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

The Trump administration’s “Make America healthy again” (Maha) agenda appears to be stalled as two of the government’s most influential public health positions sit empty.

The president has yet to nominate a permanent director for the Centers for Disease Control and Prevention (CDC), leaving an agency that has been plagued by turmoil for the past year without a leader. At the same time, Trump’s controversial pick for surgeon general, Casey Means, remains in limbo as her 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 head can manage an agency under federal law.

Jay Bhattacharya – who also runs the National Institutes of Health (NIH) – has served as interim chief of the CDC since February, and is expected to continue overseeing the agency through a delegation of authority by health secretary Robert F Kennedy Jr, according to statements from both the Department of Health and Human Services (HHS) and White House.

In a statement, HHS said that Kennedy and Chris Klomp, who serves as the director of Medicare 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 that can further the Trump administration’s objective of restoring the CDC to its original mission of fighting infectious disease”.

The agency’s last Senate‑confirmed director, Susan Monarez, took over in July but was fired less than a month later after clashing with Kennedy over his vaccine agenda. Since then, the CDC has seen an exodus of senior public health officials, many of whom accused the health secretary of politicizing the agency and stripping leaders of their independence. The upheaval followed 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 handpicked vaccine advisory panel was unlawfully appointed, and voided many of their recent decisions on vaccines, which included no longer recommending the latest version of the flu and Covid shots and the inclusion of the RSV shot for infants.

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

On Wednesday, the New York Times reported that the Trump administration is struggling to find a suitable nomination who aligns with the Trump administration’s mission and can withstand scrutiny in the Senate, and win confirmation, according to a person familiar with the situation.

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 post unfilled more than 320 days after Trump first nominated Means last May. Her initial hearing was postponed when she went into labor hours before she was set to appear.

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

During her confirmation hearing, Means evaded senators questions about vaccine guidance, argued that many of the country’s chronic health problems stem from lifestyle and environmental factors, brushed off concerns about her limited medical experience and faced scrutiny over potential conflicts of interest tied to her wellness product promotions on social media.

As Means’s appointment remains hampered, all eyes remain on the key Republican votes on the health committee that she will need 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 with various aspects of Means’s public health perspective during her confirmation hearing. Shortly after Means testified, both Collins and Murkowski told Politico they were undecided about how they plan to vote.

“These issues are important to me,” Murkowski said at the time. “Last year when the secretary was going through his confirmations, he made certain assurances about vaccines that in fairness I am not seeing have been kept.”

Cassidy, who cast the pivotal vote to confirm Kennedy as Trump’s health secretary last year, did so despite concerns about Kennedy’s anti‑vaccine history. Kennedy assured him he would not interfere with ACIP’s membership. He subsequently reversed course, reshaping the department and sidelining career public health experts.

Allies of the Maha movement have since tried to apply pressure to the Republican holdouts and confirm Means. On Wednesday, during a weekly organizing call with the political advocacy group Maha Action, Republican senator Rand Paul, also a member of the health committee, told attendees to reach out to Cassidy, Collins and Murkowski. “It should have been out. We should have voted long ago,” Paul said during the call Wednesday afternoon. He added that the three senators he named “do not currently or have not been vocal in their support for her nomination”.

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