In 1946, when the US Public Health Service and the Centers for Disease Control and Prevention (CDC) were created, life expectancy was about 66 years. Thirty four out of 1,000 children born in 1946 were expected to die before their first birthday — most from communicable diseases. Since that time the nation embarked on a remarkable array of initiatives including disease surveillance, vaccine programs, and sanitation promotion. The result is that in the last 80 years life expectancy in the US has increased to 78 years, and there have been more advances in public health than in the previous 300,000 years.
Today much of what has been accomplished is now being threatened by the Trump Administration, specifically by Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. His focus is now on ideology over science. As a result, we are now seeing the shredding of America’s global health organizations, reductions in public health staffing and funding, the fomenting of vaccine skepticism, and the dismantling of childhood vaccination programs.
The dismantling began with the sweeping purge of the HHS workforce last year. The HHS workforce has fallen from 92,000 employees in the Fall of 2024 to 74,000 today. This includes the loss of 1,300 scientists from the National Institutes of Health. Scientists studying vaccines, cancers, HIV, and mental health were laid off, as were workers supporting medicine reviews, disease tracking, tobacco regulation, and oversight of the opioid response. One employee remarked, “It took them just a few weeks to break things that will take decades to fix. I don’t think people realize how detrimental this is.”
Finding permanent leaders of the operational divisions of HHS has also proved problematic. CDC has been without a permanent leader since July 2025. Dr. Susan Monarez, the previous permanent director, received Senate confirmation in July. About a month later, Dr. Monarez was dismissed because she refused to accept the recommendations of RFK Jr’s handpicked panel of mostly anti-vaccine advisers.
Also, the nomination of Dr. Casey Means, the White House’s pick for Surgeon General, has also stalled, as two Republicans, Senators Lisa Murkowski of Alaska and Susan Collins of Maine, have expressed qualms about her statements on vaccines.
In April, the White House’s FY 2027 budget request proposed a $18 billion (12.5 percent) reduction in HHS funding. Among the largest proposed cuts are $5 billion from NIH which is the largest funder of biomedical research. The proposed budget also eliminates the National Institute on Minority Health and eliminates global health research. These proposed reductions will further erode the Department’s ability to identify new and promising prevention and treatments.
It’s not just leadership, funding reductions, and staffing levels. America is about to get a real-world experiment on how well vaccines keep us healthy. Last January, RFK Jr. took a wrecking ball to the childhood vaccine schedule. His new schedule recommends that children be immunized against 11 diseases instead of the previously recommended 17. No scientific rationale was given for these reductions. This will likely mean that more kids will contact Hepatitis A, meningitis, retrovirus, and flu (vaccines that RFK has eliminated). In March, a federal court ruled against these vaccine changes, but the Administration has not yet appealed the decision.
A real-life example of this vaccine skepticism has played out explicitly in the 2025/2026 measles outbreak. More than 4,000 cases have been reported across 45 states. Approximately 400 children have been hospitalized and three have died. Yet, despite this outbreak, CDC dramatically scaled back its social media posts on vaccinations. RFK Jr. himself has provided little or no guidance. This has created a vacuum which was filled by the news media and less credible voices. Without federal leadership we can expect more of these kinds of outbreaks and deaths.
All of this has created a crisis of confidence. Even before the most recent shock waves, Americans said they were losing trust and confidence in CDC. In April 2025, 44% of US adults polled said that they will place less trust in CDC recommendations under the new leadership. This will undoubtedly undermine the U.S. response if the country faces another public health challenge requiring a rapid, coordinated response, like COVID-19.
I worked for HHS for over 20 years. The people I met and worked with were smart and dedicated. Many could have made more money in the private sector, but they chose public service. Watching this Administration dismantle this Department and the public health system is heartbreaking. But more importantly, it is a substantial rollback of public health policy that will put the health of all Americans at risk.
