Because the U.S. is now the country where the surgeon general of the Louisiana Department of Health can cause a whooping cough outbreak in Louisiana, get caught by local journalists trying to cover up the deaths of infants that occured, and then instead of being fired in disgrace from his state level job, he's promoted to number 2 at the CDC.
You know how it's SOP in any merit based field where you really fucked up at the state level, and they send you off to do the same at a national level.