There was a notable absence last week when U.S. Health and Human Services Secretary Robert F. Kennedy Jr. announced in a 58-second video that the government would no longer endorse the COVID-19 vaccine for healthy children or pregnant women.

The director of the Centers for Disease Control and Prevention — the person who typically signs off on federal vaccine recommendations — was nowhere to be seen.

The CDC, a $9.2 billion-a-year agency tasked with reviewing life-saving vaccines, monitoring diseases and watching for budding threats to Americans’ health, is without a clear leader.

“I’ve been disappointed that we haven’t had an aggressive director since — February, March, April, May — fighting for the resources that CDC needs,” said Dr. Robert Redfield, who served as CDC director under the first Trump administration and supported Kennedy’s nomination as the nation’s health secretary.

$9.2 billion-a-year agency without leader as nomination awaits

The leadership vacuum at a foremost federal public health agency has existed for months, after President Donald Trump suddenly withdrew his first pick for CDC director in March. A hearing for his new nominee — the agency’s former acting director Susan Monarez — has not been scheduled because she has not submitted all the paperwork necessary to proceed, according to a spokesman for Sen. Bill Cassidy, R-La., who will oversee the nomination.

HHS did not answer written questions about Monarez’s nomination, her current role at the CDC or her salary. An employee directory lists Monarez, a longtime government employee, as a staffer for the NIH under the Advanced Research Projects Agency for Health.

Redfield described Kennedy as “very supportive” of Monarez’s nomination.

Instead, a lawyer and political appointee with no medical experience is “carrying out some of the duties” of director at the agency that for seven decades has been led by someone with a medical degree.

Matthew Buzzelli, who is also the chief of staff at the CDC, is “surrounded by highly qualified medical professionals and advisors to help fulfill these duties as appropriate,” Andrew Nixon, an HHS spokesperson said in a statement.

Adding to the confusion was an employee-wide email sent last week that thanked “new acting directors who have stepped up to the plate.” The email, signed by Monarez, listed her as the acting director. It was was sent just days after Kennedy said at a Senate hearing that Monarez had been replaced by Buzzelli.

The lack of a confirmed director will be a problem if a public health emergency such as the COVID-19 pandemic or a rapid uptick in measles cases hits, said Michael Osterholm, an epidemiologist at the University of Minnesota.

“CDC is a crisis, waiting for a crisis to happen,” said Osterholm. “At this point, I couldn’t tell you for the life of me who was going to pull what trigger in a crisis situation.”

At CDC headquarters in Atlanta, employees say Monarez was rarely heard from between late January – when she was appointed acting director – and late March, when Trump nominated her.

She also has not held any of the “all hands” meetings that were customary under previous CDC chiefs, according to several staffers.

One employee, who insisted on anonymity because they were not authorized to speak to the media and fears being fired if identified said Monarez has been almost invisible since her nomination, adding that her absence has been cited by other leaders as an excuse for delaying action.