The CDC is at a pivotal point. After enduring pandemic repercussions and the rise in opioid-related fatalities, the agency requires strong, decisive direction. A medical professional is not necessarily the solution.
Historically, the CDC has predominantly been led by doctors, whose training and focus center around individual patient care. While related, medicine and public health are distinct. Medicine focuses on the individual, while public health focuses on the community. Leadership of the CDC involves less diagnosis and more infrastructure, logistics, and preventative measures. The position requires not just medical knowledge, but system design to preemptively address crises.
Therefore, Susan Monarez’s nomination as acting director is particularly noteworthy. The fact that she is not a medical doctor is advantageous, as she has cultivated skills centered around prioritizing the population. Instead of concentrating on the individual patient, she possesses significant experience in the scientific and strategic aspects of public health and government. She has been involved in developing national biodefense policy at the Department of Homeland Security, fostering innovation at the White House Office of Science and Technology Policy, and recently co-led President Biden’s ARPA-H initiative as Deputy Director.
Beyond her extensive scientific background, she possesses unique experience in cross-agency coordination, management of intricate systems, and translating public health concepts into tangible outcomes. This is precisely the leadership the CDC needs currently. While she may lack experience in hospital patient care, her background is better suited to the skills required to manage the nation’s leading public health agency.
Monarez holds a Ph.D. in microbiology and immunology and has dedicated two decades to spearheading innovation and strategy across various federal agencies, including the Department of Homeland Security, the White House Office of Science and Technology Policy, and ARPA-H. Her work has covered areas like pandemic readiness, antimicrobial resistance, maternal and mental health, and digital privacy. However, her comprehensive resume and systems-oriented approach to health truly distinguish her.
Historically, the CDC excelled in this type of work, acting as more than just a disease surveillance center. It played a crucial role in eradicating smallpox, establishing national immunization programs, and enhancing water safety through engineering-based initiatives. While these achievements largely occurred under medical doctor directors, the agency has progressively shifted towards analysis and communication, moving away from implementation.
Dr. Monarez has the capability to restore the CDC to its former strengths. She has spearheaded impactful initiatives at ARPA-H, including projects aimed at transforming mental health care through scalable, technology-driven solutions and redesigning maternal health systems to reduce outcome disparities. At HRSA, she established the Center for Innovation to enhance care delivery across the nation’s safety-net providers and oversaw the creation of tools to improve resource allocation and expand access in underserved communities. Furthermore, at BARDA, she was instrumental in bolstering the nation’s preparedness for health emergencies, including expediting diagnostics and medical countermeasures for pandemic threats. Her career has centered on building solutions – not just understanding problems – but creating and implementing solutions that can be scaled to improve population health.
The consequences of an excessively clinical approach became evident during the COVID-19 pandemic. Early on, the were valued more for their accuracy in individual cases, instead of their effectiveness in and distinguishing who needed to isolate. Later, vaccine distribution prioritized for each person, even when a single dose offered considerable protection. This meant that for every 100 people who received their second dose, another 100 received nothing. It was a medically sound approach for those who received both doses but a public health setback for everyone else.
These decisions were not malicious, but reflected a patient-centered framework, rather than a population-based one. Leadership of the CDC necessitates a focus on population-level data, policy trade-offs, and systems design, all of which Monarez understands. Her has consistently prioritized operational solutions to population-wide health issues. She has successfully navigated various federal administrations, developed programs from the ground up, and advocated for scalable innovation. This is precisely what the CDC requires now to restore its credibility and address complex challenges like antimicrobial resistance, mental health, and the opioid crisis.
Her background could be particularly critical in the upcoming months. If confirmed, Monarez will report to HHS Secretary , whose vaccine skepticism has concerned public health experts. Navigating the CDC in this political climate will require not just medical expertise, but also scientific rigor, diplomacy, and unwavering integrity.
While medical insights remain crucial to public health, they can be obtained through advisors. Strategic, systems-level leadership, however, cannot be outsourced.
Monarez provides precisely that. She is a public health engineer perfectly suited for this critical time.