US Centers for Disease Control and Prevention (CDC) director Brenda Fitzgerald, MD, has resigned in the wake of revelations that she invested in several food, drug, and tobacco companies after she began her tenure at the health agency.

The investments were not illegal, but government ethics rules require federal employees to find ways to minimize conflicts of interest, either through seeking a waiver, putting the holdings in a blind trust, selling off the holdings, or recusing themselves from matters that could have an impact on the holdings.

Brenda Fitzgerald, Georgia Department of Public Health commissioner, speaks during a news conference, Monday, Oct. 20, 2014. Branden Camp/AP

Generally, federal agency nominees choose to divest, but the specifics are usually worked out between the appointee and the ethics office at the specific agency. Dr Fitzgerald, 71, had begun — but had not finished — divesting when she was named to head the CDC in July 2017. The months-long process attracted scrutiny from some members of Congress in late 2017. But a new report by the news organization Politico shows that she also made new stock purchases after she took office.

"It takes a certain kind of cluelessness for a director of the Centers for Disease Control and Prevention to purchase stock in a tobacco company a month after assuming the job as the nation's top public health official," said Peter G. Lurie, MD, president of the Center for Science in the Public Interest, in a statement.

Dr Fitzgerald was slow to sell off her holdings in the lead-up to her appointment and after, he said. "Inexplicably, she decided to make matters even worse — at a time when her existing holdings were already drawing scrutiny," Dr Lurie continued.

"There is an untenable conflict between seeking to personally profit from tobacco use and being a credible voice on tobacco and other public health issues," said Vince Willmore, vice president of communications for the Campaign for Tobacco-Free Kids in a statement to Medscape Medical News. "We are pleased that HHS Secretary Azar has accepted Dr Fitzgerald's resignation and urge him to appoint a strong leader who is committed to reducing tobacco use," he said.

According to Politico, Dr Fitzgerald owned stock in five tobacco companies at the time she was appointed: Reynolds American, British American Tobacco, Imperial Brands, Philip Morris International, and Altria Group Inc.

Then, according to documents obtained by Politico, Dr Fitzgerald made at least a dozen new investments in tobacco, drug, and food companies — including Merck & Co, Bayer, Humana, and US Food Holding Co — after she began her leadership at the agency. She also purchased shares in Japan Tobacco a day after touring the CDC's Tobacco Laboratory, which is charged with researching potential health harms of tobacco. Politico obtained Dr Fitzgerald's calendar and stock purchase information through a Freedom of Information Act request.

Dr Fitzgerald had sold all of her potentially troublesome investments by November 2017, Politico reported. But during the fall, she had to recuse herself from testifying at several congressional hearings because she had not fully divested. In December 2017, Sen. Patty Murray (D-WA) wrote to Dr Fitzgerald asking her to resolve all of her conflict of interest problems.

In a tweet after Dr Fitzgerald's resignation, Murray said, "I repeatedly raised concerns about Fitzgerald's conflicts of interest and broad recusals from work impacting public health issues like cancer and opioids — this is yet another example of this administration's dysfunction and questionable ethics."

The CDC chief stepped down within 10 hours of the Politico report, via an announcement from a spokesman for Alex Azar, who was just recently sworn in as the new head of the Department of Health and Human Services (HHS).

"Dr Fitzgerald owns certain complex financial interests that have imposed a broad recusal limiting her ability to complete all of her duties as the CDC director," the statement said. "Due to the nature of these financial interests, Dr Fitzgerald could not divest from them in a definitive time period," it continued, adding that she had tendered her resignation after discussing the conflicts with Azar.

Had Support of Medical Community

At the time of her appointment, Dr Fitzgerald was viewed as someone who could work closely with then-HHS Secretary Tom Price, MD. Both had Georgia political ties. Dr Price, an orthopedic surgeon and former Republican member of the House of Representatives from Georgia, was scrutinized about his stock holdings and potential conflicts of interest from the moment of his nomination.

The Senate narrowly confirmed Dr Price. He resigned in September 2017 after it was revealed — again, by Politico — that he had made a number of trips on private and charter flights at taxpayer expense.

Unlike Dr Price, who had received tepid support from the medical community, Dr Fitzgerald was seen as a good fit at the CDC.

She was Georgia's public health commissioner from 2011 until her appointment. She was known for an initiative to encourage language development in babies and for efforts to improve childhood immunization rates, to reduce childhood obesity, and, ironically, to encourage smoking cessation.

At the time of her appointment, she was the president-elect of the Association of State and Territorial Health Officials (ASTHO). ASTHO's executive director, Michael Fraser, PhD, praised Dr Fitzgerald when she took office. She resigned her position on the ASTHO board after joining CDC, but it was still important to have someone who'd worked as a state official at the CDC, Dr Fraser told Medscape. He called Dr Fitzgerald's resignation "disappointing," adding, "I hope they get a new director who understands states like she does."

Georges Benjamin, MD, executive director of the American Public Health Association, praised Dr Fitzgerald's appointment in 2017, telling Medscape that she "will be good for the CDC." After her resignation, Dr Benjamin wished Dr Fitzgerald "the best of luck" as she exited.

"We hope that whoever is chosen to lead CDC next will continue to actively support the agency's dedication to science-based decision making and demonstrate unwavering commitment to strengthening public health," he told Medscape today.

"We're in a time of uncertainty, as life expectancy has declined the past 2 years and budgets have been cut," he said. "Public health needs new investment and consistent leadership as we work to build the healthiest nation possible," said Dr Benjamin.

Politico reported that Anne Schuchat, MD, will serve as acting CDC director until a new appointee is named. Dr Schuchat is the CDC's principal deputy director and served as acting director before Dr Fitzgerald's appointment.