Washington

Four of the main health administration jobs in the US government are now vacant, following Jeffrey Koplan's resignation as director of the Centers for Disease Control and Prevention (CDC) on 21 February.

As well as the CDC, the National Institutes of Health (NIH) and the Food and Drug Administration are without permanent directors. The figurehead position of surgeon general — who offers health advice to the US public — fell vacant a few weeks ago with the departure of David Satcher.

The vacancies are a source of mounting concern to health advocates, who say that the situation will take its toll on biomedical research and public health. “It's just a glaring gap in scientific leadership at a critical time,” says Tony Mazzaschi, associate vice-president for research at the Association of American Medical Colleges.

But Bill Hall, a spokesman for health secretary Tommy Thompson, says: “We have very, very competent people who are acting in those positions right now and who are doing a fantastic job.”

Nevertheless, the NIH has been without a permanent director for more than two years. And in the past week Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), has fallen out of the running for the NIH's top job. White House officials say this was because he wanted to maintain his job at the NIAID while serving as NIH director — but others contend that conservatives spiked his nomination because of his past support for fetal-tissue research.

Elias Zerhouni, a radiologist and senior administrator at Johns Hopkins University School of Medicine in Baltimore, Maryland, is now being floated as a contender for the post. But he inspired a new centre at Johns Hopkins that conducts embryonic stem-cell research, and looks as vulnerable as anyone to the political machinations that are holding up health-related appointments.