Public health leaders are voicing their outrage over a Trump administration plan to fire 10,000 workers across the U.S. Department of Health and Human Services, citing the potentially irreparable harm it would cause to the nation's health.

On Thursday, HHS announced the agency was restructuring and downsizing its workforce. Among the cuts, the Food and Drug Administration would lose 3,500 full-time employees; the Centers for Disease Control and Prevention would lose 2,400; the National Institutes of Health, 1,200; and the Centers for Medicare and Medicaid Services, 300, according to HHS.

Combined with previous layoffs, early retirements and buyouts, the new cuts would reduce the HHS workforce by a quarter, to 62,000 employees. While HHS Secretary Robert F. Kennedy Jr. said the plans will reduce "bureaucratic sprawl," health advocates are concerned about what it will mean for America, which consistently lags behind other high-income nations on measures of health, well-being and life expectancy.

“I have warned my colleagues from the start — this is not some political game,” Sen. Patty Murray, D-Wash., said during a Friday media briefing with members of Congress. “The work HHS does — or in this case, stops doing — has life and death consequences.”

The HHS restructuring will also consolidate the department's divisions from 28 to 15. HHS would create a new Administration for a Healthy America, which will focus on "safe, wholesome food, clean water, and the elimination of environmental toxins."

Agencies that would be moved under the new umbrella would include the Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration and National Institute for Occupational Safety and Health.

APHA condemned the plans as "thoughtless."

“This is a nonsensical rearrangement of the agencies under their charge and an excuse to devastate the workforce for financial reasons,” Georges Benjamin, MD, APHA executive director, said in a statement. “It will increase the morbidity and mortality of our population, increase health costs and undermine our economy.”

The layoffs and restructuring announcement came days after HHS proposed eliminating $11.4 billion in grants earmarked for distribution to local and state health departments. The funds were initially for COVID-19 relief, but in 2024 Congress allowed states to use the funding for other urgent public health concerns, such as infrastructure, vaccines for children and better surveillance of infectious diseases.

Hundreds of local and state public health workers were furloughed this week because of the rescinded grants, Lori Freeman, MBA, CEO of the National Association of County and City Health Officials, said during a separate news briefing on Friday. Workers focused on immunization, community health, wastewater testing, mental health and more have been impacted.

Some health departments have lost their mobile health units and are unable to complete surveillance research on infectious diseases, Freeman said.

On Monday, Public Health-Seattle and King County was notified of revocation of several grants, one of which funds the salaries for 45 community health workers assigned to vulnerable communities in the Washington county.

“We spent years training them and embedding them in communities across the region,” Faisal Khan, MD, the agency’s director of public health, said during the Friday briefing.

Even if funding is restored in six months or one year, the program will have to start from scratch, not where it left off, he said. The health workers will have moved on.

“This is a systematic disassembly of public health services that took years to put together,” Khan said.

In Texas, the Dallas County Health and Human Services was notified Monday that three federal grants would stop. Vaccination, epidemiology, technology modification and staffing are impacted, even as the state wrestles with a major measles outbreak.

Layoffs of some staff involved in administering routine child vaccinations, including those for measles, has already begun in Dallas County, Phil Huang, MD, MPH, director and health authority at Dallas Health and Human Services, said during the briefing.

The cuts are also harming important scientific work at the national level. Monica Bertagnolli, MD, former director of the National Institutes of Health who resigned in January, said the cuts are stopping health research midstream. And even if funding streams reopen, interrupted clinical trials do not simply begin again, she said.

“If a grant is cut in the middle of a four-year study, you lose the first years,” Bertagnolli said. “Going back is not possible.”

Photo by Seventyfour, courtesy iStockphoto