Around DC, there are a lot of smart people talking about the race to fill the job of FDA Commissioner. To me, it’s more of a slog than a race; certainly, more of a marathon than a sprint. It’s highly unlikely that anyone will be nominated soon, and no one will be confirmed quickly.
In my column on May 15, 2026, column (here), I observed that:
Dr. Makary’s departure doesn’t change the fundamental difficulties of being FDA Commissioner under President Trump and HHS Secretary Kennedy. His departure gives the appearance of change, but leaves untouched the fundamental tension between FDA’s statutory, functional, and moral responsibilities and the goals, governing style, legacy, and electoral strategy of this Administration.
That column focused on Kyle Diamantas, the Deputy Commissioner for Human Foods, and why he is: 1/ a good choice for Acting Commissioner, and 2/ likely to be in the job for a significant amount of time.
This column will examine the multi-stage process for identifying, nominating, and confirming a new permanent Commissioner. It is never an easy process, and the current dynamics make it especially complex and time-consuming.
A future column will address the many difficulties in identifying the next commissioner, one who is professionally qualified, experienced in public leadership and management, widely recognized for their scientific achievements, an accomplished change agent, and committed to a strong FDA.
More so than under previous Administrations, that person would also need the capacity to implement policies and decisions on which they were not consulted and with which they do not agree. Under such uncomfortable circumstances, Dr. Susan Monarez lasted a month as Director of CDC and Dr. Richard Pazdur lasted a month as Director of the CDER.
Timeframes. Even if the Administration has an immediate successor in mind, the pre-nomination process (financial and security clearances and myriad paperwork) usually takes at least a month. The paperwork and staff review on Senate HELP Committee is usually a month, as well. My understanding is that there are limited opportunities to save time by overlapping the two intervals.
Of the 24 weeks between now and the Monday after Election Day, the Senate is likely to work only 11 weeks, mostly in June and July (i.e., frontloaded). The non-work period consumes most of August, early September, and likely all of October (i.e., backloaded).
In addition, there is no guarantee of a post-election session. Often, those sessions are limited to items that both parties agree on. If not completed this year, the President will need to submit or resubmit the nomination in January 2027, after the new Congress is sworn in.
While theoretically possible, it is hard to envision that a new FDA Commissioner will be sworn in before December 2026. Realistically, February through May of 2027 is far more likely.
The Senate Gauntlet. Given the current divisive environment regarding public health, it’s hard to see how any candidate for FDA commissioner will have a quick or easy path to confirmation. None of the recent nominees for HHS posts has had broad bipartisan support.
The alternative, a party-line vote, is impossible to imagine. Out of 53 Republican Senators, there are at least seven (McConnell, Tillis, Ernst, Cassidy, Cornyn, Collins, and Murkowski) who might not be responsive to a party-directed vote. I am not saying any of these seven Senators would be an automatic no; just that these Senators cannot be counted upon as an automatic yes in a party-line vote for an FDA Commissioner.
Any supposedly bipartisan nominee will find it hard to remain so in the face of inherently partisan and divisive questions. Imagine responses such as “FDA [will/will not] work to keep ‘forever chemicals’ out of the food supply even if EPA standards are loosened or withdrawn,”
This is just one example of current FDA issues on which bipartisan support is unlikely.
Republican Midterm Election Strategy. I don’t doubt that sincere efforts are underway in the Administration to identify the next FDA Commissioner as soon as possible. At the same time, there must be individuals in the Administration who recognize that there is little to gain — and much to lose — for Republicans if a confirmation hearing is held for a new Commissioner before the midterms.
They would not want the Senate HELP Committee publicly discussing glyphosate pesticides while the party is trying to draw electoral support from both MAHA mothers and agricultural interests, groups that are diametrically opposed on the topic.
A veritable case study of such trade-offs is laid out in a recent NYT analysis of the Louisiana court suit seeking to restrict access to the abortifacient mifepristone (here). As described, the Administration is trying to keep pro-life voters happy while trying to avoid a hot-button issue that would likely increase voter turnout among Democrats and Independents. Given these circumstances, the Administration is unlikely to want a fiery public discussion of this issue during a confirmation hearing.
In sum, a permanent commissioner is unlikely to be confirmed for months. In the meantime, Kyle Diamantas, is an ideal candidate to keep the agency afloat.
By dint of his training, demeanor, and “acting” status, he can avoid the limelight. And in the short term, he can avoid some of the difficult issues on which a permanent commissioner would need to take a stance.
