Dr. Ralph Lee Abraham, the Louisiana surgeon general who halted his state’s vaccination campaigns and delayed warning the public about a deadly whooping cough outbreak, has been quietly installed as the second-highest official at the Centers for Disease Control and Prevention. The Department of Health and Human Services has not announced this appointment. The news was first spotted by Dr. Jeremy Faust, who runs the Substack called Inside Medicine.
Abraham, a 70-year-old former Republican congressman who served three terms representing Louisiana’s 5th congressional district, began his new role as principal deputy director on Nov. 23, according to the agency’s internal database. Since then HHS has confirmed Abraham’s appointment.
The choice aligns senior CDC leadership with the views of Health Secretary Robert F. Kennedy Jr., a vaccine skeptic. Abraham promoted discredited COVID-19 treatments including ivermectin and hydroxychloroquine, and, according to Faust, Abraham was the seventh highest prescriber of ivermectin among Louisiana’s 12,000 practicing physicians in 2021, personally accounting for 1.1% of the state’s antiparasitic medicine. Clinical studies had already shown the ineffectiveness of ivermectin against COVID-19 by that time.
In September, Abraham told the Shreveport Times believes the COVID vaccine is “dangerous” and does not recommend it to his own patients. At a state legislative meeting last September, he claimed: “I see, now, vaccine injury every day of my practice” from COVID vaccines, although he did not specify the nature of these injuries. The claim contradicts extensive research showing that COVID vaccines significantly reduce hospitalizations and deaths
Abraham’s record as Louisiana’s top health official has drawn sharp criticism. In February, he ordered the Louisiana Department of Health to stop promoting mass vaccination—a decision announced the same day Kennedy was confirmed as HHS secretary. Under his leadership, the state health department delayed for months before warning doctors and the public about a whooping cough outbreak that killed two infants, the state’s first pertussis-related deaths since 2018.
Dr. Georges Benjamin, executive director of the American Public Health Association, said the delayed response was atypical. “Particularly for these childhood diseases, we usually skip all over them,” Benjamin told NPR. “These are preventable diseases and preventable deaths.”
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Dr. Nirav Shah, who served as CDC’s principal deputy director for two years before resigning earlier this year, told the New York Times that Abraham is “unqualified” for the position. “My jaw hit the floor” upon hearing the appointment, Shah said, adding that a significant aspect of the role involves emergency response. He described the delayed notification of pertussis deaths as “not only unacceptable, it’s shameful.”
As a member of Congress, Abraham has consistently advocated for repeal of the Affordable Care Act. “You should come to my practice in Mangham on a daily basis and I can show you the debacle of the ObamaCare law, if we can even call it that,” he said during a congressional debate in 2014. “As a practicing doctor, right now, it’s not working and it’s even dangerous.”
Notably, as NBC News points out, there is no evidence that Abraham is board certified in family medicine, even though he is described as a “family medicine physician” on official Louisiana state websites. The online database of the American Board of Family Medicine does not list him as board certified, and the Louisiana State Board of Medical Examiners identifies him only as a general practitioner. Abraham practiced veterinary medicine for ten years before earning his medical degree from the LSU School of Medicine in 1994.
The appointment has structural significance for the administration’s health agenda. The CDC does not currently have a permanent director; Acting director Jim O’Neill, a former biotech executive with no medical credentials, was installed in August after Kennedy fired his predecessor. Under the Federal Vacancies Reform Act, acting directors can serve only 210 days—a clock that runs out at the end of March unless a permanent nominee is named. As principal deputy director, however, Abraham could serve indefinitely without Senate confirmation, potentially giving Kennedy and the White House sustained influence over the agency’s vaccine policies.
Senator Bill Cassidy of Louisiana, the Republican chairman of the Senate Health Committee and a physician, publicly clashed with Abraham on vaccination policy. In February, Cassidy criticized Abraham’s decision to halt mass vaccination campaigns, saying, “Taking these resources away from parents is not a position for parents’ rights. It’s making health care less convenient and available for Louisianans who are very busy.”
For this story, Fortune use generative AI to help with the initial draft. Editor verified the accuracy of the information before publication.
This story originally appeared on Fortune.com