On April 1, the Trump administration began making sweeping changes to the U.S. Department of Health and Human Services (HHS) by firing thousands of staff, some of whom learned of this decision when they arrived at work on Tuesday morning and were not allowed to enter the building. According to HHS, the administration plans to reduce the HHS workforce from 82,000 full-time employees to 62,000. It is also consolidating the current 28 divisions into 15 divisions, and eliminating five of the 10 regional offices in the United States, among other changes.
HHS Secretary Robert F. Kennedy Jr. framed these changes as part of his “Make America Healthy Again” agenda, citing recent declines in life expectancy, while neglecting to mention that those declines were largely due to the COVID-19 pandemic. The Trump administration’s stated goals are to streamline HHS, save taxpayer money, focus more on chronic illness, and make HHS more responsive and efficient. It claims it can make these reforms without impacting critical services. In practice, however, the administration has cut essential funding that was helping states and cities prepare for outbreaks; reassigned leaders who were stopping biological threats in other countries from spreading; undermined the United States’ ability to quickly review and approve treatments and vaccines during an emergency; and disrupted essential work to create vaccines, tests, and treatments for dangerous diseases. These approaches do not make America healthy. They make America less safe.
How HHS Protects Americans from Biological Threats
HHS is home to much of the country’s biological readiness. Biological threats come from different sources, including naturally occurring threats such as measles and bird flu, biosafety risks in laboratories, and the potential for deliberate attacks by adversaries seeking to do harm. These risks are growing amid rapid environmental and technological changes. The planned cuts to HHS include a range of offices that are critical to U.S. national security, including cutting 2,400 staff from the U.S. Centers for Disease Control and Prevention (CDC), 3,500 staff from the Food and Drug Administration (FDA), and 1,200 staff from the National Institutes of Health (NIH). The plans also include moving many functions of the Administration for Strategic Preparedness and Response (ASPR) to the CDC, and consolidating the Biomedical Advanced Research and Development Authority (BARDA) into a newly proposed “Office of Healthy Futures.”
Although Kennedy has described these critical functions as an “alphabet soup of departments,” they bring enormous health and national security benefits to the American people. ASPR is charged with anticipating threats that might face Americans and making sure the country has the tools it needs to respond. The CDC is home to disease detectives, who work around the clock to protect Americans’ health and safety by preventing and responding to disease threats. NIH leads the world in biomedical research, investing in innovative breakthroughs that have saved millions of lives and improved health for Americans. The FDA makes sure that the medicines Americans take, and give to their children, are safe and effective. Each of these agencies has historically been the envy of the rest of the world and the model on which many countries have built their own systems. Eliminating these offices, throwing them into chaos, or undermining their missions, is equivalent to unilateral disarmament against biological threats. To invoke Oscar Wilde’s definition of a cynic, those making these cuts seem to know the price of everything and the value of nothing.
Preventing Biological Catastrophes in America
In response to 9/11 and the 2001 anthrax attacks, the George W. Bush administration and Congress reimagined the United States’ biodefenses, creating new positions and programs largely housed at HHS. The government has tweaked those programs after many biological disasters, and they have delivered security benefits – seen and unseen – for the American people, from Ebola response to Operation Warp Speed, the U.S. program to develop and manufacture COVID-19 vaccines. Coming out of the pandemic, is it once again time to accelerate the country’s biodefense programs? Yes. Is it time to take a sledgehammer to them, as threats of bird flu and measles spread at home, and outbreaks of Ebola and mpox continue abroad? Absolutely not.
Being ready for a biological catastrophe requires investing in research, manufacturing, and rapid response capacity. It includes understanding where new threats are emerging, developing countermeasures to address those threats, and stockpiling and quickly moving those countermeasures around the country in an emergency. Despite the critical role that NIH and ASPR play in preparedness for biological threats, the Trump administration placed the director of the National Institute of Allergy and Infectious Diseases (NIAID) on leave, in addition to firing thousands of staff. Dozens of people were reportedly fired from ASPR and BARDA, including some who train and prepare state and local officials to use medicines and equipment from the strategic national stockpile during emergencies. The administration also ousted the nation’s chief vaccine regulator. Meanwhile, HHS is re-evaluating its investment in vital new bird flu countermeasures, while political officials insert themselves into scientific assessments of COVID-19 vaccines.
Being ready for the next health crisis also means stopping outbreaks at their source whenever possible, and many threats emerge outside the United States. The 2014 Ebola epidemic and the COVID-19 pandemic taught us that deadly disease threats can impact American communities and take down healthcare systems, as well as take millions of lives. Both these outbreaks led the United States to double down on health security programs abroad focused on detecting threats early and responding rapidly and effectively. Through CDC’s international work, U.S. experts have trained disease detectives around the world for nearly 50 years to quickly identify and contain threats at their source, reducing the burden on the United States to respond to every threat, and keeping Americans safe. Yet this week’s staffing changes included workers at CDC’s Center for Global Health, with speculation that the Center may be eliminated completely. The USAID global health security team, which has also been eliminated, also spent decades building the capacity, supplies, and tools to assist countries around the world in order to keep these outbreaks from impacting Americans at home. Taken together, these programs – both at CDC and USAID – ensured that the 12 Ebola or Marburg outbreaks that occurred during the Biden administration did not reach U.S. shores.
Rapid Response
Biological threats are common, as evidenced by the ongoing measles and bird flu outbreaks in the United States, the Ebola outbreak in Uganda, and the global HIV/AIDS epidemic. Although some threats can be anticipated and planned for, like seasonal influenza, others, like COVID-19, emerge unexpectedly and require a rapid coordinated response. Having an emergency response plan in place before a crisis occurs determines the speed and effectiveness of that response. Without one, there can be devastating health and economic consequences.
At best, the massive disruptions to HHS will cause confusion about roles and responsibilities during biological emergencies. At worst, and more likely, these disruptions will cost lives by eliminating the very staff and capacities that are critical to moving fast and keeping Americans safe in an emergency. If Kennedy were to get a call tomorrow that a novel threat, such as a new respiratory virus, has been detected somewhere in the world, what would he do to prepare the United States? How would he and his team communicate effectively with state and local health authorities, who are reeling from massive budget cuts and the closing of regional offices? Where would he turn for the latest research on vaccines and treatments for those viruses? And who would he ask about the inventory in the Strategic National Stockpile to respond to the threat? Perhaps most importantly, how would CDC—and HHS more broadly—communicate to the American people about the threat and the measures needed to stay safe? The Trump administration’s actions have thrown HHS into a state of chaos that is unlikely to be settled soon, while biological threats will continue to pose a relentless risk to us all.
Biological Deterrence
Just as the United States deters military attacks through the strength of its military, it deters deliberate biological threats through the strength of its preparedness, detection, and response systems. Although there are efficiencies to be found within any bureaucracy, these sweeping changes send a signal of chaos rather than competence. Many of HHS’s biodefense authorities were created in the aftermath of 9/11 and the anthrax attacks that followed, and they were meant to indicate that the United States was prepared for any biological crisis, whether naturally occurring or intentional. Now the United States is telling its adversaries that it is ill-prepared to detect and respond to a health emergency. That leaves the country’s experts and the public vulnerable. Of course, the nation’s biological threat deterrence doesn’t end with HHS, but the Trump administration has abolished USAID as well, and signaled cuts to the premier Department of Defense effort to counter biological, chemical, nuclear, and radiological threats. With the biological threat reduction staff and programs across HHS, DOD, and USAID at risk, this administration is playing a very dangerous game.
What to Watch for
The administration claims the layoffs of thousands of people and the massive restructuring of agencies will not disrupt existing services. That seems unlikely given the scale and pace of the changes. In the coming weeks and months, certain indicators will tell us whether the United States is prepared for biological threats.
First, how is the U.S. government handling existing threats? As these cuts ripple across the country, Americans should pay attention to how effectively HHS, along with other federal agencies, is handling bird flu, measles, seasonal influenza, HIV, and other infectious diseases. In fact, vaccinating 95 percent of 12-month-olds against measles is one indicator of pandemic preparedness that the United States has encouraged other countries to adopt. Local HIV advocates have already started raising alarms over the impact of potential cuts to HIV prevention programs and services, even with a “miracle” HIV prevention drug on the horizon. If the United States is unable to manage known threats, how will it manage a new emergency?
Second, how are local health systems faring? The recent rescissions for state and local health authorities are leaving communities across the country high and dry as they struggle to respond to deadly threats from measles to bird flu. Just as mass layoffs at HHS were announced, the attorneys general and governors in 23 states and Washington, D.C., filed a lawsuit against HHS alleging that the revocation of more than $11 billion in federal funding previously allocated to states will cause “immediate and irreparable damage in communities across the nation.” The funding was intended, in part, for programs to combat infectious disease outbreaks and address future health emergencies. Beyond immediate responses to emerging threats, these funds were also being used to strengthen health systems, including hospitals, clinics and long term care facilities, building on lessons in surge capacity and response from COVID-19. The operations of these systems are the foundation on which any new threat will be detected, and any effective response will be built.
Third, is there a new preparedness plan in place? Before the Trump administration began gutting U.S. biodefenses, the Biden administration finalized a playbook for outbreak response that was developed and refined across administrations. It included clear options, plans, and roles for responding to biological threats, regardless of the origin of the threat. With the elimination of USAID, the restructuring of HHS, and other changes across the federal government, the Trump administration will need to update or develop a new playbook to guide an effective response with the new teams in place. Without it, the federal government will be left defenseless and scrambling to figure out who is in charge in an emergency, rather than acting quickly to protect Americans.
Editor’s note: This piece is part of the Collection: Just Security’s Coverage of the Trump Administration’s Executive Actions