The Trump administration’s ambitious “Develop America Healthy Again” (Maha) agenda is facing significant headwinds as key leadership positions at the nation’s top public health agencies remain unfilled. More than seven months into his second term, President Trump has yet to nominate a permanent director for the Centers for Disease Control and Prevention (CDC), leaving the agency in a state of prolonged uncertainty. Simultaneously, the confirmation process for his pick for surgeon general, Casey Means, has stalled in the Senate, raising questions about the administration’s ability to fully implement its health policy goals.
The CDC has been without a Senate-confirmed director for over 210 days, exceeding the legal limit for an acting director’s tenure, according to federal law. This leadership vacuum comes at a critical time, as the agency navigates ongoing public health challenges and prepares for potential future outbreaks. The situation is further complicated by a recent federal judge’s ruling that invalidated decisions made by a vaccine advisory panel handpicked by Health and Human Services Secretary Robert F Kennedy Jr., throwing vaccine recommendations into disarray.
A Prolonged Leadership Void at the CDC
Currently, Jay Bhattacharya is serving as the interim chief of the CDC, a position he’s held since February. The administration intends to continue Bhattacharya’s leadership through a delegation of authority from Secretary Kennedy, according to statements from both the Department of Health and Human Services (HHS) and the White House. However, this arrangement is seen by many as a temporary fix, lacking the stability and authority of a Senate-confirmed director.
The CDC’s last permanent director, Susan Monarez, was abruptly fired less than a month after assuming the role in July, reportedly due to disagreements with Kennedy over his approach to vaccine policy. The Guardian reported that Monarez’s dismissal triggered an exodus of senior public health officials, many of whom accused Kennedy of politicizing the agency and undermining its independence. This instability was compounded by a shooting at CDC headquarters in Atlanta, where a police officer was killed by a gunman motivated by anti-vaccine sentiments.
The search for a fresh CDC director has reportedly been hampered by the administration’s desire to find a nominee who aligns with its agenda while also being able to withstand scrutiny from the Senate. The New York Times reported this week that the White House is struggling to identify a candidate who meets both criteria.
Surgeon General Nomination Faces Senate Hurdles
Adding to the administration’s challenges, the nomination of Casey Means to be the nation’s surgeon general remains stalled in the Senate Health Committee. Means testified before the committee over a month ago, but a vote has yet to be scheduled. Her confirmation process was initially delayed when she went into labor shortly before her scheduled appearance.
Means’s qualifications have drawn scrutiny from lawmakers and public health experts. At 38, she is not a board-certified physician and does not currently hold an active medical license. While she graduated from the Stanford School of Medicine, she did not complete her residency in head and neck surgery at Oregon Health & Science University. Her background is primarily in wellness and advocacy within the Maha movement, the cornerstone of the Trump administration’s health policy.
During her confirmation hearing, Means reportedly evaded direct questions about vaccine guidance and emphasized the role of lifestyle and environmental factors in chronic disease. She also faced criticism regarding potential conflicts of interest stemming from her promotion of wellness products on social media.
Political Pressure and Uncertain Future
The fate of Means’s nomination rests with key Republican senators on the Health Committee, including Bill Cassidy of Louisiana, Susan Collins of Maine, and Lisa Murkowski of Alaska. All three expressed reservations about aspects of Means’s public health perspective during her hearing. Politico reported that both Collins and Murkowski indicated they were undecided on how they would vote.
Murkowski stated that she was concerned about assurances regarding vaccines that were made last year during Kennedy’s confirmation process, which she feels have not been kept. Cassidy, who previously voted to confirm Kennedy despite concerns about his anti-vaccine views, was reportedly assured that Kennedy would not interfere with the Advisory Committee on Immunization Practices (ACIP). However, Kennedy subsequently reshaped the department and sidelined career public health experts.
The upcoming elections add another layer of complexity. Both Cassidy and Collins are facing competitive re-election campaigns, and the issue of vaccine policy has become increasingly politicized. Julia Letlow, a Louisiana congresswoman endorsed by Trump and backed by Maha Pac, is challenging Cassidy in the primary, with Maha Pac pledging $1 million to defeat him. Letlow recently urged Cassidy to “stop blocking” Means’s nomination in a post on X, arguing that Trump is trying to change a healthcare system that prioritizes profit over prevention.
For too long, Washington has protected a healthcare system that waits until people are sick, cashes in on chronic disease, and leaves families to pay the price. President Trump is trying to change that, and Casey Means is a major part of that fight. https://t.co/wJq9q9q999
— Julia Letlow (@jbletlow) March 21, 2026
Meanwhile, allies of the Maha movement are actively lobbying Republican senators to support Means’s confirmation. During a recent organizing call with Maha Action, Senator Rand Paul urged attendees to contact Cassidy, Collins, and Murkowski, arguing that a vote should have already taken place. He suggested that those opposed to Means’s nomination should publicly state their position.
The ongoing delays in filling these critical positions raise concerns about the administration’s ability to effectively address public health challenges and implement its policy agenda. The absence of confirmed leadership at the CDC and in the surgeon general’s office creates uncertainty and could hinder the nation’s preparedness for future health crises.
The Senate Health Committee is expected to revisit Means’s nomination in the coming weeks, and the White House continues to search for a suitable candidate to lead the CDC. The next key checkpoint will be a scheduled vote on Means’s confirmation, which will likely determine the direction of public health policy under the current administration.
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