Trump Is Planning to Fire FDA Commissioner Marty Makary, After Just 14 Stormy Months. Here’s Why
It’s not often that the head of America’s most powerful health agency, the person who decides which drugs reach your medicine cabinet and what’s in the food you eat, gets shown the door by the President himself. But that’s exactly what’s unfolding right now.
On Friday, May 8, 2026, the Wall Street Journal dropped a bombshell: President Donald Trump has signed off on a plan to fire FDA Commissioner Marty Makary. The decision, though not yet formally executed, has been confirmed by multiple senior administration officials and marks the latest, and perhaps most consequential, high-level health-department firing in a Trump presidency that has already seen staggering turnover at federal health agencies.
So, what went wrong? The short version: Makary angered nearly everyone. The White House, the pharmaceutical industry, anti-abortion activists, rare-disease advocates, and even his own FDA staff all found reasons to turn on him, often simultaneously.
Let me walk you through the real story behind the headlines. Because this isn’t just another Washington political soap opera. It’s a leadership crisis that could directly affect the drugs you take, the vaccines you get, and the timeline for new medical breakthroughs.
The Breaking Point, What Finally Pushed Trump to Act
If you want to understand why Marty Makary is on the chopping block, you have to understand flavored vapes.
Back during the 2024 campaign, Trump repeatedly promised to "save vaping", a pledge that resonated strongly with younger MAGA voters. So when Makary, a Johns Hopkins-trained surgical oncologist with a deep public-health streak, refused to approve blueberry, mango, and menthol vape flavors earlier this year, Trump was furious.
According to the Wall Street Journal, Trump "upbraided" Makary last weekend for "not moving quickly enough to approve flavored vapes". Advisers told the President that Makary was “blocking Trump’s vaping agenda” and described the commissioner as a problem for the administration.
The pressure worked, sort of. Makary ultimately reversed course and approved the vape flavors on Tuesday, just days before news of his planned firing leaked. But by then, the damage was done. Trump had already lost confidence in his FDA chief.
As one senior White House official put it on background: “Top administration officials have become increasingly convinced Makary has to go because, in addition to months of turmoil, complaints from some in the pharmaceutical industry have continued to mount”.
The Makary Timeline, How We Got Here in Just Over a Year
Sometimes it’s hard to appreciate how fast things unraveled if you don’t see the full arc. So here’s a quick timeline, the highlights (lowlights?) reel of Makary’s brief, stormy tenure.
November 2024 – March 2025: The Promising Start
Trump nominates Makary, a well-respected pancreatic surgeon and best-selling author on healthcare reform, to run the FDA. He’s confirmed by the Senate in late March 2025 with a 56-44 vote, and MAHA (Make America Healthy Again) advocates cheer the appointment. Makary is seen as an ally of HHS Secretary Robert F. Kennedy Jr. and a true reformer.
Summer 2025: The First Cracks Appear
Trouble starts brewing. Makary’s FDA hands down unexpected rejections for Capricor Therapeutics’ Duchenne muscular dystrophy therapy and Disc Medicine’s rare-disease drug bitopertin. Pharma executives begin grumbling. Meanwhile, the departures pile up: the drug, biologics, and tobacco divisions are all run by acting directors because permanent leaders keep quitting.
Winter–Spring 2026: The Unraveling Accelerates
In February 2026, the FDA refuses to review Moderna’s mRNA-based flu vaccine, and Trump personally summons Makary to the White House to express frustration about vaccine handling. The agency reverses course a week later, but the image of a weak, politically cowed commissioner sticks. By late February, HHS Deputy Secretary Jim O’Neill is fired, joining former CDC Director Susan Monarez (who was ousted last summer) on the growing list of departed health leaders.
Then, in late April 2026, Makary’s closest deputy, Vinay Prasad, steps down as biologics chief after fierce industry and media blowback, leaving the Center for Biologics Evaluation and Research on its fifth leader in under 18 months.
By the first week of May, the knives are fully out. The Wall Street Journal reports Makary is on "thin ice." Less than four days later, Trump signs off on his ouster.
The Three Fronts That Sank Makary
Here’s where things get really interesting, and frankly, a little tragic from a pure management standpoint. Makary wasn’t sunk by one enemy. He was sunk by fighting on three different fronts, simultaneously, and losing on all of them.
Front #1: The Flavored Vape War
We covered this earlier, but it’s worth reiterating because it’s the immediate trigger.
Makary genuinely believed that approving sweet, fruity vape flavors would increase youth nicotine addiction, a concern backed by decades of public-health research. Trump’s political calculus was entirely different: he viewed vaping as a cultural wedge issue that could energize younger MAGA voters ahead of the 2026 midterms.
When the two worldviews collided, Makary lost decisively.
The irony? Makary ultimately did approve the vape flavors, but by that point, the White House had already concluded he was unreliable on a politically critical priority. Ouch.
Front #2: The Mifepristone Trap
If the vape clash was about politics, the mifepristone battle was even more treacherous, pitting Makary against the very conservative base Trump needs to win the midterms.
Anti-abortion activists, led by prominent groups like Susan B. Anthony Pro-Life America, demanded Makary be fired immediately for what they called his "indifference" toward restricting the abortion pill mifepristone. Makary’s FDA delayed a promised safety review of the drug, reportedly at his request, to push it past the 2026 midterm elections.
This angered anti-abortion Republicans in Congress and the activist base. During a critical election year, that’s political malpractice.
As one senior administration official told CNN: “Trump and other aides have increasingly discussed the prospect of removing Makary in recent weeks, including surveying outside allies about his job performance and fielding complaints… from anti-abortion groups”.
Front #3: The Drug-Approval Firestorm
Now, this front was less visible to the general public but arguably more damaging to the FDA’s core mission than either of the other two.
Under Makary, the FDA issued a string of high-profile drug rejections, including Replimune’s advanced melanoma therapy RP1, which the commissioner defended in a combative CNBC interview just days before news of his firing broke.
Makary pushed back aggressively, saying, "I don’t work for Replimune. I work for the American people". But pharma companies saw the pattern: political and personal judgment, rather than scientific consistency, seemed to be driving FDA decisions.
Things got so chaotic that Sanofi actually asked to pull its diabetes drug out of Makary’s own signature program — the Commissioner’s National Priority Voucher initiative, after a political appointee interfered with the scientific review. That’s like a student asking to withdraw from a class taught by the principal.
What This Means for Drug Approvals, FDA Morale, and the Midterms
Let’s take a breath, because the implications here are genuinely significant, not just for D.C. insiders, but for anyone who takes medication or counts on the FDA to keep the food supply safe.
Drug approvals will likely slow, or become more political. When agency leadership is in turmoil, career scientists become cautious. Nobody wants to make a decision that could get the next commissioner (or the White House) angry. Expect longer review timelines for novel therapies, particularly in controversial areas like vaccines, rare diseases, and reproductive health.
FDA morale is at rock bottom. One anonymous FDA staffer told Politico bluntly: “He [Makary] will not be missed by a single career person. And we will only regret it when they manage to find someone worse”. That’s the sound of an agency that’s been through the wringer, and is bracing for more.
The 2026 midterms just got a new campaign issue. With the CDC lacking a permanent director, the surgeon general position vacant, and now the FDA commissioner’s office in limbo, Democrats will argue that the Trump administration has hollowed out America’s public-health leadership. Given that health care consistently ranks as a top voter concern, this could be a potent attack line.
What Happens Next, Possible Successors and the Road Ahead
Trump’s plan “isn’t yet final and could change”, that’s the standard caveat from officials. But reading the tea leaves, it’s hard to see a path back for Makary.
Possible successors are already being whispered about: senior FDA career officials like Kyle Diamantas (deputy commissioner for human foods) or Grace Graham (deputy commissioner for policy) could step into acting roles, given their recent elevations by HHS Secretary RFK Jr..
Whoever takes the job inherits an agency with more acting director roles than permanent ones, a demoralized workforce, and a President who has shown he’s willing to directly pressure the FDA on politically sensitive decisions.
That’s a tough gig, even for a seasoned operator.
Why This Matters Beyond the Headlines
Here’s what I keep coming back to: the FDA commissioner isn’t supposed to be a political football. The agency’s credibility, its ability to make decisions based on science, not electoral math, depends on the perception (and reality) of independence.
When a President fires an FDA commissioner after publicly second-guessing vaccine decisions, vape authorizations, and drug approvals, it sends a signal to every career scientist at the agency: Your scientific judgment matters less than political loyalty.
Whether you support Trump or not, that’s a dynamic worth paying attention to. Because sooner or later, the decisions that flow from that culture will affect the drugs you take, the vaccines you receive, and the food on your dinner table.