The widespread upheaval at federal health agencies in the first month of the Trump administration comes at a time when the U.S. faces infectious disease threats on multiple fronts: The ongoing spread of bird flu around the country; the risk of emerging insect-borne viruses; and a ballooning measles outbreak in the Southwest.
Abroad, there are new strains of mpox and deadly outbreaks of Ebola and polio just a plane ride away.
Recent mass firings, primarily aimed at new and temporary workers, have thinned the ranks of the workforce that would aid in the response to outbreaks at the Centers for Disease Control and Prevention, according to interviews with more than half a dozen current staff. They requested anonymity because they were not authorized to speak publicly.
The situation has infectious disease experts worried.
"This seems like the worst time to be taking steps to degrade our nation's preparedness," says Dr. David Fleming, a former CDC official who now chairs the agency's Advisory Committee to the Director. "They are greatly diminishing CDC and the country's ability to respond to emerging infectious threats."
Those who work at CDC tell NPR they're deeply concerned about the prospect of future job cuts, and the weakening of policies around vaccination. They also caution that restrictions around communication could hamper the agency's response to unfolding outbreaks.
"The big thing that's impacting us now is the demoralizing work environment, intentional chaos, uncertainty over our jobs," says one CDC staffer. "Outbreak responses are very stressful when you have all the available resources. To be on outbreak response now in this climate is a whole new level of complexity and stress."
Dr. Deblina Datta, an infectious disease physician who retired from the CDC in 2023 says "this is just a very dangerous period of time for our country because we are addressing threats on multiple fronts. In my 24 years at the CDC, I have never seen the morale hit that is going on right now."
In response to NPR, a spokesperson for the CDC listed seven emergency responses that are currently active — such as measles in Texas, influenza A/H5N1 and mpox — but did not answer other questions about the extent of the layoffs and their impact on the agency's operations.
Fleming and other members of the committee sent a letter to acting CDC director Dr. Susan Monarez and HHS secretary Robert F. Kennedy Jr. on February 17, urging them to "take immediate action to forestall the impending crisis to our Nation's health and safety" precipitated by the firings. They haven't responded.
Key staff for detecting potential threats fired
The full extent of the cuts remains unclear, although NPR has reported that about 750 people were let go from CDC in the first wave of firings earlier this month.
And more cuts could be on the way.
"If we have another round of layoffs, then we really will start to feel the pain in a very tangible way," the CDC staffer said.
Among those who already lost their jobs: a cadre of scientists who assist local health authorities in detecting diseases, staff who are charged with preventing the introduction of dangerous pathogens from abroad, and some involved in modeling disease outbreaks to get ahead of them, CDC sources said.
One of the programs decimated by the cuts — the Laboratory Leadership Service fellowship — had previously enlisted Ph.D.-trained researchers to pitch in on disease responses for dengue in American Samoa and Puerto Rico, Marburg virus in New York and a new rabies variant in Nebraska, according to three current CDC employees. In some cases, the fellows are needed to develop lab tests in fast-moving situations.
"They are the first responders," said another CDC staffer, "Without them on the front lines, who will develop these tests? Who will do these tests?"
In fact, one CDC fellow who received a termination letter had just spent weeks helping the state of Florida develop a plan for a potential wave of Oropouche this coming summer.
Oropouche, a viral disease spread by mosquitoes and midges — and also through sexual contact — caused large outbreaks in South America and the Caribbean last year, leading to birth defects and fetal deaths similar to those caused by the Zika virus. Florida health officials had discerned from testing past samples that cases in their state had gone undetected, the fellow told NPR: "They were terrified there might be thousands of samples come summer, and they had to be ready."
The pause on communications when Trump took office, however, prevented the fellow from sharing the response plans with the state — and now the plans could languish, since the fellow has been let go.
The firings also swept up two CDC workers, both part of a public health training program, who'd been deployed to work on a tuberculosis outbreak in Kansas City, CDC sources told NPR.
Another arm of the CDC feeling the pinch of layoffs is the already overstretched team that oversees port health stations, screening travelers for dangerous pathogens at airports and land border crossings.
Three out of the 20 port health stations now have no CDC staff and half have no officer in charge, according to a current CDC employee, who's not authorized to speak publicly.
These stations are a first line of defense. Staff there assess humans and animals for disease threats and, if a case of illness is found, work with local authorities on contact tracing if other passengers were potentially exposed.
With countries dealing with outbreaks of Ebola and other diseases, it's critical to have these trained workers in place who can recognize someone with signs or symptoms and coordinate the response, says Dr. Kimberly Dodd, dean of the College of Veterinary Medicine at Michigan State University and a former USDA official.
Stations are increasingly covering for each other, and sometimes "choosing not to do certain things because there aren't enough resources," a CDC employee with direct knowledge of the situation told NPR. "It's like a web and when you rip out part of that, you can't expect it to work the same as before," the individual says.
Fears about readiness for emerging risks
It will take time to see the consequences of the cracks introduced by these mass firings – and the broader attempt to downsize federal health agencies.
"The ripple effects, and how that impacts our infectious disease and pandemic preparedness is going to be larger and more widespread than we're able to put our arms around right now," says Dodd.
Some worry the ongoing turbulence could distract from some of the most pressing public health threats on our doorstep, including bird flu and measles.
Aside from firings, other agency functions have been interrupted. For instance, the CDC's forthcoming meeting of its vaccine advisors was postponed, playing into concerns that vaccine policy could be disrupted by the new administration.
And the CDC pulled a successful advertising campaign for the flu vaccine, amid the worst flu season in years.
The clampdown on external communication that took hold when President Trump came into office impeded some lines of communication and frayed longstanding relationships between local health officials, their partners and the federal government.
While routine meetings and updates about bird flu and other urgent threats have resumed to some extent, "communication is still not where it needs to be," says Lori Freeman, executive director of the National Association of City and County Health Officials.
The targeting of the CDC was top of mind when Freeman met with Texas health officials last week amid ongoing fears about the state's measles outbreak.
"It feels like there's a lot of areas that are threatening our ability to do work on the ground," she says. She adds that she fears the CDC may pull back funds that local public health agencies rely on.
Since mid-January, 124 cases of measles have been reported in the South Plains region of Texas, and 9 cases in neighboring New Mexico.
Both states tell NPR they are in regular contact with their counterparts at the CDC. So far though, the agency doesn't have a major presence on the ground.
"We would only request assistance if the state did not have the resources to respond to the outbreak," according to Lara Anton, a spokesperson for the Texas Department of State Health Services, who confirmed that one CDC epidemiologist is in the region.
But in the City of Lubbock, where hospitals are caring for patients with measles, some local health officials are calling for more help, whether that's from state or federal authorities.
"We need some more boots on the ground to be combating this," Katherine Wells, director of public health for the City of Lubbock, told NPR.
Robert Nott, a spokesperson for the New Mexico Department of Health, said that "on the measles front, our relationship with the CDC remains productive."
Overall, notes Datta, the former CDC official, disease outbreak response is fundamentally a human-based enterprise. While it depends on data, important information needs to be relayed between epidemiologists, health care providers on the ground and public health authorities.
"Those are not automated systems, not by a long shot," says Datta, the former CDC official.
"It takes a practiced eye to say, 'what are the next set of questions that we need to be asking? How can we confirm or negate our worst fears?" says Datta.
For instance, if a few polio cases are reported from different countries over a few months, it would take a birds-eye view to understand how they're related. Knowing where the cases are coming from is key to effectively fighting an outbreak, she says.
Have information you want to share about the ongoing changes across the federal government? Reach out to these authors via encrypted communications: Will Stone @wstonereports.95, Pien Huang @pienhuang.88.
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