WASHINGTON — Pressure is mounting on the leaders of the Centers for Disease Control and Prevention — from inside and outside the agency — to speak publicly against the White House’s manhandling of C.D.C. research and public health decisions, with career scientists so demoralized they are talking of quitting if President Trump wins re-election.
The situation came to a boiling point this week when William H. Foege, a giant in public health who led the C.D.C. under Democratic and Republican presidents, called for its current director, Dr. Robert R. Redfield, to “stand up to a bully” — he meant Mr. Trump — even at the risk of being fired.
“Silence becomes complicity,” he said in an interview, after a private letter he wrote to Dr. Redfield leaked to the news media.
Dr. Redfield further infuriated public health experts by issuing a memo, released by the White House, that cleared Vice President Mike Pence to participate in the vice-presidential debate on Wednesday, even as the White House became a coronavirus hot spot. Nearly a dozen current and former C.D.C. officials — including six who still work there — called the letter highly inappropriate.
And Senator Patty Murray of Washington, the ranking Democrat on the Senate health committee, said she told Dr. Redfield in a private telephone conversation before he testified on Capitol Hill last month that he had to take a stand.
“What I said to him was that my concern was about the agency’s credibility today — and the agency’s credibility that we need as a country in the future,” Ms. Murray said in an interview. “This isn’t just about right now. If we lose all the really good scientists there, if people don’t believe the C.D.C. when they put out guidance, what happens in the next flu outbreak? What happens in the next public health crisis?”
But the C.D.C. leadership has proved far more malleable to the president’s will. The White House successfully pressured the agency to revise guidelines on matters like school reopenings, church gatherings and whether cruise ships can sail.
The C.D.C. was forced, over the serious objections of its own scientists, to post coronavirus testing guidelines that suggested asymptomatic people should not be tested. (Dr. Redfield later walked that back after the resulting uproar, and it was ultimately reversed.) And the White House thwarted a plan, laid out in a directive drafted last month by Dr. Redfield, to require individuals to wear masks on all commercial transportation in the United States.
Supporters of the agency fear the C.D.C.’s reputation will be irrevocably damaged if Dr. Redfield does not start more vigorously defending its science.
“What has happened at C.D.C. has been horrifying to see,” said Dr. Mark Rosenberg, who pioneered public health research into gun violence at the C.D.C. but was pushed out after Republicans in Congress effectively cut off funding for his work. “It’s been terribly demoralizing to people who have been working 16 and 17 hour days for weeks or months at a time while taking on Covid-19.”
Dr. Redfield declined to comment. Ms. Murray said he had given her his assent in their conversation, acknowledging without saying much that he agreed with what she said. A spokeswoman for the Department of Health and Human Services, the C.D.C.’s parent agency, said, “The American people are fortunate to have Dr. Redfield leading the C.D.C.”
The agency’s scientists know that their work will invariably collide with politics; they make decisions and do research on hot-button issues like abortion, teenage pregnancy and gun violence. But they have never seen anything quite like what is happening under Mr. Trump.
“We’ve all learned a terrible lesson,” said one C.D.C. official who spoke on the condition of anonymity for fear of being fired. “As much as we want to believe we can operate independently of politics and it’s all about the science, it took just a few months to hobble our ability to steer the course of this pandemic. So we can pretend that the politics don’t matter, but we have been kneecapped.”
Political appointees of the president meddled in the agency’s Morbidity and Mortality Weekly Reports, regarded as the “holiest of the holy” in medical literature. Equally troubling, agency officials say, is that the White House has muzzled the C.D.C., refusing to allow the nation’s leading public health experts to talk directly and regularly to the American people — a critical component of any successful infectious disease response.
The C.D.C. has made its own missteps. Sloppy laboratory practices caused the botched introduction of coronavirus tests early in the pandemic. More recently, the agency withdrew a notice on its website acknowledging for the first time that the coronavirus spreads mainly by air, saying that it had been “posted in error” on the agency’s website. The weaker version was later published.
Dr. Redfield has at times offered lukewarm statements in defense of the C.D.C., like when he told the Senate health committee that suggestions that the agency was a “deep state” were “offensive.” In an internal email last month summing up his testimony, he told agency employees that he had “shared my sadness over misperceptions regarding the scientific integrity” of the reports, and pledged that they would “not be compromised under my watch.”
The agency’s scientists say that is not enough. Current C.D.C. employees contacted would not speak on the record for fear of reprisal, but the sense of despair is clear. Many view public health as a calling, and remain at the agency knowing that they could earn much higher salaries working in industry.
One longtime C.D.C. scientist said it was time not only for Dr. Redfield to speak out, but also for senior career scientists in the agency to do so. Dr. Nancy Messonnier, the director of the C.D.C.’s National Center for Immunization and Respiratory Diseases, has hardly been seen since late February, when she enraged Mr. Trump by presciently telling reporters that day-to-day life in the United States was about to change drastically: “It’s not so much of a question of if this will happen anymore but rather more of a question of exactly when this will happen.”
Another C.D.C. veteran scientist said he and colleagues were planning to look for new jobs if Mr. Trump wins re-election.
Dr. Redfield’s memo about Mr. Pence — addressed to Marc Short, the vice president’s chief of staff — is a particular sore spot because Dr. Redfield has not examined Mr. Pence, and the C.D.C. is not involved in contact tracing to track the extent of the White House outbreak. In addition, federal law bars most executive branch employees from engaging in political activities, and some say Dr. Redfield crossed a red line.
“It sounds very manipulative,” said Dr. Foege, who served as C.D.C. director under Presidents Jimmy Carter and Ronald Reagan, adding that while he sometimes had to fend off pressure from Washington, he “was never faced with having to do something like that.”
Most current and former C.D.C. officials acknowledge that Dr. Redfield is in a terrible position, working for a president who has declared all-out war on his agency and who regards its scientists as members of a so-called deep state out to get him. Unlike Dr. Fauci, he is a political appointee and lacks Civil Service protections. And unlike the F.D.A. commissioner, he cannot turn to a powerful industry constituency like pharmaceuticals to back him up.
Some say it would be unwise for him to step down, for fear of his successor.
“What happens if 50 of the top scientists at C.D.C. say, ‘We’ve had it, we’re leaving’? Does that leave the country better off or worse off?” asked Dr. Jeffrey Koplan, who served as the C.D.C. director under Presidents Bill Clinton and George W. Bush and regularly met Dr. Redfield for lunch before the pandemic. “I suspect that Dr. Redfield is asking himself the same question.”
Dr. Foege’s letter to Dr. Redfield, dated Sept. 23 and first published by USA Today, made clear that he and Dr. Redfield had talked about the prospect of resignation. Dr. Foege helped lead the effort to eradicate smallpox in the 1970s and is a giant in the world of public health.
“As I have indicated to you before, resigning is a one-day story and you will be replaced,” he wrote. Instead, he urged Dr. Redfield to describe the administration’s failures, and his own, in a letter to the agency’s employees. Then, he concluded, “when they fire you, this will be a multiweek story and you can hold your head high.”
As pressure on him intensified this spring and summer, Dr. Redfield did not tell top aides that he was considering resigning, a former federal health official said. Instead, he would make versions of the same comment: “As long as I’m here, with the time I have left, which may not be long, we’re going to try to do x, y and z,” the official recalled.
Known as “R3” by his staff — a reference to his initials — Dr. Redfield has rarely been in Atlanta during the pandemic, with top aides seeing him only a dozen or so times. Often summoned to coronavirus task force meetings and congressional hearings, he instead has stayed at his home in Baltimore, where he helped found and run a virology institute at the University of Maryland before becoming C.D.C. director in 2018.
He was named to the job by Mr. Trump’s health secretary, Alex M. Azar II, replacing Dr. Brenda Fitzgerald, who resigned after six months on the job amid disclosures that she had bought tobacco stocks.
When he arrived at the C.D.C., one scientist there said, many in the agency were relieved. They had feared Mr. Trump might appoint someone openly hostile to science, or an opponent of vaccines. But Dr. Redfield had no experience in public health or in running a large government agency like the C.D.C., with 11,000 employees. Nor is he an especially good communicator.
“I don’t think he was the leader for this agency at this point in time,” said Dr. Georges C. Benjamin, the executive director of the American Public Health Association, who has known Dr. Redfield since they served together in the Army decades ago. “I don’t know if anybody could have been.”
Now, less than a month from the election, the question is whether the C.D.C. can recover. Dr. Foege refused to allow the possibility that it could not.
“They have to recover,” he said. “The world needs a gold standard in public health.”
Noah Weiland contributed reporting.