The United States Department of Health and Human Services (HHS) is undertaking a giant change that will result in the elimination of about 10,000 jobs and the consolidation of 28 divisions into 15. The reform, announced in a news release recently, is expected to significantly alter the operational landscape of an agency in charge of key healthcare services across the United States. Employees learnt about the layoffs from secondhand sources, which added to the commotion and confusion surrounding the announcement.

Uncertainty and Discontent Among Employees

The unexpected revelation shocked and frustrated HHS staff, especially those at the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and the Centres for Disease Control and Prevention (CDC). A Reddit site for government employees received rapid feedback, with people calling the decision "bull***" and offering sorrow for those affected. According to an anonymous NIH employee, several staff members learnt about the news through online forums before receiving formal notifications, highlighting a lack of direct contact from HHS leadership.

One NIH employee commented, "The stress level is awful for everyone. It's almost like waking up wondering, "Am I going to get cancer today?" The similarity mirrors the agency's employees' increased worry and uncertainty, as layoffs and potential dismissals loom.

Effect on Key Agencies and Functions

The anticipated cuts will have a substantial impact on administrative activities such as human resources, information technology, and procurement. According to HHS Secretary Robert F. Kennedy Jr, these cuts are intended to eliminate "bureaucratic sprawl" and shift the department's focus to chronic conditions. However, there is widespread scepticism about the potential repercussions of significant changes to the agency's basic functions.

The FDA is planning to lay off nearly 3,500 employees, or roughly 20% of its workforce. The CDC will lose over 2,000 employees, while the NIH, which is already dealing with reductions in research funding, will lose 1,200 posts. Despite promises that vital functions, such as medication evaluations at the FDA and Medicare administration at the Centres for Medicare & Medicaid Services (CMS), will be unaffected, concerns remain.

The National Treasury Employees Union's national president, Doreen Greenwald, criticises the plan, saying, "The administration's claims that such deep cuts to the Food and Drug Administration and other critical HHS offices wouldn't be harmful are preposterous." Similarly, Robert Califf, former FDA commissioner during the Obama and Biden administrations, cautioned that administrative savings could stymie product development and regulatory assessment. "The work at the FDA is highly interactive across areas of expertise," he wrote in an email, citing concerns about operational inefficiencies.

Lack of transparency and communication breakdowns

The restructure took many managers and department heads by surprise, with little to no advance notice of the magnitude of the cuts. An FDA employee from the Centre for Devices and Radiological Health stated that their division director provided no feedback or specific information on the restructuring. The employee expressed widespread uncertainty and irritation, stating that everything is based on word of mouth these days.

Similarly, an employee from the Administration for Children and Families cited a lack of additional information beyond the news statement, leaving many people concerned about their future positions.

Bipartisan criticism and concerns about public health

Democratic senators and former HHS leaders have sharply criticised major reforms, fearing they would weaken the agency's mission. Former HHS Secretary Xavier Becerra, under President Joe Biden, warned on social media, "Downgrading services for our elderly and disabled; downgrading services for mental health; downgrading our strategic preparedness and response capabilities— how can that be good for the health of any American?"

While some, such as Scott Whitaker, CEO of the medical device lobby Advamed, were optimistic that the FDA's efforts to improve patient access to medical technology would be impacted, others were less convinced.

Sara Brenner, interim FDA commissioner, acknowledged the emotional toll on staff, writing in an email, "I recognise that the changes for HHS and the FDA may be challenging for some employees, whom we value as both colleagues and friends." However, she expressed confidence that the reorganisation will eventually prepare the agency for future difficulties.

A Risky Gamble for Public Health

The reform of HHS poses substantial dangers to public health, even though it is intended to streamline operations and emphasise chronic disease care. Slashing thousands of positions—notably those in organisations responsible for public health, regulatory compliance, and scientific research—could jeopardise the country's preparedness for future health emergencies. Furthermore, a lack of transparency and communication about these decisions has damaged employee trust, destabilising an already stressed workforce. While Secretary Kennedy's objective of decreasing bureaucratic inefficiencies may be sound, the path to achieving it appears to be plagued with ambiguity, potentially leaving millions of Americans exposed to gaps in crucial services.