This week’s Pandora Report covers the firing of CDC Director Susan Monarez, ACIP’s creation of a working group to review COVID-19 vaccines, H5N1, New World screwworm, and more.
Chaos Continues at CDC
Restef Selected to Chair New ACIP COVID-19 Vaccine Working Group
CDC’s Advisory Committee on Immunization Practices (ACIP), the committee that develops recommendations for vaccine use and has been completely filled with members selected by Secretary Kennedy, has formed a new working group to review the safety of COVID-19 vaccines. The group will be led by Restef Levi, a management and health analytics expert from MIT who holds a PhD in operations research. Levi has drawn controversy in part for his past social media posts calling for all COVID-19 vaccines to be removed from the market.
This is the latest development in a series of twists and turns in vaccine policy under Kennedy. The announcement came shortly after hundreds of CDC employees in an open letter called on Kennedy to stop spreading vaccine misinformation, which they say contributed to the shooting at CDC’s main campus in Atlanta earlier this month.
Levi’s appointment kicked off yet more turmoil at the agency. He said in an interview that he plans to “…engage a range of experts in different areas; leading scientists in academia and clinicians with field experience.” He further stated, “I’m confident that, together with colleagues at the CDC and FDA, we’ll build a robust team.”
However, many doubt this will be the case. Levi’s appointment to this role, combined with broader concerns about the planned ACIP meeting this fall, brought many tensions between Kennedy and CDC leadership to a head this week, culminating in the firing of Susan Monarez and the resignation of multiple other top CDC officials.
Monarez Fired as Director, Several Other Top Officials Resign
Secretary Kennedy called former CDC Director Susan Monarez to his office in Washington earlier this week to giver her an ultimatum: fire career CDC officials and commit to backing his team if they recommended restricting access to vaccines, or risk being fired herself. Monarez had identified two red lines she refused to cross prior to her firing, according to Richard Besser, CEO of the Robert Wood Johnson Foundation and former acting CDC director. Besser told Politico, “She said that there were two things she would never do in the job,” Besser said. “She said she was asked to do both of those, one in terms of firing her leadership, who are talented civil servants like herself, and the other was to rubber stamp [vaccine] recommendations that flew in the face of science, and she was not going to do either of those things.”
This prompted a public standoff later this week as Monarez refused to resign. HHS announced on X that she was “no longer” serving as CDC director. However, Monarez was the first CDC director to require Senate confirmation after nomination under a 2023 law. As her lawyer explained, this made her both a presidential appointee and Senate confirmed officer, meaning only the president had the ability to fire her.
Following this, Monarez’s lawyers disputed HHS’ claim she was no longer CDC director, saying that Monarez “has neither resigned nor received notification from the White House that she has been fired, and as a person of integrity and devoted to science, she will not resign.”
They also said, “It is about the systematic dismantling of public health institutions, the silencing of experts, and the dangerous politicization of science. The attack on Dr. Monarez is a warning to every American: Our evidence-based systems are being undermined from within.”
The White House later announced that President Trump has fired Monarez, and that a replacement nominee will be announced soon. Deputy HHS Secretary Jim O’Neill has been selected to serve as acting CDC director, according to CBS News.
In response to this latest round of chaos, multiple senior officials at CDC resigned in protest. Two of those, Debra Houry and Demetre Daskalakis, resigned on Wednesday, hours after the White House announced Monarez had been fired. Houry was CDC’s Chief Science and Medical Officer, while Daskalakis led the National Center for Immunization and Respiratory Diseases. Both indicated they had become increasingly concerned about how vaccine policy is being handled, pointing to preparations being made for the upcoming ACIP meeting.
Houry said they feared “…some decisions had been made before there was even the data or the science to support those. We are scientists, and that was concerning to us.” Meanwhile, Daskalakis said he was “very concerned that there’s going to be an attempt to re-litigate vaccines that have already had clear recommendations with science that has been vetted. If you can’t attack access, then why not attack trust? And that’s what I think the playbook is.”
Daskalakis specifically cited the document announcing the creation of the COVID-19 Immunization Workgroup in his resignation.
Daniel Jernigan, former Director of the National Center for Emerging and Zoonotic Infectious Diseases, and Jennifer Layden, former Director of the Office of Public Health Data, also resigned in response to this latest row. Three of the four were escorted out of CDC’s main campus by security guards before a planned send-off by agency staff could be held.
The resignation of these four leaders prompted Sen. Bill Cassidy, who cast a pivotal vote to confirm RFK Jr., to call for a delay in the upcoming ACIP meeting. In a statement, Cassidy said, “These decisions directly impact children’s health and the meeting should not occur until significant oversight has been conducted.”
Further Reading:
- “5 Big Collisions Between RFK Jr. and CDC Scientists Before Director was Fired,” David Ovalle and Victoria Bisset, The Washington Post
- “‘It Feels Like the CDC Is Over,'” Tom Bartlett, The Atlantic
- “Inside the C.D.C., a Growing Sense of Despair,” Apoorva Mandavailli, The New York Times
- “As Measles Exploded, Officials in Texas Looked to CDC Scientists. Under Trump, No One Answered,” Amy Maxmen, KFF Health News
- “Trump’s Global Health Cuts Upend CDC’s Malaria Work,” Sophie Gardner and Kelly Hooper, Politico
- “Former CDC Director William Foege: How Public Health Can Fight Back in a Time of Dangerous Nonsense,” William Foege, STAT News
- “How Vaccine Policy, Including for Coronavirus, Has Changed Under RFK Jr.,” Lena H. Sun, Lauren Weber, and Rachel Roubein, The Washington Post
- “The ‘Strangling Angel’ Returns? RFK Jr.’s Policies Could Foster a Resurgence of Now-Rare Diseases,” Jennifer Herricks, The Bulletin of the Atomic Scientists
- “Blue States That Sued Kept Most CDC Grants, While Red States Feel Brunt of Trump Clawbacks,” Henry Larweh, Rachana Pradhan, and Rae Ellen Bichell, KFF Health News
- “The CDC Quietly Scaled Back a Surveillance Program for Foodborne Illnesses,” Aria Bendix, NBC News
Avian Influenza Updates and More
By Margeaux Malone, Pandora Report Associate Editor
From Dairy Farms to Backyard Flocks: Mapping America’s H5N1 Risk
Between March 2024 and May 2025, the U.S. confirmed 70 human infections with H5N1 bird flu, with four hospitalizations and one death. A recent study published in Nature Medicine takes a systematic look at these cases to determine who was affected, how they were infected, and if we should yet be concerned for human-to-human transmission of this typically highly fatal zoonotic disease.
The study, led by Melissa Rolfes and colleagues at CDC, found that nearly all cases were linked to direct contact with animals. Most cases (59%) involved dairy workers, while another third occurred during culling of infected flocks of commercial poultry. Almost all of the patients (91%) identified as Hispanic or Latino, reflecting the agricultural workforce bearing the brunt of exposure risk. Two cases linked to backyard poultry proved particularly severe, both required hospitalization and with unfortunately one fatality. These two cases more closely resembled the historic global pattern of H5N1 severity, suggesting backyard flock exposure may carry higher risks than those infected on commercial farms. The timing also coincided with USDA reports of increasing detections in backyard flocks, underscoring risks for hobbyist poultry keepers who may be less aware of the hazards and have less access to protective equipment or controls.
The good news? No human-to-human transmission was detected among 180 household contacts tested, and genetic analysis shows the virus retains avian characteristics rather than adapting for mammalian spread. CDC’s genetic sequencing efforts have identified only sporadic mutations associated with mammalian adaptation or slightly reduced antiviral susceptibility, but nothing suggesting enhanced human transmissibility. That doesn’t mean the virus won’t get there, but it is certainly comforting to know that the current risk to the general population appears low.
No new U.S. human infections have been reported since February 2025, potentially due to seasonal patterns in animal outbreaks which waned into spring and summer. However, with continued international outbreaks in commercial and backyard poultry, surveillance is just as critical as ever as we approach the fall flu season.
Further Reading:
- “Bird Flu in the US: Seventy Human Cases, Mostly Mild, But with Warning Signs,” John Drake, Forbes
- “U.S. trust in physicians as key public health messengers during the H5N1 avian influenza outbreak,” Rachael Piltch-Loeb, et al, Scientific Reports
Screwworm Secrecy: Government Transparency Under Fire
The first U.S. human New World screwworm (NWS) case since eradication efforts began has recovered, but the handling of this milestone reveals troubling communication gaps. The Maryland patient, who traveled from Central America, was confirmed to have a case of travel-associated NWS myiasis by CDC on August 4, yet the public wasn’t informed until August 24, nearly three weeks later.
This delay has sparked sharp criticism from cattle ranchers already on edge about the flesh-eating parasite’s northward spread through Mexico. “It’s irresponsible and tone deaf,” says Neal Wilkins, CEO of the conservation and cattle group East Foundation. He warns that such secrecy erodes the trust needed for effective outbreak response, stating, “It will cause many producers and landowners, wildlife managers, to simply begin to believe that they’re not being fed the whole story.”
Ranchers’ concerns are well-founded given the immense potential economic impact if the outbreak crosses the border. A screwworm outbreak in Texas alone, the biggest U.S. cattle-producing state, could cost $1.8 billion. USDA has already halted Mexican cattle imports and committed $750 million for a sterile fly production facility, but critics question whether selective information sharing with industry insiders while keeping others in the dark is the right approach.
Cattle futures dropped following news of the case, highlighting how disease transparency directly impacts markets. While there’s no evidence of transmission to other people or animals, and U.S. cattle remain disease-free, the episode emphasizes the importance of timely public health communication. In an era where trust in institutions faces constant pressure, delayed disclosure of significant disease events, even recovered cases, risks undermining the collaborative response these emerging threats demand.
Further Reading:
- “Rare, Flesh-Eating Parasite Confirmed in US For First Time in Decades,” Carly Cassella, Science Alert
- “Historical Economic Impact Estimates of New World Screwworm in the United States,” U.S. Department of Agriculture Animal and Plant Health Inspection Service
- “New World Screwworm: Re-Emergence in the Americas and Prevention Efforts,” Benedette Cuffari, News-Medical
“Why We Still Don’t Know where COVID-19 Came Form. And Why We Need to Find Out.”
Gustavo Palacios, Adolfo García-Sastre, and David A. Relman authored this article for The Bulletin of the Atomic Scientists in which they discuss China’s COVID-19 response and the country’s obligations under the International Health Regulations. They write in part, “SAGO explicitly called for detailed records from several countries, especially China, but also Germany and the United States. While we can reasonably assume that the United States and Germany withheld portions of the requested intelligence to protect sources, methods, or collection practices, China withheld information that in most countries is treated as publicly available health information, such as early viral genome sequences, laboratory safety documentation, and detailed environmental samples from animal markets. We recognize that some of these data may be politically sensitive, as it relates to wildlife trade regulations or national biosecurity programs. Nonetheless, during a pandemic, China’s obligations under the International Health Regulations must take precedence.”
“The Sarin Shortcut: How AI Lowers the Bar for Chemical Weapons”
Ash Jogalekar recently published this article in The Bulletin of the Atomic Scientists, writing in part, “By enabling three-dimensional similarity searches, AI-guided planning of chemical synthesis routes, and predictions of how chemical warfare agents work in the body at a molecular level and at massive scale, these tools can identify unlisted but functionally equivalent precursors and products. Combined with large language model-based prompt engineering, today’s technologies can lower the obstacles to designing novel agents. Current regulatory barriers—including lists that categorize harmful substances—are not designed for this fast-moving frontier. Unless regulatory bodies evolve into adaptive systems that model the effects and not just the molecular structures of these compounds, the static lists of these organizations will lag dangerously behind technological advances. Those regulatory organizations can use AI, which is the instrument leading humans into this threat to begin with, to counter it.”
“Inside the Hot Zone: OPCW Trains Experts with Live Chemical Agents”
This post from OPCW describes how the organization, in collaboration with Slovakia, conducted an advanced live-agent training course in June. It explains how 18 international experts donned protective gear to train in a live hot zone, gaining hands-on experience in handling CW agents. The trainings included exercises in detection, sample collection, decontamination, and emergency response and aimed to build muscle memory, judgement, and confidence.
“Our Storied Health Film and Media Series”
From Brown Pandemic Center: “In a time of growing mistrust in science and heightened political division, Our Storied Health—a groundbreaking film and media series curated by Dr. Jennifer Nuzzo and Dr. Jennifer Galvin as part of the Brown Arts IGNITE initiative—aims to transform public health communication by blending artistic storytelling with scientific insight. Through screenings and discussions of five independent films on critical health issues, the project encourages a shift from outdated, politicized messaging to innovative, trust-building approaches. This effort offers a vital roadmap to restore confidence in public health and marks the beginning of a broader movement to reimagine how we communicate to protect and improve community well-being.”
Read about the series here.
What We’re Listening To 🎧
Biosecurity: Changing the Game, Part II – Germ-Wars, Treaties, and Global Trust: Demystifying the Biological Weapons Convention
“In the second part of this conversation, Dr. Dinah Nasike, Dr. Alex Kyabarongo (a veterinarian, former Political Affairs Intern at the Biological Weapons Convention, and currently a Masters of Biodefense Candidate at the Schar School of Policy and Government at George Mason University) and Sandra Matinyi (Biosecurity Game Changers Fellow and the Executive Director of Nuo Bioscience, Uganda) continue their discussion of Biological Weapons Convention.”
Listen here.
Entanglements by Undark, Kicking Off Season 2: Should We Make Viruses More Dangerous – For Science?
“We’re back! This week on Entanglements: Should we make viruses more dangerous? Our hosts discuss this question, and its contentious history, with a microbiologist from the Johns Hopkins School of Public Health and a virologist from the Pasteur Institute in Paris.”
Listen here.
NEW: GHS 2026
From GHS: “We’re excited to officially announce that the 4th Global Health Security Conference (GHS2026) will be held in Kuala Lumpur on the 9 – 12 June, 2026!”
“Building on the incredible momentum of GHS2024 in Sydney, we look forward to bringing together the global health security community once again – this time in one of Southeast Asia’s most vibrant and dynamic cities.”
“Registration and Call for Abstracts are now live!”
Learn more, submit abstracts, and register here.
Biological Threats in the Age of Emerging Biotechnology – A Workshop Series
From NASEM: “The National Academies of Sciences, Engineering, and Medicine (NASEM) will convene an ad hoc planning committee to organize a workshop series with international scientists. The series will engage early-career and established experts to: a) examine dual-use risks in biotechnology research; b) explore potential misuse of knowledge, tools, and materials; c) review existing frameworks for assessing and mitigating dual-use concerns; and d) identify steps to reduce exploitation while promoting responsible innovation. The workshops will focus on balancing scientific progress with security considerations. Key insights and recommendations will be compiled in a publicly available workshop proceedings document.”
These workshops will take place 10 am-1 pm ET on September 10, 17, and 18. Register here.
CTD–SPECTRE Symposium, “Tropical and Emerging Infectious Diseases for Clinicians and Translational Scientists”
“The CTD-SPECTRE Symposium on Tropical and Emerging Infectious Diseases for Clinicians and Translational Scientists 2025 offers a unique opportunity to connect with global experts, gain cutting-edge insights, and collaborate with peers dedicated to infectious disease research and treatment.”
“Taking place September 16 -19, 2025, at the historic Grand Galvez in Galveston, TX, this immersive symposium will unite clinicians, translational investigators, and trainees to explore the latest breakthroughs in tropical and emerging infectious diseases.”
“Hosted by the Division of Infectious Diseases at UTMB, Center for Tropical Diseases (CTD) and Special Pathogens Excellence in Clinical Treatment, Readiness, & Education (SPECTRE) Program.”
Learn more and register here.
Mirror Image Biology: Pushing the Envelope in Designing Biological Systems – A Workshop
From NASEM: “Most biological molecules are chiral entities where their mirror images have different structures and functional characteristics. Scientists have begun synthesizing left-handed DNA and RNA and creating proteins that can write left-handed nucleic acids. This, and other related research, is described as “mirror biology” and includes research toward creating mirror-image self-replicating living systems. The National Academies will host a foundational workshop on mirror biology, focusing on the state of the science, trends in research and development, risks and benefits of this research, and considerations relating for future governance of relevant enabling technologies.”
This event will take place virtually, September 29-30. Register here.
Global Conference on Biological Threat Reduction
From the World Organisation for Animal Health: “In October 2025, WOAH is hosting its third Global Conference, with the goal of galvanising advocacy efforts to manage the rising risk of biological threats from across the world.”
“The Global Conference on Biological Threat Reduction – which will take place in Geneva on 28-30 October 2025 – will bring together top minds in the fields of
health-security, emerging technologies, and biothreat reduction policies, from the public and private sectors – to focus on the latest strategies, challenges and innovations in combating biological threats to our interconnected ecosystems.”
“The Conference will bring together approximately 400 participants from different sectors, including animal health, law enforcement and security, public health, international and regional organisations, investment and development partners, private sector and industry representatives, research, academia and regulatory authorities, youth organisations.”
“Attendees will engage in thought-provoking discussions and innovative technical presentations aimed at strengthening prevention, preparedness and response capabilities across the world.”
“The event will be guided by a narrative that traces WOAH’s commitment to biological threat reduction and the increasingly relevant role it plays at the health-security interface. Against the backdrop of an uncertain future, WOAH believes that synergies between sectors can drive positive change – making the world a safer and healthier place. ”
Learn more and register here.
Applied Biosafety Call for Papers
“The Editors of Applied Biosafety are pleased to announce a forthcoming Special Issue focused on the myriad of topics associated with global biosafety management. This special issue will showcase examples of innovative approaches, creative solutions, and best practices developed and used around the world for managing risks associated with the handling, use, and storage of infectious biological agents, toxins, and potentially infectious materials in research and clinical settings.”
Learn more and submit by November 1 here.
64th ISODARCO Course
From ISODARCO: “In recent years, the global security landscape has become increasingly volatile, shaped by a convergence of geopolitical tensions, technological advancements, and evolving nuclear doctrines. The post-Cold War order that once provided a measure of predictability in global security has eroded. Conflicts such as the wars in Ukraine and Gaza, rising tensions in the Indo-Pacific, and strategic competition between major powers have reshaped alliances and strategic postures.”
“At the same time, disruptive technologies including artificial intelligence, quantum computing, hypersonic missiles, and cyber threats – are adding new layers of complexity to both nuclear and conventional deterrence dynamics. These technologies are not only distorting the information landscape but also compressing decision-making timelines and complicating signaling mechanisms, increasing the risk of miscalculation.”
“Effectively managing nuclear escalation risks in this environment will require a combination of innovative diplomacy, technological safeguards, and renewed dialogue mechanisms to rebuild trust, reduce misperceptions, and stabilize strategic relations.”
“The ISODARCO 2026 Winter Course presents an invaluable opportunity for students and experts to discuss and examine these dynamics in depth and explore approaches to re-establishing strategic stability and reducing nuclear dangers in a volatile world.”
This course will take place January 11-18, 2026, in Andalo. Learn more and apply here.
The Pandora Report 