April 10, 2025, 3 p.m.
With grant terminations and massive layoffs at the Centers for Disease Control and Prevention, experts and advocates are worried about the future of the U.S. public health system.
The Health and Human Services Department last week began executing plans to lay off 10,000 employees, with 2,400 employees coming out of the CDC. That’s on top of other cuts among probationary employees that occurred earlier this year.
Simultaneously, CDC terminated a wide swath of grants going out to state and local health departments, including dollars that support immunization efforts, epidemiological and laboratory resources, and community health workers.
David Fleming, chair of the Advisory Committee to the Director of the CDC, described what is happening at the agency as a “quiet but very severe public health crisis.”
“The actions that the administration has undertaken is reversing decades of work and knowledge at the premier, up until now, prevention agency in the world,” said Fleming. “But CDC has been effectively destroyed in the past two weeks.”
In Texas, where measles cases recently surpassed 500 and two school-aged children have died of the disease, grant terminations could total $550 million for the Department of State Health Services and the organizations it contracts with, including local health agencies and universities, said Chris Van Deusen, a spokesperson for DSHS. He said the department is looking to see if other sources could replace some of the terminated dollars.
The Washington State Department of Health was informed by CDC on March 24 that multiple grants—totaling at least $140 million—were being terminated immediately.
“This funding has been essential in supporting critical public health systems, including disease monitoring, reporting, and vaccine efforts for COVID-19 and other respiratory viruses,” said Shelby Anderson, a spokesperson for the department, in an email to the National Journal.
Anderson said one of the grants supports work of 150 full-time employees, and the loss of funding “would weaken the state’s ability to respond to outbreaks such as Mpox, measles, and H5N1 (bird flu).”
Currently, the termination of $11 billion in public health funding, including from CDC, has been paused due to a temporary restraining order issued last week by a Rhode Island district judge, but only for the 23 states that brought the suit, including Washington. Anderson said the state’s health department is working with the governor’s and state attorney general’s offices to understand the implications of the court order.
“This administration’s attacks on public health are not over, but today’s order should give Washingtonians confidence that programs that prevent the spread of infectious diseases, support mental health and get people out of substance abuse will continue to be funded for now,” Washington state Attorney General Nick Brown said in a statement last week.
Adriane Casalotti, chief of public and government affairs at the National Association of County and City Health Officials, told National Journal that the association was assessing the impacts of the March 24 grant terminations.
“That has directly led to people losing their jobs in communities across the country, programs stopping in their tracks, and future efforts that were planned not happening,” she said. “That includes significant impacts to work like global vaccination clinics, work like foodborne illness programs, work like keeping people safe in nursing homes from preventable spread of disease, and losing skillsets like epidemiologists and nurses.”
Casalotti said the restraining order is an “important step in the judicial process but it in no way fixes what has already occurred.”
When it comes to staffing cuts, HHS has not provided details of the programs that have been affected, but lawmakers, experts, and advocates are worried about what this could mean for public health.
On the day of the layoffs, several Senate Democrats sent a letter to HHS Secretary Robert F. Kennedy Jr. denouncing the cuts across the department, including CDC.
"In focusing CDC’s mission solely on infectious diseases, Americans will lose access to chronic disease prevention programs across the country, including breast and cervical screening services for low-income women, which provided screenings for 1.5 million women over a five-year period,” they wrote.
The Senate Democrats also argued that the cuts in staffing “will devastate state and local health departments who are on the front lines of promoting and protecting Americans’ health.”
Fleming, the advisory-committee chair, expressed frustration at the “secrecy” by which staffing reductions and program eliminations are occurring. “The leadership at CDC that runs the agency and makes sure that it is working has essentially been decapitated,” he said. “In the last two weeks, a majority of high-level CDC leaders have either resigned or have been fired.”
He said the advisory committee was not learning about these layoffs from the agency, but rather from the media or from former staff that are speaking out.
Fleming, a clinical associate professor at the University of Washington, sent a letter with other advisory-committee members to Kennedy last week describing their concerns about the layoffs.
“These sweeping reductions inflict such extensive harm that it is impossible to fully capture their impact in brief—each undermines different critical public health functions in profound ways,” they wrote.
They listed affected CDC programs, including ones focused on asthma, HIV, tobacco use, violence prevention, and work safety.
“Logic and law dictate you suspend these actions until you engage Congress, which has legally authorized the programs you are proposing to eliminate,” the committee members wrote. “There are far less damaging and more cost-effective approaches to keeping America safe and healthy.”
