Are Federal Spending Cuts Endangering America's Most Vulnerable

CANN continues to monitor the restructuring of federal health agencies and the impacts of funding cuts on public health programs nationwide. This article is part of our developing coverage.

Two infants in Louisiana recently died from whooping cough—the first such deaths in the state since 2018. This tragedy comes amid a twelve-fold increase in whooping cough cases, from just 11 in 2023 to 149 in 2024, with 110 already recorded in the first three months of 2025 alone. These deaths occurred shortly after a February 13th decision by the Louisiana Surgeon General to end all vaccine promotion and outreach events statewide—the same day Robert F. Kennedy Jr. was confirmed to lead the U.S. Department of Health and Human Services (HHS).

These preventable deaths are the direct consequence of an intensifying assault on America's public health infrastructure, as the Trump Administration executes an $11.4 billion clawback of COVID relief funds from state health departments while simultaneously gutting federal health agencies through mass layoffs. The consequences of these dangerous, ideologically-driven policies are unfolding across the country and, as public health experts predicted, people are dying.

A System Already at the Breaking Point

Before these cuts, state and local health departments were already operating in a perpetual state of crisis. Years of chronic underfunding and staffing shortages had left America's public health system dangerously fragile and ill-equipped to handle emerging health threats.

In Utah, 70-90% of the state's public health funding comes from the federal government. Local health departments, particularly in rural and underserved areas, often function with minimal staff and resources, stretching their capacity to its limits to fulfill basic functions.

"This is going to be a major dent in our ability to be prepared for whatever new threat might come," warned Connecticut Health Commissioner Manisha Juthani. Philip Huang, Dallas County Health director, pointed out that even modest cuts can have outsized impacts on smaller departments: "It may not be in the millions, but these are really small health departments that have very few staff, very little capacity. And then if you hit those, then it starts to really impact their ability to respond."

The $11.4 Billion Clawback: A Devastating Blow

On March 25, 2025, the Centers for Disease Control and Prevention (CDC) announced it was pulling back $11.4 billion in COVID-19 funding previously allocated to state and local health departments across the nation. The announcement came without warning, leaving health officials scrambling to assess impacts on critical programs and staff.

The administration's justification was blunt and misleading: "The COVID-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago," said HHS Director of Communications Andrew Nixon in a statement to NBC News. This characterization fundamentally misrepresents how these funds were being used.

While the grants were initially authorized for pandemic response, they had evolved to support core public health functions: tracking infectious disease outbreaks, monitoring wastewater for early detection of disease spread, supporting community health workers in underserved areas, addressing health disparities, and maintaining vaccination programs for multiple preventable diseases.

The financial impact on states is severe: Texas faces the loss of $877 million, Florida $482 million, and North Carolina $100 million in cuts affecting immunization efforts and infectious disease monitoring. In Kentucky, $34 million in already-committed funds are now inaccessible, despite previous federal guarantees those funds would be available through March 2026.

Minnesota's Department of Health has issued layoff notices to 170 workers and rescinded offers to 20 new hires in response to losing $220 million in federal funding. This has resulted in slower responses to infectious disease outbreaks with fewer lab technicians and public health investigators.

The HHS Bloodbath: Dismantling Decades of Expertise

On April 1, 2025, HHS began executing the largest mass layoff in its history—eliminating 20,000 positions (10,000 through direct layoffs and another 10,000 through early retirement and voluntary separation offers).

The manner of these dismissals was particularly callous. According to the Associated Press, "Some staffers began getting termination notices in their work inboxes at 5 a.m., while others found out their jobs had been eliminated after standing in long lines outside offices to see if their badges still worked." Some workers who received layoff notices were directed to contact an EEO official who had died months earlier.

As the layoffs commenced, HHS Secretary Robert F. Kennedy Jr. tweeted triumphantly, "The revolution begins today!" When confronted by a fired HHS employee asking about the impact on people with disabilities, Senator Jim Banks responded, "You probably deserved it," then called the worker "a clown" as elevator doors closed.

Critical CDC and HIV Programs Decimated

MedPage Today reports that the hardest-hit areas of the CDC included centers focused on injuries, global health, chronic disease prevention, and infectious diseases including HIV, hepatitis, STIs, and tuberculosis. Directors of at least three major CDC centers were reassigned or placed on administrative leave.

The cuts strategically targeted offices serving vulnerable populations. The Administration for Community Living, which coordinates programs like Meals on Wheels, saw approximately 40% of its staff eliminated. The Office of Minority Health was largely dismantled, and entire offices were eliminated, including the Office of Science and Data Policy and Freedom of Information Act offices at the CDC.

The HIV+Hepatitis Policy Institute's Carl Schmid warned that the elimination of HHS's Office of Infectious Disease and HIV Policy would have lasting consequences:

"The expertise of the staff, along with their decades of leadership, has now been destroyed and cannot be replaced. We will feel the impacts of these decisions for years to come and it will certainly, sadly, translate into an increase in new HIV infections and higher medical costs."

These cuts follow the forced resignation of Dr. Peter Marks, the FDA's top vaccine safety official, who had resisted Kennedy's vaccine misinformation. In his departure letter, Marks wrote that "truth and transparency are not desired by the secretary, but rather he wishes subservient confirmation of his misinformation and lies."

Louisiana: Where Anti-Vaccine Policy Has Already Claimed Lives

Louisiana offers a foreboding preview of what happens when ideology trumps evidence-based public health practice. On February 13, 2025, Louisiana Surgeon General Dr. Ralph Abraham issued a directive ending all vaccine promotion and outreach events by the state health department.

Jennifer Herricks of Louisiana Families for Vaccines warned: "And the consequences of lower vaccination rates? More illness. More hospitalizations. More deaths." Tragically, her prediction has already come true for two Louisiana families who lost their babies to a vaccine preventable disease.

The memo came despite Louisiana experiencing its worst whooping cough outbreak in over a decade. Manning Family Children's Hospital in New Orleans has been admitting 1-2 children weekly for whooping cough, with cases statewide skyrocketing from 11 in 2023 to 149 in 2024.

By February 20—less than a week after the vaccine promotion ban—news outlets reported the first infant death from whooping cough. A second soon followed. Yet the health department did not officially confirm these deaths until March 28, more than a month later. In that belated announcement, Abraham did acknowledge that "vaccines are the best way to protect against infections, especially for babies," but this came after the vaccine preventable deaths had already occurred.

Vaccine Science Under Attack

During an American Public Health Association panel on vaccine science, Dr. Paul Offit of the Children's Hospital of Philadelphia compared the dismantling of public health agencies to an invasion "by a foreign nation" whose interest "is to destroy public health agencies." He emphasized that the HHS cuts will cause a significant loss of institutional knowledge vital for future public health emergencies.

Offit noted that NIH-funded research on mRNA technology "probably saved roughly 3 million lives" during the COVID pandemic. The dismantling of vaccine expertise comes amid a resurgence of vaccine-preventable diseases, with two deaths already reported in the measles outbreak affecting several states.

Public Health Leaders Unite in Opposition

Over 100 of the nation's most respected public health leaders—including former HHS Secretaries, CDC Directors, and state health officials—have issued an open letter urging Congress to halt the Trump administration's dismantling of public health infrastructure.

The letter, organized by For Our Health, warns: "This is a moment of profound danger for public health. The dismantling of CDC is not just an internal agency matter—it will leave states, communities and American families without the support they need to protect themselves from disease, misinformation and chronic illness."

Broader Impacts: New Threats for PLWH and Vulnerable Populations

For people living with HIV and other immunocompromised conditions, the dismantling of public health infrastructure creates particularly dangerous vulnerabilities. The elimination of the HHS Office of Infectious Disease and HIV Policy removes coordination for HIV programs across federal agencies.

With the Health Resources and Services Administration (HRSA) facing staffing reductions, coordination of HIV prevention and treatment programs could be compromised. These structural changes risk undermining the health infrastructure that people living with HIV depend on for essential care.

The closure of wastewater surveillance programs eliminates a key early warning system for HIV cluster detection, while the decimation of health equity programs removes vital supports for marginalized communities disproportionately affected by HIV.

Breaking: Judge Blocks Funding Cuts as HHS Backtracks

In a significant development, U.S. District Judge Mary McElroy announced on April 3 she would issue a temporary restraining order blocking the Trump administration's $11.4 billion funding cuts to state health departments. During the hearing, McElroy stated that the 23 states and District of Columbia that filed the lawsuit "make a case, a strong case, for the fact that they will succeed on the merits."

This judicial intervention represents a critical, if temporary, reprieve for state health departments already reeling from layoffs and program cancellations. New York Attorney General Letitia James responded to the ruling by tweeting: "We're going to continue our lawsuit and fight to ensure states can provide the medical services Americans need."

Simultaneously, Secretary Kennedy has begun backtracking on the sweeping cuts, claiming it was "always the plan" to reinstate certain employees and programs after terminating them. Kennedy acknowledged that "personnel that should not have been cut were cut" and said some would be reinstated, including a CDC program that monitors blood lead levels in children.

This claim contradicts the chaotic, across-the-board nature of the cuts that eliminated entire divisions and critical public health functions. Kennedy's assertion that "we're going to do 80% cuts, but 20% of those are going to have to be reinstalled, because we'll make mistakes" reveals a reckless approach to public health administration where critical programs and expertise are eliminated first, with potential consequences evaluated only after damage is done.

These developments suggest mounting pressure against the administration's public health cuts is beginning to have an effect, reinforcing the importance of continued advocacy and legal challenges.

The Fight to Preserve Public Health: What Comes Next

The combined impact of the COVID funding clawback and HHS restructuring represents an unprecedented assault on America's public health infrastructure. Twenty-three state attorneys general have already filed legal challenges against the funding cuts, arguing they exceed executive authority and violate appropriations law.

Recent election results suggest the administration's approach to public health may be backfiring politically. In Wisconsin's Supreme Court race, liberal candidate Susan Crawford defeated her conservative opponent despite record spending by DOGE architect Elon Musk. Meanwhile, special elections in Florida districts that Trump won by 30 points saw Republican margins cut in half.

This political landscape creates an opening for effective advocacy. Congressional representatives, particularly those in vulnerable districts, may be increasingly receptive to constituent concerns about public health funding. The moment calls for coordinated action: contact your representatives to demand oversight hearings and funding restoration; document and report public health impacts in your community; and support organizations working to preserve essential health services.

The preventable deaths we're witnessing are the predictable consequence of policies that prioritize ideology over scientific evidence and public health. Our collective advocacy can make the difference between a temporary setback and lasting damage to our nation's public health infrastructure.

America's Vaccination Problem

Politics Trump Public Health

The United States is confronting a serious resurgence of vaccine-preventable diseases, exemplified by the measles outbreak in Texas and New Mexico that has now infected over 124 people and claimed the life of an unvaccinated child. This crisis coincides with multiple failures in public health leadership and unprecedented political interference in evidence-based practice.

Recent Centers for Disease Control and Prevention (CDC) analysis reveals that the percentage of children with a vaccine-hesitant parent varies dramatically by vaccine type — from 56% for COVID-19 vaccines to 12% for routine childhood vaccines. This growing hesitancy has created dangerous gaps in community protection across the country.

In a rapid succession of alarming developments within a single week, we've witnessed a new confirmed measles case in Kentucky from an international traveler, Health and Human Services (HHS) Secretary Robert F. Kennedy (RFK) Jr.'s cancellation of a multimillion-dollar project to develop an oral COVID-19 vaccine, and the FDA's abrupt cancellation of a critical advisory committee meeting on next season's flu vaccine formulation. During his first cabinet meeting appearance, Kennedy incorrectly stated there had been two measles deaths (there was one) and downplayed the outbreak as "not unusual" — a claim physicians immediately contradicted.

This confluence of declining vaccination rates, active disease outbreaks, and systematic dismantling of public health infrastructure represents a crisis entirely of our own making. It’s 2025 and children are dying from diseases we've known how to prevent for decades, not because of scientific limitations, but because of a collective failure to prioritize evidence over ideology.

A Dismantling in Real Time

At the February 27 cabinet meeting, HHS Secretary Kennedy made several troubling statements about the ongoing measles outbreak. "Measles outbreaks are not unusual," Kennedy claimed, an assertion quickly refuted by medical experts.

"Classifying it as 'not unusual' would be inaccurate," said Dr. Christina Johns, a pediatric emergency physician. "Usually an outbreak is in the order of a handful, not over 100 people that we have seen recently with this latest outbreak in West Texas."

Dr. Philip Huang, director of Dallas County Health and Human Services, was more direct: "This is not usual. Fortunately, it's not usual, and it's been because of the effectiveness of the vaccine."

Kennedy's statement that two people had died from measles was also incorrect – Texas officials confirmed there has been one death, an unvaccinated school-aged child. His claim that patients were hospitalized "mainly for quarantine" was astonishingly false. Local health officials reported that most patients required treatment for serious respiratory issues, including supplemental oxygen and IV fluids.

Meanwhile, in just his first two weeks in office, Kennedy has taken several actions that threaten to undermine vaccine development and public health guidance:

1. The FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) meeting scheduled for March was abruptly canceled. This annual meeting is crucial for selecting the strains to be included in next season's flu vaccines. A wise move in the middle of the worst flu season in 15 years. Norman Baylor, former director of the FDA's Office of Vaccine Research and Review, told NBC News: "I'm quite shocked. The VRBPAC is critical for making the decision on strain selection for the next influenza vaccine season."

2. Kennedy halted a $460 million contract with Vaxart to develop a new COVID-19 vaccine in pill form, just days before 10,000 people were scheduled to begin clinical trials.

3. Just days earlier, Kennedy indefinitely postponed a meeting of the CDC's Advisory Committee on Immunization Practices (ACIP), which helps determine vaccine recommendations for states and insurers.

Dr. Paul Offit, a member of VRBPAC and vaccine expert at Children's Hospital of Philadelphia, expressed his dismay: "I feel like the world is upside down. We aren't doing the things we need to do to protect ourselves."

Evidence of Vaccine Success Amid Political Attacks

In striking irony, the CDC Morbidity and Mortality Weekly Report (MMWR) just published new data demonstrating the remarkable success of the human papillomavirus (HPV) vaccination program in preventing cervical cancer. During 2008–2022, cervical precancer incidence decreased 79% among screened women aged 20–24 years, the age group most likely to have been vaccinated. Higher-grade precancer incidence decreased 80% in the same group.

This success story illustrates what effective vaccination programs can achieve when supported by consistent policy and healthcare provider recommendations. The HPV vaccine has prevented countless future cancers in a generation of young people, with similar potential for other vaccines when politics doesn't interfere with public health.

The contrast between this evidence of vaccine success and the current administration's assault on public health infrastructure could not be more glaring. At the very moment when scientific data confirms vaccines' life-saving impact, political appointees are systematically dismantling the systems designed to implement and monitor vaccination programs.

The False Promise of "Informed Consent"

Kennedy has justified halting vaccine promotion by claiming he wants future campaigns to focus on "informed consent" instead. However, experts warn this framing misrepresents the concept and creates dangerous misperceptions about vaccines (which, to be fair, would make it right in RFK Jr.’s wheelhouse—if only that were the actual job description).

Mark Navin, Lainie Friedman Ross, and Jason A. Wasserman explained in STAT News: "True 'informed consent' requires an understanding of how people process information about risks, and public health must promote collective benefits rather than focus entirely on individual autonomy."

Simply listing potential vaccine side effects without context creates predictable cognitive biases, similar to hearing about a shark attack and becoming afraid to swim despite the infinitesimal risk. As these experts note, "It is more like handing someone a list of everything that could go wrong on an airplane without mentioning that flying is far safer than driving."

The CDC's canceled 'Wild to Mild' campaign appropriately conveyed what matters most: vaccines' ability to turn severe, potentially deadly disease cases into manageable, mild illnesses—reducing hospitalizations, complications, and deaths. Replacing this messaging with uncontextualized risk information isn't enhancing informed consent — it's promoting fear and hesitancy.

The Expanding Measles Threat

Measles is making a dangerous comeback. The Kentucky Department of Health confirmed its first case since 2023 in an adult who recently traveled internationally. While contagious, the individual visited a Planet Fitness gym, potentially exposing others—a not-so-subtle reminder that wiping down equipment is more than just good manners.

This case adds to outbreaks in nine states, including Texas, New Mexico, Alaska, Georgia, New Jersey, New York, and Rhode Island. The most severe remains in West Texas’ Gaines County, where nearly 14% of schoolchildren have religious exemptions from required vaccinations.

On February 26, an unvaccinated child in that Texas community became the first U.S. measles fatality since 2015 and the first pediatric death since 2003. Before vaccines, measles killed 400 to 500 Americans annually.

These outbreaks are particularly tragic given that the MMR vaccine is exceptionally safe and effective. Two doses provide 97% protection against a disease that, without vaccination, would infect nearly every child by age 15. Among 10,000 measles cases, 10 to 30 children will die, 2,000 will require hospitalization, and over 1,500 will suffer serious complications, some with lifelong consequences.

By contrast, severe vaccine side effects are extraordinarily rare—fewer than four in 10,000 people experience fever-related seizures, blood clotting issues, or allergic reactions. As beloved children’s author Roald Dahl wrote after losing his daughter Olivia to measles encephalitis in 1962: "I think it is almost a crime to allow your child to go unimmunized."

Roald Dahl and the open letter he wrote in 1986, encouraging parents to vaccinate their children against measles. (Credit: Ronald Dumont/Daily Express/Getty Images)

Declining Vaccination Rates

Vaccination rates for measles and other preventable diseases have been trending downward, creating dangerous gaps in community protection. According to research from the Center for American Progress, kindergarten MMR vaccination rates have fallen below the critical 95% threshold needed for herd immunity. Since the 2019-20 school year, coverage has dropped from 95% to approximately 93% nationwide, leaving over 250,000 children vulnerable to infection.

This decline is even more concerning at the state level. Thirty-nine states saw vaccination rates fall below the 95% threshold in the 2023-24 school year, an increase from 28 states during the 2019-20 school year. Overall, less than 93% of kindergarten children were up to date on their state-required vaccines in 2023-24, compared with 95% four years earlier.

COVID-19 and influenza vaccination rates show similar concerning trends. According to the CDC's vaccination tracking data, only 23.1% of adults have received the 2024-25 COVID vaccine, while 45.3% have received the seasonal flu vaccine. For adults 65 and older, these rates are somewhat higher but still insufficient – 44.4% for COVID and 70.2% for flu.

A 2022 modeling study estimated that over 9.1 million children (13.1%) in the United States are currently susceptible to measles infection. If pandemic-level vaccination declines persist without catch-up efforts, that number could rise to over 15 million children (21.7%), significantly increasing the risk of larger and more frequent outbreaks.

When Vaccines Become Political Identifiers

Vaccine-preventable diseases disproportionately impact vulnerable communities. Flu vaccination rates vary significantly by race, with 49% of White adults vaccinated, compared to 42% of Black adults and 35% of Hispanic adults. These disparities stem from access barriers, medical mistrust, and inconsistent provider recommendations.

The politicization of vaccines exacerbates these challenges. Support for school vaccine mandates has dropped from 82% in 2019 to 70% in 2023, driven by a sharp decline among Republicans (79% to 57%), while Democratic support remains stable at 85-88%. Similar trends appear among White evangelical Protestants, where support for school vaccine requirements fell from 77% to 58%. This geographic clustering of under-vaccinated populations fuels outbreaks—exactly what’s unfolding in West Texas.

Partisan divides extend beyond COVID-19. Republicans report lower annual flu vaccination rates than Democrats (41% vs. 56%), and among those fully vaccinated against COVID-19, Democrats are nearly three times as likely to have received a recent booster (32% vs. 12%). Vaccine hesitancy also correlates with education levels, further compounding risks in communities with both lower socioeconomic status and conservative political leanings.

Addressing these disparities requires public health strategies that acknowledge political polarization while working beyond it. Culturally tailored messaging, trusted community voices, and policies that eliminate access barriers are essential to counteract the social and ideological forces shaping vaccine decisions today.

State-Level Assaults: Louisiana's Ban on Vaccine Promotion

Federal attacks on vaccine policy are now playing out at the state level. In February 2025, the Louisiana Department of Health announced it would no longer promote mass vaccination through health fairs or media campaigns—a directive from Surgeon General Dr. Ralph Abraham that drew immediate backlash from the medical community.

Nine state medical organizations, including the Louisiana State Medical Society, issued a joint letter condemning the move: "Immunizations should not be politicized. Healthcare should not be politicized. Public health should not be politicized. Your relationship with your physician should not be politicized."

Dr. Vincent Shaw, president of the Louisiana Academy of Family Physicians, called the opposition unprecedented and warned that halting vaccine promotion could bring back diseases he's "only seen in textbooks, like measles and rubella." Meanwhile, Abraham has misrepresented his credentials, falsely identifying as a board-certified family medicine physician—raising serious concerns about the expertise guiding public health policy.

The consequences are already surfacing. Dr. Mikki Bouquet, a Baton Rouge pediatrician, reports growing parental skepticism about routine vaccinations. "Now parents are asking which vaccines are really necessary. That's absurd—it’s like asking which vitamin matters most. You need them all."

Even Republican Senator Bill Cassidy, despite voting to confirm RFK Jr. as HHS Secretary, has criticized the policy, warning that cutting vaccine outreach ignores the reality of parents' lives.

This shift underscores a troubling trend: political ideology overriding evidence-based public health, with the most vulnerable populations poised to suffer the consequences.

The Fight for Evidence-Based Solutions

This past week has marked a dangerous escalation of political interference in public health. The cancellation of vaccine advisory meetings, the halting of innovative vaccine development, and the downplaying of a deadly measles outbreak signal a fundamental shift away from science-based policy.

Healthcare professionals can no longer afford to stay on the sidelines. Beyond their clinical roles, they must become active policy advocates by:

1. Contacting state and federal representatives to oppose policies that undermine vaccination

2. Engaging with professional organizations to develop unified advocacy efforts

3. Providing expert testimony at legislative hearings on vaccine-related bills

4. Writing op-eds and speaking to media about vaccine safety and efficacy

5. Countering misinformation as trusted community voices

6. Supporting candidates who prioritize evidence-based public health policies

Medical organizations must also wield their influence more effectively. The recent joint statement from nine Louisiana medical groups demonstrates the power of unified action, while hospital systems—often major employers—hold political capital that should be used to safeguard public health infrastructure.

Community advocates play a critical role, too. Parents, faith leaders, and business owners can amplify vaccine messaging and reinforce public health norms. Even conservatives who support science-based medicine must speak out. As Senator Bill Cassidy’s rebuke of Louisiana’s vaccine policy shows, principled advocacy can transcend partisan divides when children's health is at stake.

The choice is clear: we either defend decades of vaccination progress or risk a return to the preventable suffering of the pre-vaccine era. Healthcare providers willing to advocate beyond clinic walls will determine which path we take.