# OPEN LETTER: To the Senate committee keeping American health waiting > Introduction: a letter addressed to those holding the keys - Author: Maxime Marquette - Publisher: MadMax (https://mad-max.co) - Section: Open letter - Published: 2026-07-03 - Canonical URL: https://mad-max.co/en/article/lettre-ouverte-lettre-ouverte-a-la-commission-senatoriale-qui-fait-attendre-la-sante-americaine ## Introduction: a letter addressed to those holding the keys ### Why this letter is necessary now Senator **Bill Cassidy**, ladies and gentlemen of the **Senate Health, Education, Labor and Pensions Committee**, I am writing this open letter because a concrete problem persists in front of you: according to **Axios**, a series of **Donald Trump** **nominations** to some of the country's most critical health posts are still waiting for their **confirmation** **hearings**. This is not a minor bureaucratic detail. It is the absence of full-time political leadership at the **Centers for Disease Control and Prevention** and the **Food and Drug Administration**, two agencies that directly protect the health of **340 million Americans**. ### What this letter seeks to accomplish I don't claim to know every political calculation behind these delays. But as a columnist, I can restate the facts as reported, and pose a simple question: how much longer will American **public health** have to wait for its own leadership? ## The leadership vacuum you must fill ### Agencies without political direction for months **Senator** **Cassidy**, you know better than anyone: there is currently no full-time political leader at either the **CDC** or the **FDA**, according to **Axios**. The **Surgeon General** post, the federal government's most visible medical voice, also remains vacant. This situation comes after the massive budget cuts imposed last year by the **Department of Government Efficiency**, a context that makes the swift **nomination** of leaders capable of stabilizing already-weakened agencies all the more urgent. ### An administration trying to make up for lost time I recognize that **Trump** has recently made his picks for several key posts: assistant secretary for health, assistant secretaries for planning, and assistant secretaries for preparedness, according to **Axios**. That is a step in the right direction, but a late one. This accumulated delay, on posts so essential to national **health security**, can no longer be treated as a mere scheduling matter when the country needs stable leadership in its **public health** agencies. ## You, Senator Cassidy, at the center of this equation ### A gatekeeper whose authority is beyond question It is you, Senator **Cassidy**, who will chair most of these **nominations**, according to **Axios**. Your position as chair of the **Senate Health Committee** makes you the chief gatekeeper of this process, a role whose importance far exceeds the recent personal quarrels with the **White House**. I know your relationship with **Trump** has seen sharp tension: according to **Axios**, you had a tense verbal exchange with the president during a closed-door meeting on the war in **Iran** last week, and you have also clashed with Health Secretary **Robert F. Kennedy** Jr. over **vaccine** policy. ### An electoral defeat that has not weakened your institutional role I also note, with all the transparency I owe my readers, that you lost your primary in May to a **Trump**-backed candidate, according to **Axios**. Despite that, you do not seem determined to derail the current **nominations**, which deserves to be publicly acknowledged. Your statement to **CBS**, where you called the lack of stability a "problem," sums up on its own the stakes of this letter: the institutional stability of American **public health** cannot indefinitely depend on personal quarrels between a senator and a president. ## Erica Schwartz, the candidate who could stabilize the CDC ### A reassuring profile after months of turbulence **Senator** **Cassidy**, you yourself said you were "very favorably impressed" after meeting **Erica Schwartz**, the nominee to lead the **CDC**, according to **Axios**. This former deputy surgeon general and retired U.S. Coast Guard officer represents, according to several analyses, a far more consensus-driven choice than her predecessors. According to **CNN**, **Schwartz**'s **nomination** was announced shortly after **Kennedy** himself made more vaccine-friendly remarks during a **Congress**ional hearing, a context that could ease her **confirmation** hearing before senators worried about current **vaccine** policy. ### The Weldon and Monarez precedent still weighing on this file Allow me to remind you, Senator, that **Schwartz** is not the administration's first attempt to fill this post. **David Weldon** had his **nomination** withdrawn in 2025 for lack of sufficient votes, while **Susan Monarez**, later confirmed by a strictly partisan vote of **51 to 47**, left office after a tenure marked by internal tensions. This chaotic history explains why your public satisfaction after meeting **Schwartz** represents an important signal for the entire file: after two failed or turbulent attempts, the country needs a **nomination** that finally results in stable, lasting leadership. ## Nicole Saphier, a choice far from the Casey Means controversies ### A radiologist rather than a controversial MAHA movement figure The **nomination** of **Nicole Saphier** as **Surgeon General**, a radiologist at **Memorial Sloan Kettering Cancer Center**, marks a striking contrast with that of **Casey Means**, whose bumpy path you know well, Senator **Cassidy**. **Means**, an ally of Secretary **Kennedy**, had refused, under your direct questioning during her February hearing, to explicitly encourage vaccination, according to several sources including **ABC News** and **Axios**. That evasive answer immediately raised doubts about her ability to secure the votes needed for her **confirmation**. ### A withdrawn nomination that soured your relations with Trump **Trump** ultimately withdrew **Means**'s **nomination** in late April, publicly accusing you, according to **Axios**, of "intransigence and political games." This direct presidential accusation illustrates just how much this health **nominations** file has become a source of personal friction between you and the **White House**. I note, with a degree of cautious optimism, that despite this difficult episode, you now seem willing to move quickly on **Saphier**'s **nomination**, a far less controversial choice that could finally fill a post that has been vacant for too long. ## Sean Kaufman and Chris Klomp, the less publicized files ### Emergency health preparedness that can no longer wait Beyond the most visible posts, Senator **Cassidy**, your committee will also have to examine the **nomination** of **Sean Kaufman** as assistant secretary for preparedness and response, a crucial role for the country's ability to respond quickly to any future health crisis. According to **Axios**, your spokesperson **Stephen Lewerenz** confirmed that your committee plans to hold **hearings** in **July** for **Schwartz**, **Saphier**, and **Kaufman**, adding that "the committee will do its job to confirm qualified nominees and serve the American people." ### A separate vote for the assistant secretary for health **Chris Klomp**'s **nomination** as assistant secretary for health follows a different path, needing a vote from the **Senate Finance Committee** rather than your own committee, according to **Axios**, which illustrates the procedural complexity of a nomination process split across several committees. This fragmentation of the **confirmation** process across several Senate committees, however procedurally normal, complicates the overall coordination needed to quickly rebuild a coherent and functional federal health team. ## The weight of moderate senators on the final outcome ### Murkowski and Collins, the votes Casey Means lacked **Senator** **Cassidy**, you know the outcome of these **confirmations** doesn't rest on your committee alone. According to **The Hill**, Senators **Lisa Murkowski** of Alaska and **Susan Collins** of Maine had expressed reservations about **Means**'s candidacy, reservations that ultimately weighed heavily in her final withdrawal. This arithmetic reality is a reminder that the administration can no longer afford to put forward controversial candidates who risk losing the support of moderate Republican senators, in a **Senate** where every vote matters given the narrow majority. ### A change in strategy that appears to be paying off According to **David Mansdoerfer**, a former Health Department official under **Trump**'s first term, the administration seems to have learned this lesson: "I think they're finding candidates who fit this particular obstacle course," he told **Axios**, a direct reference to your committee's rigor. This change in strategy, if it holds true during the **July** **hearings**, could finally break the impasse that has characterized this administration's health **nominations** since the start of its second term. ## The FDA, the great absentee of this letter ### A commissioner post still without an announced candidate Senator **Cassidy**, I must highlight a persistent blind spot in this file: according to **Axios**, there is to date no announced candidate for the commissioner post at the **Food and Drug Administration**, the agency responsible for drug and food safety for the entire country. This vacancy, even longer than that at the **CDC**, leaves the agency without clear political direction at a time when, according to **Axios**, it is already shifting its approach to rare disease drugs toward a stance more favorable to the pharmaceutical industry. ### An administrative silence that is worrying This prolonged silence over the **FDA**'s leadership deserves, in my view, at least as much attention as that given to the **CDC** and **Surgeon General** **nominations**, given how directly this agency's decisions affect the everyday safety of millions of American consumers. I encourage you, Senator **Cassidy**, to publicly question the administration on its intentions for this crucial post, rather than let this file quietly slide to the bottom of the summer's legislative priorities. ## What this impasse reveals about American health governance ### A symptom of an administration still rebuilding This buildup of vacant posts, more than a year into **Trump**'s second term, reveals a broader symptom: this administration's persistent difficulty rebuilding a coherent **public health** team after the internal upheaval of its first year, notably the budget cuts from the **Department of Government Efficiency**. This phenomenon is not limited to health agencies alone, but it carries particular resonance there, given how much public trust in federal health institutions directly depends on the stability and credibility of their appointed leaders. ### A question of credibility for the entire West A country that aspires to remain the center of gravity of the free world against authoritarian regimes cannot afford to let its **public health** agencies operate without stable political direction for months, a vacuum that weakens the international credibility of its own public health system. I firmly believe that the speed and composure with which these **nominations** are ultimately handled will send an important signal about the administration's ability to govern effectively, well beyond the **public health** sector alone. ## A direct call to action for July ### What I concretely expect from your committee **Senator** **Cassidy**, through this open letter, I ask you to honor the commitment made by your spokesperson to hold these **hearings** in **July**, with no further delay that would prolong this leadership vacuum already harmful to American **public health**. I also ask you to keep exercising your gatekeeping role with the same rigor you demonstrated on the **Means** file, while speeding up, as much as possible, the process for candidates as consensus-driven as **Schwartz** and **Saphier** appear to be. ### A responsibility that transcends partisan divides This responsibility, Senator, far exceeds the personal tensions you may have had with the **White House** or Secretary **Kennedy**. It concerns directly the federal government's ability to protect the health of all Americans, regardless of their political affiliation. I will keep watching, in the weeks ahead, how your committee honors this commitment to **hearings** in **July**, convinced that the speed of this institutional response will be a revealing test for the entire American **public health** system. ## What the chaotic path of these nominations reveals ### A year of false starts that has come at a cost Reviewing this entire file, Senator **Cassidy**, it becomes clear that this year of false starts, between **Weldon**'s withdrawal, **Monarez**'s turbulent tenure, and the failure of **Means**'s nomination, has cost the institutional credibility of America's federal health agencies dearly. Every additional month without stable leadership at the **CDC** and **FDA** represents a growing risk to the country's ability to respond quickly to any new health crisis, whether an epidemic, a food safety alert, or a drug safety issue. ### A chance to finally turn the page The **nominations** of **Schwartz** and **Saphier** represent, in my view, a real opportunity to finally turn the page on this particularly chaotic year for American **public health** governance, provided your committee acts with the diligence promised for **July**. I will keep documenting this file with the same rigor, ready to publicly acknowledge any concrete progress, just as I will not hesitate to flag any new delay that would needlessly prolong this institutional vacuum harmful to all Americans. ## Congress facing its own responsibilities ### An oversight role the Senate cannot ignore **Senator** **Cassidy**, beyond your own committee, it is the entire Senate that bears a constitutional responsibility in this file: to diligently confirm competent leaders for agencies on which the **health security** of **340 million Americans** directly depends. This oversight responsibility, laid out by the American Constitution itself, should never be subordinated to short-term electoral calculations or personal tensions between a senator and an administration, however sharp they may be. ### A precedent that goes beyond the Trump administration alone I note, with all the objectivity I owe my readers, that confirmation delays for health posts are not unique to this administration: several previous administrations, Democratic and Republican alike, have faced similar delays for strategic posts. But the current scale of this vacuum, combined with the internal upheaval caused by the **Department of Government Efficiency** cuts, makes this situation particularly worrying for the entire country's institutional credibility. ## What the international example teaches us ### Western allies who don't have the luxury of waiting **Senator** **Cassidy**, allow me a comparison I find useful: several Western allies of the United States, faced with similar health crises in recent years, have managed to quickly appoint competent leaders atop their **public health** agencies, without leaving these posts vacant for months. This ability to act quickly, amid growing geopolitical competition with authoritarian regimes like China and Russia, represents a strategic advantage the United States should not sacrifice on the altar of internal quarrels. ### A credibility also built in institutional details I repeat, Senator: a country's ability to effectively govern its own health institutions sends a direct signal to both allies and adversaries about its internal solidity and its ability to face future crises. A West that aspires to remain the center of gravity of the free world cannot afford to multiply institutional vacuums, however technical they may appear at first glance, at such a tense geopolitical moment. ## Robert F. Kennedy Jr.'s role in this equation ### A secretary whose positions complicate the process Senator Cassidy, I cannot close this letter without directly addressing the role of Health Secretary **Robert F. Kennedy Jr.**, whose positions on vaccine policy continue, according to Axios, to complicate reaching consensus around several of these nominations. Your repeated friction with him, publicly documented, illustrates a broader tension within the administration itself between advocates of a more orthodox public health line and those defending the more controversial positions of the MAHA movement. ### A recent shift that deserves acknowledgment I note, however, with the nuance I owe my readers, that Kennedy recently made more vaccine-friendly remarks during a Congressional hearing, according to several journalistic sources, a gesture that could ease the confirmation of candidates like Schwartz. If this shift holds in the secretary's future positions, it could help unblock a nomination process that, until now, has too often run into internal tensions between your committee and the Health Department. ## Conclusion: the ball is in your court, Senator ### What history will remember about this moment Senator Cassidy, history will likely remember this pivotal moment in the summer of 2026 as the one where your committee had the chance to end, once and for all, the chronic instability that has marked this administration's health nominations since it took office. You hold, in your hands, the concrete power to turn promises of hearings into actual confirmations, restoring to the CDC, the FDA, and the Surgeon General post the stability of leadership they have desperately needed for far too long. ### A final word for the Americans who are waiting For the millions of Americans who depend daily on these agencies for their health security, this open letter is meant as a simple but essential reminder: political gamesmanship should never take precedence over the fundamental need for competent leaders at the head of the institutions that protect their health. I wish you, Senator Cassidy, the clarity and determination needed to see these confirmations through as quickly as possible, for the benefit of all Americans who do not have the luxury of waiting indefinitely for Washington to settle its internal quarrels. **By Maxime Marquette, columnist** ## Columnist's transparency note ### Editorial stance I am not a journalist but a **columnist and analyst**. My expertise lies in observing and analysing the geopolitical, economic and strategic dynamics that shape our world. My work is to take political strategies apart, to understand global economic movements, to put the decisions of international actors in context and to offer analytical perspectives on the changes that are redefining our societies. I do not claim the cold objectivity of traditional journalism, which stops at reporting facts. **I claim analytical clarity**, rigorous interpretation and a deep understanding of the complex issues that concern us all. My role is to give meaning to the facts, to place them in their historical and strategic context, and to offer a critical reading of events. ### Method and sources This text keeps the basic distinction between **verified facts and interpretive analysis**. The rule never changes: a factual claim is published only when a verifiable source supports it, and the sources this article actually used are listed under **Sources**, never here. **Primary source families** used by the publication, when the story has them: official statements from governments and international institutions, public statements by political leaders, reports from intergovernmental organisations, dispatches from recognised international news agencies. **Secondary source families**: specialised publications, internationally recognised news media, analyses from established research institutions, reports from industry organisations. When an article cites statistical, economic or geopolitical data, it comes from the institutions that produce it (intergovernmental organisations, central banks, national statistics offices), and the exact institution is named under **Sources**. ### Nature of the analysis The analyses, interpretations and perspectives in the analytical sections of this article are a **critical, contextual synthesis** based on the information available, the trends observed and the expert comments cited in the sources consulted. My role is to interpret these facts, to set them in the context of today's geopolitical and economic dynamics, and to give them a coherent meaning within the larger story of the changes shaping our time. These analyses reflect expertise built through continuous observation of international affairs and an understanding of the strategic mechanisms that drive global actors. This article describes a documented state of affairs on its publication date, not a prediction: later developments may shift its outlook. No update is promised in advance; when an article is corrected or completed, the change is dated in the text. ## Sources ### Primary sources - [These Trump health nominees are awaiting Senate hearings — Axios, June 30, 2026](https://www.axios.com/2026/06/30/trump-senate-hearing-cdc-fda-cassidy) ### Secondary sources - [Retired Coast Guard officer with decades of public health experience is Trump's pick to lead CDC — CNN, April 16, 2026](https://www.cnn.com/2026/04/16/health/erica-schwartz-cdc-director) - [Casey Means's brother says 'conversations happening' in surgeon general confirmation fight — The Hill, April 9, 2026](https://thehill.com/policy/healthcare/5825058-senate-confirmation-casey-means-update/) - Senate confirms Trump nominee Susan Monarez as CDC director — AOL/AP, July 30, 2025 - [Takeaways from hearing to confirm surgeon general nominee Casey Means — BBC News, February 25, 2026](https://www.bbc.com/news/articles/c9q5y2yqw2zo) - [Inside the White House decision to nominate Erica Schwartz as CDC director — CNN, April 17, 2026](https://www.cnn.com/2026/04/17/politics/inside-trump-erica-schwartz-cdc-nomination-decision) --- Source: Maxime Marquette, MadMax. When citing, name the author and link https://mad-max.co/en/article/lettre-ouverte-lettre-ouverte-a-la-commission-senatoriale-qui-fait-attendre-la-sante-americaine