Senator Cassidy should vote no on Dr. Erica Schwartz's nomination as CDC Director.

Senator Cassidy should vote no on Dr. Erica Schwartz's nomination as CDC Director. The nominee demonstrated a lack of preparation, insufficient independence, or both. Even if Trump's next nominee could be worse, the Senate shouldn't abdicate its advice-and-consent role. In April, Dr. Erica Schwartz was nominated to serve as the next CDC Director. For a Trump nominee, Dr. Schwartz seemed remarkably normal. While the choice coincided with overt Trump administration efforts to reduce HHS drama (and negative headlines), the nomination still seemed too good to be true. On paper, she seemed great. But it was the support of trusted voices that really reassured many of us who didn’t know her personally—voices like Dr. Jerome Adams, who served as the US Surgeon General during President Trump’s first term while managing to maintain credibility and respect in our field. Beyond that, even if a Trump nominee were to be qualified, there would still be lingering concerns over whether the pick had been compromised. Had Dr. Schwartz indicated (or explicitly promised) that she would suppress her own pro-vaccine views if confirmed, instead bending to Secretary Robert F Kennedy Jr.’s anti-vaxxer worldviews, all in exchange for a fancy senior leadership position in the federal government? I’d assumed we would not find out the answer to this key question until after confirmation, just as we hadn’t known what Dr. Susan Monarez would do until she took office. (Ultimately, she stood up to RFK Jr., and was promptly fired.) Time would tell, we all thought. For a time, everything progressed swimmingly. As I recently wrote here, my main concern eventually became that Dr. Schwartz’s nomination would be withdrawn after the main roadblock to the confirmation of far crazier candidates, HELP committee chair Bill Cassidy, got primaried by a Trump-endorsed candidate this spring. With Cassidy exiting the Senate in January, 2027, I worried that the administration would pull Schwartz, name a replacement who was far more aligned with Secretary Kennedy, and delay the confirmation process until the next Congress was seated. Then something truly unexpected happened: Dr. Schwartz’s testimony before Senator Cassidy’s committee last week was a full-on disaster. Suddenly, we had a new problem. Or, rather, the resurgence of a previous problem that we’d passively worried about: that despite her record, Dr. Schwartz could not be trusted to defend science by standing up to Secretary Kennedy, if she were to be confirmed. But her answers to softball questions asked by the senators last week were absolutely unacceptable. To be clear, the bar she had to clear was exceedingly low. Nobody expected her to throw Secretary Kennedy’s wacky views under the bus in a Senate confirmation hearing. But she refused even to say that she would report to Congress if she were ever instructed by Kennedy (or anyone else) to do anything that was unscientific or that went against the health of the American people. This was not a trick question. Elsewhere in the hearing, she demonstrated a lack of knowledge about the agency she has been nominated to lead. All of this was simply not credible. The one vote that matters… Now, Senator Cassidy has a conundrum on his hands. To confirm or not to confirm? (Indeed, the fate of her nomination is, for all intents and purposes, rests with him.) The argument in favor of confirmation goes like this: We know Dr. Schwartz has a pro-science track record. So, despite her abysmal hearing performance last week—which some have chalked up to her not wanting to anger her new sponsors, Secretary Kennedy and President Trump—it would be best to have her lead the CDC, rather than risk that someone far, far worse gets nominated and confirmed instead. The argument against confirmation goes like this: If she couldn’t stand up to Secretary Kennedy’s nonsense when the questions were hypothetical and he was not even in the room, then surely she’ll implode when there’s actual pressure. I’ve thought about this long and hard. Even though I wrote last week that Dr. Schwartz had lost my support, that wasn’t precisely the same as advocating that Senator Cassidy should actually vote against her confirmation. But I am saying that now. I also said it to two people whom I believe have Senator Cassidy’s ear this week. Senator Cassidy should vote no on Dr. Schwartz’s nomination as CDC Director. Given her performance before the Senate HELP Committee, we can conclude either that she is not adequately prepared for the job (which comes as a huge disappointment and surprise, given what we’ve all heard about her prior service) or that she is so fearful of Kennedy and Trump that she will not be able to perform the job the way the American people need her to. So, it’s a lose-lose. And if by some miracle, Dr. Schwartz is confirmed and does stand up to Secretary Kennedy—as Dr. Monarez did—it seems likely that her tenure will also be very brief. Certainly Dr. Schwartz is behaving as though she is under the same impression. Whether or not Schwartz is confirmed, a pro-vaccine CDC Director in 2026 will likely suffer the same fate as the one who served in 2025 did. In that case, Senator Cassidy can only achieve one thing: ensuring that testimony before the Senate has any meaning whatsoever. A vote against Dr. Schwartz is a vote in favor of both scientific integrity and in the separation of powers. Try as he might behind closed doors, but Senator Cassidy simply cannot assure that a pro-science, pro-vaccine CDC Director will have job security. He lacks the power. No off-the-record meetings can restore the trust that Dr. Schwartz torched in her hearing last week. What Cassidy can do, however, is stand up, one last time, for the notion of genuine advice and consent. In the end, Cassidy cannot guarantee that the next CDC Director will be independent, no matter what private assurances are offered. But he can, one last time, insist that nominees who fail to demonstrate independence, competence, or both do not receive his vote. It won't undo his vote to confirm Secretary Kennedy. But it would be a step in the right direction in his waning days as a US Senator—one that, hopefully, his successors will follow. Why upgrade to Inside Medicine? “He’s very thoughtful and careful. He doesn’t just blast out against something; he gives it a fair evaluation and makes a helpful and useful comment. So he’s emerging as one of the most respected medical public health commentators.” —Dr. Anthony Fauci If you value independent reporting and analysis, please consider upgrading to a paid subscription. Your support makes Inside Medicine possible. Thanks! Comments? Questions? Ideas? Venting? Please share your views in the Comments section. Thank you for reading! If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.