Dr. Marty Makary, former commissioner of the Food and Drug Administration, resigned on Tuesday, making him the fifth Senate-confirmed health official to leave their position since early 2025.

Makary joins a growing list of departures that is reshaping the federal health landscape in the United States under President Donald Trump. As more confirmed officials leave these positions, Trump-appointed replacements have taken over as “acting” officials under the Federal Vacancies Reform Act. But these temporary leaders are not Senate-confirmed like their predecessors — a shift that law experts suggest could impact public health and safety jurisdiction.

“If you don’t have a Senate-confirmed candidate, you’re in considerable difficulty, because that person is subject to political interference,” Lawrence Gostin, a professor at Georgetown University Law Center who specializes in global health law, told HuffPost. “There is no congressional check on what that person does.”

The Senate appointment system aims to ensure that, while the president can appoint nominees for these high-ranking officials, the Senate has the final say in making sure these administrators operate with independent, nonpartisan leadership.

“Without the Senate hearings and confirmation in place with acting officials, it just basically gives the president and [Health and Human Services] secretary enormous authority and discretion to have politics weigh in on final decisions, rather than science,” Gostin said. “This directly affects the health of the American population.”

Confirmed officials can push back against the president’s wishes, but an acting official may not. Confirmed officials can also only be removed through a formal process, whereas acting officials can be replaced immediately, leaving them with little protection.

Acting officials also have a 210-day limit to their power — anything they try to implement after 210 days is illegitimate. If the acting official is not nominated by the president during the 210 days, they must step down. This would leave the position vacant, and the head of the department may take over the role’s essential functions, but doesn’t technically fill the seat.

“We’ve not seen [this] many vacancies at the agency head and division heads,” Gostin said. “[This] causes us a problem because these agencies don’t have the scientific staff and leadership that would lead them to make science-based, evidence-based decisions.”

Having this series — a merry-go-round of different acting directors — shows that science isn’t driving [the choices]. Politics is.

A lot of the important roles that determine American public health laws are left vacant right now — or are filled with unconfirmed acting officials.

The acting FDA commissioner and the acting FDA Center for Biologics Evaluation and Research (CBER) head — Kyle Diamantas and Katherine Szarama, respectively — did not go through Senate confirmation, nor did Rear Admiral Denise Hinton, who was the acting U.S. Surgeon General in 2025.

While Dr. Jay Bhattacharya was Senate-confirmed to serve as the National Institutes of Health (NIH) director, he is now also serving as the acting director of the Centers for Disease Control and Prevention, for which he does not have a Senate mandate. The president has since nominated Dr. Nicole Saphier for U.S. surgeon general and Dr. Erica Schwartz for director of the CDC, since neither role has permanent or confirmed leadership.

These vacancies did not materialize overnight, but instead show these science-backed officials were at odds with what the administration wanted to prioritize.

Susan Moranz, the former director of the CDC, was fired in August for not being “aligned with the president’s agenda of Making America Healthy Again.” Dr. Jeanne Marrazzo, the former National Institute of Allergy and Infectious Diseases (NIAID) director, claims she was fired by HHS Secretary Robert F. Kennedy Jr. in October 2025 after they clashed over vaccine research.

Dr. Peter Marks resigned as head of the FDA’s CBER in April 2025 after reportedly disagreeing with Kennedy over vaccine policies. Additionally, the U.S. surgeon general seat has remained empty since Dr. Vivek Murthy left the position in January 2025.

Gostin argues that the consequences of eliminating Senate-confirmed, nonpartisan health leadership are already making waves. Over the past year, medical experts across the country have expressed concern over various decisions made by federal health agencies, including changes to vaccine recommendations for children and tapping vaccine-skeptic officials to run the CDC.

Makary’s resignation was reportedly tied to rumors that Trump would fire him after the FDA delayed authorization of fruit-flavored e-cigarettes, according to the Washington Post. Trump’s alleged frustration with Makary likely stemmed from Trump’s vow to “save” vapes during his 2024 presidential campaign and his close relationships with big tobacco companies, like Altria Group and Reynolds American, which both donated to the White House ballroom.

Last week, the FDA approved four flavored vapes by the Los Angeles-based company, Gas — even though Makary told ABC News last July that cracking down on illegal e-cigarettes would be a “top priority” for the FDA. Days later, Makary stepped down.

There is also an ongoing U.S. Supreme Court case about blocking lawsuits against Roundup weedkiller because the herbicide has been linked to cancer. But after Bayer’s CEO met with White House officials last year, Trump issued an executive order in February declaring the Roundup chemical glyphosate critical to the country. Trump’s decision even sparked backlash from the Make America Healthy Again movement, seeing as even Kennedy condemned the chemical in his first MAHA report in May.

In January, Kennedy released official dietary guidance that essentially “flipped” the food pyramid, contradicting years of scientific evidence and research. While most Americans likely don’t read dietary guidelines, they do influence what is served in schools, military bases and federal food aid, and will impact U.S. healthcare.

Gostin argues this pattern may only deepen as acting officials fill most of these seats.

“Having this series — a merry-go-round of different acting directors — shows that science isn’t driving [the choices],” Gostin said. “Politics is.”

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