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?

Ideological Crusade Against DEI Will Yield Dire Consequences for Medical Research

“The tenets of DEI demand that you discriminate against white people by giving preferential treatment to other races,” said right-wing activist Robby Starbuck on Jordan Peterson’s podcast on February 2nd, 2025 (Jordan B. Peterson, 2025)

This conspiracy theory is the underlying sentiment being used by the current Trump Administration to justify its targeted actions against people of color, women and gender-nonconforming people, and lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people in the United States. Unfortunately, it will yield dire consequences for medical research…and undercut efforts to achieve health equity!

How these actions have played out across the federal government’s various agencies and throughout the medical and scientific research spaces has been both stark and shocking:

An analysis conducted by the chairs of dozens of boards at the National Institutes of Health (NIH) in March found that, of the 43 experts whose review board positions were eliminated without notice or reasons—scientists with expertise in the fields of mental health, cancer, and infectious disease—38 were female, Black, or Hispanic:

According to the analysis, six percent of White males who serve on boards were fired, compared with half of Black and Hispanic females and a quarter of all females. Of 36 Black and Hispanic board members, close to 40 percent were fired, compared with 16 percent of White board members. The analysis calculated the likelihood that this would have happened by chance as 1 in 300 (Johnson, 2025).

National Institutes of Health

Board members generally serve terms lasting five years; several members’ terms had just begun in the past year.

Beyond the firing of non-White males serving in the NIH, funding has also been stripped from dozens of NIH-funded research efforts, including those studying Black maternal and fetal health, as well as cancer and HIV. These efforts, according to the termination letters received by the researchers, are “antithetical to the scientific inquiry, do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness” (Hellmann, 2025).

“At HHS, we are dedicated to restoring our agencies to their tradition of upholding gold-standard, evidence-based science. As we begin to Make America Healthy Again, it’s important to prioritize research that directly affects the health of Americans,” said U.S. Department of Health and Human Services (HHS) spokesman, Andrew Nixon. “We will leave no stone unturned in identifying the root causes of the chronic disease epidemic as part of our mission to Make America Healthy Again” (Hellmann, 2025).

Similar to the justification for terminating non-White male employees, the underlying sentiment of this statement implies that any research efforts that seek to identify the root causes of why chronic diseases disproportionately impact minority populations are scientifically invalid, and that we should instead be generalizing research rather than investigating how to help those who bear the greatest impacts.

This is the “new normal” in the United States, and the impacts that the conspiracy-laden politics of revenge and white grievance will have on scientific research could potentially take a generation to correct and repair. Many of the scientists, themselves, have chosen to abandon the United States, quickly sliding into dysfunction, for safer pastures:

• Since the current administration began occupying The White House, universities in European nations have been opening their doors to scientists fleeing ‘censorship” and “political interference” (Kassahm, 2025a). So far, opportunities for relocation have been posted in Belgium, Canada, France, and the Netherlands (Duster, 2025), with other countries in active discussions on how to capitalize on the desires of U.S. scientists to leave the country.

…and these countries will have thousands of takers. According to a survey conducted the scientific journal, Nature, of the 1,608 scientists who responded to their poll question asking, “Are you a U.S. researcher who is considering leaving the country following the disruptions to science prompted by the Trump administration,” 75.3% (n=1,211) responded that they were considering doing so (Witze, 2025).

• Aix-Marseille University set up a program called “Safe Place for Science” (Mokhtarthu, 2025), which created 20 positions for fleeing scientists:

At a time when academic freedom is sometimes called into question, Aix-Marseille University is launching the Safe Place For Science program, providing a safe and stimulating environment for scientists wishing to pursue their research freely (Mokhtarthu, 2025).

This program received 298 applications in a month, of which 242 were deemed eligible, and included applicants from Johns Hopkins University, NASA, Columbia, Yale, and Stanford (Kassam, 2025b).

An article also published in Nature clearly defines what is occurring in the United States.:

Many countries have tried to emulate this model of science-led growth, and to stop the ‘brain drain’ of talent to better-resourced laboratories in the United States. Now, the actions of the administration run the risk of slowing, if not halting, that trend, as the country seeks to devalue scientific evidence in policymaking and attack the structures supporting the domestic knowledge ecosystem, including universities, libraries, and museums (Nature, 2025).

This type of exodus from scientific minds and expertise is called a “brain drain,” a term coined after World War II to describe the emigration of scientists and technologists to North America from post-World War II Europe. We are now seeing this again…but in reverse. The United States has long served as a safe haven for scientists and experts escaping political influence and authoritarian regimes across the planet; we are now the country to which they are fleeing.

Missing from many of these discussions is the very real concern of what this means for any data publications released during the current administration:

The current administration has made no efforts to hide that they will be actively directing and controlling the release of information from federal agencies and departments:

One of the first official actions under this administration was to immediately pause all external communications from health agencies, including social media posts, scientific reports, website updates, and Federal Register notices (Association for the Advancement of Blood & Biotherapies, 2025). This pause ordered all documents and communications to be reviewed by a presidential appointee before issuing, directed federal employees not to speak at any public speaking engagements, and required coordination with political appointees before corresponding with Congress or state governors.

Further evidence comes from Robert F. Kennedy, Jr., who has ordered the Centers for Disease Control and Prevention (CDC) and the NIH to disregard decades of scientific studies and findings in order to find the “environmental factors” that are “causing” the “autism epidemic” (Wadman, 2025).

Both incidents, along with a litany of other incidents of overt attempts by this administration to not only control the flow of information but to force research to be rewritten to comply with a conspiracy-driven ideology, raise troubling questions that have yet to be fully confronted:

Can anything put forth by the Trump Administration be considered trustworthy?

How can any data released during these troubling times be considered valid when this administration has made clear that only data that agrees with their worldview is acceptable?

For example, the CDC releases its annual HIV Surveillance Report, and its current year’s findings vastly differ from those of previous years.

What if demographic data are missing? What if states whose governments align with the regime receive glowing reports, while those that don’t receive black marks? After scientists have drafted their findings, how can we guarantee that the data has not been tampered with and altered to support the regime’s positions?

More importantly, how vast will the devastation be to our institutions and to public trust in them, particularly at a time when the regime has spent nearly a decade sowing conspiracy theories and disinformation against them?

We need to grapple with these questions and consider their implications for the future of equity research and our nation.