Fitzgerald's resignation comes as CDC faces huge funding cuts

Dr. Brenda Fitzgerald's resignation as director of the Centers for Disease Control and Prevention comes at a precarious time for the agency. It's trying to address a flu epidemic while bracing for possible deep cuts to its funding.

HHS announced Fitzgerald's resignation Wednesday one day after Politico reported that she had invested in shares of a tobacco company after joining the agency last July.

A CDC spokesperson said Dr. Anne Schuchat, CDC principal deputy director, would serve as interim director until a permanent replacement is named.

Dr. Umair Shah, executive director of the Harris County Public Health Department in Texas and president of the National Association of County and City Health Officials, said the White House should name a permanent director soon to help advocate against funding cuts as the threat of a second government shutdown looms if Congress fails to pass a spending bill by Feb. 8.

"You cannot rely on an interim director for an extended period of time without over time having an impact on activities within that organization and outside of that organization," Shah said.

During the last government shutdown, HHS planned for more than 60% of CDC's staff to be furloughed, according to the department's contingency staffing plan. If a similar plan is put in place this time, the CDC could get hit badly just as it's trying to track and respond to one of the worst flu seasons in years. Another funding crisis could take place in March if lawmakers do not agree to raise the debt ceiling to avoid the government from defaulting on its loans.

But many experts see President Donald Trump's pending budget as having the biggest potential impact on the CDC. The Trump administration suggested cutting the agency's annual budget by more than $1.2 billion. The president's next draft budget is due Feb. 5.

Michael Fraser, executive director for the Association of State and Territorial Health Officials, said an agency director has a direct line to the White House to pled its case for funding. He's not sure whether an interim director would take on that same advocacy role.

"When you have a secretary-appointed, president-approved person in that job it can sometimes be a more influential voice," Fraser said.

Fitzgerald quit after severe scrutiny over her decision to bypass testifying at congressional hearings.

Sen. Patty Murray (D-WA) claimed Fitzgerald was forced to recuse herself from hearings such as one held last October on the opioid crisis and a Senate health committee's hearing held earlier this month on the nation's preparedness against public health emergencies because she continued to hold financial stakes in companies that posed potential conflicts of interest.

"The agency has not been as visible as they need to be," said Dr. Georges Benjamin, executive director of the American Public Health Association. "They can be most effective playing a leadership role in the nation's health threats. I hope the next director will be able to do that. Funding and a coordinated national response to many health threats requires CDC leadership."

Benjamin said the next person selected to become permanent director needs to be 'fully vetted' for conflicts before being approved.

But some public health advocates expressed disappointment over Fitzgerald's resignation and praised her for her leadership. "All indications were that she was doing a very good job keeping the agency focused," said John Auerbach, president and CEO of Trust for America's Health.

Shah said the past year demonstrated the importance of the nation's public health agency. Aside from addressing the opioid crisis, it has responded to a slew of natural disasters, including hurricanes Harvey and Maria in Texas and Puerto Rico as well as a rash of wildfires across the state of California.

"We have gone through an incredibly difficult time when it comes to emergencies in our nation," Shah said. "It's always helpful and important to have one singular point of contact and leader like the CDC to be able to provide that perspective."

Benjamin felt the CDC's professional workforce was resilient and would not allow Fitzgerald's departure or uncertainties over funding to distract from their mission.

"I think this will be a fleeting issue," Benjamin said. "Dr. Fitzgerald needs to tell her story. I wish her well in her next endeavor."

This marks the second time Schuchat will lead the agency. She became acting CDC director in Jan. 2017 when former CDC Director Dr. Thomas Frieden resigned after Trump's inauguration. She held the post until Fitzgerald took office in July of that year.

Shah said Schuchat was a solid choice to lead the agency .

"The fact that Dr. Schuchat is there really provides some comfort to those in public health," he added.

An edited version of this story can also be found in Modern Healthcare's Feb. 5 print edition.