Chaos and Consequences: The Impact of Mass Firings and Funding Delays on US Federal Health Agencies

Introduction: A Crisis in Federal Health Agencies

The first month of the Trump administration has brought unprecedented chaos to federal health agencies, including the Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and the National Institutes of Health (NIH). Mass firings, funding interruptions, and communication freezes have disrupted critical public health efforts, leaving employees and experts concerned about the deadly consequences of these actions. The country is currently battling multiple health crises, including a historic measles outbreak in West Texas, the worst seasonal flu in over a decade, and the ever-present threat of bird flu. Dr. Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at Brown University, warns that continued disruptions could have deadly consequences.

Mass Firings and Their Devastating Impact on Employees

Since February 14, over 700 employees at the CDC and FDA, and 1,100 at the NIH, have been fired. These cuts disproportionately targeted probationary employees, including medical device reviewers, food safety experts, lab fellows focused on infectious diseases, and specialists working on maternal health. Many of these employees were in their probationary periods because they had taken on new roles within the past two years. Despite receiving high performance reviews, some were terminated with letters citing poor performance, a contradiction that has left many questioning the fairness of the process.

One CDC employee, who spoke anonymously, shared her devastation, stating that the vital work she and her colleagues had dedicated themselves to was being "mocked, devalued, and criticized." Another FDA employee described feeling "abandoned" but expressed his eagerness to return to work to serve the American people. These stories highlight the personal and professional toll of the firings, as many of these employees chose government work over higher-paying jobs in the private sector to contribute to public service.

The Broader Consequences for Public Health Missions

The firings have raised concerns about the ability of federal health agencies to fulfill their critical missions. The FDA’s cuts, for example, have alarmed the medical technology industry, with AdvaMed, a trade association, warning that the loss of expertise could negatively impact patient care. Similarly, the CDC’s terminations have affected programs like the Epidemic Intelligence Service (EIS), which has been instrumental in responding to public health emergencies since the 1950s. While the EIS was spared after public outcry, other training programs, such as the Public Health Associate Program and the Laboratory Leadership Service, were not as fortunate.

Dr. Richard Besser, president of the Robert Wood Johnson Foundation and former acting director of the CDC, called the cuts to these programs "incredibly short-sighted," emphasizing their role in identifying infectious diseases, tracking antibiotic resistance, and monitoring viruses like bird flu. The terminations have also disrupted local public health efforts, with the Big Cities Health Coalition warning that the loss of "boots on the ground" in communities across the country puts public health at risk.

Leadership in Crisis: Resignations and Retaliation

The chaos within federal health agencies has extended to leadership ranks. Jim Jones, the FDA’s deputy commissioner for human foods, resigned after 89 employees on his team were fired. At the CDC, Dr. Nirav Shah, the acting principal deputy director, announced his departure, while at the NIH, Deputy Director Dr. Lawrence Tabak and Dr. Michael Lauer, deputy director for extramural research, announced their retirements. Sources within the NIH expressed skepticism about the voluntary nature of these departures, suggesting that other leaders may be forced out.

Meanwhile, some agencies have realized the importance of reversing certain terminations. The CDC has sought to rescind firings of employees with critical roles, and the US Department of Agriculture is working to reinstate workers essential to the nation’s bird flu response. However, the damage may already be done, as fired employees were often locked out of agency systems so quickly that they couldn’t transfer their knowledge to remaining staff.

Funding Delays and the Freeze on Communication

The disruptions extend beyond firings. A communications pause implemented in the early days of the Trump administration has delayed crucial meetings and funding decisions. For example, a key advisory board meeting for the National Cancer Institute was canceled, potentially delaying $200 million in cancer research funding. Even approved grants are on hold, with one Nobel laureate warning that he may have to lay off staff if funding isn’t released soon.

Researchers are also bracing for potential cuts to the NIH’s funding of indirect costs, which are essential for supporting research infrastructure. The academic and medical communities have pushed back against this proposal, arguing that it would undermine the US’s position as a global leader in scientific research. A temporary restraining order is currently in place while a judge considers lawsuits challenging the policy.

The Future of Public Health Under New Leadership

Much of the chaos in federal health agencies predates the arrival of Robert F. Kennedy Jr., the new HHS secretary and a well-known anti-vaccine advocate. However, public health experts fear that Kennedy’s leadership will only exacerbate the challenges. Kennedy has already sparked concerns by delaying a key meeting of vaccine advisers to the CDC, raising fears that he may interfere with the established process for making vaccine recommendations.

Dr. Amesh Adalja of the Johns Hopkins Center for Health Security warned that Kennedy’s leadership could make it more difficult to control infectious disease outbreaks, particularly given his skepticism of germ theory and his calls to pause infectious disease work. As the US faces some of the most significant public health challenges in decades, the ability of federal agencies to respond effectively is more critical than ever. The continued instability within these agencies threatens not only the careers of dedicated public servants but also the health and safety of the American people.