The revolving-door leadership of the nation’s top public health agency took another possible turn Wednesday, when Dr. Erica Schwartz’s nomination came before a U.S. Senate committee.

Schwartz, 54, is running for director of the Atlanta-based Centers for Disease Control and Prevention, charged with protecting Americans from preventable health threats.

His career has been spent largely in military uniform, including in a leadership role in the U.S. Coast Guard, where he oversaw the organization’s system of 41 clinics and 150 infirmaries, as well as policies promoting vaccinations for service members. She later served as deputy surgeon general, where she helped lead uniformed medical and health professionals stationed at the CDC and government health agencies serving the general public.

The CDC long enjoyed an excellent international reputation, but has been in crisis since Trump returned to office last year. Largely due to layoffs and resignations, the agency has lost more than 3,000 employees, or more than a quarter of its workforce. Morale has plummeted as a succession of mostly temporary leaders come and go: The front office is filled with political appointees, many of them with little or no training in medicine or public health.

“There are still really good people working there (at the CDC). They are doing their best to navigate turbulent waters,” said Dr. David Margolius, director of Cleveland’s health department and leader of a U.S. coalition of big-city health departments. But the CDC no longer appears to have the authoritative and communicative leadership it had on outbreaks and other public health emergencies.

“Basically, everyone has to choose their own adventure, rather than being directed by a national public health department,” Margolius said.

The agency is overseen by Health Secretary Robert F. Kennedy Jr., who was a leading voice in the anti-vaccine movement before being tapped to lead the CDC and other federal health agencies. Kennedy had promised not to change the country’s vaccination schedule. But soon after taking office, Kennedy said he would investigate the childhood vaccine schedule and then attempted to substantially rewrite vaccine recommendations for children. Some of those efforts were put on hold earlier this year by a federal judge.

The administration’s first choice to lead the CDC was former Florida congressman Dr. David Weldon, but his March 2025 Senate confirmation hearing was canceled an hour before it was to begin. Weldon said at the time that he had been told there were not enough senators willing to vote for him.

The White House then passed to Susan Monarez, who had served as acting director of the CDC. Monárez was confirmed by the Senate, but was removed in less than a month. Trump administration officials said she was not aligned with their agenda, so they fired her.

Several key CDC scientific leaders resigned in protest, saying Monarez’s firing dashed their hopes that a CDC director could protect against political meddling in the agency’s scientific research and health recommendations.

Since then, there has been a revolving door in the agency’s leadership, with the short-term role of acting director moving from one Washington-based HHS official to another. National Institutes of Health Director Jay Bhattacharya has been overseeing the CDC most recently.

In April, Trump nominated Schwartz, calling her “incredibly talented.” At a congressional hearing in April, Kennedy said he approved of the choice but refused to commit to supporting any vaccine guidance she might issue.

Last month, Schwartz submitted letters to the government addressing his finances and potential conflicts of interest. He wrote that if confirmed, he will leave his current job at UnitedHealth Group, where he earns about $850,000 in salary and bonuses, and cash out his stock options. He will also resign from the board of directors of Butterfly Network Inc., a Massachusetts company that makes ultrasound devices; on the board of directors of Atlanta-based Aveanna Healthcare, a home health care provider; and the board of directors of the Florida-based Searching for Solutions Institute.

Also at Wednesday’s hearing, senators will consider the nomination of Sean Kaufman as Under Secretary for Preparedness and Response, or ASPR. That job involves overseeing preparations for and response to public health emergencies and disasters.

Last year, the Trump administration announced a plan to shift those responsibilities to the CDC, but the dramatic restructuring of HHS has not happened.

The undersecretary’s office is involved in decisions about funding next-generation vaccines against pandemic influenza or other infectious disease threats. In posts on LinkedIn, Kaufman made comments applauded by vaccine skeptics, arguing against the hepatitis B vaccine for newborns and saying he served as an expert witness to defend people who refused the COVID-19 vaccine.

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