President Trump has reportedly signed off on a plan to dismiss Food and Drug Administration Commissioner Marty Makary, according to multiple major news outlets, ending a tumultuous tenure marked by DOGE-driven staff cuts, internal personnel conflicts, and policy battles over vaccines, abortion medication, and vape regulation. The White House has not yet confirmed a replacement.
President Trump has approved a plan to fire FDA Commissioner Marty Makary, sources familiar with the matter told The Wall Street Journal, with subsequent confirmation from Bloomberg, The Washington Post, Politico, and the Financial Times. Insiders cautioned, however, that the decision is not yet final and could still change.
Makary, a surgeon and Johns Hopkins professor who was confirmed as FDA Commissioner earlier this year, was seen as broadly aligned with the Make America Healthy Again (MAHA) movement championed by Health and Human Services Secretary Robert F. Kennedy Jr. Despite that alignment, he reportedly drew the ire of key administration allies over a series of consequential regulatory decisions.
According to reporting from the New York Times, Makary made enemies within the administration through his handling of vaping regulations, oversight of the abortion pill mifepristone, and decisions to reject certain new drug applications — positions that put him at odds with both anti-abortion advocates and pro-deregulation factions inside the White House.
The FDA has been in near-constant turmoil since the start of Trump's second term. Sweeping staff reductions tied to the Department of Government Efficiency (DOGE) initiative hollowed out portions of the agency, while high-profile personnel controversies — including the brief reinstatement and subsequent departure of a divisive vaccine regulator — raised concerns among public health experts about the agency's stability and independence.
The Washington Post reported that the administration had not yet decided who would serve as acting commissioner following Makary's departure, raising further uncertainty about leadership continuity at one of the country's most consequential regulatory bodies.
Makary's expected dismissal makes him the latest senior health official to lose his position under the Trump administration, following significant leadership changes across the Department of Health and Human Services and related agencies. The Financial Times noted he is the latest in a line of top health officials to be pushed out.
The White House had not issued a formal statement on the matter as of the time of reporting, and Makary himself had not publicly commented.
Analysis
Why This Matters
- The FDA regulates roughly 20 cents of every dollar spent in the US economy, overseeing drugs, medical devices, food safety, and more — leadership instability directly affects the speed and reliability of those processes.
- Makary's removal signals ongoing internal fractures within the MAHA coalition, suggesting the administration's health policy agenda remains contested even among nominal allies.
- With no named successor, the FDA faces a period of acting leadership, which typically slows major regulatory decisions and can unsettle pharmaceutical and biotech markets.
Background
The FDA has undergone significant disruption since Trump returned to office in January 2025. DOGE-affiliated budget and staffing cuts reduced the agency's workforce, prompting warnings from former officials and public health advocates about diminished capacity to review drug applications and conduct safety oversight.
Marty Makary was confirmed as Commissioner in early 2025 after being nominated partly on the strength of his public profile as a critic of medical establishment orthodoxy and his association with MAHA movement priorities. He came in with broad expectations from deregulatory and wellness-focused factions that he would streamline approvals and reduce bureaucratic friction.
However, tensions emerged relatively quickly. Makary's decisions on vaping regulation displeased industries and advocates expecting lighter oversight, while his approach to the abortion pill mifepristone angered anti-abortion groups who had hoped for stricter controls. These competing pressures left him without a firm base of political support within the administration.
Key Perspectives
Trump Administration: Officials who spoke to media outlets described Makary's tenure as creating friction on key policy priorities, particularly around reproductive health regulation and vaping. The decision to remove him reflects a desire for tighter alignment between the FDA's actions and White House political objectives.
Public Health Community: Many public health experts and former FDA officials had already raised alarms about the agency's stability under current conditions, warning that politicised leadership transitions and staff losses compromise the scientific integrity and operational capacity of the regulator.
Critics and Skeptics: Some observers note that Makary's dismissal — if confirmed — illustrates the difficulty of satisfying ideologically diverse factions within the MAHA coalition. Critics argue that repeated leadership churn makes coherent long-term regulatory policy impossible and increases risk for patients and the pharmaceutical industry alike.
What to Watch
- Whether Trump names a permanent commissioner quickly or leaves the agency under acting leadership for an extended period, which would signal the depth of internal disagreement about the FDA's direction.
- Congressional reaction, particularly from senators on the Health, Education, Labor, and Pensions (HELP) Committee, who would need to confirm any permanent nominee.
- Market signals from pharmaceutical and biotech companies, whose drug approval timelines are directly affected by FDA leadership and staffing stability.