Mass HHS layoffs sow ‘chaos,’ make US less safe, experts say
Key takeaways:
- HHS began laying off 20,000 workers from various health agencies.
- The layoffs are part of a raft of cuts to the nation’s health care infrastructure that has alarmed experts.
The mass layoffs initiated by HHS this week, including in the upper echelons of the NIH, have sowed chaos and will make Americans less safe from disease, experts warned.
In a statement, the Infectious Diseases Society of American lamented what it called a “profound loss” of critical expertise at HHS. The layoffs apparently reached the top of several institutes at the NIH, including the director of the National Institute of Allergy and Infectious Diseases (NIAID).
“We cannot do the complex and serious work of protecting Americans from infectious diseases amid this chaos and confusion,” Infectious Diseases Society of America president Tina Tan, MD, said in a statement.
HHS announced last Friday that 20,000 layoffs were coming to the various agencies it oversees as the head of the nation’s health care apparatus. The layoffs are part of what HHS called a “dramatic restructuring” meant to align with the Trump administration’s stated goal of dramatically downsizing the federal government.
The plan is to reduce the number of full-time HHS employees to 62,000, consolidate 28 divisions into 15 and halve the number of regional offices to 10, the department said. Cuts at the CDC, FDA, NIH and CMS include reductions in workforce, which have already begun.
According to reports, among those who were laid off or offered reassignment on Tuesday was NIAID director Jeanne M. Marrazzo, MD, MPH, who was chosen in 2023 to succeed Anthony S. Fauci, MD, as the country’s top infectious diseases doctor. Bloomberg reported that Marrazzo was offered a reassignment to the Indian Health Service division.
The directors of the NIH’s National Institute of Child Health and Human Development, the National Institute on Minority Health and Health Disparities and the National Institute of Nursing Research also were offered reassignments to the Indian Health Service “as part of a broader effort to strengthen the Department and more effectively promote the health of the American people,” according to a letter obtained by Nature.
The New York Times reported that Fauci’s wife, Christine Grady, PhD, MSN, a senior investigator in the NIH’s department of bioethics, also was reassigned, as was H. Clifford Lane, MD, director of the NIAID’s clinical research division.
Emily Erbelding, MD, MPH, director of the NIAID’s Division of Microbiology and Infectious Diseases, told The Washington Post that she was also put on leave and offered a job with the Indian Health Service.
“It’s a lot of leadership out the door, really suddenly and without even the opportunity to plan for some succession,” Erbelding told the Post.
According to CNN and other outlets, the layoffs hit CDC divisions focused on global health, HIV, injury prevention, STIs, tuberculosis and workplace safety. The New York Times reported that communications offices at the CDC, FDA and elsewhere also were downsized, and that NIH’s communications director Renate Myles was reassigned. According to the paper, the director of the FDA’s Center for Tobacco Products, Brian King, PhD, MPH, was also reassigned, just days after the agency’s top vaccine regulator, Peter Marks, MD, PhD, retired as director of the Center for Biologics Evaluation and Research. Marks was under pressure to resign or be fired, the Wall Street Journal first reported.
“The FDA as we’ve known it is finished, with most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed,” former FDA commissioner, Robert Califf, MD, wrote on LinkedIn.
“I believe that history will see this a huge mistake,” Califf wrote. “I will be glad if I’m proven wrong, but even then there is no good reason to treat people this way. It will be interesting to hear from the new leadership how they plan to put ‘Humpty Dumpty’ back together again.”
Multiple messages to HHS seeking confirmation of the layoffs and answers to questions about them were not returned. We also reached out to Marrazzo, a former member of the Healio | Infectious Disease News Editorial Board, but have not heard back.
On the social media platform X, HHS Secretary Robert F. Kennedy Jr. reiterated that the layoffs were part of an “overhaul” to realign HHS to end the country’s chronic diseases epidemic.
“This is a difficult moment for all of us at HHS,” Kennedy wrote. “Our hearts go out to those who have lost their jobs. But the reality is clear: what we’ve been doing isn’t working. Despite spending $1.9 trillion in annual costs, Americans are getting sicker every year. In the past four years alone, the agency’s budget has grown by 38% — yet outcomes continue to decline. We must shift course. HHS needs to be recalibrated to emphasize prevention, not just sick care. These changes will not affect Medicare, Medicaid, or other essential health services.”
The layoffs occurred on the first day of work for NIH Director Jay Bhattacharya, MD, PhD, and FDA Commissioner Martin A. Makary, MD, MPH, who were confirmed by the Senate last week. (The CDC is still without a full-time director, although the administration has announced a new nominee for that post.)
Democratic lawmakers said the administration was illegally trying to “unilaterally weaken and reorganize HHS” by ignoring funding set aside in the funding bill passed by Congress and signed by the president last month.
“The ... reorganization completely disregards how Congress appropriated funding. The reorganization seeks to illegally eliminate agencies Congress explicitly appropriated funding for and illegally move functions and programs for which Congress explicitly appropriated funding for one agency to carry out to other agencies it did not,” Sens. Patty Murray of Washington and Tammy Baldwin of Wisconsin and Congresswoman Rosa DeLauro of Connecticut wrote in a letter to Kennedy.
“The magnitude of staff reductions and reorganizations will also very likely prevent the department from executing its responsibilities under the law,” the lawmakers wrote.
The layoffs followed other attempts by the administration to drastically downsize the federal workforce and reduce funding for scientific research and public health.
Almost two dozen states and the District of Columbia have sued Kennedy and HHS to prevent the cancelation of more than $11 billion worth of COVID-era funding from the CDC that was earmarked for state and local public health departments.
According to the suit, which was filed in the U.S. District in Rhode Island, the funds were supporting “a wide range of urgent public health needs such as identifying, tracking, and addressing infectious diseases; ensuring access to immunizations; fortifying emergency preparedness; providing mental health and substance abuse services; and modernizing critical public health infrastructure.”
The CDC and HHS did not respond to requests for comment about the cuts, which have alarmed public health experts.
“These cuts will make Americans far less safe and healthy,” Lawrence O. Gostin, JD, co-faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University, told Healio. “Public health is essential to every American ranging from protection against deadly infectious diseases through to prevention of chronic diseases like cancer and heart disease. Public health is the last thing a responsible government should cut.”
NBC News reported that the grants were announced in termination notices saying, “Now that the pandemic is over, the grants and cooperative agreements are no longer necessary.”
According to Gostin, if Congress appropriates funds for specific purposes, including public health, HHS “has no authority to refuse to spend it.”
“What the Trump administration doesn’t get is that Congress, not the president, holds the power of the purse,” Gostin said.
According to the “wall of receipts” posted on the website of the Department of Government Efficiency (DOGE), the largest canceled grant totaled $877 million and was meant for the Texas state health department, which is currently responding to a large and deadly measles outbreak.
“Cutting funds from state and local health departments makes Americans less safe from serious infectious diseases,” Anne Schuchat, MD, former principal deputy director of the CDC, told Healio. “The idea that epidemic responders in the midst of a measles outbreak in Texas may be losing their jobs while the virus continues to spread within and beyond that state should terrify Americans who just want the best for their families.”
The South Plains Public Health District in Texas, which has been responding to the measles outbreak, planned to spend some COVID-related funds by the end of this year, but said a pause on that funding has not affected the department’s ability to respond to measles, although director Zach Holbrooks, MA, executive director for the health district, said the situation “may be different for other health departments.”
The Trump administration has been trying to freeze payments for federal grants and programs that it believes are wasteful or unnecessary across the government through executive orders and DOGE, including for HIV research. Several of these efforts are also currently working their way through the legal system.
Allison Agwu, MD, SCM, immediate past president of the HIV Medicine Association and associate professor of infectious diseases at the Johns Hopkins School of Medicine, who has had a grant terminated, told Healio that she knows researchers who have appealed their grant terminations, but said the process has not been clear.
“There’s not even a chain of command. It’s creating chaos,” Agwu said.
References:
- Department of government efficiency. https://doge.gov/savings. Accessed April 2, 2025.
- HHS announces transformation to make America healthy again. https://www.hhs.gov/about/news/hhs-restructuring-doge.html. Published March 27, 2025. Accessed April 2, 2025.
- HHS. TAGGS: HHS COVID-19 awards. https://taggs.hhs.gov/Coronavirus. Accessed April 2, 2025.
- IDSA. Statement on April 1 HHS job cuts. https://www.idsociety.org/news--publications-new/articles/2025/statement-on-april-1-hhs-job-cuts/. Published April 1, 2025. Accessed April 2, 2025.
- Robert F. Kennedy Jr. (@SecKennedy). April 1, 2025. X (Twitter).
- Kozlov M. ‘One of the darkest days’: NIH purges agency leadership amid mass layoffs. Nature. https://www.nature.com/articles/d41586-025-01016-z. April 1, 2025.
- Murray, DeLauro, Baldwin demand answers on RFK Jr.’s plans to gut HHS. https://www.murray.senate.gov/murray-delauro-baldwin-demand-answers-on-rfk-jr-s-plans-to-gut-hhs/. Published March 31, 2025. Accessed April 2, 2025.
- State of Colorado v. U.S. Department of Health and Human Services. United States District Court for the District of Rhode Island 2025. https://storage.courtlistener.com/recap/gov.uscourts.rid.59214/gov.uscourts.rid.59214.1.0.pdf. April 1, 2025.
- Stolberg SG, et al. Mass layoffs hit health agencies that track disease and regulate food. The New York Times. https://www.nytimes.com/2025/04/01/us/politics/trump-federal-layoffs-health-food.html. April 1, 2025.
- Valencia N, et al. ‘It’s a bloodbath’: Massive wave of job cuts underway at US health agencies. CNN. https://www.cnn.com/2025/04/01/health/staff-cuts-at-federal-health-agencies-have-begun/index.html. April 1, 2025.
- Whyte LE. FDA’s top vaccine official forced out. The Wall Street Journal. https://www.wsj.com/politics/top-vaccine-official-out-at-fda-f39a5a16. March 28, 2025.
- Zadrozny B. CDC is pulling back $11B in Covid funding sent to health departments across the U.S. NBC News. https://www.nbcnews.com/health/health-news/cdc-pulling-back-11b-covid-funding-sent-health-departments-us-rcna198006. March 25, 2025.
- Zhang RC. Fauci’s successor put on leave as RFK Jr. reshapes agencies. Bloomberg Law. https://news.bloomberglaw.com/health-law-and-business/faucis-successor-put-on-leave-as-rfk-jr-reshapes-agencies. April 1, 2025.
Perspective
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Few doubt we are living in a time of historic change. And it seems as if the impact is concentrated in medicine broadly, but particularly in public health and infectious diseases. Recent decades have witnessed great advances in immunology, antiviral drug development and vaccines, to name a few. But the COVID-19 pandemic also exposed our eroded public health infrastructure, and our limited ability to communicate clearly and convincingly why our experts in science and medicine deserved the broad base of public trust they felt they’d earned.
Much of our research agenda and funding is being questioned by political leaders with immediate and still-evolving effects. Doubts on vaccine efficacy and safety are widely aired and simultaneously cases of otherwise preventable measles are rising. Eager to move on from the COVID-19 pandemic and the HIV epidemic, funding for prevention research is the focus of substantial cuts, although both viruses are still very much present — raising the specter of a resurgence in transmission in the United States and worldwide. Expanding workforce reductions, meanwhile, cloud career prospects for many in, or considering entry into, medical and scientific fields.
The debate is far from resolved and where we end up is hard to predict. We can only hope that the essential structures of public health are not only preserved but strengthened. [They should also] reflect the reality that while local ownership in approaches is laudable, infections don’t recognize the physical boundaries of states and countries or the reality of global travel. We need to admit the real problems that led to this point and the urgent need for a considered dialog to ensure that changes help achieve the improved health we all deserve.
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HHS announces transformation to Make America Healthy Again. https://www.hhs.gov/about/news/hhs-restructuring-doge.html. Published March 27, 2025. Accessed April 2, 2025.
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