At home and abroad, America’s approach to public health is changing rapidly. Tens of thousands of federal health workers are poised to lose their jobs and foreign aid cuts are interrupting programs touching everything from malaria prevention to the treatment of HIV. But along with cuts, new programs and priorities are rising up in their place. Journal health business editor Jonathan Rockoff and senior writer Betsy McKay look at what’s changing and how this will affect lives around the world. Luke Vargas hosts. Further Reading: Health Department Begins Sweeping Job Cuts RFK Jr. Plans 10,000 Job Cuts in Major Restructuring of Health Department Trump Administration Weighing Major Cuts to Funding for Domestic HIV Prevention Johns Hopkins Slashes More Than 2,000 Jobs Due to USAID Cuts Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What major changes are happening in U.S. public health?
And this week, at home and abroad, America's approach to public health is changing rapidly. Tens of thousands of federal health workers are poised to lose their jobs. State health departments are seeing billions in funding from Washington being zeroed out. And foreign aid cuts are interrupting programs for malaria prevention and treatment of HIV.
But along with cuts, new programs and new priorities are rising up in their place. So what's in store as the U.S. embarks on its biggest public health shakeup in modern history? Let's dive in. Well, we can't list all of the changes that are being made to the U.S. public health system, but let me run through a few of them very quickly.
The Department of Health and Human Services is shedding around 20,000 employees within the Centers for Disease Control and Prevention. Entire departments are being eliminated, including for HIV prevention, violence prevention, and injury prevention. Also gone at the CDC.
is a team that maintained a database of injuries and violent deaths, which was widely relied upon by policymakers and researchers. And in a move that will be felt beyond the Beltway, the administration has cut off billions of dollars in federal grants that were awarded to state and local health departments for a range of programs, like tracking infectious diseases or treating addiction.
Chapter 2: Why are federal health job cuts occurring?
That is being challenged in the courts, but in the meantime, some state health departments have already begun layoffs. With me today are Wall Street Journal health business editor Jonathan Rockoff and senior writer Betsy McKay. Jonathan, lots of changes clearly afoot here. What reasons is the administration giving for this shakeup?
A lot of this comes from this criticism of the pandemic response and how overarching the public health response to the pandemic was. And this feeling that because the public health authorities sort of overstepped their authority, we need to rein it back again. We see this most saliently in vaccines. There's a lot of criticism on the right about mandating vaccines and things like that.
And so a lot of the cuts have been targeted at vaccines in particular.
Yeah, John is absolutely right. We are at the tail end of a very bruising pandemic, very bruising to public health in the sense that there was a lot of anger and backlash, and that remains, and the view that government was not efficient. More broadly speaking, the administration says chronic diseases are worsening and changes need to be made. So there's two things here.
There are the philosophical changes. They view a smaller, more effective government and more focused on chronic diseases. then there is the immediate impact of the changes being made suddenly and the disruption that that causes.
Though obviously the long-term ones are not too difficult to conjure up, possibly a reemergence of certain diseases or at least slowed efforts to try and cure others, right?
Yeah, absolutely. Because when you disrupt a public health program or any health program, you are going to have consequences, if not immediately, certainly down the line. You know, an important part of fighting HIV is not treating people already infected with HIV, but preventing people from getting it, giving them access to pre-exposure prophylaxis, education, many other programs.
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Chapter 3: What are the implications of cuts to HIV prevention programs?
And most of them seem to be targeted for cuts.
We already see right now that no matter who's in charge, that there are going to be public health threats and that whoever is in charge is going to have to deal with them. Right now, we're seeing this measles outbreak in the Southwest and then some other states. And we're also dealing with bird flu. So these threats remain. I think part of what the Trump administration and Robert F. Kennedy Jr.
are doing is sort of rethinking what the balance should be. And as Betsy has sort of laid out, I think there's a... There's a different sense of what we should invest our preventative resources in and whether that should be in something like HIV or whether it should be in chronic diseases.
Yeah, take us into what we're seeing around chronic disease, a pullback in monitoring maybe, and yet Robert F. Kennedy Jr. very focused on what he believes to be the root causes of certain health issues in the United States.
Chapter 4: How is the government restructuring public health priorities?
Well, it's a little unclear. He's definitely been out front about how he thinks we need to do more to prevent chronic diseases. But we haven't necessarily seen a lot of specifics around how he would do that. So that's TBD. What we have seen is skepticism about vaccines and about some of the other sort of infectious disease prevention efforts. And then we see Robert F. Kennedy Jr.
himself using mixed descriptions of the efficacy and safety of the vaccines and agencies in HHS beginning efforts to take a look at the safety and efficacy of the vaccines, even though most researchers say that's already been settled and that vaccines are really good and they prevent diseases like measles and they don't cause autism.
One other thing to note here is the other sort of early tangible impact that we're seeing in the public health, healthcare spaces and research there's been cuts to NIH and other funding of medical research.
Chapter 5: What is the future of chronic disease prevention in the U.S.?
So for the last generation, a lot of the progress that we've seen against serious diseases like cancer has started in government-funded academic laboratories, which have found the causes of the diseases insights that lead to drugs to treat those diseases. And what may happen, but we aren't sure yet, is that that sort of link between government funding and academic advances may be broken.
We have got to take a short break, but when we come back, we will look at what happens when the U.S. pulls back on public health spending domestically and abroad. Stay with us.
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All right. Before the break, we were talking about some of the changes coming to public health priorities and funding in Washington. And, John, I just want to ask you, before we start looking abroad, aren't there other entities in the U.S. that could step in here, be it states, philanthropies, the private sector, to cover any funding gaps that emerge?
This gets at the underlying debate. We've been doing things for the past generation a certain way, but there's no reason why we have to do them that way. And I think the Trump administration, to its credit, is taking a hard look at how we've been doing things. And the government has been this huge funder of medical research.
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Chapter 6: What are the potential impacts of reduced funding for medical research?
But philanthropies have also funded medical research, and pharmaceutical companies and other health care companies have also funded research. And perhaps with the Trump administration's prodding, that will get rejiggered and we'll see a different amount of life sciences industry funding of academic labs, for instance. What people say in the academic world, for instance, is...
That without that government funding, we might not see a lot of the basic research that has led to advances against cancer, against high cholesterol, against other diseases, because there needs to be sort of a minimum level of government funding of basic research before industry and philanthropy is willing to step in.
Betsy, something similar is happening abroad. John referring there to going back to square one on the domestic public health funding model and challenging old assumptions. That is kind of what's happening as the U.S. namely pulls back U.S. Agency for International Development projects for public health around the world.
Yeah, it's another rethink. The State Department and the administration have said there's a lot of waste in our funding. We're funding a lot of things around the world. We need to rethink this and we need to reevaluate exactly what we want to fund. Secretary of State Marco Rubio has said that
Some of the health programs that USAID funded will be continued, but they must qualify as serving American interests, which is a pretty broad definition.
USAID was sort of the epitome of the United States' exercise of soft power internationally. It didn't have direct benefit to the United States. It didn't help us erase trade deficits or ink trade deals or have any sort of direct benefit. And the Trump administration has completely rethought that approach.
We are already seeing just on the African continent health systems racing to try and respond to a change in U.S. funding. Nigeria announcing measures to try and soften the impact of these U.S. aid cuts and finding other ways they can fund their health programs in South Africa. Scientists
Maybe he's trying to find a silver lining here, saying this maybe is the opportunity the continent needed to break its dependence on foreign aid. Betsy, do we have an idea of what that alternate model would be? I know you've spoken to a lot of people as you try to understand the effects of these cuts specifically abroad. What's their thinking?
Well, it's difficult to understand what that model would be right now. Certainly every country that has lost money, I mean, some African countries are heavily, heavily dependent on donors abroad. They have two things they're looking at. One, how much money can they themselves put up?
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Chapter 7: How does public health spending affect global health initiatives?
We've grown comfortable with a United States where measles hasn't run rampant, where there isn't polio, where we're not dealing with tuberculosis outbreaks all over, where children are drinking fluoridated water and avoiding a lot of cavities and tooth decay.
There are, as we've discussed, reasons why we would want to take a look at how we've done all these infectious disease and other public health efforts in the United States and whether the mix of federal and state funding for those efforts needs to change and whether philanthropies and industry needs to step up more.
But what public health folks argue we don't want to do is to go back to a place where the threat of polio was prevalent, where we are dealing with measles outbreaks spreading around the country, where we are seeing more and more people developing HIV-AIDS. And so the worry that they have is...
While we take a look at how we've done public health for a generation, are we going to go back to the place that we thought we had left behind?
Jonathan Rockoff is The Wall Street Journal's health business editor, and Betsy McKay is a senior writer for the journal. John, Betsy, thank you both so much. Thank you.
Thank you.
And that's it for What's New Sunday for April 27th. Today's show was produced by Charlotte Gartenberg and Anthony Bansi, supervising producer Sandra Kilhoff, and deputy editor Chris Sinsley. I'm Luke Vargas, and we'll be back tomorrow morning with a brand new show. Until then, thanks for listening.
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