Trump’s Maha agenda stalled as top CDC and surgeon general roles sit empty | Trump administration

The Trump administration’s Make America Healthy (Maha) agenda appears to be stalled as two of the government’s most influential public health positions remain vacant.

Donald Trump has yet to name a permanent director for the Centers for Disease Control and Prevention (CDC), leaving an agency mired in turmoil for a year without a leader. At the same time, the president’s controversial pick for surgeon general, Casey Means, remains in limbo as his nomination stalls in the Senate.

The CDC has now been without a Senate-confirmed director for more than 210 days, the maximum length of time an acting director can lead an agency under federal law.

Jay Bhattacharya – who also heads the National Institutes of Health (NIH) – has served as acting head of the CDC since February and is expected to continue to oversee the agency through a delegation of authority from Health Secretary Robert F Kennedy Jr, according to statements from the Department of Health and Human Services (HHS) and the White House.

In a statement, HHS said Kennedy and Chris Klomp, who is Medicare director and deputy administrator of the Centers for Medicare and Medicaid Services (CMS), “are working with the White House on the CDC director search by evaluating candidates who can advance the Trump administration’s goal of restoring the CDC to its original mission of fighting infectious diseases.”

The agency’s last Senate-confirmed director, Susan Monarez, took office in July but was fired less than a month later after a conflict with Kennedy over his vaccination program. Since then, the CDC has witnessed an exodus of top public health officials, many of whom have accused the health secretary of politicizing the agency and stripping leadership of their independence. The upheaval follows a shooting at CDC headquarters in Atlanta, where a gunman – who blamed the Covid vaccine for making him depressed and suicidal – killed a police officer.

Most recently, a federal judge ruled earlier this month that Kennedy’s hand-picked vaccine advisory committee was illegally appointed and reversed many of its recent vaccine decisions, which included no longer recommending the latest version of the flu and Covid vaccines and the inclusion of the RSV vaccine for infants.

Since only the CDC director can formally approve vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP), the lack of a permanent director effectively shifts that authority to Kennedy as secretary of Health and Human Services, according to Anne Joseph O’Connell, a Stanford law professor.

On Wednesday, The New York Times reported that the administration was struggling to find a nominee who was both consistent with its agenda and able to withstand Senate scrutiny, according to a person familiar with the matter.

As the White House searches for a permanent CDC director, its nominee for the nation’s top doctor remains stuck in limbo. Casey Means testified more than a month ago, but the Senate Health Committee has yet to schedule a vote — leaving the position vacant more than 320 days after Trump first nominated Means last May. Her initial hearing was postponed when she went into labor before her appearance.

Means, 38, who is neither a board-certified physician nor an active medical license holder, graduated from the Stanford School of Medicine but did not complete her residency in head and neck surgery at Oregon Health and Science University. Her scientific experience is mainly focused around her work as an influencer and leader within the Maha space – a key pillar of the Trump administration’s health policy.

During his confirmation hearing, Means evaded questions about vaccination guidelines, argued that many of the nation’s chronic health problems stem from lifestyle and environmental factors, brushed off concerns about his limited medical experience and faced criticism over potential conflicts of interest related to his social media promotions of wellness products.

While Means’ nomination remains hobbled, all eyes remain on the key Republican votes on the health committee that she will have to advance — namely Bill Cassidy of Louisiana and two GOP moderates, Susan Collins of Maine and Lisa Murkowski of Alaska.

All three lawmakers expressed skepticism about various aspects of Means’ public health perspective during his confirmation hearing. Shortly after Means’ testimony, Collins and Murkowski told Politico they were undecided about how they planned to vote.

“These questions are important to me,” Murkowski said at the time. “Last year, when the secretary looked at his confirmations, he gave some assurances regarding vaccines that, in all honesty, I don’t see have been sustained.”

Cassidy, who voted last year to confirm Kennedy as Trump’s health secretary, did so despite concerns about Kennedy’s anti-vaccine history. Kennedy assured him that he would not interfere with ACIP membership. He then changed course, reshaping the department and sidelining career public health experts.

Cassidy and Collins are also up for re-election this year, adding political pressure as Republicans warn that Kennedy’s vaccine policy changes could hurt the party in the midterms. Cassidy — a former doctor who chairs the health committee — faces a major challenge from Louisiana Rep. Julia Letlow. Letlow is endorsed by Trump and backed by Maha Pac, who pledged $1 million to defeat Cassidy.

On Thursday, Letlow urged the outgoing president to “stop blocking” Means’ nomination in an article on

Collins, meanwhile, is expected to face a competitive race against the Democrat who emerges from the Maine primary.

Allies of the Maha movement have since tried to put pressure on The Republican recalcitrants to confirm the means. On Wednesday, during a weekly engagement call with the political advocacy group Maha Action, Republican Sen. Rand Paul, also a member of the health committee, asked participants to contact Cassidy, Collins and Murkowski. “We should have voted a long time ago,” Paul said on the call. He added that the three senators he nominated “have not expressed support for his nomination.”

On the call, which the Guardian joined, Paul added that if Means’ nomination for surgeon general can’t get the support it needs, then members who oppose her “should at least be officially opposed to her.”