By Josh Nathan-Kazis

After months of contentious hearings, President Donald Trump's appointees to lead the government's top health agencies are mostly settling into their new offices, setting the scene for a new policy era amid constrained resources.

The latest Senate confirmations came late Tuesday, when senators approved Dr. Jay Bhattacharya to lead the National Institutes of Health, and Dr. Marty Makary to lead the Food and Drug Administration. The Senate confirmed Health and Human Services Secretary Robert F. Kennedy, Jr. in mid-February.

Some important health positions remain unfilled. The Senate Finance Committee on Tuesday voted to advance the nomination of the former television host Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services. A vote by the full Senate should come soon, and is likely to succeed.

And on Monday, the White House nominated the acting director of the Centers for Disease Control and Prevention, Dr. Susan Monarez, to lead the agency. That came days after it withdrew the nomination of Dr. Dave Weldon, a former congressman with a history of vaccine skepticism.

Still, the lion's share of the health appointees Trump named late last year are now in place. They arrive as staff cuts batter both NIH and the FDA, part of the broader layoffs that have swept the federal government since the beginning of Trump's second term.

Mass firings hit the FDA in February, and a number of media outlets have reported plans to cut thousands of workers at NIH. FDA workers have also been ordered to return to work in person, ending a pandemic-era policy that had allowed many of them to work from home.

Disruptions in NIH grantmaking have had dramatic ripple effects across academic medicine.

Here are three things to watch in the coming days.

Shifting Winds on Vaccine Policy

Vaccine policy has been a major concern as the Trump team has arrived at the healthcare agencies, given the much-discussed vaccine skepticism of Kennedy and of Weldon, the former CDC nominee.

The replacement of Weldon with Monarez, a longtime federal official, as the CDC nominee, appears to be a setback for the vaccine skeptics. It is an acknowledgment of the deep resistance even among some Senate Republicans to allowing Kennedy's views on vaccines to reshape the federal health agencies.

Within the health apparatus, however, Kennedy's ideas do seem to be having an effect. The Washington Post reported Tuesday that HHS had hired a prominent vaccine skeptic to run a study looking at links between vaccines and autism.

Departures at CDC

The Associated Press reported that five top leaders had left CDC at once on Tuesday, and that three other senior leaders had departed in recent weeks. The people who left Tuesday include the head of the CDC's Office of Science and the leader of its National Center on Birth Defects and Developmental Disabilities.

Last month, the CDC's principal deputy director, Dr. Nirav Shah, left the agency. He had been a top official responding to the bird flu outbreak, and a regular presence on the periodic press calls the Biden administration had organized to discuss the virus.

That creates challenges for Monarez, who will arrive at an agency missing many of its top people.

Worries over Slowdowns at FDA

Drugmakers rely on a fully-staffed FDA for timely reviews of drug approvals. Though the number of total layoffs thus far to hit FDA is unclear, estimates are in the hundreds. If those workers left the divisions of the FDA that review new medicines, it could be a big deal for the biopharma industry, which would need to wait longer to get its new drugs approved.

A note early this week from Jefferies analyst Andrew Tsai looked at FDA employment data, and found that the vast majority of the top employees in the divisions that review new medicines remain in their jobs. The changes in the top ranks at the drug-review divisions, Tsai wrote, seem "non-eventful."

Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com

This content was created by Barron's, which is operated by Dow Jones & Co. Barron's is published independently from Dow Jones Newswires and The Wall Street Journal.

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March 26, 2025 12:37 ET (16:37 GMT)

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