FDA Leadership Drama: Will Marty Makary Remain as Commissioner?

The Food and Drug Administration (FDA) was expected to be a predictable agency under President Trump’s health bureaucracy. Instead, it has become a source of constant drama, with recent reports suggesting Commissioner Marty Makary was on the verge of being fired.

Why this matters: The FDA regulates nearly one-fifth of the U.S. economy. Organizational instability, sudden policy shifts, and political interference can disrupt entire industries.

Latest developments: Late last week, Makary appeared to avoid dismissal after multiple outlets reported that President Trump had authorized his firing. However, the situation remains fluid, with no official confirmation.

Under Makary’s leadership, the FDA has faced significant controversies, including debates over abortion pills, flavored vapes, vaccine issues, and drugs for rare diseases. At the same time, he has pushed to accelerate drug approvals, streamline clinical trials, and reduce regulatory burdens—changes that will shape the agency’s future regardless of his tenure.

Key questions:

• Will Makary remain as commissioner?
• Who will replace him if he leaves?
• How will the FDA’s policies evolve under new leadership?

Trump’s response: When asked about Makary’s potential firing on Friday, Trump stated,

"I've been reading about it, but I know nothing about it."

Internal dynamics: A White House official told Politico that senior Health and Human Services leaders—not the White House—were pushing for Makary’s removal. Reports emphasized Trump’s tendency to change his mind, leaving Makary’s fate uncertain.

Makary is scheduled to testify on the FDA’s 2027 budget before the Senate Appropriations Committee on Wednesday.

Potential successors: If Makary departs, insiders expect a more conventional FDA leader. Internal candidates include:

• Kyle Diamantas, Deputy Commissioner for Food
• Former FDA Commissioner Stephen Hahn
• Brett Giroir, former acting commissioner

Industry expectations: Analysts predict the White House will nominate a commissioner who aligns with the administration’s push for a more industry-friendly FDA. Capstone analyst Will Humphrey noted,

"We expect the White House to nominate a less disruptive, pro-industry commissioner, consistent with other recent steps the administration has taken to moderate the agency."

Workforce concerns: The FDA’s ability to evaluate treatments has been weakened by high turnover. While Makary announced plans to hire 3,000 additional scientists this month, Raymond James analyst Chris Meekins reported that staffing at the agency’s biologics and drug evaluation centers has dropped by over 19% since Trump took office. Key leadership roles, including director and deputy director positions, remain vacant.

Upcoming decisions: The FDA faces critical choices on:

• Experimental treatments for cancer, ADHD, and rare diseases
• Moderna’s mRNA flu shot, which the agency initially declined to evaluate before reversing its decision

These decisions will test the FDA’s future direction under potentially new leadership.