Quality Unit Oversight Failures: A Critical Analysis of Recent FDA Warning Letters

The continued trend in FDA warning letters citing Quality Unit (QU) deficiencies highlights a concerning reality across pharmaceutical manufacturing operations worldwide. Three warning letters recently issued to pharmaceutical companies in China, India, and Malaysia reveal fundamental weaknesses in Quality Unit oversight that extend beyond isolated procedural failures to indicate systemic quality management deficiencies. These regulatory actions demonstrate the FDA’s continued emphasis on the Quality Unit as the cornerstone of pharmaceutical quality systems, with expectations that these units function as independent guardians of product quality with sufficient authority, resources, and expertise. This analysis examines the specific deficiencies identified across recent warning letters, identifies patterns of Quality Unit organizational failures, explores regulatory expectations, and provides strategic guidance for building robust quality oversight capabilities that meet evolving compliance standards.

Recent FDA Warning Letters Highlighting Critical Quality Unit Deficiencies

Multiple Geographic Regions Under Scrutiny

The FDA has continues to provide an intense focus on Quality Unit oversight through a series of warning letters targeting pharmaceutical operations across Asia. As highlighted in a May 19, 2025 GMP Compliance article, three notable warning letters targeted specific Quality Unit failures across multiple regions. The Chinese manufacturer failed to establish an adequate Quality Unit with proper authority to oversee manufacturing operations, particularly in implementing change control procedures and conducting required periodic product reviews. Similarly, the Indian manufacturer’s Quality Unit failed to implement controls ensuring data integrity, resulting in unacceptable documentation practices including torn batch records, damaged testing chromatograms, and improperly completed forms. The Malaysian facility, producing OTC products, showed failures in establishing adequate training programs and performing appropriate product reviews, further demonstrating systemic quality oversight weaknesses. These geographically diverse cases indicate that Quality Unit deficiencies represent a global challenge rather than isolated regional issues.

Historical Context of Regulatory Concerns

FDA’s focus on Quality Unit responsibilities isn’t new. A warning letter to a Thai pharmaceutical company earlier in 2024 cited Quality Unit deficiencies including lack of control over manufacturing operations, inadequate documentation of laboratory preparation, and insufficient review of raw analytical data. These issues allowed concerning practices such as production staff altering master batch records and using erasable markers on laminated sheets for production records. Another notable case involved Henan Kangdi Medical Devices, where in January 2020 the FDA stated explicitly that “significant findings in this letter indicate that your quality unit is not fully exercising its authority and/or responsibilities”. The consistent regulatory focus across multiple years suggests pharmaceutical manufacturers continue to struggle with properly empowering and positioning Quality Units within their organizational structures.

Geographic Analysis of Quality Unit Failures: Emerging vs. Mature Regulatory Markets

These FDA warning letters highlighting Quality Unit (QU) deficiencies reveal significant disparities between pharmaceutical manufacturing practices in emerging markets (e.g., China, India, Malaysia, Thailand) and mature regulatory jurisdictions (e.g., the U.S., EU, Japan). These geographic differences reflect systemic challenges tied to regulatory infrastructure, economic priorities, and technological adoption.

In emerging markets, structural weaknesses in regulatory oversight and quality culture dominate QU failures. For example, Chinese manufacturers like Linghai ZhanWang Biotechnology (2025) and Henan Kangdi (2019) faced FDA action because their Quality Units lacked the authority to enforce CGMP standards, with production teams frequently overriding quality decisions. Similarly, Indian facilities cited in 2025 warnings struggled with basic data integrity controls, including torn paper records and unreviewed raw data—issues exacerbated by domestic regulatory bodies like India’s CDSCO, which inspects fewer than 2% of facilities annually. These regions often prioritize production quotas over compliance, leading to under-resourced Quality Units and inadequate training programs, as seen in a 2025 warning letter to a Malaysian OTC manufacturer whose QU staff lacked GMP training. Supply chain fragmentation further complicates oversight, particularly in contract manufacturing hubs like Thailand, where a 2024 warning letter noted no QU review of outsourced laboratory testing.

By contrast, mature markets face more nuanced QU challenges tied to technological complexity and evolving regulatory expectations. In the U.S. and EU, recent warnings highlight gaps in Quality Units’ understanding of advanced manufacturing technologies, such as continuous manufacturing processes or AI-driven analytics. A 2024 EU warning letter to a German API manufacturer, for instance, cited cybersecurity vulnerabilities in electronic batch records—a stark contrast to emerging markets’ struggles with paper-based systems. While data integrity remains a global concern, mature markets grapple with sophisticated gaps like inadequate audit trails in cloud-based laboratory systems, whereas emerging economies face foundational issues like erased entries or unreviewed chromatograms. Regulatory scrutiny also differs: FDA inspection data from 2023 shows QU-related citations in just 6.2% of U.S. facilities versus 23.1% in Asian operations, reflecting stronger baseline compliance in mature jurisdictions.

Case comparisons illustrate these divergences. At an Indian facility warned in 2025, production staff routinely overruled QU decisions to meet output targets, while a 2024 U.S. warning letter described a Quality Unit delaying batch releases due to inadequate validation of a new AI-powered inventory system. Training gaps also differ qualitatively: emerging-market QUs often lack basic GMP knowledge, whereas mature-market teams may struggle with advanced tools like machine learning algorithms.

These geographic trends have strategic implications. Emerging markets require foundational investments in QU independence, such as direct reporting lines to executive leadership, and adoption of centralized digital systems to mitigate paper-record risks. Partnerships with mature-market firms could accelerate quality culture development. Meanwhile, mature jurisdictions must modernize QU training programs to address rapidly changing technologies and strengthen oversight of decentralized production models.

Data Integrity as a Critical Quality Unit Responsibility

Data integrity issues feature prominently in recent enforcement actions, reflecting the Quality Unit’s crucial role as guardian of trustworthy information. The FDA frequently requires manufacturers with data integrity deficiencies to engage third-party consultants to conduct comprehensive investigations into record inaccuracies across all laboratories, manufacturing operations, and relevant systems. These remediation efforts must identify numerous potential issues including omissions, alterations, deletions, record destruction, non-contemporaneous record completion, and other deficiencies that undermine data reliability. Thorough risk assessments must evaluate potential impacts on product quality, with companies required to implement both interim protective measures and comprehensive long-term corrective actions. These requirements underscore the fundamental importance of the Quality Unit in ensuring that product decisions are based on accurate, complete, and trustworthy data.

Patterns of Quality Unit Organizational Failures

Insufficient Authority and Resources

A recurring theme across warning letters is Quality Units lacking adequate authority or resources to fulfill their responsibilities effectively. The FDA’s warning letter to Linghai ZhanWang Biotechnology Co. in February 2025 cited violations that demonstrated the company’s Quality Unit couldn’t effectively ensure compliance with CGMP regulations. Similarly, Lex Inc. faced regulatory action when its “quality system was inadequate” because the Quality Unit “did not provide adequate oversight for the manufacture of over-the-counter (OTC) drug products”.

These cases reflect a fundamental organizational failure to empower Quality Units with sufficient authority and resources to perform their essential functions. Without proper positioning within the organizational hierarchy, Quality Units cannot effectively challenge manufacturing decisions that might compromise product quality or regulatory compliance, creating systemic vulnerabilities.

Documentation and Data Management Deficiencies

Quality Units frequently demonstrate inadequate oversight of documentation and data management processes, allowing significant compliance risks to emerge. According to FDA warning letters, these issues include torn batch records, incompletely documented laboratory preparation, inadequate retention of weight printouts, and insufficient review of raw analytical data. One particularly concerning practice involved “production records on laminated sheets using erasable markers that could be easily altered or lost,” representing a fundamental breakdown of documentation control. These examples demonstrate how Quality Unit failures in documentation oversight directly enable data integrity issues that can undermine the reliability of manufacturing records, ultimately calling product quality into question. Effective Quality Units must establish robust systems for ensuring complete, accurate, and contemporaneous documentation throughout the manufacturing process.

Inadequate Change Control and Risk Assessment

Change control deficiencies represent another significant pattern in Quality Unit failures. Warning letters frequently cite the Quality Unit’s failure to ensure appropriate change control procedures, highlighting inadequate risk assessments as a particular area of concern. FDA inspectors have found that inadequate change control practices present significant compliance risks, with change control appearing among the top ten FDA 483 violations. These deficiencies often involve failure to evaluate the potential impact of changes on product quality, incomplete documentation of changes, and improper execution of change implementation. Effective Quality Units must establish robust change control processes that include thorough risk assessments, appropriate approvals, and verification that changes have not adversely affected product quality.

Insufficient Batch Release and Production Record Review

Quality Units regularly fail to conduct adequate reviews of production records and properly execute batch release procedures. A frequent citation in warning letters involves the Quality Unit’s failure to “review production records to assure that no errors have occurred or, if errors have occurred, that they have been fully investigated”. In several cases, the Quality Unit reviewed only analytical results entered into enterprise systems without examining the underlying raw analytical data, creating significant blind spots in quality oversight. This pattern demonstrates a superficial approach to batch review and release decisions that fails to fulfill the Quality Unit’s fundamental responsibility to ensure each batch meets all established specifications before distribution. Comprehensive batch record review is essential for detecting anomalies that might indicate quality or compliance issues requiring investigation.

Regulatory Expectations for Effective Quality Units

Core Quality Unit Responsibilities

The FDA has clearly defined the essential responsibilities of the Quality Unit through regulations, guidance documents, and enforcement actions. According to 21 CFR 211.22, the Quality Unit must “have the responsibility and authority to approve or reject all components, drug product containers, closures, in-process materials, packaging material, labeling, and drug products”. Additionally, the unit must “review production records to assure that no errors have occurred or, if errors have occurred, that they have been fully investigated”. FDA guidance elaborates that the Quality Unit’s duties include “ensuring that controls are implemented and completed satisfactorily during manufacturing operations” and “ensuring that developed procedures and specifications are appropriate and followed”. These expectations establish the Quality Unit as both guardian and arbiter of quality throughout the manufacturing process, with authority to make critical decisions regarding product acceptability.

Independence and Organizational Structure

Regulatory authorities expect Quality Units to maintain appropriate independence from production units to prevent conflicts of interest. FDA guidance specifically states that “under a quality system, it is normally expected that the product and process development units, the manufacturing units, and the QU will remain independent”. This separation ensures that quality decisions remain objective and focused on product quality rather than production metrics or efficiency considerations. While the FDA acknowledges that “in very limited circumstances, a single individual can perform both production and quality functions,” such arrangements require additional safeguards including “another qualified individual, not involved in the production operation, conduct[ing] an additional, periodic review of QU activities”. This guidance underscores the critical importance of maintaining appropriate separation between quality and production responsibilities.

Quality System Integration

Regulatory authorities increasingly view the Quality Unit as the central coordinator of a comprehensive quality system. The FDA’s guidance document “Quality Systems Approach to Pharmaceutical CGMP Regulations” positions the Quality Unit as responsible for creating, monitoring, and implementing the entire quality system. This expanded view recognizes that while the Quality Unit doesn’t assume responsibilities belonging to other organizational units, it plays a crucial role in ensuring that all departments understand and fulfill their quality-related responsibilities. The Quality Unit must therefore establish appropriate communication channels and collaborative mechanisms with other functional areas while maintaining the independence necessary to make objective quality decisions. This integrated approach recognizes that quality management extends beyond a single department to encompass all activities affecting product quality.

Strategic Approaches to Strengthening Quality Unit Effectiveness

Comprehensive Quality System Assessment

Organizations facing Quality Unit deficiencies should begin remediation with a thorough assessment of their entire pharmaceutical quality system. Warning letters frequently require companies to conduct “a comprehensive assessment and remediation plan to ensure your QU is given the authority and resources to effectively function”. This assessment should examine whether procedures are “robust and appropriate,” how the Quality Unit provides oversight “throughout operations to evaluate adherence to appropriate practices,” the effectiveness of batch review processes, and the Quality Unit’s investigational capabilities. A thorough gap analysis should compare current practices against regulatory requirements and industry best practices to identify specific areas requiring improvement. This comprehensive assessment provides the foundation for developing targeted remediation strategies that address the root causes of Quality Unit deficiencies.

Establishing Clear Roles and Adequate Resources

Effective remediation requires clearly defining Quality Unit roles and ensuring adequate resources to fulfill regulatory responsibilities. FDA warning letters frequently cite the absence of “written procedures for QU roles and responsibilities” as a significant deficiency. Organizations must develop detailed written procedures that clearly articulate the Quality Unit’s authority and responsibilities, including approval or rejection authority for components and drug products, review of production records, and oversight of quality-impacting procedures and specifications. Additionally, companies must assess whether Quality Units have sufficient staffing with appropriate qualifications and training to effectively execute these responsibilities. This assessment should consider both the number of personnel and their technical capabilities relative to the complexity of manufacturing operations and product portfolio.

Implementing Robust Data Integrity Controls

Data integrity represents a critical area requiring focused attention from Quality Units. Companies must implement comprehensive data governance systems that ensure records are attributable, legible, contemporaneous, original, and accurate (ALCOA principles). Quality Units should establish oversight mechanisms for all quality-critical data, including laboratory results, manufacturing records, and investigation documentation. These systems must include appropriate controls for paper records and electronic data, with verification processes to ensure consistency between different data sources. Quality Units should also implement risk-based audit programs that regularly evaluate data integrity practices across all manufacturing and laboratory operations. These controls provide the foundation for trustworthy data that supports sound quality decisions and regulatory compliance.

Developing Management Support and Quality Culture

Sustainable improvements in Quality Unit effectiveness require strong management support and a positive quality culture throughout the organization. FDA warning letters specifically call for “demonstration of top management support for quality assurance and reliable operations, including timely provision of resources to address emerging manufacturing and quality issues”. Executive leadership must visibly champion quality as an organizational priority and empower the Quality Unit with appropriate authority to fulfill its responsibilities effectively. Organizations should implement programs that promote quality awareness at all levels, with particular emphasis on the shared responsibility for quality across all departments. Performance metrics and incentive structures should align with quality objectives to reinforce desired behaviors and decision-making patterns. This culture change requires consistent messaging, appropriate resource allocation, and leadership accountability for quality outcomes.

Conclusion

FDA warning letters reveal persistent Quality Unit deficiencies across global pharmaceutical operations, with significant implications for product quality and regulatory compliance. The patterns identified—including insufficient authority and resources, documentation and data management weaknesses, inadequate change control, and ineffective batch review processes—highlight the need for fundamental improvements in how Quality Units are structured, resourced, and empowered within pharmaceutical organizations. Regulatory expectations clearly position the Quality Unit as the cornerstone of effective pharmaceutical quality systems, with responsibility for ensuring that all operations meet established quality standards through appropriate oversight, review, and decision-making processes.

Addressing these challenges requires a strategic approach that begins with comprehensive assessment of current practices, establishment of clear roles and responsibilities, implementation of robust data governance systems, and development of a supportive quality culture. Organizations that successfully strengthen their Quality Units can not only avoid regulatory action but also realize significant operational benefits through more consistent product quality, reduced manufacturing deviations, and more efficient operations. As regulatory scrutiny of Quality Unit effectiveness continues to intensify, pharmaceutical manufacturers must prioritize these improvements to ensure sustainable compliance and protect patient safety in an increasingly complex manufacturing environment.

Key Warning Letters Discussed

Linghai ZhanWang Biotechnology Co., Ltd. (China) — February 25, 2025
- (For the original FDA letter, search the FDA Warning Letters database for “Linghai ZhanWang Biotechnology Co” and the date “02/25/2025”)
Henan Kangdi Medical Devices Co. Ltd. (China) — December 3, 2019
- (For the original FDA letter, search the FDA Warning Letters database for “Henan Kangdi Medical Devices” and the date “12/03/2019”)
Drug Manufacturing Facility in Thailand — February 27, 2024
- (For the original FDA letter, search the FDA Warning Letters database for “Thailand” and the date “02/27/2024”)
BioAsia Worldwide (Malaysia) — February 2025
- (For the original FDA letter, search the FDA Warning Letters database for “BioAsia Worldwide” and the date “02/2025”)

For the most authoritative and up-to-date versions, always use the FDA Warning Letters database and search by company name and date.

FDA Warning Letter Analysis: Critical CGMP Violations at BEO Pharmaceuticals

The FDA’s recent warning letter to BEO Pharmaceuticals highlights significant compliance failures that serve as crucial lessons for pharmaceutical manufacturers. The inspection conducted in late 2024 revealed multiple violations of Current Good Manufacturing Practice (CGMP) regulations, spanning from inadequate component testing to serious process validation deficiencies. This analysis examines the key issues identified, contextualizes them within regulatory frameworks, and extracts valuable insights for pharmaceutical quality professionals.

Component Testing and Supplier Qualification Failures

BEO Pharmaceuticals failed to adequately test incoming raw materials used in their over-the-counter (OTC) liquid drug products, violating the fundamental requirements outlined in 21 CFR 211.84(d)(1) and 211.84(d)(2). These regulations mandate testing each component for identity and conformity with written specifications, plus validating supplier test analyses at appropriate intervals.

Most concerning was BEO’s failure to test high-risk components for diethylene glycol (DEG) and ethylene glycol (EG) contamination. The FDA emphasized that components like glycerin require specific identity testing that includes limit tests for these potentially lethal contaminants. The applicable United States Pharmacopeia-National Formulary (USP-NF) monographs establish a safety limit of not more than 0.10% for DEG and EG. Historical context makes this violation particularly serious, as DEG contamination has been responsible for numerous fatal poisoning incidents worldwide.

While BEO eventually tested retained samples after FDA discussions and found no contamination, this reactive approach fundamentally undermines the preventive philosophy of CGMP. The regulations are clear: manufacturers must test each shipment of each lot of high-risk components before incorporating them into drug products9.

Regulatory Perspective on Component Testing

According to 21 CFR 211.84, pharmaceutical manufacturers must establish the reliability of their suppliers’ analyses through validation at appropriate intervals if they intend to rely on certificates of analysis (COAs). BEO’s failure to implement this requirement demonstrates a concerning gap in their supplier qualification program that potentially compromised product safety.

Quality Unit Authority and Product Release Violations

Premature Product Release Without Complete Testing

The warning letter cites BEO’s quality unit for approving the release of a batch before receiving complete microbiological test results-a clear violation of 21 CFR 211.165(a). BEO shipped product on January 8, 2024, though microbial testing results weren’t received until January 10, 2024.

BEO attempted to justify this practice by referring to “Under Quarantine” shipping agreements with customers, who purportedly agreed to hold products until receiving final COAs. The FDA unequivocally rejected this practice, stating: “It is not permissible to ship finished drug products ‘Under Quarantine’ status. Full release testing, including microbial testing, must be performed before drug product release and distribution”.

This violation reveals a fundamental misunderstanding of quarantine principles. A proper quarantine procedure is designed to isolate potentially non-conforming products within the manufacturer’s control-not to transfer partially tested products to customers. The purpose of quarantine is to ensure products with abnormalities are not processed or delivered until their disposition is clear, which requires complete evaluation before leaving the manufacturer’s control.

Missing Reserve Samples

BEO also failed to maintain reserve samples of incoming raw materials, including APIs and high-risk components, as required by their own written procedures. This oversight eliminates a critical safeguard that would enable investigation of material-related issues should quality concerns arise later in the product lifecycle.

Process Validation Deficiencies

Inadequate Process Validation Approach

Perhaps the most extensive violations identified in the warning letter related to BEO’s failure to properly validate their manufacturing processes. Process validation is defined as “the collection and evaluation of data, from the process design stage through commercial production, which establishes scientific evidence that a process is capable of consistently delivering quality product”.

The FDA identified several critical deficiencies in BEO’s approach to process validation:

BEO shipped products as early as May 2023, but only prepared and approved validation reports in October 2024-a clear indication that validation was retroactively conducted rather than implemented prior to commercial distribution.
Process validation reports lacked essential details such as comprehensive equipment lists, appropriate critical process parameters, adequate sampling instructions, and clear acceptance criteria.
Several validation reports relied on outdated data from 2011-2015 from manufacturing operations at a different facility under a previous business entity.

These findings directly contradict the FDA’s established process validation guidance, which outlines a systematic, three-stage approach:

Process Design: Defining the commercial manufacturing process based on development and scale-up activities.
Process Qualification: Evaluating process capability for reproducible commercial manufacturing.
Continued Process Verification: Ongoing assurance during routine production that the process remains controlled.

The FDA guidance emphasizes that “before any batch from the process is commercially distributed for use by consumers, a manufacturer should have gained a high degree of assurance in the performance of the manufacturing process”. BEO’s retroactive approach to validation fundamentally violated this principle.

Pharmaceutical Water System Failures

A particularly concerning finding was BEO’s failure to establish that their purified water system was “adequately designed, controlled, maintained, and monitored to ensure it is consistently producing water that meets the USP monograph for purified water and appropriate microbial limits”. This water was used both as a component in liquid drug products and for cleaning manufacturing equipment and utensils.

Water for pharmaceutical use must meet strict quality standards depending on its intended application. Purified water systems used in non-sterile product manufacturing must meet FDA’s established action limit of not more than 100 CFU/mL. The European Medicines Agency similarly emphasizes that the control of the quality of water throughout the production, storage and distribution processes, including microbiological and chemical quality, is a major concern.

BEO’s current schedule for water system maintenance and microbiological testing was deemed “insufficient”-a critical deficiency considering water’s role as both a product component and cleaning agent. This finding underscores the importance of comprehensive water system validation and monitoring programs as fundamental elements of pharmaceutical manufacturing.

Laboratory Controls and Test Method Validation

BEO failed to demonstrate that their microbiological test methods were suitable for their intended purpose, violating 21 CFR 211.160(b). Specifically, BEO couldn’t provide evidence that their contract laboratory’s methods could effectively detect objectionable microorganisms in their specific drug product formulations.

The FDA noted that while BEO eventually provided system suitability documentation, “the system suitability protocols for the methods specified in USP <60> and USP <62> lacked the final step to confirm the identity of the recovered microorganisms in the tests”. This detail critically undermines the reliability of their microbiological testing program, as method validation must demonstrate that the specific test can detect relevant microorganisms in each product matrix.

Strategic Implications for Pharmaceutical Manufacturers

The BEO warning letter illustrates several persistent challenges in pharmaceutical CGMP compliance:

Component risk assessment requires special attention for high-risk ingredients with known historical safety concerns. The DEG/EG testing requirements for glycerin and similar components represent non-negotiable safeguards based on tragic historical incidents.
Process validation must be prospective, not retroactive. The industry standard clearly establishes that validation provides assurance before commercial distribution, not after.
Water system qualification is fundamental to product quality. Pharmaceutical grade water systems require comprehensive validation, regular monitoring, and appropriate maintenance schedules to ensure consistent quality.
Quality unit authority must be respected. The quality unit’s independence and decision-making authority cannot be compromised by commercial pressures or incomplete testing.
Testing methods must be fully validated for each specific application. This is especially critical for microbiological methods where product-specific matrix effects can impact detectability of contaminants.

FDA Under Fire: The Troubling Impacts of Trump’s First 100 Days

The first 100 days of President Trump’s second term have been nothing short of seismic for the Food and Drug Administration (FDA). Sweeping layoffs, high-profile firings, and a mass exodus of experienced staff have left the agency reeling, raising urgent questions about the safety of drugs, devices, and food in the United States.

Unprecedented Layoffs and Firings

Mass Layoffs and Restructuring

On April 1, 2025, the Department of Health and Human Services (HHS) executed a reduction in force that eliminated 3,500 FDA employees. This was part of a larger federal downsizing that saw at least 121,000 federal workers dismissed across 30 agencies in Trump’s first 100 days, with health agencies like the FDA, CDC, and NIH particularly hard hit. Security guards barred entry to some FDA staff just hours after they received termination notices, underscoring the abruptness and scale of the cuts.

The layoffs were not limited to support staff. Policy experts, project managers, regulatory scientists, and communications professionals were let go, gutting the agency’s capacity to write guidance documents, manage application reviews, test product safety, and communicate risks to the public. Even before the April layoffs, industry had noticed a sharp decline in FDA responsiveness to routine and nonessential queries-a problem now set to worsen.

High-Profile Departures and Forced Resignations

The leadership vacuum is equally alarming. Key figures forced out or resigning under pressure include:

Dr. Peter Marks, CBER Director and the nation’s top vaccine official, dismissed after opposing the administration’s vaccine safety stance.
Dr. Robert Temple, a 52-year FDA veteran and regulatory pioneer, retired amidst the turmoil.
Dr. Namandjé N. Bumpus, Deputy Commissioner; Dr. Doug Throckmorton, Deputy Director for regulatory programs; Celia Witten, CBER Deputy Director; Peter Stein, Director of the Office of Drugs; and Brian King, head of the Center for Tobacco Products, all departed-some resigning when faced with termination.
Communications, compliance, and policy offices were decimated, with all FDA communications now centralized under HHS, ending decades of agency independence.

The new FDA Commissioner, Martin “Marty” Makary, inherits an agency stripped of much of its institutional memory and scientific expertise. Add to this very real questions about about Makary’s capabilities and approach:

1. Lack of FDA Institutional Memory and Support: Makary steps into the role just as the FDA’s deep bench of experienced scientists, regulators, and administrators has been depleted. The departure of key leaders and thousands of staff means Makary cannot rely on the usual institutional memory or internal expertise that historically guided complex regulatory decisions. The agency’s diminished capacity raises concerns about whether Makary can maintain the rigorous review standards and enforcement practices needed to protect public health.

2. Unconventional Background and Public Persona: While Makary is an accomplished surgeon and health policy researcher, his career has been marked by a willingness to challenge medical orthodoxy and criticize federal health agencies, including the FDA itself. His public rhetoric-often sharply critical and sometimes inflammatory-contrasts with the FDA’s traditionally cautious, evidence-based communication style. For example, Makary has accused government agencies of “lying” about COVID-19 boosters and has called the U.S. food supply “poison,” positions that have worried many in the scientific and public health communities.

3. Alignment with Political Leadership and Potential Conflicts: Makary’s views align closely with those of HHS Secretary Robert F. Kennedy Jr., particularly in their skepticism of certain mainstream public health measures and their focus on food additives, pesticides, and environmental contributors to chronic disease. This alignment raises questions about the degree to which Makary will prioritize political directives over established scientific consensus, especially in controversial areas like vaccine policy, food safety, and chemical regulation.

4. Contrarianism and a Tendency Towards Conspiracy: Makary’s recent writings, such as his book Blind Spots, emphasize his distrust of medical consensus and advocacy for challenging “groupthink” in health policy. Critics worry this may lead to the dismissal of well-established scientific standards in favor of less-tested or more ideologically driven policies. As Harvard’s Dr. Aaron Kesselheim notes, Makary will need to make decisions based on evolving evidence, even if that means occasionally being wrong-a process that requires humility and openness to expert input, both of which could be hampered by the loss of institutional expertise.

5. Immediate Regulatory and Ethical Challenges: Makary inherits unresolved, high-stakes regulatory issues, such as the controversy over compounded GLP-1 drugs and the agency’s approach to ultra-processed foods and food additives. His prior involvement with telehealth companies and outspoken positions on food chemicals could present conflicts of interest or at least the appearance of bias, further complicating his ability to act as an impartial regulator.

Impact on Patient Health and Safety

Reduced Oversight and Enforcement

The loss of thousands of staff-including scientists and specialists-means fewer eyes on the safety of drugs, devices, and food. Despite HHS assurances that product reviewers and inspectors were spared, the reality is that critical support staff who enable and assist reviews and inspections were let go. This has already resulted in:

Delays and unpredictability in drug and device approvals, as fewer project managers are available to coordinate and communicate with industry.
A likely reduction in inspections, as administrative staff who book travel and provide translation for inspectors are gone, forcing inspectors to take on additional tasks and leading to bottlenecks.
The pausing of FDA’s unannounced foreign inspection pilot program, raising the risk of substandard or adulterated imported products entering the U.S. market.

Diminished Public Communication

With the elimination of FDA’s communications staff and the centralization of messaging under HHS, the agency’s ability to quickly inform the public about recalls, safety alerts, and emerging health threats is severely compromised. This loss of transparency and direct communication could delay critical warnings about unsafe products or outbreaks.

Loss of Scientific Capacity

The departure of regulatory scientists and the decimation of the National Center for Toxicological Research threaten the FDA’s ability to conduct the regulatory science that underpins product safety and efficacy standards. As former Commissioner Robert Califf warned, “The FDA as we’ve known it is over, with most leaders who possess knowledge and deep understanding product development safety no longer in their positions… I believe that history will regard this as a grave error”.

Impact on Clinical Studies

Oversight and Ethical Safeguards Eroded

FDA oversight of clinical trials has plummeted. During Trump’s previous term, the agency sent far fewer warning letters for clinical trial violations than under Obama (just 12 in Trump’s first three years, compared to 99 in Obama’s first three), a trend likely to worsen with the latest staff cuts. The loss of experienced reviewers and compliance staff means less scrutiny of trial protocols, informed consent, and data integrity, potentially exposing participants to greater risk and undermining the credibility of U.S. clinical research.

Delays and Uncertainty for Sponsors

With fewer staff to provide guidance, answer questions, and manage applications, sponsors of clinical trials and new product applications face longer wait times and less predictable review timelines. The loss of informal dispute resolution mechanisms and scientific advisory capacity further complicates the regulatory landscape, making the U.S. a less attractive environment for innovation.

Impact on Good Manufacturing Practices (GMPs)

Inspections and Compliance at Risk

While HHS claims inspectors were not cut, the loss of support staff and administrative personnel is already affecting the FDA’s inspection regime. Inspectors now must handle both investigative and administrative tasks, increasing the risk of missed deficiencies and delayed responses to manufacturing problems. The FDA may increasingly rely on remote, paper-based inspections, which proved less effective during the COVID-19 pandemic and could allow GMP violations to go undetected.

Global Supply Chain Vulnerabilities

The rollback of foreign inspection programs and diminished regulatory science capacity further expose the U.S. to risks from overseas manufacturers, particularly in countries with less robust regulatory oversight. This could lead to more recalls, shortages, and public health emergencies.

A Historic Setback for Public Health

The Trump administration’s first 100 days have left the FDA a shell of its former self. The mass layoffs, firings, and resignations have gutted the agency’s scientific, regulatory, and communications capacity, with immediate and long-term consequences for patient safety, clinical research, and the integrity of the U.S. medical supply. The loss of institutional knowledge, the erosion of oversight, and the retreat from global leadership represent a profound setback for public health-one that will take years, if not decades, to repair.

As former FDA Commissioner Califf put it, “No segment of FDA is untouched. No one knows what the plan is”. The nation-and the world-are watching to see if the agency can recover from this unprecedented upheaval.

Citations:

The Expertise Crisis at the FDA

The ongoing destruction of the U.S. Food and Drug Administration (FDA) through politically driven firings mirrors one of the most catastrophic regulatory failures in modern American history: the 1981 mass termination of air traffic controllers under President Reagan. Like the Federal Aviation Administration (FAA) crisis—which left aviation safety systems crippled for nearly a decade—the FDA’s current Reduction in Force (RIF) has purged irreplaceable expertise, with devastating consequences for public health and institutional memory.

Targeted Firings of FDA Leadership (2025)

The FDA’s decimation began in January 2025 under HHS Secretary Robert F. Kennedy Jr., with these key terminations:

Dr. Peter Marks (CBER Director): Fired March 28 after refusing to dilute vaccine safety standards, stripping the agency of its foremost expert on biologics and pandemic response.
Peter Stein (CDER Office of New Drugs): Terminated April 1 following his rejection of a demotion to a non-scientific role, eliminating critical oversight for rare disease therapies.
Brian King (Center for Tobacco Products): Dismissed April 3 amid efforts to weaken vaping regulations, abandoning enforcement against youth-targeting tobacco firms.
Vid Desai (Chief Information Officer): Axed April 5, sabotaging IT modernization crucial for drug reviews and food recall systems.

Expertise Loss: A Regulatory Time Bomb

The FDA’s crisis parallels the FAA’s 1981 collapse, when Reagan fired 11,345 unionized air traffic controllers. The FAA required five years to restore baseline staffing and 15 years to rebuild institutional knowledge—a delay that contributed to near-misses and fatal crashes like the 1986 Cerritos mid-air collision. Similarly, the FDA now faces:

Brain Drain Accelerating Regulatory Failure

Vaccine review teams lost 40% of senior staff, risking delayed responses to avian flu outbreaks.
Medical device approvals stalled after 50% of AI/ML experts were purged from CDRH.
Food safety labs closed nationwide, mirroring the FAA’s loss of veteran controllers who managed complex airspace.

Training Collapse
Reagan’s FAA scrambled to hire replacements with just 3 months’ training versus the former 3-year apprenticeship. At the FDA, new hires now receive 6 weeks of onboarding compared to the previous 18-month mentorship under experts —a recipe for oversight failures.
Erosion of Public Trust
The FAA’s credibility took a decade to recover post-1981. The FDA’s transparency crisis—with FOIA response times stretching to 18 months and advisory committees disbanded—risks similar long-term distrust in drug safety and food inspections.

Repeating History’s Mistakes

The Reagan-era FAA firings cost $1.3 billion in today’s dollars and required emergency military staffing. The FDA’s RIF—projected to delay drug approvals by 2-3 years—could inflict far greater harm:

Pharmaceutical Impact: 900+ drug applications now languish without senior reviewers, akin to the FAA’s 30% spike in air traffic errors post-1981.
Food Safety: Shuttered labs mirror the FAA’s closed control towers, with state inspectors reporting a 45% drop in FDA support for outbreak investigations.
Replacement Challenges: Like the FAA’s struggle to attract talent after 1981, the FDA’s politicized environment deters top scientists. Only 12% of open roles have qualified applicants, per April 2025 HHS data.

A Preventable Disaster Motivated by Bad Politics

The FDA’s expertise purge replicates the FAA’s darkest chapter—but with higher stakes. While the FAA’s recovery took 15 years, the FDA’s specialized work in gene therapies, pandemic preparedness, and AI-driven devices cannot withstand such a timeline without catastrophic public health consequences. Commissioner Marty Makary now presides over a skeleton crew ill-equipped to prevent the next opioid crisis, foodborne outbreak, or unsafe medical device. Without immediate congressional intervention to reverse these firings, Americans face a future where regulatory failures become routine, and trust in public health institutions joins aviation safety circa 1981 in the annals of preventable disasters.

The FDA and HHS Layoffs: A Catastrophic Blow to Public Health, Science, and Transparency

The recent mass layoffs at the Food and Drug Administration (FDA) and other agencies under the Department of Health and Human Services (HHS) represent a seismic shift in the U.S. public health landscape. These actions, spearheaded by HHS Secretary Robert F. Kennedy Jr., are not just a bureaucratic reshuffle—they are a direct assault on public health, the pharmaceutical and medical device industries, and the very principles of scientific inquiry and transparency.

Impact on Public Health

The decision to lay off 10,000 employees across HHS, including 3,500 at the FDA, is a reckless gamble with public health. These cuts come at a time when the nation faces complex challenges such as emerging infectious diseases, the regulation of cutting-edge medical technologies, and the ongoing need for robust food safety measures. The FDA’s ability to approve new drugs, monitor post-market safety, and evaluate medical devices has been severely compromised. Entire teams responsible for drug approvals and post-market surveillance have been gutted, leaving critical regulatory gaps that could jeopardize patient safety.

The layoffs have also disproportionately affected specialized areas like artificial intelligence (AI) in medical devices—a field that requires high levels of expertise due to its complexity. With half of the AI-focused staff at the FDA’s Center for Devices and Radiological Health (CDRH) terminated, delays in approving life-saving innovations are inevitable. Medical device companies are already reporting disruptions in their interactions with the FDA, with meetings canceled due to the absence of key reviewers.

The Fallout for Industry

Pharmaceutical and medical device manufacturers are facing an unprecedented regulatory bottleneck. The layoffs have introduced significant delays in product approvals, with some industry insiders estimating that timelines could stretch by months or even years. This is not just an inconvenience for companies; it directly impacts patients waiting for new treatments and technologies. The uncertainty is compounded by the elimination of entire communications teams at the FDA, leaving stakeholders without clear channels to navigate this chaotic environment.

Undermining Science

Science thrives on stability and expertise—both of which have been decimated by these layoffs. The FDA and NIH have long been global leaders in biomedical research and innovation. By removing experienced scientists, regulators, and administrators en masse, these agencies are being hollowed out at their core. This is not just a loss for the U.S.; it weakens global public health efforts that rely on American leadership in research and regulation.

Transparency Under Siege

Perhaps most egregious is how these changes undermine transparency—a principle Secretary Kennedy himself pledged to uphold through “radical transparency.” Instead, we see a systematic erosion of public accountability:

FOIA Offices Gutted: The FDA’s Freedom of Information Act (FOIA) office has been severely impacted, with many officers laid off or reassigned. At other agencies like the CDC, FOIA offices have reportedly been shuttered entirely. This makes it nearly impossible for journalists, researchers, and citizens to access critical information about government operations.
Public Meetings Canceled: Advisory committee meetings that traditionally allow public input on vaccine recommendations and other health policies have been postponed or canceled without explanation.
Opaque Decision-Making: HHS has increasingly relied on administrative maneuvers to bypass public comment periods required under federal law. This creates a “fait accompli” system where stakeholders only learn about policy changes after they are implemented.

These actions betray not only Kennedy’s promises but also the foundational principles of democratic governance. FOIA exists to ensure an informed citizenry capable of holding its government accountable—a safeguard now dangerously weakened.

A Call to Action

The layoffs at HHS and FDA are more than just a bureaucratic reshuffling—they are an existential threat to public health infrastructure, scientific progress, and governmental transparency. These cuts may save $1.8 billion annually—a mere 0.1% of HHS’s budget—but they come at an incalculable cost to human lives and societal trust. The pharmaceutical industry cannot function effectively without a competent regulatory partner; public health cannot flourish without transparent governance; science cannot advance without institutional support.

This is not reform—it is sabotage disguised as efficiency. It is time for Congress, industry leaders, public health advocates, and every concerned citizen to demand accountability before this crisis deepens further.