This Is What—and Who—We’re Losing in RFK’s PurgeThe story of one scientist, a career in public health, and the crisis at the CDC.
UNTIL THIS PAST THURSDAY, Demetre Daskalakis was in charge of the CDC’s division for immunization and respiratory disease—making him, arguably, the federal official most directly and singularly responsible for issues related to COVID-19 vaccination. But in late May, when Health and Human Services Secretary Robert F. Kennedy Jr. announced a major change in the official recommendations for who should get COVID shots, Daskalakis learned about it the same way the rest of America did: via social media. “We were sitting in a room of senior leaders, and I was talking about outbreaks, which is one of the topics I present on,” Daskalakis told me, recalling the scene inside a routine morning meeting at CDC headquarters in Atlanta. “Then all of the sudden my phone blew up [with] all kinds of messages from people asking about the new vaccine schedule. And I was like, ‘I have no idea what you’re talking about.’” Daskalakis opened X on his phone, then told the dozen assembled colleagues what HHS had just posted there: an official video of Kennedy announcing that the CDC would no longer recommend COVID-19 shots for pregnant women or children without major underlying medical conditions. Daskalakis strongly opposed the decision, given that COVID-19 can cause severe complications during pregnancy and infect newborns who are dependent on the antibodies they get in utero. The disease sometimes puts even healthy children into the hospital. He was also stunned that word had come down this way, with neither him nor anybody in his division having been told that the announcement was coming, let alone consulted on it. Daskalakis told me he tried to keep an open mind, asking senior HHS officials for a chance to see whatever studies or hear out whatever experts they believed justified the policy shift. If the CDC was going to publish these guidelines, he felt, its scientists had an obligation to review the evidence behind them. But Daskalakis says HHS officials rebuffed his repeated requests.¹ “The answer was no—they declined to share any of the materials that they were using to support that decision,” Daskalakis said. “We’ve never seen it. CDC has never seen it.” The announcement was one of a series of clashes that pitted Kennedy against the CDC’s career scientists and eventually agency director Susan Monarez, in an escalating conflict that exploded into public view last week after Monarez refused to sign off on some of Kennedy’s directives about vaccines. That in turn led to an extraordinary, unprecedented days-long spectacle in which Donald Trump fired Monarez, prompting Daskalakis and three of his fellow senior scientists to resign. Daskalakis and the other CDC leaders had been discussing such a move for weeks, hesitant to abandon their posts or colleagues but fearing their ongoing presence at the CDC was lending scientific credence to unscientific policies. They also knew their positions were precarious, given that Kennedy’s aides had been pushing Monarez to fire them. With even some Republican lawmakers expressing alarm, Kennedy and the White House have defended their actions as necessary to carry out the “Make America Healthy Again” agenda. “There’s a lot of trouble at CDC,” Kennedy told reporters, “and it’s going to require getting rid of some people over the long term in order for us to change the institutional culture and bring back pride and self-esteem and make that agency the stellar agency that it’s always been.” In reality, pride and self-esteem at the CDC are at a low ebb, thanks in part to staff cuts and a shuttering of programs ordered by the Trump administration—and to the August shooting on the CDC campus carried out by a gunman who said he was angry about COVID vaccination. Kennedy was conspicuously slow to acknowledge the attack, which left a police officer dead, or to express solidarity with CDC workers. Trump also didn’t say anything right away. In fact, he still hasn’t commented on the shootings.² And whether that’s a sign of his contempt for the CDC or merely his failure to care about it, it helps explain why Kennedy has been able to impose his will so freely—and why the agency has become such a diminished version of its former self. Long the envy of the world for its capabilities and expertise, the CDC finds itself no longer able to advocate for what its scientists believe the best available research shows. In addition, the agency has since January shed literally centuries’ worth of collective experience through a combination of firings, retirements, and resignations. Every one of these people is taking with them skills and knowledge that will be difficult to replace. But there may be no single individual whose departure better captures what is being lost and destroyed than Daskalakis. DASKALAKIS SAYS HE WANTED to be a doctor for as long as he can remember, going back to childhood. But he made the decision for real while he was an undergrad at Columbia University in the early 1990s, volunteering to work with AIDS patients during what was still the peak of the crisis. “I would meet people in the world, and then I would never see them again, and then I would find out that they were in Bellevue or in St. Vincent’s and they were dying,” Daskalakis said. “And so I basically thought: ‘This is what I want to do—I don’t want people to die or suffer from infectious diseases.’” After graduation, he spent most of the next fifteen years in Boston and New York—studying for a medical degree at New York University and a master’s in public health at Harvard, and training at Boston’s Beth Israel Deaconess and then New York’s Bellevue hospitals. In 2014, his work got the attention of New York City officials, who brought him over to the public health department as assistant commissioner. Protecting public health in America’s largest, most densely populated city meant dealing with everything from Ebola to hepatitis to food poisoning—all while coordinating across departments in a vast governing bureaucracy. It also meant overseeing emergency management, especially in 2018 and 2019 while helping to lead the response to New York City’s worst measles outbreak in thirty years, with hundreds of documented diagnoses and more than sixty hospitalizations. The cases were concentrated in a cluster of ultra-Orthodox Jewish communities in Brooklyn with low vaccination rates. A surge in shots ultimately helped to end the outbreak. Daskalakis thinks a key to success was community engagement, because it was only by enlisting the help of trusted elected and faith leaders that he felt like public health officials were able to change minds. “I’d worked in the community engagement space for HIV,” Daskalakis said, “but never did I imagine myself sitting there in a wedding banquet hall in Williamsburg—not far from where I lived—with the administrative rabbis from all the yeshivas in Brooklyn, talking about vaccines.” In 2020, Daskalakis was on the front lines of the response to COVID in its early, most devastating months, when sickness and death overwhelmed New York’s hospitals. Looking back, he told me, he thinks a lot about how many lives medical providers and government officials saved despite so many staggering challenges, including a public health infrastructure suffering from decades of neglect and a rapidly evolving pathogen that scientists had never seen before. But he has also thought a lot about where the response went wrong—like going “full throttle” on closures for too long, or speaking too confidently about the ability of vaccines to prevent infection altogether rather than to prevent the most severe, life-threatening effects. “You need to say, ‘This is what we think we know, but this may change tomorrow,’ and just be really clear about risk communication,” Daskalakis said. “You need to approach everything with less confidence and hubris, and more transparency.” IN LATE 2020, Daskalakis left New York’s public health agency to join the CDC in Atlanta, to work on HIV once again. He brought with him an appreciation of nuanced messaging and community engagement as bulwarks against misinformation. And thanks to the time he spent trying to win over vaccine skeptics in Brooklyn, Daskalakis told me, he was familiar with some of the people most responsible for spreading it. “It was pretty clear that Mr. Kennedy was a part of the system that was creating some of the disinformation we were fighting,” Daskalakis said. Even so, Daskalakis says, he was initially optimistic because Kennedy seemed to be going out of his way to say he wanted an open, collaborative relationship with CDC staff—and that he was genuinely interested in scientific inquiry. “When he had his welcome speech at HHS,” Daskalakis said, “I made sure that my entire staff tuned in, because it was an opportunity to hear what his thinking was like, so that we could work together with him—to meld science with his thinking in a way that achieved the important clinical public health and scientific goals, and that also addressed what his vision was for health in the U.S.” But that early promise proved empty, Daskalakis said, as he watched Kennedy give interviews where he’d make false claims, especially about the cutting-edge mRNA vaccines widely thought to be the best weapon against future pandemics or bioterror attacks. Daskalakis was also dismayed that Kennedy never sought or received a briefing from his staff, even as measles was burning through West Texas. Then there was Kennedy’s decision to dismiss every sitting member of the CDC’s vaccine advisory commission and replace them with well-known vaccine critics whose views are outside the mainstream scientific consensus. The swap was a prelude to a discussion, at the commission’s subsequent meeting, like none that Daskalakis or anybody else on the CDC’s career staff had seen before. The agenda that day included a debate over whether to keep allowing use of the preservative thimerosal in flu shots, because somebody in HHS leadership (it’s not clear who) had added the item a week before. The unusually late change left CDC staff without time to prepare or vet outside presentations fully, and when the meeting commenced they discovered a briefing they had written rejecting evidence of thimerosal’s alleged harms was not in the official materials. One of Kennedy’s hand-picked members, the controversial anti-vaccination physician Robert Malone, said the briefing had not been “authorized by the office of the secretary.” He and all but one of the new committee members went on to vote in favor of banning thimerosal. Scientists across the country blasted the decision as inconsistent with evidence, and predicted it would make getting flu shots harder in some parts of the country. The common denominator in these and other developments was a lack of consultation with CDC staff. Daskalakis says he interpreted it as an attempt to use the agency as a “public health shield,” in order to provide cover for decisions that actual CDC officials found highly objectionable—the very thing that prompted last week’s confrontations, the firing of Monarez, and the resignations by Daskalakis and his counterparts. Their departures leave the CDC without some of its strongest, most independent advocates for public health and intellectual rigor, but the logic makes sense to fellow scientists like Tara Palmore, a highly regarded infectious disease specialist who just stepped away from a twenty-year career at the National Institutes of Health. “Dr. Daskalakis is a public health hero and a beacon of courage,” Palmore told me, “at a time when public health is under open assault by our own government.” WHILE KENNEDY AND THE TRUMP White House were explaining the CDC departures as a necessary step in their agenda, their supporters were hailing them. The MAHA movement and its MAGA converts have come to see the entire public health establishment as the enemy, and remain furious over COVID-era restrictions that they say were merely an instrument of social control. In their view, purging anybody who had anything to do with pandemic responses is as essential as purging anybody who prosecuted January 6th rioters, or who investigated Trump’s relationship with Russia. But many Kennedy and Trump supporters seemed particularly elated about the dispatch of Daskalakis, who is gay and has a long association with groups representing the LGBTQ community. This isn’t at all surprising given his line of work: The AIDS epidemic was a society-altering catastrophe, one that inspired legions of future doctors—gay and straight alike—to pursue careers in infectious disease. Today they make up a disproportionate share of the specialty’s senior ranks. Daskalakis’s profile had first drawn attention back in 2022, when the Biden administration brought him to the White House to coordinate the government’s response to mPox,³ another new disease that was affecting the LGBTQ community disproportionately. Right-wingers gleefully posted screen grabs of photos he’d put on his Instagram feed, in which he was showing off his bare chest, proclivity for leather, and tattoos that some social media critics said showed he was satanic. “I wish I were that interesting,” Daskalakis quipped to Politico at the time. Last week MAGA and MAHA keyboard slingers were at it again, reposting the old photos with snarky captions. They also mocked his resignation letter because it referred to “pregnant people” rather than “pregnant women,” and specified that his pronouns were he/him/his. Fox News saw fit to give the reaction its own article, which included a few Republican leaders (like Florida Gov. Ron DeSantis) piling on with their own missives. The antipathy toward Daskalakis is consistent with the way Trump and his supporters now subordinate everything to their culture-war causes, especially when those causes touch on gender issues. But it’s not especially clear why a medical expert’s attention to pronouns or pride in his sexuality and looks—he’s been called “a hot, young Stanley Tucci”⁴—should matter given the skills Daskalakis has to offer, and the inevitable need for them in the future. “Outbreaks are complicated social and biological events, and people who have a lot of experience managing them are going to be way more effective at managing them than somebody who’s never done it before,” Ashish Jha, dean of Brown University’s School of Public Health, told me in a phone interview. Jha served in the Biden administration, and recruited Daskalakis for the mPox response. “He was my first call,” Jha said. “He’s very expert at managing respiratory disease outbreaks. And when you lose someone like him, you really lose the ability to run a coordinated response.” Sarah Despres got to know Daskalakis while she was working at HHS in the Biden administration, handling the public health portfolio. “His experience gives him that rare combination of scientific knowledge, practical judgment and extraordinary communication skills,” she told me. “The federal government should be recruiting more like him, not pushing him away.” There are plenty of people who seem to appreciate these sorts of contributions. And on Thursday afternoon, a few hundred of them gathered outside CDC headquarters, showering Daskalakis and two of the other resigning leaders with cheers and the occasional hug as they took a final walk out of the building. It was about an hour later that I spoke to Daskalakis, as he was driving home. I asked if anything about the past few weeks made him hopeful. He said yes, citing the work of health-care professionals who have taken it upon themselves to speak out against Kennedy’s pseudoscience and issue their own recommendations on vaccines. “I have faith in people outside of government,” Daskalakis said. “The professional organizations, doctors, nurses, and other providers—and also the parents who will do what’s right for their kids based on the advice of people they can trust.” “So I’m hopeful in that sense,” he added. “I’m just not necessarily hopeful that the federal government is going to be the answer anymore.” 1 HHS did not respond to my queries for this article. Yes, this has become a pattern. No, I’ve never seen anything like this level of nonresponsiveness—not even in Trump’s first presidential term. 2 The shooting was on August 8. After twenty days had gone by, White House Press Secretary Karoline Leavitt was asked last week, following the firing and resignations at CDC, why the president hadn’t acknowledged the shooting. She said, “We absolutely were very much aware of that shooting” and then proceeded to describe Kennedy’s response. 3 The mPox disease is caused by the monkeypox virus, and until 2022 that’s how the medical community referred to the disease. The World Health Organization officially changed the designation, citing concerns that the term “monkeypox” was being used in “racist and stigmatizing” ways. 4 Also noted in the same Politico article, well worth reading. You’re a free subscriber to The Bulwark—the largest pro-democracy news and analysis bundle on Substack. For unfettered access to all our newsletters and to access ad-free and member-only shows, become a paying subscriber.We’re going to send you a lot of content—newsletters and alerts for shows so you can read and watch on your schedule. Don’t care for so much email? You can update your personal email preferences as often as you like. To update the list of newsletter or alerts you received from The Bulwark, click here. 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