Twenty-Eight Days of Confirmed Leadership
By almost any measure, the Centers for Disease Control and Prevention is the most important public health agency in the United States. It leads the nation's response to infectious disease outbreaks, tracks chronic disease trends, sets vaccination guidelines, and provides the epidemiological data that state and local health departments depend on for their own operations. So the fact that the CDC has operated with a Senate-confirmed director for just 28 days during the current presidential administration is a statistic worth pausing on.
Leadership instability at the CDC is not simply a bureaucratic inconvenience. The agency's effectiveness depends on its ability to issue authoritative guidance that the medical community, state health departments, and the public trust and follow. Acting directors, however capable, carry less institutional authority than confirmed leaders. They may be reluctant to make bold decisions, knowing that a permanent director could arrive at any time with different priorities. And the uncertainty about permanent leadership can affect staff morale and retention at an agency that has already seen significant turnover in recent years.
The vacancy reflects broader turbulence at the Department of Health and Human Services, where organizational restructuring and shifting policy priorities have created an environment of persistent uncertainty. Key positions across HHS remain unfilled or staffed by acting officials, creating a leadership landscape that looks more like a provisional arrangement than a functioning administrative structure.
A Bipartisan Achievement Worth Noting
Against this backdrop of institutional instability, a genuinely noteworthy development has occurred on Capitol Hill. Congressional staffers from both parties recently gathered to celebrate the passage of the first bipartisan health care legislation in over three years — a package negotiated as part of the HHS funding bill approved by Congress last month.
In the current political environment, any bipartisan legislative achievement deserves attention, but a health care deal is particularly significant given the depth of partisan division on nearly every health policy issue. The specifics of the package reflect compromise on funding levels, program authorizations, and policy provisions that both parties could accept, even if neither side got everything it wanted.
The celebration itself — staffers from opposing parties in the same room marking a shared accomplishment — represents something increasingly rare in Washington. Health policy has been one of the most contentious arenas in American politics for more than a decade, and the ability to find common ground on any aspect of it suggests that pragmatism has not been entirely extinguished by polarization.
The FDA and the Ultra-Processed Food Debate
While Congress found rare agreement on health funding, the executive branch has been generating its own health policy headlines through a focus on food regulation that represents a significant departure from previous administrations. FDA Commissioner Martin Makary and HHS Secretary Robert F. Kennedy Jr. have been prominently visible in pushing regulatory changes around food quality and safety, with a particular emphasis on ultra-processed foods and artificial additives.
One of the more headline-grabbing developments involved a public appearance at a USDA event where the elimination of artificial colors in ice cream products by 2028 was announced. While the specifics of this particular regulation are narrow, the broader signal is unmistakable: the current administration is willing to use regulatory authority to challenge food industry practices that previous administrations largely left to market forces and consumer choice.
The ultra-processed food debate touches on fundamental questions about the role of government in dietary choices. Public health research has increasingly linked ultra-processed food consumption to obesity, cardiovascular disease, cancer, and other chronic conditions, providing a scientific basis for regulatory intervention. But the food industry represents a massive economic force, and any regulatory restrictions will face intense lobbying pressure and legal challenges.
HHS Restructuring: What We Know and What We Do Not
The broader restructuring underway at HHS has generated significant speculation but limited concrete public information. What is clear is that the department is undergoing organizational changes that affect multiple agencies and offices, with implications for everything from drug approval processes at the FDA to grant-making at the National Institutes of Health.
Personnel changes at the senior level have been frequent, contributing to the leadership instability visible at agencies like the CDC. The pace of these changes makes it difficult for career staff to maintain consistent programmatic direction, and the lack of Senate-confirmed leaders at key positions means that some of the department's most consequential decisions are being made by officials whose tenure may be measured in months rather than years.
For the health care industry, this instability creates planning challenges. Hospital systems, insurers, pharmaceutical companies, and medical device manufacturers all depend on predictable regulatory environments to make investment decisions. When the leadership and direction of the agencies overseeing their industries is uncertain, it becomes harder to commit to long-term strategies.
The Policy Landscape Going Forward
The competing dynamics playing out in Washington health policy — bipartisan legislative accomplishment alongside executive branch disruption — are likely to persist through the near term. Congress has demonstrated that it can still find agreement on health care when the political incentives align, particularly when funding deadlines force action. But the executive branch's combination of leadership vacancies, aggressive regulatory postures on food and nutrition, and organizational restructuring creates an environment where the rules of engagement are shifting faster than many stakeholders can track.
For patients and consumers, the practical effects of these dynamics vary widely depending on which specific policies ultimately take effect. Bipartisan health legislation typically includes provisions that expand access to care, fund research, or address specific public health challenges with broad support. Executive regulatory actions on food and nutrition could improve dietary health outcomes if well-designed and effectively implemented, but could also face legal challenges that delay or block their implementation.
What remains most concerning is the leadership vacuum at agencies like the CDC. The challenges facing American public health — from chronic disease epidemics to pandemic preparedness to antimicrobial resistance — require sustained, authoritative leadership that can set priorities, allocate resources, and maintain public trust over time. Twenty-eight days of confirmed leadership is not a foundation on which that kind of institutional capacity can be built.
This article is based on reporting by STAT News. Read the original article.
