My Love Letter to CDC

It’s been a while since I posted on this blog – four years to be exact. So much has changed in those four years. 

Flashback to January 2021.

Biden was inaugurated and the first COVID-19 vaccines from Pfizer and Moderna had just received emergency use authorization. I remember feeling such intense relief that my family could finally be protected from this virus, and that a more pro-science administration would put public health front and center.

January 2021 was also when I defended my dissertation in epidemiology at the University of Michigan, focusing on vaccine hesitancy, measles outbreaks, and the mathematical models we can use to assess outbreak risk in communities. 

I’d known I wanted to work in the infectious disease space for a long time, but the dream of being a disease detective started in 2014, when there was a Meningitis B outbreak (not the strain contained in the vaccine we routinely get, which contains strains ACYW) during my senior year at Princeton. Members of the CDC’s Epidemic Intelligence Service (EIS) came to campus to roll out the Bexsero Meningitis B vaccine, which wasn’t yet approved in the United States. Thanks to the quick response, the outbreak ended, though there were 9 cases and 1 death. This experience made me realize that this was what I wanted to do: be on the front lines of public health, protect communities, fight infectious diseases, and get vaccines in arms. 

So it was a real dream come true to start as an Epidemic Intelligence Service Officer at the CDC in June 2021. However, the COVID-19 pandemic changed the EIS experience a lot from my expectation. Instead of being in the office every day at the CDC campus, my cohort had a mostly *remote* experience since COVID was still raging. Nonetheless, from my home office, I started working on the Shingles vaccine recommendation for immunocompromised persons aged 19-49. This was my first exposure directly to ACIP, or the Advisory Committee on Immunization Practices. This is an essential, external group of scientists that reviews CDC vaccine science to make recommendations about vaccine use in the US. 

A few weeks later, I was deployed to Fort McCoy in Wisconsin for the Afghan repatriation response, or Operation Allies Welcome (OAW), when there was a growing measles outbreak. This first field experience was overwhelming and humbling. But it was exactly what I wanted to learn and be a part of – a chance to protect community health, illustrate the power of vaccines, and conduct good, in person shoe-leather epidemiology. My OAW experience turned into a large modeling project measuring the impact of the vaccination campaign. It turns out that without the mass measles, mumps, rubella (MMR) vaccination, there could have been over 5,000 measles cases – instead of the 47 that were reported. This, I thought, was the proof policymakers needed that vaccines unequivocally work.

Responding to outbreaks and measuring and modeling the impact of vaccines and other public health interventions became my focus for the next three and a half years. This work reinforced my gratitude for vaccines – how well they work, the diseases they protect us from, and the gift they give us to grow old and experience life without disability. I deployed to many outbreaks: to the COVID-19 vaccine task force, working on vaccine hesitancy and how to address it. I helped respond to the MPX outbreak in 2022, working with a modeling team of scientists to characterize how it was spreading – what were the key parameters underlying transmission of this new virus? I responded to a polio outbreak in New York, only the second identification of community transmission of poliovirus in the United States since 1979. I transitioned out of EIS and became the program lead for mumps, setting scientific strategy and working to understand why we still have cases despite an effective vaccine, and how the third dose of MMR works during mumps outbreaks. In the last two years, I deployed to more measles outbreaks (they’re becoming more frequent!), including one in a migrant shelter in Chicago. The modeling showed that our intervention, rapid mass vaccination, reduced possible cases from 235 to 57. 

Across all these outbreak responses, I was consistently impressed by the people I met. Whether at CDC, a state or a local health department, public health workers are the public’s defenders, not only by stopping the spread of disease but also advocating for public health control measures and fighting the politicization of vaccination and masking and other pro-health tools. These public health warriors are scientists, policy makers, communications experts, and physicians who accept less pay, less glamour, and more stress to work as civil servants, to keep communities healthy and free from disease. 

Fast forward to today, February 15, 2025. 

I want to highlight three big losses whose adverse effects we will need to monitor with vigilance in the weeks, months and years ahead: new HHS leadership, CDC staff cuts, and downstream effects of federal budget cuts on states and localities.

• HHS leadership: I am still reeling from the confirmation of RFK Jr. as HHS Secretary. I dedicated a chapter of my dissertation to anti-vaccine leaders and conspiracies, and he was prominently featured. His fringe beliefs will now gain legitimacy and possibly be mainstreamed. What changes he brings about in our approach to vaccines and science more broadly will cost American lives, plain and simple.  

• Staff cuts: The last few weeks at CDC have been horrible. This was expressly the point. My last day at CDC, February 14, saw dramatic staff cuts of up to 10% across the agency. The ‘probationary staff’ cuts encompass those who have been at CDC for a year or less in a Title 5 position, or 2 years or less in a Title 42 position (different hiring mechanisms). As a result, the first year Epidemic Intelligence Service officers were notified they would be terminated. There may no longer be an EIS program in the future. It is so painful to see the destruction of the program that drew me to CDC and is a global leader in outbreak response.  Americans will now be exposed to a dramatic deterioration of the nation’s capacity to deal with public health emergencies.

• Downstream effects of reduced funding: The weakening of our state and local public health infrastructure also looms. The federal government funds a large proportion of state and local health department budgets. Steep cuts to HHS/CDC funding directly leads to cuts in state/local health departments. For example, the Epidemiology and Laboratory Capacity Cooperative Agreement grant funds state and local jurisdictions to “detect, prevent, and respond to emerging infectious diseases”. If this grant were to be cut, this would be extremely damaging, especially as we face current outbreaks of Avian Influenza, measles, and a historically bad norovirus season, and future outbreaks of unknown pathogens. Federal funding cuts means your local health department may not have the resources to respond to an outbreak in your community.

For all these reasons, now seems like a fitting time to resume this blog. Federal employees are not able to publicly share their opinions. In making the difficult personal and professional decision to leave CDC, I get to reclaim my voice. I will use it to communicate accurate scientific information, as the truth may be harder to come by.