Blackout: Draconian Cuts Imperil Health and Safety in the United States

The Trump Administration’s “Skinny Budget,” released on May 2nd, 2025, includes proposals to cut billions in annual federal spending on critical public health and disease data gathering, surveillance, and tracking in the United States, including cuts that will directly impact the lives of many of America’s most vulnerable populations.

The programs and centers the Administration proposes eliminating include (Payne, 2025):

• Those housed in the Centers for Disease Control and Prevention (CDC), such as the National Center for Chronic Diseases Prevention and Health Promotion, National Center for Environmental Health, National Center for Injury Prevention and Control, the Global Health Center, and the Public Health Preparedness and Response;

• Research housed within the National Institutes of Health (NIH), such as the National Institute on Minority and Health Disparities and the National Center for Complementary and Integrative Health; and

• Programs housed within the Substance Abuse and Mental Health Services Administration (SAMHSA), such as funding for harm reduction programs that have repeatedly been shown to reduce drug overdose deaths and the spread of infectious diseases through the sharing of syringes and smoking paraphernalia, and eliminating all funding for the Mental Health Programs of Regional and National Significance, Substance Use Prevention Programs of Regional and National Significance, and the Substance Use Treatment Programs of Regional and National Significance.

The proposed cuts follow prior cuts that included billions of dollars in federal grant funding allocated for data collection, surveillance, and disease tracking in the United States, including approximately $11.4 billion from the CDC and roughly $1 billion from SAMHSA. Many of these grants were created explicitly through the legislative process, meaning that these funds have been appropriated and allocated for specific uses. Several lawsuits are currently winding their way through various federal courts in efforts to restore Congressionally mandated funding.

The majority of the cuts proposed by this Administration are designed to remove federal funding from programs that “do not align with this administration’s priorities,” which demonstrably do not include ensuring the health and safety of vulnerable populations. The justifications provided for these cuts consistently and incorrectly accuse programs and funding of being duplicative, of engaging in illegal and/or unethical practices, and of committing the greatest sin: promoting diversity, equity, and inclusion (DEI). The cumulative effect is likely to result in a blackout for critical public health surveillance.

Moreover, many of the programs they would cut serve as the backbone to infectious disease testing, surveillance, and prevention in the United States. Due to the structure of our nation’s healthcare system and governance, each state’s respective departments of health and epidemiology receive significant funding from the CDC, NIH, and SAMHSA, which allows them to function and provide the services they are designed to provide. Congress allocates these funds to the respective federal departments and agencies, which then distribute them to individual states using a combination of formula-based and competitive grants. This model provides funding to states to conduct testing, disease surveillance, and outbreak tracking, as well as to provide services that they would otherwise be unable to provide due to their respective state budgets consistently failing to provide sufficient funding to support these activities.

The Skinny Budget proposal explicitly intends to eliminate that support, openly stating that these are activities that states should fund.

So long, and thanks for all the fish.

These cuts would, of course, hit the poorest states the hardest—states located primarily in the South, Midwest, and Mountain West—where testing, surveillance, and tracking have already been struggling, at best, and failing, at worst.

One of the best lessons learned from the COVID-19 pandemic and MPOX outbreak in 2023 was that, when properly funded, resourced, and staffed, disease surveillance and reporting can, in fact, work in the United States to prevent the spread of infectious diseases and avoidable deaths.

Those days, however, are over.

Sitting Secretary of Health, Robert F. Kennedy, Jr., has already exacted draconian job cuts within the various agencies under his purview, including (Gardner, 2025):

• Eliminating ~1/3 of jobs at the National Center for Chronic Disease Prevention and Health Promotion, including the wholesale elimination of the Office on Smoking and Health, Oral Health, Population Health, and some of the Reproductive Health divisions;

• The Office of Health Equity;

• The National Institute for Occupational Safety and Health (NIOSH);

• The Birth Defects Center;

• ~1/4 of the staff at the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention;

• ~1/3 of the staff at the CDC’s Injury Center;

• The Division of Environmental Health Science and Practice;

• The elimination of the partnership and health equity branch at the National Center for Immunization and Respiratory Diseases; and

• 81 staff from the Administration for Strategic Preparedness and Response.

The cuts perpetrated by this administration have already hit the states, resulting in the elimination or laying off of dozens of epidemiologists and data scientists (Mandavilli, Sanger-Katz, & Hoffman, 2025).

Essentially, this leaves the hen house unmonitored while the foxes gleefully attack.

Graham Mooney, a public health historian at Johns Hopkins University, put it best:

“If the U.S. is interested in making itself healthier again, how is it going to know, if it cancels the programs that helps us understand these diseases” (Stobbe, 2025).

We are entering perilous times, and it remains unclear how public health efforts in the United States will fare. Indeed, we can expect to see significant negative impacts in poor and minority communities, but those impacts are unlikely to remain contained within those communities: diseases spread beyond their initial bounds, and people will die.

The bigger question remains: how will we be able to save lives if we don’t know whose lives we’re trying to save?