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Former representative Dave Weldon, MD (R-Fla.), President-elect Donald Trump's pick to run the CDC, will have his work cut out for him, one infectious disease expert says.

Anne Schuchat, MD, former principal deputy director of the CDC, said that among the critical duties for Weldon, should he be confirmed by the Senate, will be:

• Assuring high-quality, nimble, and expert support to state and local public health authorities
• Protecting Americans from new and re-emerging threats (both infectious and noninfectious, natural and man-made, arising at home or abroad)
• Modernizing data systems and capacities for public health
• Sustaining or where needed improving high-quality scientific expertise, in-house and through partnerships
• Assuring laboratory excellence (quality and safety)

"Dealing with the leading causes of death, illness, and disability requires these capacities," she wrote in an email. "A focus on chronic disease prevention, as is being described for some of the health nominees in the media, is welcome by many public health experts, but it is important to recognize the capacity for infectious threats to inflict high burdens of disease relatively rapidly and to lead to second-order disruptive effects."

"Whether it's the longstanding AIDS epidemic, the short-term $40 billion global economic impact of SARS in 2003, or the devastation of COVID-19 or the 1918 influenza pandemics, administrations don't get to choose whether a major infectious threat will emerge on their watch," Schuchat said. "But they need to be accountable for being prepared to detect promptly, mitigate the worst effects, and if possible prevent their occurrence."

"When Indiana suffers an explosive outbreak of acute HIV infection linked to drug injections, or there is ... a new congenital birth defect [that] is caused by virus-infected mosquito bites, swift and expert federal responses are needed to support public health authorities and the clinical community," she added. "Preserving the outbreak response capacity is essential."

Not much is known about Weldon's history with healthcare administration. He was born in Amityville, New York in 1953. He got a BS degree from the State University of New York at Stony Brook and an MD from the State University of New York at Buffalo. Weldon, an internist, served in the Army for 6 years and in the Army Reserve for 5 years, completing his service in 1992. He served in Congress from 1995 to 2009, and then in Florida.

During his time in Congress, Weldon and then-Rep. Carolyn Maloney (D-N.Y.) sponsored a bill in 2007 to move oversight of vaccine safety away from CDC to a new agency. "Their reasoning [was] that CDC is also in charge of promoting vaccination, so there's a potential conflict of interest," Joe Antos, PhD, senior fellow emeritus at the American Enterprise Institute, said in an email to 麻豆传媒. "He won't be doing that in this administration -- Elon [Musk] and Vivek [Ramaswamy] are pushing to reduce bureaucracy, not increase it. But this says that he doesn't trust CDC to follow, or even know, what 'the science' is." Musk and Ramaswamy are Trump's choices to head a Department of Government Efficiency -- an organization outside the federal government -- aimed at cutting government costs and increasing efficiency.

Weldon's view of the CDC "has been reinforced by the terrible performance of CDC during COVID: contradictory and eventually disproven claims about cloth masks, CDC preventing the use of privately developed COVID tests, and CDC support for closing schools," Antos said. "All this suggests that CDC will be less vocal under the new administration, and will likely take more time to get outside advice before making public health pronouncements."

Antos noted that Weldon will be the first CDC director nominee to require Senate confirmation, per a provision in the 2024 budget bill. "I don't think that makes the job more political since the recent directors have been politically active themselves," he said. "Weldon will certainly want to consolidate functions and cut back on the number of people in his immediate office -- the [organization] chart is a mess."

However, Antos said, "Reorganizations take time -- more than 2 years, and often more than 4. They can also be reversed to some extent by the next administration. It's unclear whether Weldon and [Robert F. Kennedy Jr., Trump's nominee to head HHS] will be willing to fight for a long time with outside groups (patients, pharma, the rest of the health sector) to make more than cosmetic changes to CDC."

Some analysts were more circumspect about what Weldon might do. "I'm just not going to comment on what people did or said all the way back when I had hair," said Rodney Whitlock, PhD, a longtime health policy analyst who is currently an advisor with the consulting firm McDermott+. "I'm not saying he should be treated as a completely clean sheet, but he should be given deference to speak for himself now more than from his past."

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