Understanding the Healthcare Impact of Mass Firings in Washington‌‌

This commentary was adapted from episode 168 of the Health & Veritas podcast. The views expressed are the author’s own. Subscribe for weekly doses of expert insight on health and the healthcare industry.

Now is a good time to explain what we know about the early policy and personnel changes of the new administration and what they mean for health and healthcare. This is neither meant to be exhaustive nor finished. I think much more will happen and we will periodically report and discuss it on Health & Veritas. But there is enough known now that we can start to understand the impact. ‌

There has been an enormous shift in personnel in essentially all of the health agencies. Some of this has occurred due to voluntary early retirement; some of it is firing of people in their probationary periods. Some of it is through wholesale reductions in force, including the closure of existing programs. And some of it has been partially or fully voluntary, when senior officers no longer can feel comfortable working under current conditions. The net effect of all of this is that entire programs have been closed, leadership in key regulatory roles has been lost—with little bench to replace them—and remaining staff are left trying to figure out who they report to and how they do their work.‌

Broad cuts at the National Center for Chronic Disease and Health Promotion within the CDC came alongside cuts to programs to prevent HIV, injury prevention, and reproductive health. At the FDA, leaders of major divisions, including the former Yale faculty member Peter Marks, who led the biologics center, were forced to resign. Entire groups and centers have been shut down or planned to shut down. ‌

It is very important to point out that these are not political appointees, who routinely turn over when a new administration arrives. These people are part of the permanent workforce and have served in the Bush, Obama, Trump, and Biden administrations. ‌

We now have a clearer picture of how the funding of research is changing. In many cases, high-priority areas are losing their funding or being dramatically deprioritized. For example, health disparities and the need to prevent and treat HIV are no longer priorities for this administration. ‌

In some instances, for seemingly calibrated political purposes, institutions such as Columbia, Princeton, and Penn are having grants cancelled; researchers there and elsewhere are having to either change their focus or fight for internal funding for ongoing important work—diabetes, COVID, rare diseases—that is at risk. This will separately impact the educational mission of these schools. ‌

Eleven billion dollars of appropriated funding to the states for public health preparedness and epidemic management have been withdrawn—this at a time when we are having the worst measles outbreaks in over 30 years. Twenty-three attorneys general are fighting this. But the intent of the current administration is clear., and legal maneuverings have mixed records of success. ‌

Institutions near and far are curtailing or shutting many graduate programs that were previously fully or partly funded by the federal government. And state governments are facing uncertainty of their own in terms of budget decision making. So first-, second- and third-order effects are still to be determined in full. ‌

But it is clear that the effective shut down of USAID and the delayed or cancelled funding of PEPFAR will lead to countless deaths globally and a huge loss of standing for the U.S. in the world. Our medical diplomacy days are over, apparently, at least for now. And programs that are very important and were considered embedded in government—the Agency for Healthcare Research and Quality and the Office of the Assistant Secretary for Planning and Evaluation, among others—are just disappearing right in front of our eyes.‌