The Gutting of America Public Health Agencies: One Year After the HHS Restructuring
A Department in Disarray
In the spring of 2025, the Trump administration initiated the most dramatic restructuring of the U.S. Department of Health and Human Services (HHS) in the agency history. Now, one year later, the full scope of the transformation and its consequences are becoming clear.
The numbers alone tell a stark story. HHS shed approximately 20,000 full-time employees, shrinking from 82,000 to 62,000 workers. The cuts spanned every major agency: the FDA lost roughly 4,300 staff across fiscal years 2025 and 2026; the CDC saw approximately 2,900 positions eliminated; and the NIH experienced deep reductions in its research workforce. By the end of 2025, between a quarter to a third of CDC employees had been terminated.
The restructuring, led by HHS Secretary Robert F. Kennedy Jr., was framed as an effort to streamline bureaucracy and return agencies to their core missions. But a year removed from the initial reduction-in-force (RIF) notices, the picture that has emerged is one of depleted institutional knowledge, disrupted programs, and a public health infrastructure that many experts warn has been dangerously weakened.
What Was Lost: Programs and Expertise
The cuts did not fall evenly. Some of the hardest-hit areas include HIV Prevention, Infectious Disease Surveillance, Vaccine Policy and Development, Food and Drug Safety, and Global Health programs. CDC Division of HIV Prevention, long considered a global model for evidence-based public health intervention, was substantially reduced. Trust for America Health reported that CDC proposed FY 2026 budget would represent a 53% reduction from prior levels if fully adopted.
The very capacity that allowed the United States to track COVID-19 variants, monitor influenza strains, and detect emerging pathogens has been eroded. Epidemiologists, laboratory scientists, and data analysts who formed the backbone of the nation disease surveillance network are gone.
The CDC Advisory Committee on Immunization Practices (ACIP) the independent expert panel that has guided U.S. vaccine policy for decades was fundamentally reshaped. Multiple long-serving committee members were replaced, and the committee relationship with the pharmaceutical industry and its traditional evidence-review processes were restructured.
CDC global health programs, which maintained surveillance stations in dozens of countries and provided technical assistance for outbreak response worldwide, were dramatically scaled back. The implications extend far beyond U.S. borders in an interconnected world, a pathogen emerging anywhere can arrive anywhere within hours.
The Brain Drain: Institutional Knowledge Cannot Be Replaced Quickly
One of the most concerning aspects is not just the number of jobs eliminated, but whose jobs they were. Federal health agencies employed career scientists with decades of specialized expertise people who understood not just the technical aspects of their work but the institutional history of what had been tried before, what worked, and what failed. You cannot simply rehire your way out of this problem, one former senior CDC official told Healthcare Dive. The people who left took with them relationships with state health departments, understanding of complex surveillance systems, and knowledge of how to navigate emergency response protocols.
The FDA faced a similar exodus of talent. Drug reviewers who had spent careers evaluating specific therapeutic classes left the agency, taking their accumulated expertise. For pharmaceutical companies navigating the approval process, this has meant working with less experienced reviewers and facing greater uncertainty about regulatory expectations.
The Rebuilding Effort: Promises and Skepticism
By early 2026, the administration began to acknowledge the need to rebuild. Acting CDC Director Jay Bhattacharya, who also serves as NIH Director, told CDC employees at a March 2026 town hall that the agency was looking to shore up some of the gaps in its workforce. At a congressional hearing in April 2026, HHS officials stated that the department was on track to grow its workforce back to pre-cut levels but with, in their words, a better group of people who are actually going to address chronic health.
That framing has drawn sharp criticism. Public health experts argue that the original workforce was already addressing chronic disease alongside infectious threats, and that the characterization of career civil servants as somehow inadequate is both inaccurate and demoralizing. Moreover, recruiting new staff has proven challenging. The turmoil of the RIF process has made federal health agencies a harder sell for top scientific talent.
Public Trust: The Hidden Casualty
Perhaps the most difficult-to-measure consequence is the erosion of public trust. A KFF poll conducted in early 2026 found low confidence among Americans that the FDA and CDC are making independent, non-political decisions. This trust deficit has practical consequences: when public health agencies issue guidance during an outbreak, recommend vaccination, or approve new treatments, their effectiveness depends on public willingness to follow that guidance.
The restructuring has also created regulatory uncertainty for the industries these agencies oversee. Drug companies, medical device manufacturers, and food producers all depend on predictable regulatory pathways. When agency leadership is in flux, review timelines stretch, and guidance documents become outdated, innovation can stall.
What Comes Next
The HHS restructuring is not complete. Leadership vacancies remain at multiple agencies. The confirmation of Dr. Erica Schwartz as CDC Director is pending. The FDA continues to operate under interim leadership in several key divisions. And the FY 2027 budget process is underway. Key questions will determine the long-term impact: Can the agencies rebuild? Will Congress intervene? And what happens in the next public health emergency? The ultimate test of the restructured HHS will come during the next novel pathogen outbreak, foodborne illness crisis, or natural disaster requiring a public health response. The question is not whether such an event will occur, but whether the diminished agencies will be ready when it does.
Conclusion: A Reckoning Deferred
The HHS restructuring represents one of the most significant experiments in public health governance in American history. Its architects argue that a leaner, more focused department will be more effective. Critics counter that the cuts have hollowed out essential functions and sacrificed irreplaceable expertise. The truth likely lies somewhere in between but it will take years, and perhaps a crisis, to know for certain. What is clear is that the American public health system, once the envy of the world, is navigating a period of profound uncertainty. The consequences of getting this wrong are measured not in budget lines or org charts, but in human lives.
Published May 31, 2026
