Q&A with Debra Houry

Debra Houry, who served as chief medical officer and deputy director for program and science at the Centers for Disease Control and Prevention, was one of several senior CDC officials who resigned in protest over the firing of Director Susan Monarez last week. Others who quit included Demetre Daskalakis, who ran the National Center for Immunization and Respiratory Diseases; Daniel Jernigan, who led the National Center for Emerging and Zoonotic Infectious Diseases; and Jennifer Layden, who led the Office of Public Health Data, Surveillance, and Technology. Houry spoke to Nancy Vu about her resignation, what it was like working under Robert F. Kennedy Jr., and the impact of the shooting that recently took place at agency headquarters. This interview has been edited for length and clarity.

You served as the CDC’s chief medical officer and deputy director for program and science, but what exactly did you do?

I was the senior-most career official at CDC. I oversaw all of our national centers, as well as the Office of Science. And then all of our medical and scientific guidance would come through me for review and approval.

I was also the transition lead for the agency. Each agency appoints somebody, and I was the one to help bring on the Trump administration.

Can you walk me through how you and the other senior CDC officials came to the decision to resign? What was the straw that broke the camel's back? Was it the firing of Dr. Monarez, or was it something else?

So it had been leading up to that. Demetre and Dan both worked for me—we had talked a lot about many of the issues we were facing together. Demetre had a lot of the issues around the Advisory Committee on Immunization Practices, along with the issues around vaccines versus vitamins to combat measles.

Dan Jernigan—his center oversees immunization safety, and so he had been dealing with some of the requests for our vaccine safety data from David Geier and Lyn Redwood. And I had both of that, plus trying to be the interface between our political leadership at CDC and our career staff while navigating things like the budget cuts, terminations, and the potential reorganization of the department.

And over time, it was like a thousand paper cuts. We were waiting for scientific leadership to come. When Susan came, she wanted to make some changes to the Advisory Committee on Immunization Practices, and that was great to see. She wanted to have somebody with more policy experience for ACIP’s designated federal official, and she wanted to have more transparency by putting up on the website the materials in advance of the ACIP meetings and to open them up for public comment.

But HHS did not agree with her change to the designated federal official, and they asked her to come to D.C.

For me, that was the sign that I was done. We had been through enough that we knew we were no longer going to be successful at CDC. And so Dan, Demetre, and I—we talked about it, and I actually had their resignation letters in my inbox on Monday, along with a draft of mine. And we decided we would wait and see what happened with Susan. When she was escorted out on Wednesday, I hit "submit" on all three.

As the most senior career official at the CDC, what was it like to work under Kennedy?

It was different from any other prior administration I’ve worked with. Under the prior Trump administration, I had briefed the White House on things, and I had certainly briefed the secretary and the assistant secretary regularly, particularly the assistant secretary.

Under this administration, I never briefed the secretary on vaccines, measles, chronic disease, H5N1. Nor did Demetre or Dan. We offered several times, but the offer was never accepted.

I would get requests through clearance channels like, “Make sure that vitamin A is included in your information on measles.” And so we would—but we would do it in the appropriate manner. It did not need to be overly prominent, because it has a small role to play in measles. So we tried to really balance requests like that.

We did not have much communication. I learned about the changes to the CDC’s guidance on COVID vaccines while sitting in a senior leadership meeting when it hit social media. Usually I would have participated in that decision, reviewed the guidance, and been familiar with the data behind it. We asked for the data behind it, but never received it.

For the short time that Dr. Monarez led the CDC, was morale better than what it was?

Well, that’s difficult to answer, and I can tell you why: We had a shooting five days into it.

But I can tell you in her first four or five days, people saw a difference in me. I had been doing my best to make decisions, but we would have to vet things or get them approved via our chief of staff or HHS. And when Susan came, I was able to present things to her, and she was able to make decisions, and we could move forward.

Those were the first four or five days of Susan. She had already been very clear on scientific transparency. She had done a lab tour, she was engaging with staff. She was warm and genuine.

And then the shooting happened. It was a violent attack on our agency, and in my mind, on public health. And so then certainly after that, many of our staff, rightly so, were traumatized. And Susan, because we were remote, was not as visible then.

What do you know about the acting CDC director, Jim O'Neill? Do you think the CDC will be in better or worse hands?

I have not had much exposure to him. I know he’s an operations person, and he’s not a scientist or a clinician. That gives me concern, given that the scientific leadership bench is quite thin now at CDC.

Back on April 1, half of my leadership team resigned or was reassigned, and now you’ve got me, Demetre, Dan, and Jen who are also gone. So I think probably about 80 percent of the center and office directors are “acting” officials.

What can you tell me about the number of career officials who are in place now at the CDC versus the political appointees? What’s the impact of having such a high number of politicals at a scientific agency?

Approximately 2,500 people were placed on administrative leave earlier this year. Some of them were terminated. So we’ve had a lot of brain drain there. We have also had the highest number of political appointees at CDC ever.

Under the prior Trump administration and the Biden administration, we did have political appointees. But they had experience in public health and/or federal government, and I found them to be very effective because they could talk with their political counterparts in the department or the White House and be an advocate for CDC. I would say that many, but not all, of the current political appointees at CDC don’t have that same level of experience.

Senator Bill Cassidy and other senators are calling for oversight into the resignations and firings. Have you talked to Cassidy or other lawmakers about their oversight efforts?

I have spoken with several members and staffers from both parties this past week. I’m not going to say who, but I can say I think that there has been interest in talking to some of the recent people who have resigned, and I think that’s appropriate.

Have you been called to testify in front of the Senate Committee on Health, Education, Labor, and Pensions, or other committees?

I have not. I would guess there’s a high likelihood I will, but I have not been asked.

What direction do you think the CDC, and more broadly HHS, is heading towards on the issue of public health? What do you think will be the result of Kennedy’s efforts to consolidate power within the department?

The move to consolidate agencies into the Administration for a Healthy America I think would be devastating for CDC and public health for a couple of reasons.

One, public health doesn’t act like that. You look at the health department, and they’re not splintered to different parts. They might have different departments or sections, but they’re pretty seamless. And some of our grants, like the public health infrastructure grant, are for priorities for each state. I think it’d be hard to say, “You can only have these priorities, but not something else that’s killing people in your state.”

The second thing is, it’s going to change fundamentally what some of these programs look like. Drug overdose is the most highly requested Epi-Aid by communities. That will be lost when it goes to AHA. Each month, we send out test kits on new fentanyl analogs and drugs. Things like that won’t happen anymore, because that lab and response component will be lost.

I think it’s really important for people to understand, this is not a Republican-versus-Democrat thing. When you look at CDC engagement with the prior Trump administration, it was very positive overall. Certainly during COVID there were some setbacks and things like that, but our engagement with the department was very different than what it is under this administration.

Can we expect in the coming days more resignations from high-level officials within CDC, or maybe other agencies under HHS?

I think there’s a high likelihood. I can tell you several of the remaining leaders at CDC have called me because I was their boss, and what I have said to them is, “Please take some time. CDC needs leaders and scientists and people on the ground to stay, so do not do anything rash." But I do know many are considering leaving.

What is your message to Kennedy as he continues on?

I think my message to Kennedy would be to listen to the CDC scientists. Have briefings from them. Take a minute to learn more about the agency directly from the people on the ground.

And it is not helpful to say things like, “Don't trust the experts.” That just further erodes trust. If he wants to work with CDC, the best way to do that is to work directly with CDC and its career officials.