FDA Commissioner Makary is about to be fired. The job has turned into a revolving door.

Trump is preparing to fire FDA Commissioner Marty Makary — and the firing, when it comes, will barely register as news inside the agencies that actually matter.

Makary, confirmed by the Senate in March 2025 on a 56-44 vote, lasted 13 months. He is the fourth person to hold the FDA commissioner job since Trump took office. That is not unusual. It is the pattern.

Three major health agencies — FDA, CDC, and the FDA's biologics review arm CBER — have cycled through 15 different people in their top three roles in less than 18 months, according to BioSpace. The average tenure in any of these jobs is four or five months. That is not enough time to learn the building, let alone run it.

The practical consequence is concrete. In February, the FDA refused to review an application for Moderna's mRNA flu vaccine, according to BioSpace. Makary was called to the White House. Trump expressed frustration. One week later, FDA accepted an amended application.

The churn creates an environment where drug companies cannot build regulatory strategies around people. They have to build them around the institutional patterns that outlast every individual occupant — because the individual occupants keep getting replaced.

Makary's short tenure included at least two decisions that put him in direct conflict with outside pressure. He rejected a cancer immunotherapy called RP1 over the objection of the external advisory panel that had recommended approval. He defended the decision publicly: "I don't work for Replimune," he said in a May 5 CNBC interview. "By law, we can only approve drugs with substantial evidence." A company executive later alleged a competitor had pressured the FDA; Makary did not reverse course.

He also refused to approve blueberry, mango, and menthol vape flavors from a company called Glas — a decision that, according to New Republic, complicated Trump's campaign promise to win back Gen Z voters where his approval rating sat at 24 percent.

Peter Marks, who had run CBER for a decade and built its gene and cell therapy program, was forced out in March 2025. Since then, five different people have held his job.

Makary's resistance to pressure from multiple directions — industry, advocates on both sides of the abortion debate, and the White House on vaping — may be what made him a target for the MAHA movement that has consolidated around Trump. It is also, paradoxically, the trait that FDA-watchers inside the agency have cited as the most professionally admirable.

The agencies will keep running. The revolving door will keep turning. And the next commissioner will last until they don't.