Amid widespread cuts throughout the Department of Health and Human Services' (HHS), the Centres for Disease Control and Prevention's (CDC) is expected to let off some 2,400 workers, or 18% of its staff, in a radical reorganisation. Widespread worries about the country's ability to address current and new public health problems have been raised by the layoffs, which are a result of a strategic shift towards a more focused infectious disease mandate. 

According to recent reports, workers in several sectors, including substance misuse, birth defects, injury prevention, occupational safety, tobacco control, and reproductive health, were immediately given "reduction-in-force" letters. The remaining employees were left in a state of confusion, as some were forbidden from CDC offices and others were put on administrative leave with ongoing pay until June. "If there was an outbreak, I would not know who is deployment-ready to get on a plane in the next 24 hours," a source told STAT. 

The Trump administration has used the CDC's mission expansion as justification for these cuts. Despite cuts to the agency's global duties, including HIV prevention and TB containment, HHS Secretary Robert F. Kennedy Jr. assured that the new emphasis on infectious illnesses would simplify operations and save money. However, some argue that this shift could jeopardise the CDC's existing framework for more comprehensive public health initiatives. 

Secondary data supports these worries. For instance, former CDC director Tom Frieden warned that the elimination of tobacco prevention programs is "a gift to Big Tobacco," and he described the workforce reductions as "a recipe for disaster." These views were reflected by Richard Besser, the head of the Robert Wood Johnson Foundation and a former interim director of the CDC, who emphasised that disaster preparedness has historically been harmed by budget cuts made during transitional periods. "I had been responsible for emergency preparedness and response for the CDC for the last four years, which is why I was appointed acting director," Besser said. "I am extremely concerned about the agency's capacity to respond to a public health emergency as it undergoes dismantlement." 

The reorganisation has also had an impact on high-level leadership. Important individuals were instructed to report to the Indian Health Service, including Jonathan Mermin and Dylan George, who are leaders in HIV prevention and illness forecasting, respectively. In the meantime, there have been large staff reductions at vital organisations like the Biomedical Advanced Research and Development Authority (BARDA) and the Strategic National Stockpile (SNS). The destruction of the CDC's Global Health Centre, which has been essential for tracking disease outbreaks overseas, raises concerns that such actions could compromise the agency's ability to respond quickly to catastrophes in the future. 

The surviving employees are becoming increasingly anxious, according to internal communications. In an all-hands memo, CDC Chief of Staff Matt Buzzelli acknowledged the chaos and encouraged staff to use available services for help during the unpredictability. On the other hand, many people feel demoralised. "The bread and butter of public health work has been under-resourced and undervalued for so long," emphasised Katie Bollbach of Partners in Health, who cautioned that these cuts might cause generational harm to the country's public health infrastructure. 

The magnitude and velocity of these staff reductions pose a significant threat to the preparedness of the American public health system. The administration runs the risk of leaving the CDC ill-prepared to handle chronic diseases that call for ongoing action in addition to infectious disease threats by eliminating important divisions and excluding seasoned professionals. These cuts might have long-term effects that impact everything from emergency response to preventive care.