Jennifer Shuford’s resignation and Trump’s measles debacle

The merry-go-round of appointments and resignations at the top of the US public health system continues with a regularity that is now worthy of study by epidemiologists. The New York Times reports today that Jennifer Shuford, deputy director and chief medical officer of the Centres for Disease Control and Prevention (CDC), will step down on 12 November, after just four months in the post. She had been personally chosen by Donald Trump to help restore stability to the federal agency tasked with protecting Americans from infectious diseases. Now someone will have to be found to stabilise the stabiliser. Meanwhile, a measles outbreak continues in the United States, having reached staggering proportions, while the Trump administration and its Secretary of Health, Robert F. Kennedy Jr., appear to be devoting a considerable amount of their energy to reshuffling senior staff, reviewing vaccination recommendations and disputing the death toll.

Shuford was one of the few figures in whom public health experts had placed some hope. An epidemiologist and former Texas health commissioner, she had led the state’s response to the 2025 measles outbreak, earning a reputation as a competent professional, data-driven and aware of the importance of childhood vaccinations. Her arrival at the CDC last June had been welcomed as a sign that, after months of upheaval, some experienced professionals would remain to tackle the diseases affecting Americans. In her official statement, Shuford thanked Trump and Kennedy for the extraordinary experience and explained that she wished to devote more time to her family. Personal reasons must be respected. However, the Washington Post also reports that there is disagreement over the administration’s vaccination policy, according to a well-informed source. What the decisive reason for her departure was remains unclear at this stage. The result remains the same: another qualified professional is leaving a top post at an agency that is in desperate need of continuity.

To fully appreciate the significance of this news, it is worth recalling what has happened at the CDC since Trump took office. The first nominee for the post, Dave Weldon, had his nomination withdrawn before the Senate confirmation vote. He was succeeded by Susan Monarez, a scientist who had previously served as acting director of the agency and who, once confirmed, lasted less than a month. In August 2025, she was sacked following a clash with Kennedy, to whom she had refused to grant carte blanche over vaccination decisions and the management of scientific staff. Her dismissal led to the resignation of other senior executives, including Debra Houry, the CDC’s chief medical officer; Demetre Daskalakis, director of the Centre for Vaccines and Respiratory Diseases; and Daniel Jernigan, head of emerging infectious diseases. These professionals, who had spent years building up expertise, surveillance programmes and epidemic response capabilities, had left, denouncing the politicisation of public health.

Following Monarez’s departure, an interim editor-in-chief, Jim O’Neill, was appointed, and eventually Erica Schwartz took over, alongside a new management team that included Shuford. The change of leadership was supposed to resolve the crisis. Today we find ourselves once again in the position of seeking a replacement, with Satish Pillai tasked with temporarily taking over the duties of the outgoing director. With every change, the names on the office doors change, whilst the scientific expertise accumulated by the institution continues to be lost. Above all, it is becoming increasingly difficult to imagine what a competent director could achieve when the decisions they are supposed to make on the basis of scientific evidence depend on the political leadership’s willingness to accept them.

The measles outbreak highlights the consequences of this approach to governance. After decades of successful vaccination campaigns, the United States is witnessing the return of a disease that it had declared eliminated from the country in 2000. As of 22 October, confirmed cases in 2026 had reached 4,410, almost double the number recorded in the whole of 2025. In Pennsylvania, where a particularly severe outbreak has developed, state health authorities have reported five deaths linked to measles, whilst the CDC recognised just three across the whole country. The discrepancy also concerns the method of classifying deaths: the federal agency changed its counting system, relying on death certificates rather than data transmitted directly by the states, with consequences for the timeliness and completeness of the available information. According to a Reuters investigation, Kennedy is said to have personally asked the new director, Schwartz, to remove certain deaths reported by Pennsylvania from the federal tally. The Department of Health has disputed that account. One extraordinary fact remains: whilst measles is spreading, federal and state authorities are publicly arguing over the number of people who have died from it.

Yet, for measles, we have one of the most effective vaccines ever developed. With two doses, protection against the disease reaches around 97 per cent. We know the vaccination coverage thresholds required to prevent the virus from circulating, and we know which population groups are most at risk of complications. The problem in the US now concerns the ability of institutions to use established scientific knowledge to protect the population. Kennedy, who built much of his reputation by spreading unfounded doubts about vaccine safety, now heads the federal department that is supposed to promote their use. And Trump continues to support initiatives that follow the same line, including the proposal to split certain combined paediatric vaccines into multiple doses, without any proven general clinical need to do so.

The institutional outcome is equally significant. In June 2025, Kennedy simultaneously dismissed all seventeen members of the Advisory Committee on Immunisation Practices – the expert committee that formulates vaccination recommendations for the CDC – replacing them with people of his own choosing. In January 2026, the administration amended the federal paediatric vaccination schedule, reducing the number of universally recommended vaccinations. A federal court subsequently suspended the implementation of those changes and the effects of the committee appointments, giving rise to further legal proceedings. Thus, the uncertainties introduced by political decisions were compounded by those arising from legal challenges. Scientific societies and several states have begun to draw up guidelines independent of the federal ones. One of the main advantages that a national health system can offer is gradually being lost: the availability of consistent recommendations, developed through shared scientific procedures and stable enough to guide the work of doctors.

The disaster, of course, also affects biomedical research. The National Institutes of Health, which for decades have been one of the main drivers of global medical research, have been hit by a campaign to cut funding, halt projects and reduce staff numbers. By January 2026, according to a report published by Nature, the administration had already cut or frozen over 7,800 research grants across various federal bodies, whilst around 25,000 staff had left the scientific agencies. Further investigations carried out in the following months documented the impact on universities, laboratories and researchers involved in multi-year programmes. Some of the measures were overturned by the courts, but the restoration of funding does not automatically make up for lost time, nor does it guarantee that a disbanded research group can be reconstituted.

Here, an aspect of Trump’s policies emerges that deserves particular attention. Scientific research is a long-term endeavour, requiring coherent programmes, specialist expertise and a reasonable degree of predictability in working conditions. A laboratory may take years to recruit the necessary staff and develop experimental technology. An epidemiological surveillance programme derives its value from the continuity of its observations, as this is the only way to recognise a change in the incidence of a disease in a timely manner. The federal government is introducing a degree of instability into these activities that is undermining their functioning. Every researcher who loses funding, every epidemiologist who leaves an agency and every programme that is discontinued represents a loss of scientific capacity that will take time and resources to recover.

All this is taking place under the banner of the ‘Make America Healthy Again’ movement, through which Kennedy promises to restore health to Americans and free institutions from the influence of big pharmaceutical companies. The promise might seem appealing, were it not for the criteria used to select which areas of expertise to promote. Mistrust of scientific authorities has itself become a political credential, whilst a willingness to apply well-documented knowledge can become a reason for incompatibility with the administration’s leadership. Conflicts of interest within the pharmaceutical industry are a real problem, requiring rigorous oversight and transparency. Entrusting health policy decisions to a secretary who has repeatedly promoted claims contradicted by scientific evidence offers no guarantee of greater independence.

The point is that Trump and Kennedy seem to regard scientific institutions in the same light as any other administrative body over which they can exercise their power of appointment and political direction. This is a view that ignores the specific role of these institutions. A minister may legitimately decide on the general priorities for healthcare spending, whilst taking responsibility for these decisions before the electorate. The efficacy of a vaccine, the existence of an epidemic risk and the interpretation of clinical data, on the other hand, require verification procedures that must be capable of producing results which may be unwelcome to the minister himself. A health agency loses its usefulness when this possibility is subordinated to the political convenience of those who run it.

Jennifer Shuford is set to leave on 12 November. Perhaps it is indeed for family reasons, as she has stated, and it would be wrong to attribute intentions to her that she has not publicly expressed. But this latest departure makes an even clearer picture of a phenomenon that now goes beyond the motivations of the individuals involved. Qualified professionals who join the civil service to restore credibility to its decisions end up working within a system in which that credibility is eroded on a daily basis by the actions of the very government that appointed them. Some are sacked, others resign, whilst others remain and are forced to deal with the consequences of policies contested by a significant section of the scientific community.

It has taken the United States decades to build a biomedical research and public health system that has made a decisive contribution to medical progress worldwide. Trump and Kennedy are demonstrating just how quickly it is possible to undermine its functioning. The most disturbing thing is that the damage will continue to have consequences even after they have left the scene: researchers who have changed careers, laboratories that have closed down and eroded confidence in vaccinations will not return by decree. As for the CDC, a new deputy director will be sought, who will probably be presented as the right person to restore order and confidence. Then we shall see how long that lasts. Measles, meanwhile, does not have to go through any appointment or confirmation process, and quietly carries on doing its job.