(CNN) — Over the course of a year, the US Centers for Disease Control and Prevention has seen a traumatic shooting, abrupt leadership changes and a shattering of its image as a globally respected public health agency.
So by the time the Trump administration started looking for a new director, there was one requirement that topped the search criteria.
“We just need someone who’s not crazy,” a White House official told CNN amid the lengthy hunt for a nominee that finally culminated with Trump tapping Erica Schwartz, a former deputy surgeon general and retired US Coast Guard officer, for the job in April.
On Wednesday, Schwartz — President Donald Trump’s third pick to lead the CDC — appears before the Senate Health, Education, Labor and Pensions Committee to face confirmation. She testifies alongside Sean Kaufman, the president’s nominee for Assistant Secretary of Preparedness and Response.
Schwartz’s selection was aimed at bringing stability to the agency after near-constant upheaval that has decimated morale and deeply shaken Americans’ faith in the administration’s health agenda, senior health officials and others familiar with the matter told CNN at the time.
In the months since, the need for strong CDC leadership has only sharpened. The public health agency has battled disease outbreaks on multiple fronts, providing support for an Ebola outbreak in central Africa while scrambling to contain a spike in parasitic diarrhea across multiple states.
Schwartz is a notable departure from prior contenders considered by the administration, who have toed the “Make America Healthy Again” line. She has a lengthy record of guiding vaccination programs and crises responses for the government – a stark contrast to Trump’s first CDC pick, whose nomination was withdrawn, in part, because it became clear his vaccine skepticism would prevent him from getting the job.
Her candidacy has already won praise on Capitol Hill, generating hope within the administration that she’ll win quick confirmation.
And as the White House intensifies its focus on the midterm elections, the move is the latest sign of how significantly Trump aides have sought to rein in a Health and Human Services Department led by Robert F. Kennedy Jr. that once enjoyed wide latitude to pursue divisive efforts to overhaul vaccines and other core health policies.
But the move has already shaken the MAHA faithful, while still leaving some mainstream public health experts unconvinced.
“She’s a good and well-qualified nominee, and would be in any administration. However, the issue is not her qualifications — it’s the environment that she’s being asked to work in,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and spokesperson for the Infectious Diseases Society of America. “If this is supposed to be some kind of pivot away from what’s been going on for the last year, it will all be window dressing if RFK Jr. is still in place.”
Meanwhile, Toby Rogers, a prominent vaccine critic, declared on X that Schwartz’s appointment would be “a slap in the face to the medical freedom base that gave Trump the presidency in 2016 and 2024.”
“The White House isn’t even trying to win the midterms at this point,” he added.
The White House did not respond to a request for comment.
A notable shift
The White House has been eager to get the health department away from unflattering headlines in the run-up to midterm elections that could cost Republicans control of Congress — and stall President Donald Trump’s agenda.
Vaccines had been a particular sticking point. Trump withdrew his first nominee, former congressman Dr. Dave Weldon, when it became clear his vaccine views would stall a vote.
The CDC director who was confirmed, Dr. Susan Monarez — a scientist and longtime public health official — immediately clashed with Kennedy over vaccine policies and his efforts to oust some senior CDC officials. She was removed less than a month into the job.
After Monarez’s high-profile departure last August, some Trump officials questioned whether it was even worth attempting to find another nominee to run the agency.
Kennedy installed his then-deputy secretary, Jim O’Neill, as interim head, and sought to concentrate much of the decision-making among the department’s political leadership in Washington.
Yet senior White House and HHS officials soon soured on O’Neill, who rarely spent any time at the CDC’s Atlanta headquarters and was seen among political appointees as a subpar public communicator, according to people familiar with the matter.
The agency is currently being overseen by Jay Bhattacharya, who was acting director until March, and is still managing some duties; Bhattacharya is also director of the National Institutes of Health.
The White House, in the meantime, grew increasingly frustrated with HHS’ constant internal upheaval and was alarmed by polling showing that Kennedy’s vaccine agenda threatened to drag down the GOP in the midterms.
The struggle to steer health messaging onto more populist ground was evident during a string of HHS budget hearings in April, when Kennedy was interrogated by Democrats on measles outbreaks, vaccine safety, and the causes of autism, along with at least one reference to raccoon genitalia that was recently disclosed in a book citing Kennedy’s alleged diary entries.
The secretary variously defended his actions and promised improvements, particularly at the CDC, where he conceded morale was at a “nadir” last year amid layoffs and high-profile departures.
“I think this new team is really going to be able to revolutionize CDC and get it back on track,” he said before the House Appropriations subcommittee in April, referencing Schwartz and three new public health appointees named that month.
Several months of internal discussions about smoothing out the HHS upheaval preceded the pick.
In late January, Susie Wiles, the White House chief of staff, ordered a review of the department. Afterward, White House officials worked alongside Kennedy to orchestrate a shakeup of HHS leadership, including jettisoning O’Neill and installing new advisers atop the department.
One of those advisers, Medicare chief Chris Klomp, was named HHS’ chief counselor and has since moved quickly to stabilize HHS and its various sub-agencies, three people familiar with the situation told CNN. Klomp is well liked within the White House and has come to wield remarkable influence over personnel decisions and other critical activities, those people said.
Among the priorities was to find a permanent CDC director who could ably run the agency — and crucially, avoid subjecting the administration to yet more damaging news cycles that would distract from the White House’s core midterms message.
Klomp led the effort to identify and interview candidates over several weeks, the sources said, seeking officials mainstream enough to win confirmation in a closely divided Senate, yet still willing to work closely with Kennedy on a broader overhaul of the CDC.
In a notable shift, that criteria did not include sharing Kennedy’s skepticism of vaccines, two of the sources familiar with the selection process said. Kennedy was initially skeptical of Schwartz as a potential candidate, two people familiar with the matter said, but grew more supportive after meeting with her, ultimately signing off on her recommendation to the White House.
Meanwhile Klomp’s influence grew as he led the search for Schwartz and other top health officials. In June, Trump named Klomp deputy secretary of HHS, effectively making him Kennedy’s second-in-command at the agency.
Kennedy’s power on the wane?
Since taking tighter control of HHS’ activities, White House officials have discouraged Kennedy and his aides from publicly discussing their efforts to overhaul vaccine policies — viewing the issue as politically toxic to voters and unhelpful ahead of the midterms.
In a further effort to signal HHS’ renewed commitment to stabilizing the agency, officials also pre-emptively lined up top advisers whom they planned to appoint around Schwartz. They include former Walmart executive Sean Slovenski, Texas health commissioner Jennifer Shuford and senior Food and Drug Administration official Sara Brenner.
Brenner, a career staffer who closely aligned herself with Kennedy at the outset of the administration, is expected to serve as a liaison between Kennedy and the CDC’s leadership in Atlanta, one of the people said, while also serving as a top adviser to Kennedy on the agency’s priorities.
Kennedy has largely gone along with the changes overseen by the White House in recent months, mindful of remaining close to Trump and still of the belief that he can make headway on some of his own personal priorities, people familiar with the secretary’s thinking said.
He is expected to spend much of the months leading up to the midterms on the road, talking up the administration’s work on healthier eating and lower drug prices. He has largely dropped any public discussion of further vaccine changes, and acquiesced to a White House effort to boost a pesticide that he had once vocally opposed.
Yet for some close Kennedy supporters who once heralded his appointment atop HHS as the start of a health care revolution, the sudden reversion back to a more traditional set of priorities has proven increasingly tough to swallow.
Aaron Siri, a vaccine injury lawyer who has worked as Kennedy’s personal attorney and sought to unravel federal vaccine policies, told CNN: “The only thing [Schwartz] will likely restore is the CDC to business as usual – cheerleading for industry instead of being a regulator over industry.”
“I believe that left to his own devices, Secretary Kennedy would not have chosen her,” he added.
This story has been updated with additional information.
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