CDC Sinks into the Swamp

The cuts are about political control, not cost savings

In his video announcing his plan to fire 2,400 CDC workers, Robert Kennedy, Jr. said, “We have two goals…to save the taxpayer money by making our department more efficient…and to radically improve our quality of service.”

I’m sure that to many people, those goals and the cuts sound reasonable. Every big organization is riddled with waste. What’s wrong with trimming 18% of staff and running CDC more efficiently?

But everyone I know in public health is aghast. Katelyn Jetelina of Your Local Epidemiologist called the cuts “dangerous”. Former CDC Director Tom Frieden wrote that they will “cost American lives and dollars”. They both argued that Americans’ lives were worth more than the financial savings.

The story is much worse than that, though. The loss of Americans’ lives from the cuts is real, but the job cuts aren’t about saving money. They are about bending CDC to the Trumpians’ will.

First, the financial savings are tiny. Most of CDC’s budget is passed through to state and local health departments. My estimates are that cutting 18% of its staff would reduce CDC’s expenditures by less than 5%. The dollar savings from that would be less than what CMS (with its annual budget of $1.5 trillion) spends every three hours. If Kennedy truly wanted to save taxpayer money, there are many easier and smarter ways he could do it.

Second, the cuts are not even remotely designed with efficiency or quality of service in mind. They are mainly ideological and political.

HHS has not produced a list of the units that have been cut or eliminated. (So much for “radical transparency”.) But CDC staffers have crowd-sourced a list, which is being passed around among former CDC staff. The list is still evolving and probably not completely correct, but it’s close enough to see clear patterns. Dozens of units have been targeted, ranging from the Division of Human Development and Disability within the National Center for Birth Defects and Developmental Disabilities to the agency’s Freedom of Information Act Office. This list shows what Kennedy and the plan’s other architects’ real motives are:

• Cultural conservative ideology. The cultural conservatives clearly influenced the cut choices. It’s no surprise that the Office of Health Equity was eliminated. But Kennedy’s team also cut the Division of Reproductive Health. (I guess no one told them that this office does not provide or recommend abortion. It helps women have healthy pregnancies.) They made major cuts in the Division of HIV Prevention, I assume because they think this division is merely helping gay men and trans women. And they cut the Division of Violence Prevention, presumably because it discourages people from using guns.

• Industry payback. It’s not hard to see the hand of big industries here. Why, other than to appease fossil fuel interests, would Kennedy’s team eliminate the Climate and Health program, the Environmental Public Health Tracking program, and the Asthma and Air Quality Branch? All of these are in the National Center for Environmental Health, which was hit hard. They also took a sledgehammer to the National Institute of Occupational Safety and Health, firing 2/3 of its staff. NIOSH does the research needed to protect workers from health risks on the job. Among many other cuts, the Miner Safety program is gone, which may dismay some coal miners who thought this administration might care about them. And, in a move that particularly telling, Kennedy eliminated the Office on Smoking and Health, responsible for fighting the number one killer in America. (At the same time, the FDA reassigned its lead tobacco regulator.) Clearly, Trump is paying back his Big Tobacco campaign contributors.

• Control of communications. The cuts eliminate many units with the word “communications” in their titles, including the main Office of Communications in the CDC Director’s office. Nearly every politician sees mass communication only as a means of self-promotion, and Kennedy is no different. Of course he wants all communications to go through him. But for those who work in public health, communications are about getting accurate, useful information to people making decisions about health. CDC protects our health by providing hard data, information, and expert advice to state and local health departments, health care providers, experts, and the public. It’s completely appropriate that CDC has many units responsible for communications on their specific areas of expertise – for example, the Communication, Education, and Behavioral Studies Branch in the tuberculosis prevention unit – which was eliminated. That cut will mean that health care providers treating people with tuberculosis will do it less well, and TB may be more likely to spread. Cuts like that across CDC may give Kennedy a few more ratings points, but they will contribute to a general dumbing down of our health system – and us.

• Political control. Most disturbing, these cuts are designed to give Kennedy - a lawyer with loopy, dangerous ideas about health - a high degree of control over CDC. They do that by taking responsibility for information technology, human resources, and contracting out of CDC and moving it to HHS. These functions are the levers that leaders use to manage their organizations. If the CDC Director is not in charge of CDC’s information flow, hiring, and contracting, what control does he or she actually have?

At the same time that this Reduction in Force was announced, several directors of the individual centers within the CDC were also fired – excuse me, “reassigned” to an Indian Health Service job in Alaska. These were the most telling decisions of all. These directors will clearly be replaced, so there are zero cost savings in firing them, and their replacements will likely be Kennedy apparatchiks. Never before has a new administration installed political appointees below the level of the CDC Director.

So the HHS “Reduction in Force and Reorganization” is not that at all. It is Trump and Kennedy trying to transform CDC into a propaganda arm of Trump’s Republican party. That attempt is not unique to CDC, of course. From what I read, it’s happening throughout the federal government, and is much worse at the EPA. But is this what Americans want of an agency whose mission is to protect their health?