"The CDC is over." My Loooong Chat With Queer Public Health Leather Daddy Dr. Demetre Daskalakis, Transitioning from the CDC Back to NYC.
The LGBTQ health expert, he of the shirtless selfies, was among a cadre of top CDC officials to walk out in protest of the madness under RFK Jr. Soon he'll be back in NYC—as top doc at Callen-Lorde.
Hi Caftaners! Hope you’re all well as we come up on the holiday season. (Hanukah starts Monday!) As I’ve said before, please pardon the lowered frequency on my Caftan interviews recently. I had to do major revisions on my novel Cat Burglars of Paris coming out in 2027 (so far away…will books even be legal by then?) on top of having a more or less full-time editing gig these days. I was posting about one interview a week before all that, so now I’ve been aiming for two a month.
And here’s my latest, which is wonkier than the hot lead photo would suggest. Have you heard of Dr. Demetre Daskalakis, 52? For years, the Greek-American muscle daddy was an LGBTQ health powerhouse in NYC, first at Mt. Sinai then heading up the HIV response for the NYC health department, where—through a series of unapologetically queer initiatives, especially around U=U (Undetectable = Untransmittable for people living with HIV) and PrEP—he brought new HIV cases in the city to record lows.
Then, as a reminder of how relatively normal the Trump 1. 0 administration was compared to 2.0, he was brought to CDC toward the end of that administration to do the same work—and no, he says, nobody asked him to tone down his spicy Instagram.
He was kept on through Biden, redeployed to work on vaccines during Covid and beyond. But then along came Trump 2.0 and non-doctor nutcase RFK Jr.—with, among other quackery, his passionate belief that vaccines cause autism (which real science has amply discredited)—as the head of the nation’s health response. Late last summer, after CDC head Dr. Susan Monarez was ousted when she refused to co-sign RFK Jr.’s non-science-backed agenda, Daskalakis was one of four top CDCers to quit simultaneously in protest.
What would Daskalakis do next? Would he come back to NYC, where he is beloved by the queer community? Guess what? Yep! Early this month, Callen-Lorde, NYC’s top LGBTQ-serving health center, announced that, starting in February, Dr. Demetre would be joining them as their chief medical officer (CMO).
Dr. D will have his work cut out for him. As a federally qualified health center (FQHC), Callen-Lorde gets lots of federal money. As some of you may know, Callen-Lorde’s venerable Boston counterpart, Fenway Health, which also receives federal funding, got major backlash from the Boston-area queer community in October when it announced that, in compliance with the trans-hating Trump 2.0 administration, it would no longer offer puberty blockers or hormones (in other words, gender-affirming care) for patients under age 19. (I asked Daskalakis if Callen-Lorde did this, to which he replied—disingenuously but savvily, in my opinion— that he didn’t know because he didn’t work there yet. Callen-Lorde has a teen health program but, currently at least, its web page doesn’t explicitly say that it offers gender-affirming medical treatments other than therapy…in fact, it doesn’t use the word “gender-affirming” at all.)
This Caftan interview is more current-events-oriented and less personal than usual. It’s largely about what’s happened to public health, including LGBTQ public health, under Trump 2.0, and what Dr. D thinks has to happen next. I loved talking to Dr. D, who was in Palm Springs for an immunization conference when we spoke, looking out on a pool from his hotel room.
He’s a spaz in the best sense of the word. He kept saying he was exhausted from doing interviews and had to go soon, but every time I asked him a new question, he was off and running, blending expertise with his signature intensity. He’s, in my opinion, someone very good at speaking with rat-a-tat-tat salty candor but also smart enough to know—per the example above—when to keep his mouth shut. I think he’s truly passionate about keeping queer people healthy, perhaps as only someone who really lives a queer life could be. When he and his husband, artist and yoga instructor Michael Macneal, lived in NYC, they were often seen shirtless and in harnesses (and in ample tattoos) out dancing in the city or Fire Island—and I hope to see them out again soon, as they settle back into a NYC life. (News flash: They weren’t crazy about Atlanta.) I’m grateful to Dr. D for the 90 minutes he gave me for this chat.
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This was one of the darkest years I’ve ever experienced. I spent the first half of it in a deep (albeit functional) depression because I (still) cannot believe the gleeful cruelty that is playing out in this country under Trump 2.0. (If your stomach turns at what ICE is doing to people and families in this country, as mine does, can I ask: Have you looked into efforts in your city to nonviolently resist ICE? Believe me, they are out there.)
I feel there are signs that more and more Americans are realizing that this administration could give two shits about doing anything to actually help them and is only invested in hurting people—everyone from long-serving federal workers to immigrants to trans folks to whomever they see as their enemies. I really hope that by this time next year we’ll have come through midterm elections that cut this administration and its bootlicking right-wing Congress off at the knees.
At the same time, I’ve cherished what’s gotten me through this year: My friends who listen to my political angst and then say, “Okay, bitch, see you at the clurb.” (Looking at you Sittu, Mikey, Ravi, William and more.)
The networks of people in this city, especially the scruffy Gen Z kids with their baggy thrift clothes and low affect, who’ve given me hope as I’ve joined them in everything from getting Mamdani elected to trying to mitigate ICE’s damage. And the joy of driving up to Boston to see my family intermittently. I hope you, too, have your things that are getting you through. Until I see you again (and I hope to have one more Caftan before the year’s out!), I wish you the happiest holidays possible under the circumstances and I thank you for your Caftan support. I love bringing these chats to you.
Now here’s the hot, brilliant and loquacious Dr. Demetre…
Demetre, welcome back to NYC in advance! You’re like the queer, tatted leather daddy version of Gabe Kotter. So can you tell me how the conversation between you and Callen-Lorde started?
I was sitting in CDC soon after the shooting and Patrick McGovern, Callen-Lorde’s CEO, whom I’ve known for years, called to ask if I knew anyone who’d potentially be interested in being CMO, and I was like, “Yeah—me.” I’d been interviewing for other things, not in a super-active, I-need-to-get-out-of-CDC way but more as a way to find a nondramatic exit strategy. I definitely felt like my utility at CDC in the current environment was very low, and I wanted to be back closer to the front lines. That’s where the future is now, because the federal government is currently in a destruction zone.
So what’s crazy is that my Callen-Lorde interviews were on the day I submitted my CDC resignation. And after the interviews, I had my final conversation with my boss, Deb[ra Houry], about quitting CDC. She, I and Dan Jernigan resigned on August 28, right after Susan Monarez was ousted. Prior, I’d said to Deb, “I don’t know how much longer I can do this,” and she said, “Then you should get your letter of resignation ready.” But when Susan was called to RFK Jr.’s office to be chastised for saying she wouldn’t just rubber-stamp things without scientific process, that was a signal that everything was about to go down. So Deb, Dan and I decided to do 24 hours of research into whether we wanted to be quit or be fired, the latter of which would’ve had strings attached that would’ve made it hard to speak candidly about what was going on. So we decided unanimously to quiet, during which we were seeing news and tweets about Susan being ousted. We decided we were going to put our resignation letters on social media as well as send it to our teams of people we supervised. [Tim: Demetre’s letter—“Enough is enough,” it reads—ricocheted across the Internet, getting millions of views.]
And we also decided to do no media the night we resigned, but to wait for the next day.
Okay, let’s just keep talking about CDC for the moment. After you resigned, you immediately became a much more public figure than you’d been the day before. Did you get hate?
Yeah. I’m an easy target in this environment because I’m gay. During mpox, anytime I would say anything that was appropriate for the community to hear, I would have a backlash that invariably included at least one death threat.
And that was during Biden, right?
Yeah, but the environment was already so bad. But at least in that administration, some people cared that I was getting death threats. Under Trump 2.0, no one cared. But when I resigned, instead of getting the normal “faggot this, queer that, gimp that—”
Gimp?
A submissive leather person. It’s from Pulp Fiction.
And there was a gimp in South Park which people would post on my Twitter, which I actually thought was more entertaining than offensive. So when I resigned, I was ready for it. But I didn’t expect to have members of Congress like Ted Cruz post pictures of me at the Pines Party…
…and say mean things about my sexuality and my credentials. I had Rand Paul go in front of media and say I should never have had my CDC job in the first place because of my lifestyle.
I submitted all that in a report to the Atlanta Police Department.
Good! What did or does it feel like to be targeted that way?
I don’t care. I mean, I care about my husband, my family, my house and my dogs. But these people I don’t give two shits about. And that’s my superpower. Target me all you want. I stand by my record, and if the best you’ve got is to say, “You’re gay,” well, at least I don’t say, “Ted Cruz, you’re fat and gross.” If all they can do is attack some feature of my life that is, frankly, not that controversial, I just don’t care. [White House press secretary] Karoline Leavitt attacked me from the White House briefing room.
She said when you resigned, “We don’t want someone like him anyway.”
CNN asked me what I thought of that and I literally said, “I appreciate the note from her, but I just don’t care.”
Who the fuck is she to say anything about me? What do I care if you don’t like the fact that I use my pronouns and refer to pregnant people as people? Oh, well! You don’t bully someone who’s been bullied their entire life and has become immune to it. I’m not a kid anymore. My dad taught me not to tolerate a bully and he was right. I don’t. Rand Paul, you’re an opthamologist—what do you know about infectious diseases?
Right. You came into CDC when again?
I was a Trump 1.0 hire. I was recruited by [Trump 1.0 CDC director] Robert Redfield’s team.
Was the fact that you were gay or openly at parties in a harness, or even just very frank about the health aspects of gay sex, an issue?
No. I actually think that my track record with community health for a priority population was probably a selling factor.
And that was because Trump 1.0 was so much less ideological and that there were still good, normal public health people at CDC?
Trump 1.0 modeled itself after NYC and created the Ending the Epidemic initiative. They were in it to win it. They were trying to get the epidemic controlled in a way it never had been. That’s why I was recruited, because I’d gotten the numbers down in NYC to the lowest level in history. Unfortunately now they’re going back up again because of the usual factors that cause stigma. But no—the CDC under Trump 1.0 vetted me thoroughly.
And were your Trump 1.0 colleagues at CDC, for lack of a better word, normal?
They were mainly career servants, with a very small number of political appointees. But the ratio was like 12 to 1. Now, in the director’s office, there are no career servants.
As it is now across all the federal agencies.
Right. Now they’re like, “You’re really good at running a battery company, so you’ll be a great chief of staff for CDC.” That’s true—the current chief of staff of the CDC is a battery executive.
Oh my God. So as your time at CDC shifts into Covid and then into Biden, do things normalize after the embarrassments of Covid under Trump, like his recommending using bleach? In retrospect, did the Biden CDC during Covid misstep?
Totally. The challenging part is that Covid was an unprecedented—well, yes, there was an actual huge pandemic in 1918, but every subsequent one had been pretty small change until Covid, where countless people got sick and some died. Part of humility in public health is having to admit that, during Covid, things went both well and badly under both administrations. Under Trump 1.0, Operation Warp Speed [to get out vaccines quickly] was one of the most amazing public health interventions in the history of modern life. They proved that you could do what the pandemic plan said, which was to get a vaccine out there fast to end a pandemic.
But do I think all the things the Biden administration did were great? No. Some of the communications weren’t so great. And some of that has more to do with the changing science. Let me give you a great example. CDC said, “Yay, we’re doing great, the vaccine is getting us to a good place, the pandemic is being driven down.” And then they loosen up their mask guidance. And the next thing was that I was at my desk at CDC, working on Covid, and my friend [data scientist] Michael Donnelly from NYC called to tell me that all his vaccinated friends went to Bear Week or July 4 in Ptown and got Covid. Then it became clear that the vaccine could prevent or mitigate some infections but not all. So should the risk communication have been better? Probably. But that’s the reality of doing public health—not everything is perfect and hindsight is 20/20.
The narrative from the right is that the Biden administration completely botched Covid. Is there a grain of truth in that? Did it overmessage shutting down school and work such that it had bad socioeconomic consequences?
We’re getting way off my area of expertise, but I think that a lot of the decisions about school closure were state decisions. Both the Trump 1.0 and Biden administrations had moments where the guidance changed and was unclear, but the problem is that science changes, so the guidance has to change. I can’t tell you who handled it better because everyone handled it as best they could in the moment.
Can you conjecture, if a crisis of the scale of Covid, or even half the scale—
Good luck.
You know what I’m going to ask? How would it go right now?
Disastrously. They’ve fired how many people at CDC? During Covid, CDC barely had enough people to manage the mammothness of the outbreak. Rather than downsizing government to actually make it more efficient, they removed anything with the word “equity” in it. So suddenly you have this patchwork of missing people and expertise. Also, they defunded half a billion dollars of mRNA vaccines for pandemics? Good luck! Imagine Operation Warp Speed starting over from scratch. They want to pretend there’s no such thing as a pandemic.
So if it needed to happen today for a new virus, it could not?
Absolutely not. We’d be so far behind right now because of defunding mRNA development, and then add the lack of staff. Are we going to have RFK Jr. be our incident commander? Good luck with that. Is he going to remove yellow dye from something and hope that people don’t die from a pandemic? Come on.
Right. Do you think there’d be a kind of apartheid where states with good health departments like New York would fare better than those with low resources like Alabama?
Yes. There are lovely people in states like Alabama and Mississippi who do public health who are not ready for what would happen if another pandemic hit. If states like that knock on the White House door right now for help, there’s no one there to help.
Right. Ugh. So Demetre, if you were writing a screenplay about what life was like at CDC from this past Inauguration Day on, how would it play? I’ve wanted to ask you this all year.
It felt like we were in an airplane that was hijacked. Or maybe like The Last of Us where the fungus took over the brain—where CDC was being transformed into a zombie and at any point, you could step on a landmine and be killed. That’s the conversation I had with the people I supervised, that I was walking through a minefield. There was so little communication coming from HHS. They were flying the plane and we had no idea where it was going.
Did you ever have a face to face moment with RFK Jr. or his closest, uh, hijackers?
I got to see some of the hijackers, the political appointees who came to CDC who were hell-bent on destroying public health, and specifically vaccines. I never met RFK Jr. I was the head of vaccines and I never received an email from him. I’d briefed prior secretaries. RFK Jr. doesn’t care about what’s happening on the inside or the science. He has come with his pre-decided formula for what he wants to do, and he’s just going to keep doing it. That plane isn’t headed toward Orlando anymore—it’s heading toward a building.
A long time ago, he was well-regarded for playing a big role in cleaning up the Hudson River. What do you think happened with him?
I can’t postulate. I’m not his biographer. I don’t know what shifted him from environmental law into this strange anti-vaccine space. It seems as if the common denominator is mercury. He had a problem with mercury in fish and now has a problem with mercury in vaccines. So many of the anti-vax people that he recruits into the mix talk about environmental science as though it were the same as pharmaceutical science. And that’s not the case. There’s not very much mercury in vaccines anymore, and all the data shows that it’s the kind of mercury that you excrete and it doesn’t build up in your body. But there’s this constant fallacy of association between environmental claims and pharmacology.
Throughout the past year when you were still at CDC, what was your line in the sand in terms of when you’d leave?
My boss Deb said to me, “You need to think about what your line is.” For me, it was that if, at any point, I was going to be used for evil, not good, and to be part of the harm, that was the end of what I could do. When they changed the Covid schedule [guidance about who should get vaccines when], we figured out a way to make the vaccines still accessible for everybody. When they tried to put crazy shit into the measles guidance, Deb and I were able to mitigate that. When they fired the ACIP [vaccine advisory] folks and we were starting to work with the new people and didn’t know how bad it was going to be, we were trying to work with them. But that was a main reason I left. I was going to be sitting in that room representing CDC while they presented conspiracy theories? I would feel complicit.
What do you feel toward these people? Rage? Contempt?
I actually feel sorry for them. They drank their own Kool-Aid. I actually believe there are some people who aren’t going to make millions of dollars around vaccine litigation who truly believe that they’re doing something good, because they don’t believe in science. There’s one person very high in the anti-vaccine mix at CDC, and I’m not going to say who, who doesn’t believe that we landed on the Moon. These are non-scientists who really believe that an increase in vaccines is linked to an increase in autism, even though the science doesn’t back it up.
But I don’t feel sorry for the people whose goal is to destabilize the vaccine infrastructure to create clout for themselves, to prove that they’re not wrong. That’s a big RFK Jr. motivator. He wants to be able to say, “After all these years, look, I’m not wrong. I’m not a kook.” Then there’s the people who are going to make hundreds of millions of dollars over litigation if they destabilize the vaccine infrastructure.
Do you think we’ll ever come out of this nightmarish upside-down-world of public health?
In 10 or 15 years. The damage they’re doing is extensive and irreparable. There’s no point in trying to preserve or rebuild the public health they’re destroying. We should be focusing all our energy on the future state, because the past is dead.
Say, fingers crossed, we have a sane, normal administration after this. In Year 1, what should they do for public health?
They need to hire a head of HHS who has experience running public health in large organizations. Because that person has to be like a CEO taking over a company that just went bankrupt that they need to restructure from top to bottom, with very close approximation to what the end-users of public health, the people, need. They need to take a moment and let the scientists do their science, let the responders do their response, support them, and then focus on fixing it. Because it will be in ruins that can’t be shored up. They need to reboot. Like when you bring in a CEO who’s there to build a new thing instead of repairing an old thing. And they don’t need a tech bro. They need someone with the executive skills who also understands public health. It’s done. CDC is done. I said that the day after I quit. CDC is over. They have damaged it beyond repair, so this is an opportunity to build something you can’t destroy with one guy from DOGE who’s 22 years old saying, “Let’s cut this center.” It can’t be like this again. This was designed to be destroyed.
Why, though? Isn’t the destruction more about the destroyers than the system itself?
I don’t think so. We’re seeing what people need, these regional public health collectives that are emerging that are trying to figure out how to be more region-appropriate. So [anything in the future resembling] CDC needs to become an organization in the service of regional and state organizations rather than some kind of overarching thing. The expertise needs to occur closer to the ground. So these new regional centers should be hiring old CDC people to do jobs, because that’s the future. If the classical period is the Acropolis and the Acropolis is in ruins because now it’s the Dark Ages, you don’t go back to fix the Acropolis. You make the Sistine Chapel. Move on. People are wasting their time trying to save something that’s on fire.
Right. So on a spicier note, when you were in NYC, you and your husband were well-known for going out and partying, clubs and such. Did you two do any of that when you were in Atlanta?
Atlanta’s boring.
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