report that the CDC’s critical functions have remained “intact and effective” and that changes were part of an effort “to restore credibility through transparency, gold standard science, and accountability.”
Jernigan, who resigned last August from a senior CDC role that the report said still has no permanent replacement, said the leadership shuffle has meant there has not been a “strong, present CDC director” to advocate for funding, hiring and retention of skilled scientists. As the report described the current hantavirus outbreak, the CDC deployed teams to evacuate and quarantine Americans who may have been exposed, health officials briefed reporters and Bhattacharya appeared on a Fox News program to urge Americans not to worry, while Jernigan said the CDC’s public messaging contained errors and overstated what was known at the time; Jernigan also urged the CDC to let more career scientists speak to the public.
“That will do more for trust and for calming the nerves of the U.S. right now,” Jernigan said. The report also described how, in recent months ahead of midterm elections, the White House and HHS have shifted messaging toward health initiatives related to diet, lifestyle and affordability, publicly moving away from Kennedy’s first-year effort to roll back vaccine guidelines.
While Kennedy has remained a prominent voice in health policy, the report said his advisers’ recent nominations have suggested his close allies may not always be placed at the top of the agency leadership list. For example, the report said Trump nominated radiologist and former Fox News personality Dr. Nicole Saphier last month, after withdrawing a surgeon general nominee embedded in Kennedy’s Make America Healthy Again movement; it said Saphier has advocated vaccines more forcefully than Kennedy and has criticized actions by the current HHS as “embarrassing,” with Senate confirmation still required.
Jernigan said he worries Kennedy will not always center the best science in decisions. “The driver for the secretary is the ideology,” he said. “And that’s not a strategy for really improving the health of Americans.”