CDC’s Total Overhaul Takes Shape

Summary

Bloomberg Businessweek: “CDC’s Total Overhaul Takes Shape”

Aired: September 15, 2025 | Hosts: Carol Massar, Tim Stenovec
Guests:

• Dr. Richard E. Besser, President/CEO of Robert Wood Johnson Foundation, former Acting Director of CDC
• Jessica Nix, Bloomberg News Health Reporter

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Episode Overview

This episode probes the seismic changes underway at the Centers for Disease Control and Prevention (CDC) after new leadership at the Department of Health and Human Services (HHS)—notably under RFK Jr.—sparked widespread restructuring. Bloomberg’s Carol Massar and Tim Stenovec are joined by reporter Jessica Nix and former acting CDC director Dr. Richard Besser to unpack the causes and consequences of the CDC’s overhaul, the state of US public health, the political dynamics fueling division and distrust, and what the changes mean for future crises.

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Key Discussion Points & Insights

1. The State of American Health & Healthcare System

• Dr. Richard Besser (03:13):
  • Calls the American health diagnosis “the right diagnosis”—the public is unhealthy, and the system is not functioning.
  • Points out access to healthcare is tied to employment, resulting in “millions of people...who don’t have access to high quality, comprehensive, affordable health care.”
  • Notes recent legislation is expected to cause “tens of millions of people” to lose healthcare.
  • Argues income/poverty and social factors are greater drivers of health than health care itself.

“We are seeing that in America the rates of chronic disease are extremely high, and we need to do more to address that. So I think that there probably is a lot of agreement around what the problem is. There is less agreement in terms of what the drivers of that are or what the solution should be.”
— Dr. Richard Besser (04:26)

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2. The Overhaul of the CDC: Layoffs, Dismantled Divisions, and Loss of Expertise

• Jessica Nix (05:17):
  • Describes “a complete dismantle at the CDC” since RFK Jr. took over HHS.
  • Notes mass layoffs in divisions studying chronic disease, gun violence, injury prevention.
  • Mentions the disbanding of the vaccine advisory committee—the Advisory Committee on Immunization Practices (ACIP)—with members handpicked by RFK Jr.
  • Details recent chaos, including a shooting at CDC headquarters and the firing of a newly appointed CDC director over vaccine policy.

"So there’s so much confusion and chaos at the CDC that the actual work is not as able to get done because everyone’s gone."
— Jessica Nix (06:12)

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3. What’s Being Lost — US and Global Impact

• Dr. Besser (06:56):
  • Calls current moves “the destruction of the world’s leading public health agency.”
  • CDC historically looked to as “a beacon for public health around the world”—not anymore.
  • Criticizes the firing of thousands of federal health workers, elimination of the Office on Smoking and Health (smoking = top cause of preventable chronic disease).
  • Compares to earlier reform attempts: “At the start of the Obama administration, there were efforts to look across the agency, where was it lacking, where could it do better.”
  • Notes that before COVID, CDC had strong bipartisan trust, but the pandemic heralded politicization, job losses, and public distrust.

"What we’re seeing here is the destruction of the world’s leading public health agency.... The CDC doesn’t just provide public health expertise for the United States. It had been looked at as a beacon for public health around the world. That’s no longer the case."
— Dr. Richard Besser (07:14)

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4. Dismantling Vaccine Policy and Public Trust

• Key Developments:
  • Advisory Committee on Immunization Practices (ACIP) taken over and “dismantled” by new appointees.
  • CDC director fired weeks into her tenure for disagreements over vaccine policy.
  • Concerns vaccine policy is now piecemeal—states creating their own protocols for distribution, reimbursement, recommendations.

“The idea that we can’t look to the CDC because this advisory group has become so politicized, so staffed with people who have strong anti-vaccine agendas will put us at great risk.... This will lead people to be confused and it will lead some people to make a decision that I think is not good for the health of their families.”
— Dr. Richard Besser (14:01)

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5. CDC Cuts: Consequences for Local Public Health

• Dr. Besser (11:13):
  • Cites real examples: health departments in Texas and Milwaukee calling CDC for help with crises (“lead in their water”) and finding there’s “no one there.”
  • Warns about “public health being invisible when it’s working properly”—damages only clear when failures and crises emerge.

“When there’s a crisis in a community and public health can’t respond, then you will see it. And then, hopefully, people in their communities will say, this doesn’t work for us.”
— Dr. Richard Besser (11:48)

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6. Partisanship, Communication Failures, and Trust

• Why the Division? (12:04-13:25)
  • Trust in CDC was strong before COVID, including through H1N1, when both parties avoided politicizing the response.
  • COVID response was politicized; public health officials were silenced, guidance changes interpreted as incompetence.
  • Once trust is lost, “it’s extremely hard to get it back.”

“You need active communication to build trust and maintain trust. And once you’ve lost trust, it’s extremely hard to get it back.”
— Dr. Richard Besser (13:17)

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7. The Future of Public Health & Fragmentation

• Jessica Nix (15:42):

  • Predicts “a state by state approach to public health,” especially regarding vaccine policy.
  • CDC can no longer provide the “nationwide view,” leading to disparities in access, recommendations, and insurance coverage.

• Insurance Uncertainty (16:17):

  • Without CDC endorsement, insurers face ambiguity: will they cover vaccines recommended on the state level, or not at all?

“As of this year, insurance companies are still going to cover vaccines, but health experts have been telling us and in our reporting that the cost of a vaccine is probably less than the cost of the illness that you’re going to get later on and then your hospital bill and everything else.”
— Jessica Nix (16:32)

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Notable Quotes & Memorable Moments

• “The big question is what are the drivers of [America’s ill health]? … Some of the biggest drivers of health have to do with income and whether someone has the income to be able to afford healthy, nutritious food, [and] the leisure time to be able to get physical activity.”
  — Dr. Besser (03:36)

• “There’s so much confusion and chaos at the CDC that the actual work is not as able to get done because everyone’s gone.”
  — Jessica Nix (06:12)

• “We need to rebuild trust. We have as our Secretary of Health one of the nation’s leading anti-vaccine advocates, and someone who has demonstrated no respect for the Centers for Disease Control and Prevention.”
  — Dr. Besser (08:56)

• “The CDC doesn’t just provide public health expertise for the United States. It had been looked at as a beacon for public health around the world. That’s no longer the case.”
  — Dr. Besser (07:14)

• “It’s only when [public health is] not working properly and then gets stressed. So whenever there’s a crisis in a community and public health can’t respond, then you will see it.”
  — Dr. Besser (11:42)

• “The idea that we can’t look to the CDC because this advisory group has become so politicized...will put us at great risk.”
  — Dr. Besser (14:01)

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Timestamp Guide to Key Segments

• 03:13–04:49: Dr. Besser lays out the fundamental health challenges in the US
• 05:17–06:23: Jessica Nix describes what’s happening inside the CDC: layoffs, loss of expertise, chaos
• 06:56–09:13: Dr. Besser assesses the CDC’s destruction and what’s being lost globally
• 09:35–11:05: Implications of the overhaul for US/global pandemic response
• 11:13–12:04: Local public health impacts and examples of real-world gaps
• 12:20–13:27: Examining why trust in the CDC has eroded post-COVID
• 13:42–15:02: The state and fate of vaccination policy in the US
• 15:42–16:55: Jessica Nix and Carol Massar on what’s next for American public health policy and insurance

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Conclusion

This episode offers an urgent, insider look at the CDC’s current crisis and transition—tying broad healthcare realities to the granular fallout of hasty restructuring and politicization. The discussion underscores how the CDC’s fate will shape not only America’s preparedness for future pandemics, but the everyday health and safety of its people and the world. The loss of central leadership and national coordination signals increased confusion, state-by-state disparities, and uncertain insurance coverage going forward. The question animating the episode: Can trust, expertise, and public health cohesion be salvaged, or are we witnessing the irreversible fracturing of a historic institution?

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Transcript

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[Carol Massar]

You're listening to Bloomberg Businessweek with Carol.

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Massar and Tim Stanvak on Bloomberg Radio.

[Bloomberg Businessweek Host]

We truly, truly respect all that is going on and is important to investors and we're going to stay on it, including watching all of the days IPOs at the same time. The team here at Bloomberg Businessweek Daily has been thinking a lot about some of the stories that impact investors longer term, impact all of the Bloomberg audience and that have often been in the headlines but often get buried and lost in the never ending flow of headlines, social media posts and DC Press events. And so today we wanted to take a look at the cdc. We're talking about the Centers for Disease Control and Prevention which was the subject recently of a Bloomberg businessweek deep dive. It was entitled America Will get sick. A CDC's total overhaul takes shape. And Tim, that reporting by Bloomberg's Jessica Nix and Madison Mueller.

[Carol Massar]

Jessica Nix joins us now here in the studio. Also joining us today, Dr. Richard E. Besser, President and CEO of the Robert Wood Johnson foundation, former acting director of the CDC, and the Agency for Toxic Substances and Disease registry in early 2009. That was during the early months of the first Obama administration. He joins us from New Jersey. Dr. Besser, I do want to start with you. And just big picture, I think many Americans would agree, regardless of their political affiliation, regardless of how they feel about what's happening at the CDC and HHS right now, that Americans are unhealthy in general, that Americans are sick, that the American health system has not been working for years. Why hasn't it? What hasn't been working?

[Dr. Richard Besser]

Yeah, you know, I think that's the right diagnosis. And, and the big question is what are the drivers of that? And there are many, you know, starting at the health care level. You know, health care is, is a small component of people's overall health. But we, it is important. And we're the only wealthy nation in which your ability to access health care is so dependent on where you happen to have a job. There are millions of people in our country who work more than one job per day who don't have access to high quality, comprehensive, affordable health care. Without that, they will tend to show up in emergency rooms. They'll show up late for care and be sicker. We also are seeing with the latest legislation out of Washington, that tens of millions of people, in addition, are going to lose their health care access. So that will move us in the wrong direction. Some of the biggest drivers of health have to do with, with income and whether someone has the income to be able to afford healthy, nutritious food, whether they have the income and the leisure time to be able to get, get physical activity. These are critical components of health in America. But we are seeing that in America the rates of chronic disease are extremely high, and we need to do more to, to address that. So I think that there probably is a lot of agreement around what the problem is. There is less agreement in terms of what the drivers of that are or what the solution should be.

[Bloomberg Businessweek Host]

All right, so let's get to, and I want to bring in Bloomberg News health reporter Jessica Nix, who wrote this story with Madison Mueller. And Jessica, in your reporting, you know that there is a small but vocal contingent that's long been demanding changes at the cdc. And then with an ally in RFK Junior, the HHS secretary, finally getting these critics kind of getting what they want. But scientists are really worried because they feel like they've been sidelined. What is everyone so worried About?

[Jessica Nix]

Well, we've seen in the past few months, since RFK came in to take over the Department of Health and Human Services, a complete dismantle at the CDC for what we've seen in the past. There was a lot of criticisms of the CDC during the COVID pandemic in terms of guidance around what schools should be doing. So social distancing, masking. It really divided a lot of the public. Since RFK has come in, we've seen mass layoffs in terms of divisions that study chronic disease, gun violence, injury prevention. We've also seen the dismantle of a vaccine panel called the Advisory Committee on Immunization Practices, who's supposed to meet next week. And handpicked members from RFK have now come into that panel and dismantled vaccine policy as we know it. In August, we also saw a shooting at the CDC where the CDC was the attack from a gunman who fired nearly 500 rounds at the buildings. Weeks after that, the CDC director was fired weeks into her tenure over vaccine policy. So there's so much confusion and chaos at the CDC that the actual work is not as able to get done because everyone's gone.

[Bloomberg Businessweek Host]

So, Dr. Bester, let's bring you in. I mean, the worries justified. Do we need. You know, I guess I want to take a step back because I think it's fair to say that sometimes we have institutions that have been in place for a long time and there are aspects that. That get a little stale or that maybe could be improved. And so it's good to take a look at things. But I'm just wondering your view as a former acting director of the cdc. What. What needs to maybe be fixed at the cdc? What is maybe wrong about the current approach or. And what is right maybe about the current approach?

[Dr. Richard Besser]

Yeah, I mean, it is so important to. To look critically at our institutions and ask the question, how can they perform better? Where have they not performed well, and how. Address that. It's critical. I worked at the CDC for 13 years under Republican and Democratic administrations. I ran emergency preparedness for four years during the Bush administration, which is why I was made acting director at the start of the Obama administration, to be able to respond to public health crises. What we're seeing here is the destruction of the world's leading public health agency. The CDC doesn't just provide public health expertise for the United States. It had been looked at as a beacon for public health around the world. That's no longer the case. The administration came in and haphazardly fired tens of thousands of Federal health workers. So many people at the cdc for an administration that is concerned about chronic disease, they eliminated the office on smoking and health. And smoking is the leading preventable cause of chronic disease. There hasn't been any coherent approach to this. At the start of the Obama administration, there were efforts to look across the agency. Where was it lacking? Where could it do better? Before the start of the COVID pandemic, the public's take on the CDC was very high. It had very high approval ratings. But we saw with the COVID pandemic, CDC makes some mistakes. But we also saw the intentional politicization of public health by an administration that saw the opportunity for political gain across the nation. We saw hundreds of talented public health professionals be vilified, people leave their jobs, some forced out, some not able to take the stress or the blatant threats to their health and safety.

[Bloomberg Businessweek Host]

And.

[Dr. Richard Besser]

And now with this administration at a time where we need to rebuild trust, we have as our Secretary of Health, one of the nation's leading anti vaccine advocates and someone who has demonstrated no respect for the Centers for Disease control and prevention.

[Jessica Nix]

Dr. Besser, you mentioned that the CDC is this beacon of global public health. We saw what they did during the COVID pandemic. But what does this mean for future pandemics that might pop up if we have a dismantled cdc, not just for the US but also for the world?

[Bloomberg Businessweek Host]

Okay, my heart just stopped beating because we are going to get another global pandemic. Dr. Besser.

[Dr. Richard Besser]

Yeah. The question is when? Not, not if, but one of the challenges, you know, it's not just the CDC being decimated. The elimination of the of usaid, the Agency for International Development. The CDC works very closely with USAID personnel around the globe to make sure that health departments are ready. Public health professionals are ready to be able to detect and respond to signals very quickly to ensure that other countries can control disease. But it also helps ensure that new diseases don't come to our shores. Dropping out of the World Health Organization, which is designed to be the body to help share information around the globe, help ensure that problems are contained where they arise, that is leaving us as a nation less secure, more defenseless. The cut of billions of dollars to the CDC means a cut of billions of dollars to state and local health departments because most of the money to the CDC is passed on. That means that in our communities they're not going to be as well prepared, not just for the next pandemic or major infectious disease crisis, but for making sure the restaurant you go to for dinner is Serving you food that doesn't make you sick. And when your kids go to the swimming pool, they can swim in that water without getting harmed. These are some of the things that the CDC has done that they're not able to do with what's taken place under this administration.

[Carol Massar]

So, Doctor, when, in your view, do we start to see the effects, if we haven't already, of these cuts that you've been talking about?

[Dr. Richard Besser]

Well, we are seeing them. And your reporting did such a nice job lifting that up. Where a health department in Texas calls the CDC for assistance and there's no one there to help. We heard early on in Milwaukee, where they're dealing with lead in their water supply, they called the cdc, but the group that worked on lead poisoning had been let go. These are things that will affect people at the community level. It will continue to grow. But in general, public health is invisible when it's working properly. It's only when it's not working properly and then gets stressed. So whenever there's a crisis in a community and public health can't respond, then you will see it. And then hopefully people in their communities will say, this doesn't work for us. We need. We need the CDC to be supported. We need our state and local public health departments to be supported.

[Bloomberg Businessweek Host]

Dr. Besser, why are we so divided when it comes to. There are those of us who are like, yeah, I trust the government, I trust the CDC and what they say. And then there are those that don't. Is it just politically motivated or is it people who don't feel like they get good health care and so they're like, this system is just not working?

[Dr. Richard Besser]

Yeah, it's a great question. I think that there are a number of factors. Before COVID pandemic, the approval rating by both parties was very, very strong. With the COVID pandemic, there were mistakes that CDC made, but I led the CDC at the start of the H1N1 swine flu pandemic. And during that period, we saw extremely high approval ratings. The reason for that was there was intentionally efforts to not politicize the response. People from both parties came together and said, we're going to do what it takes to keep people in our communities safe. What we recommend now may change as we learn more information. That's a good thing. With the COVID pandemic, whenever there was a change in guidance, it was jumped on as a sign that the agency didn't know what they were doing. And CDC wasn't allowed to talk directly to the public. And after the first two months in the pandemic. And that is a setup for disaster because you need active communication to build trust and maintain trust. And once you've lost trust, it's extremely hard to get it back.

[Jessica Nix]

Dr. Besser, we've also seen this dismantle of the vaccine committee at the CDC which decides which insurance people are going to be able to have to be able to get their vaccines. So what does that mean to watch this dismantle of the vaccine policy as well?

[Dr. Richard Besser]

Yeah. So I'm a general pediatrician and I practiced pediatrics for more than 30 years. And I know that nothing I did as a pediatrician had more proven value than helping my patients make sure that they were vaccinated completely and on time. And that took spending a lot of time with parents answering their really good questions so that they were comfortable making the right decision for their children. And I always said if you have a question, if you want some, some honest information, go to the CDC website, they'll give you all the information. We can't do that anymore. That is a major problem. We're seeing other organizations step up. The Academy of Pediatrics represents pediatricians. I'm a member of that group. They have guidance. We're seeing states come up with guidance. But the idea that we can't look to the CDC because this advisory group has become so politicized, so staffed with people who have strong anti vaccine agendas will put us at great risk. And what I'm hearing about the committee meeting for next week is that they will raise great concerns about safety in the COVID vaccine. Safety concerns that have not been verified scientifically. And this again will lead people to be confused and it will lead some people to make a decision that I think is not good for the health of their families.

[Bloomberg Businessweek Host]

All right. And as we know, confusion, uncertainty, never good. It doesn't matter what area of the world or our lives that we're talking about. Dr. Besser, thank you so much. Dr. Richard Besser, president and CEO of the Robert Wood Johnson foundation, former acting director of the cdc, joining us from New Jersey on this Friday. Hey Jessica, before you go, incredible story. Highly recommend everybody check it out on the Bloomberg and reading. And you do quote Dr. Besser. He said it here and he said in a very short time we've seen an incredible destruction of the agency that leaves people here and around the world at increasing risk. And of course he was talking about the cdc. Your kind of thoughts after, you know, having a further discussion with Dr. Besser and where we are in terms of health care in America.

[Jessica Nix]

It's going to be really interesting to watch what happens to public health across the US Right now we're seeing a bit of a piecemeal policy around vaccine policy in the US Too, as states are kind of adopting their own guidelines or working together about how can we start making sure that Covid vaccines are still offered at pharmacies now as well. So we're seeing a state by state approach to public health now, which is difficult without the cdc, because the CDC does provide, provide that nationwide view of what's happening to the, to the nation's health care.

[Bloomberg Businessweek Host]

Right. And it sounds like different states have different monies and that will kind of determine some of the health care.

[Carol Massar]

Well, not just that. I think insurance companies have an interesting position here because if the CDC doesn't necessarily recommend something, but states do, then what is an insurance company going to cover and to what extent does that actually push somebody to get or not get a certain medicine?

[Jessica Nix]

That's a great question and I think we're going to be seeing that play out, especially starting next year when the next plan starts. As of this year, insurance companies are still going to cover vaccines, but health experts have been telling us and in our reporting that the cost of a vaccine is probably less than the cost of the illness that you're going to get later on and then your hospital bill and everything else.

[Carol Massar]

So they deal with preventative medicine, right?

[Bloomberg Businessweek Host]

Exactly right. And folks have been preaching that for such a long time. Thank you so much. You're reporting. And also joining us here, Bloomberg News health reporter Jessica Nick.

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