Federal health department reorganizes and slashes staff

April 1, 2025 — In what is being described as a “bloodbath,” the Department of Health and Human Services (DHHS) has dramatically reduced staff at the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Food and Drug Administration (FDA) and other federal health agencies.

Word of the cuts—which are expected to include 10,000 people—came early Tuesday morning, shortly before Health Secretary Robert F. Kennedy, Jr. swore in new NIH director Jay Bhattacharya, MD, PhD, and new FDA commissioner Marty Makary, MD, MPH. Some staffers first learned of the news when their badges no longer allowed them to access their offices.

The changes affect many of the agencies’ operations, including the CDC’s National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Division of Global HIV and TB, and Division of Reproductive Health. The CDC’s Office of Health Equity, Office of Women’s Health and Office of Minority Health all appear to be on the chopping block, according to a listing of cuts DHHS employees shared with reporters. Administrative functions, such as communication, were hit especially hard.

“In addition to the losses across the Department of Health and Human Services, the elimination of entire branches within the Centers for Disease Control and Prevention’s HIV Prevention Division devoted to evaluating interventions, developing treatment guidelines and targeting resources where they are needed most will result in chaos, inefficiencies and interruptions in essential care,” said HIV Medicine Association chair Colleen Kelley, MD, MPH. “The randomness of today’s actions is reckless and will harm Americans rather than make them healthy.”

High-level staff cuts include NCHHSTP director Jonathan Mermin, MD, MPH, Jeanne Marrazzo, MD, MPH, who succeeded Anthony Fauci, MD, as head of the National Institute for Allergy and Infectious Diseases (NIAID), NIAID deputy director for clinical research Clifford Lane, MD, and FDA Center for Tobacco Products director Brian King, PhD, MPH. Mermin and Marrazzo reportedly declined reassignment to positions with the Indian Health Service in Alaska.

“In a matter of just a couple days, we are losing our nation’s ability to prevent HIV,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement. “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.”

The staffing cuts and restructuring of agencies and operations “will touch all points of the cancer continuum, from prevention to research, to treatment access and survivorship care, and could disrupt our nation’s ability to develop early detection tests and treatments for the more than 200 diseases we know as cancer,” Wayne Frederick, MD, interim CEO of the American Cancer Society, said in a separate statement. “The abrupt and widespread reductions could also result in future cancer breakthroughs languishing in labs while patients suffer.”

DHHS Reorganization

On March 27, Kennedy announced a “dramatic restructuring” of DHHS that will involve 10,000 layoffs in addition to another 10,000 people who accepted buyouts or early retirement. The cuts are projected to save about $1.8 billion annually.

The staff cuts would eliminate about a quarter of the DHHS workforce, reducing it from about 82,000 to 62,000 full-time employees. According to the Wall Street Journal, which first reported the news, the FDA is expected to lose 3,500 employees (about 19% of its workforce), the CDC will lose 2,400 people (about 18%), the NIH will lose 1,200 people (about 6%) and the Centers for Medicare and Medicaid Services will lose 300 people (about 4%).

DHHS’s 28 divisions will be reduced to 15. A new Administration for a Healthy America will combine multiple agencies, including the National Institute for Occupational Safety and Health, the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration, which oversees the Ryan White HIV/AIDS Program. CBS reported that the entire staff of the Office of Infectious Disease and HIV/AIDS Policy, which runs the Ending the HIV Epidemic Initiative that President Donald Trump launched during his first term, could be laid off.

“We are streamlining HHS to make our agency more efficient and more effective,” Kennedy said in a post on X. “We will eliminate an entire alphabet soup of departments, while preserving their core functions by merging them into a new organization called the Administration for a Health America, or AHA. This overhaul will improve the health of the entire nation.”

But clinicians, researchers and advocates fear that the cuts will decimate public health, patient care, timely drug approvals and crucial medical research.

“There is no other way to say this: Today is the day the CDC was essentially dissolved,” Dr. Boghuma Titanji of Emory School of Medicine said on BlueSky. “What’s left is a husk. People will die as a direct result.”

The cuts will affect state and local health efforts, especially in rural areas and in red states that lack the resources or political will to use their own funding to help fill the gaps.

“The CDC is being gutted and that has real effects on people in my state,” Joseph Cherabie, MD, of Washington University in St. Louis, whose work focuses on HIV, sexual health and LGBTQ health posted on BlueSky. “We still see new HIV diagnoses each day, [and] if we can’t test and measure data, then people will develop advanced HIV and die.”

Missouri relies on CDC funding for pre-exposure prophylaxis (PrEP) and HIV surveillance. “Our efforts are largely dependent on these federal grants,” Cherabie told Wired. “We use them to make sure that we are able to distribute HIV testing equipment. We use them to make sure that we can get information and data on how much PrEP is being distributed, how many HIV diagnoses we have, how many HIV tests we’re giving out. If we lose that, then we’re moving around in the dark.”

Cuts to FDA staff could slow the approval of new drugs and medical therapies, and some experts fear changes in the agency’s philosophy could affect the stringency of its reviews—though it’s not clear whether criteria would become looser or stricter. Staff reductions at the Center for Veterinary Medicine include scientists working on bird flu. So far, the FDA’s Oncology Center of Excellence appears to be spared.

“The FDA as we’ve known it is finished, with most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed,” former FDA commissioner Robert Califf, MD, said on LinkedIn. “I believe that history will see this a huge mistake…It will be interesting to hear from the new leadership how they plan to put Humpty Dumpty back together again.”

Last week’s ouster of Peter Marks, MD, PhD, as director of the FDA’s Center for Biologics Evaluation and Research, is particularly concerning as he oversaw vaccines, which have long been in Kennedy’s crosshairs.

“I was willing to work to address the Secretary’s concerns regarding vaccine safety and transparency by hearing from the public and implementing a variety of different public meetings and engagements with the National Academy of Sciences, Engineering, and Medicine,” Marks wrote in his resignation letter. “However, it has become clear that truth and transparency are not desired by the Secretary, but rather he wishes subservient confirmation of his misinformation and lies.”

The Centers for Medicare and Medicaid Services has seen the smallest staff reduction so far, but it lost its Office of Equal Opportunity and Civil Rights. President Donald Trump has said he would protect Medicaid, Medicare and Social Security, but his unofficial deputy, Elon Musk, frequently accuses the programs of fraud, and the House of Representatives has proposed budget cuts of $880 billion, which may be impossible to achieve without slashing them.

By Liz Highleyman

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• Healio: Mass HHS layoffs sow ‘chaos,’ make US less safe, experts say