A little more than 8 years ago, in 2017, I penned an opinion piece on the fate of emerging and re-emerging infectious diseases at the dawn of the first presidency of Donald J. Trump. In hindsight, I was hopelessly young and naïve back then, expecting temporary and minor setbacks. I did foresee that President Trump will follow his campaign promises to reduce funding for global health. However, I could not have predicted that a once-in-a-lifetime global pandemic (COVID-19) would unfold during his term. This pandemic lead to an unprecedented scientific achievement to develop and deploy a safe and effective vaccine using novel technology for a novel pathogen within record time, partly supported by the federal government’s Operation Warp Speed program. At the same time, inconsistent messaging on, and the politicization of, mitigation measures for COVID-19 by the federal government fractured the national response, with each State and local jurisdiction imposing different guidelines and regulations along political lines. This was exacerbated by the disbanding of the National Security Council’s Directorate for Global Health Security and Biodefense in 2018, and later by the withdrawal of the United States from the World Health Organization in 2020. Some federal employees who voiced opposition to political messages were replaced or reassigned, and the Centers for Disease Control was under political pressure to delay or modify guidelines and publications in alignment with the administration’s priorities. In addition to further eroding trust in public health, these issues resulted in the highest cumulative incidence rate of COVID-19 in the US by the end of 2020 among all G-8 countries. Voters responded to the chaos they saw by electing President Biden and Vice President Kamala Harris in November 2020, putting an end to the first presidency of Donald Trump on January 20, 2021.
However, after another tumultuous four years, President Trump managed to convince enough US citizens to vote him back in office, narrowly defeating Vice President Kamala Harris for the presidency. This time around, he and his team were much better prepared to execute their “Make America Great Again” agenda from day one. On Inauguration Day, President Trump signed 26 Executive Orders, which are not laws but documents that express the intent of the new administration. Among these, he immediately withdrew the US from the World Health Organization, amounting to a loss of 15% of its funding. He also immediately stopped all foreign aid, including humanitarian and public health, for 90 days, pending a review if those funds align with the administration’s priorities. Since then, President Trump has issued numerous additional executive orders. The orders with a focus on health have in general prioritized chronic, non-infectious and lifestyle health, indicating a focus away from infectious diseases, despite the recent experience with COVID-19. Other executive orders have established and clarified the role of the “Department of Government Efficiency” (DOGE). This new “department”, which is really a part of the United States Digital Services, is led by Elon Musk, the world’s richest person. Its stated purpose is to modernize and increase the efficiency of the federal government. However, since its establishment 7 weeks ago, it has mostly focused on reducing the federal workforce across agencies. At least 103,452 federal employees, mostly those still in their probationary period, have been terminated, regardless of their role or performance, including in public health related agencies such as the Center for Disease Control and the National Institute of Health. Some of these terminations have been reversed and some employees have been rehired after either realizing their critical role, or due to judicial rulings. However, each agency was mandated to develop and submit plans for significant Reductions in Force, with up to 700,000 federal employees to be let go out of about 3 million current federal employees. Some argue that the true aim of these reductions is not cost savings and efficiency, but political, such as the “deconstruction of the administrative state” and removal of regulations that provide checks and balances on the executive branch. Similarly, the new administration has effectively disbanded the USAID (the US Agency for International Development), which provided life-saving nutrition and medication across the globe. Its official website was shut down, its 10,000 employees terminated, and its grants cut. President Trump appointed loyalists with questionable history and expertise as Cabinet members and political appointees to lead federal agencies, including Secretary of Health and Human Services Robert Kennedy Jr., a well-known vaccine sceptic. Under the new leadership, the National Institute of Health grant review process has ground to a halt, with study sections that evaluate grant proposals not submitted to the Federal Register, and therefore unable to happen, with no decisions on submitted grants. On March 7, Matthew J. Memoli, M.D., the Acting Director of the NIH shared news that NIH is moving to a more centralized review model through its Center for Scientific Review (CSR) for cost saving. Additionally, NIH has issued a “Dear Colleague” letter on February 7, 2025, indicating that it would limit indirect costs at 15% of direct cost of grants, severely limiting funding going to host institutions. While this policy change has been suspended due to ongoing litigation, the new administration has not dropped this cost-cutting measure. Finally, the publication of the official journals of the Center for Disease Control, the Morbidity and Mortality Weekly Report and the Emerging Infectious Disease, were temporarily suspended in the chaos of the implementation of the changes of the new administration.
What will be the consequences of this wholesale destruction of biomedical, public health and global health infrastructure connected to the federal government in the United States? It is hard to tell, but it’s likely to be severe. Reductions-in-force in the federal government will leave agencies short-staffed to prepare for, detect, and respond to emerging health threats. Case in point, the ongoing measles outbreak in West Texas have spread to neighboring New Mexico and seeded to a dozen other states already, exacerbated by confusing misinformation coming from the Secretary of HHS. Avian flu is biding its time in birds as well as in cattle, infecting farm workers (sometimes silently), while we normalized drinking milk with avian flu virus inactivated by pasteurization. New World Screwworm has broken the sanitary barrier in Panama and is spreading northward toward the US. Unchecked climate change will exacerbate all these issues, turning back the clock on the progress made against emerging and re-emerging diseases since the World War II. All these and other health issues can rapidly come to the forefront, necessitating a federal response, which will be limited by workforce and funding shortages. Meanwhile, people in other parts of the world will be left abandoned by the US to die of hunger or manageable infections, such as HIV/AIDS. The reputation of the federal government internally, and the US as a country in general, will suffer consequently. Finally, biomedical research will grind to a halt, suspending progress on discovery of treatments and preventions. The new administration might very well succeed in bringing back the “good old days” with increased morbidity and mortality due to infectious diseases. At the same time, a whole cohort of scientists is at risk of leaving academia, from the PhD students, postdoctoral researchers and research scientists whose funding has been cut, to the Assistant Professors who might be denied tenure because of lack of progress and success in grantsmanship. Many of these brilliant minds will find opportunities in industry, and stay there, where they won’t be able to contribute to teaching the next generation. The federal employees who have been, and will be terminated, are the youngest, freshest minds (like some of my own students), and their loss will be a loss for the federal government, as they will find opportunities in state, local and tribal governments. In sum, I believe we, both the citizens of the US and of the world, will be the biggest losers, especially those living in poverty and already marginalized who depend most on aid or federal services.
Some might argue that I’m painting an unnecessarily bleak picture. In fact, I have friends and colleagues who support the current administration and believe that all will turn out well. I wish I could agree with their sentiment, but the facts I see lead me elsewhere. I’m older and hopefully wiser than when I wrote my piece at the beginning of the first Trump presidency, and I know more what’s at stake. If you’re close to power, please prove me wrong, and show me that what you’re doing benefits the public – or if you happen to agree with me, try and stop the madness. While I don’t feel I have power over these events, I do have a voice that I can raise, such as here, to protest the unjust, inhumane and insane nature of the decisions being made in Washington, D.C. Please do the same and support each other in the process. If you mentor students and others, please support them and let them know that they’re not alone, and that you understand their fear and confusion, and Stand up for Science with them. If you live outside of the US, please understand that the current administration does not have our mandate, and they do not represent most Americans. I don’t know what the next four years will bring, and I’m wise enough now not to even try to guess – all I know is that we have no choice but to continue doing science, teaching students and treating patients to the best of our ability, no matter the circumstances.