5 Ways the Chaos at HHS Could Affect Your Community’s Health

 The Equation Read More 

As a molecular biology PhD student studying heart disease, I’ve seen firsthand how basic scientific findings can eventually translate into promising therapies. But as important as it is, biomedical research is only one piece of the puzzle when it comes to curing the number one killer in the US. Public health initiatives like nutrition education and assistance, tobacco regulation, and diabetes prevention programs also support the work of scientists and medical doctors working to tackle heart disease. This federally-funded health ecosystem—public health, biomedical research, clinical trials, and drug approval—will all be affected by recent personnel cuts at the U.S. Department of Health and Human Services (HHS).

On March 27, HHS Secretary Robert F. Kennedy, Jr. announced what he called HHS’ Transformation to Make America Healthy Again. It’s a large-scale restructuring and reduction of the Department, and its centers and institutes, to follow President Trump’s DOGE Executive Order. HHS is a large federal agency that includes, among other sub-agencies, the National Institutes of Health (NIH), the Centers for Disease Control (CDC), the Food and Drug Administration (FDA), the Health Resources and Services Administration (HRSA), and the Centers for Medicare and Medicaid Services (CMS). Layoffs of 20,000 employees—one-quarter of the current HHS workforce—began on April 1st.

It’s not yet clear what the effects of eliminating so many positions and offices at these agencies will be: new, consolidated offices may be formed, remaining offices may absorb some of the work of eliminated offices, or the work of eliminated offices may simply be abandoned (perhaps the most likely outcome, given the chaotic implementation). Although it is still a developing situation, here is what slashing the public health workforce could mean for science and Americans’ health.

Despite RFK’s pledge to “Make America Healthy Again”, he is ordering the CDC to begin shrinking, and in some cases eliminating, infectious disease offices. These actions have hit HIV prevention and treatment efforts especially hard, through the deep cuts at the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP) and the Global Health Center’s Division of Global HIV and Tuberculosis. With the near elimination of the NCHHSTP’s Division for HIV Prevention, a division dedicated to the goal of “No New HIV Infections,” cities and states that rely on federal grants and technical assistance to distribute HIV-prevention medication could experience planning disruptions, potentially leading to increased incidence of preventable infection.

Local health departments in Texas have already been forced to cancel measles vaccination events. City and county health departments, like those in Dallas, work to protect against the spread of disease, injuries, and environmental hazards, like ensuring that water is safe to drink after a natural disaster. They also work to promote healthy behaviors and increase the quality and accessibility of health services. To do this, they rely on federal data, funding, and expertise—which has been severely disrupted due to the layoffs and canceled CDC grants and contracts. Vaccination efforts may also be hindered by the staffing reductions at the National Center for Immunization and Respiratory Diseases’ Immunization Services Division, which administers the Vaccines for Children Program (preventing nearly 30 million hospitalizations since 1994) and studies vaccine delivery, uptake, and effectiveness. Testing and tracking efforts targeting the bird flu, which has been ravaging avian populations and poses a risk to humans and house cats via unpasteurized milk, may be affected by layoffs in the FDA’s Center for Veterinary Medicine, which has already warned staff that the center may face “significant challenges and delays.”

A recent spate of grant terminations for infectious disease response and research have compounded the challenges posed by staffing reductions. On March 25, the CDC canceled $11.4 billion in COVID-19 grants to state and local health departments that were not set to expire for another 6 months. Despite HHS’s statement that COVID-19 is a “non-existent pandemic that Americans moved on from years ago,” the virus remains a public health issue, killing 8,324 Americans in the past three months. Terminating some health departments’ COVID-19 testing and tracking programs could also impact their ability to track other diseases, like the flu and measles. Biomedical researchers have also had NIH grants pulled for infectious disease-related projects. A crowdsourced grant termination tracker indicates that nearly 50% of the 754 NIH grants canceled in the past several weeks pertained to vaccines, HIV, or COVID-19. These grant terminations, paired with the layoffs of infectious disease researchers within HHS, echo RFK Jr.’s  unsettling statements as a Presidential candidate: “I’m gonna say to NIH scientists, God bless you all… We’re going to give infectious disease a break for about eight years.”

Despite Secretary Kennedy’s assertion that the goal of the Making America Healthy Again agenda is “ending the chronic disease epidemic,” downsizing HHS hinders chronic disease research and prevention. Large swathes of the CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), a center that focuses on environmental, clinical, and educational interventions to prevent and manage chronic illnesses, were axed. Because the Center grants over 75% of its budget to fund state, local, and tribal efforts to measure and prevent chronic diseases in their communities, restructuring activity is likely disrupting funding sources for local public health initiatives. NIH layoffs at institutes that study cancer, stroke, neurological disorders, diabetes, and aging also threaten the continuity of basic research and clinical trials that provide hope to those living with chronic diseases.

The restructuring of HHS may also compromise smoking research and regulation, in what former CDC Director Dr. Tom Frieden calls a “gift to Big Tobacco.” The NCCDPHP’s Office of Smoking and Health, also gutted in the restructuring process, is a leader in tobacco research and public health campaigns for smoking cessation. The FDA’s Center for Tobacco Products has also been heavily impacted: Kennedy put the Director, Dr. Brian King, on administrative leave, along with other Center leaders in the Office of Management, Office of Health Communication & Education, Office of Regulations, Office of Compliance and Enforcement, and Office of Science. The Center regulates the manufacture, distribution, and marketing of tobacco products and educates the public about their dangers. Given that smoking remains the primary cause of preventable death in the US, deregulation of tobacco products or a decline in federally-funded cessation efforts could have deadly consequences.

The near-total elimination of CDC centers like the National Center for Environmental Health (NCEH) and the National Institute of Occupational Safety and Health (NIOSH) will make it much harder to monitor and respond to environmental health and occupational safety hazards. The NCEH coordinates programs to protect Americans from health hazards like natural disasters and severe weather, poor air quality and asthma, lead poisoning, and radiation exposure. Already, the cuts to the NCEH’s lead program have left Milwaukee schools without CDC expertise and guidance in dealing with a lead poisoning investigation. The NCEH’s Environmental Public Health Tracking Program funds 33 states to consolidate data from local, state, and national levels to monitor, display, and assess health risks for public health officials.

The NCEH also runs the National Biomonitoring Program, which monitors human exposure to various environmental chemicals to alert regulators to abnormalities. Given the reduction of the NCEH, it’s not immediately clear what the future of these programs will be. NIOSH investigates job-related health hazards and how to prevent them and provides evidence-based recommendations to the Occupational Safety and Health Administration to protect workers. NIOSH programs affected by staffing cuts include the National Personal Protective Technology Laboratory, the Risk Evaluation Branch, the Office of Agriculture Safety and Health, and Miner Safety, among others. These layoffs could mean lapses in black lung monitoring and treatment, personal protective equipment certification, and research on chemical exposure limits. According to HHS, a new Administration for a Healthy America (AHA) office will include divisions of Environmental Health and the Workforce, suggesting that some NIOSH and NCEH projects may be included in the AHA, but no specific details about the structure or function of the AHA have been released. These actions, taken together with FDA cuts (described below) and recent deregulation at the Environmental Protection Agency, suggest that Americans should be increasingly concerned about exposure to health-harming substances in their environment and workplaces, which goes against the administration’s promises to eliminate “environmental toxins.”

The FDA has also experienced deep cuts, including leadership positions in food safety, drug evaluation, and information technology offices. Although HHS asserts that the restructuring will not directly impact FDA reviewers and inspectors (those who review scientific data submitted by applicants or assess regulatory compliance), shaking up FDA leadership and reducing administrative operations may make it harder for reviewers and investigators to do their jobs, resulting in potential delays in approvals of new drugs or medical devices. Vaccine recommendations may also face logistical difficulties, given the layoffs of FDA staff supporting the Vaccines and Related Biological Products Advisory Committee. The elimination of many policy offices could also spell trouble for companies seeking FDA approval, who often rely on the expertise of those offices to help navigate the new drug or medical device application process.

Americans – including those who work at HHS – haven’t heard much from the agency about what positions were cut and how this will affect HHS services and operations. A quick scan of a crowdsourced document of offices impacted by the reductions in staffing reveals that this may be because many were communications and media offices across HHS. These include offices that handle requests under the Freedom of Information Act (FOIA). A “FOIA” request allows people to obtain government documents and data that may not be on their website; it is the public’s access to the government’s work. This is a move that threatens transparency and accountability. American taxpayers, who have grown accustomed to communication from the health agencies they fund, may find themselves frustrated by a relative lack of public information and engagement going forward. Kennedy is also spearheading efforts to introduce misinformation into official HHS websites and reduce public comment opportunities on HHS decisions.

The dust is still settling from the massive changes at HHS, and it is too early to know the extent of the impacts on public health, biomedical research, and innovation. Despite Senator Cassidy’s invitation to testify before the Senate Health, Education, Labor, and Pensions committee, RFK Jr. has so far ignored attempts at oversight. So if you are concerned that the reduction in force will create lapses in Americans’ public health and safety, contact your Congresspeople to demand transparency from HHS about the effects of the staff reductions on their communities.

Natalie Gehred is a PhD Candidate in Molecular Biology at UCLA and a Science Policy Intern at the Union of Concerned Scientists through the National Science Policy Network. Natalie studies cardiac scarring in heart failure and is interested in evidence-based healthcare and health policy.