A week of chaos in public health
The truth is, there’s a lot we don’t know yet.
It’s been a week—a week of confusion, chaos, and concern. The new U.S. administration wasted no time hitting the pause button on almost everything in public health: communications, data, hiring, traveling. Positions are being removed, chairs rearranged, and there have been some… aggressive… emails.
A federal senior advisor told me, “Welcome to the away game.” In other words, the landscape has shifted—we are on a different playing field, with different refs. Shock, aggression, and swiftness appear to be strategic tactics only hyper-driven by a record of questioning the role of science and public health.
But, as unsettling as this feels, now is the time to stay steady. Public health world: Do not destabilize. The health of 330 million Americans depends on it.
Chaos and uncertainty in the world of public health
When an administration changes, it’s not unusual to reassess programs and shift priorities. It’s also not unusual to pause communications while leaders find their footing. The Health and Human Services is enormous; a pause happened during the Biden and Obama transitions, for example.
However, the scope of a pause ordered this week is unusual. For example, CDC’s scientific publication, MMWR, wasn’t published yesterday. It was the first time in 70 years this has happened, and it included three discoveries on the H5N1 (bird flu) outbreak—an active biosecurity threat to Americans. Also, every Friday, CDC updates its respiratory virus data on external dashboards. Today, only a small subset of data is being released.
Here’s what’s unfolded so far:
All communications from HHS have been paused until Feb. 1, including all data updates on the website, CDC’s MMWR, HANs (emergency alerts), an meetings with partners. (Since the original announcement, some data has been released, so there is progress on this front and it’s changing by the minute.)
NIH study sections—which determine which research projects at academic institutions get funded—have been canceled, and travel has been paused. An NIH email suggests that all scientific presentations may now require review by a presidential appointee. (This is highly unusual. And this poor person reviewing presentations is going to get so bored.)
Key gatherings like the National Vaccine Advisory Committee and the Presidential Advisory Council for Combating Antibiotic Resistance have been called off.
HHS is searching for DEIA programs and threatening anyone who disguises them. They are asking for people to report colleagues.
160 colleagues from the National Security Council were sent home, leaving gaps in areas like emerging biological threats and medical preparedness.
The big question is… why?
Some measures could be a sign of a transition or just a general lack of knowledge of what these agencies actually do. We’re also seeing a leadership gap in critical agencies, like CDC, where an interim director was just announced yesterday, but still no Chief of Staff has been named.
But other moves could certainly be deliberate, signaling a value shift. It’s more than unsettling when scientists receive emails asking them to report colleagues or have their work micromanaged. And it’s easy to assume, especially given the first Trump administration, that these are signs of something bigger to come around control of information flow.
The truth is it’s likely a combination, but we don’t know yet.
Why this matters
These changes are deeply personal for those on the front lines. Entire teams are on administrative leave, and researchers face uncertainty about the future of their work. Epidemiologists ready to release critical public data have been paused. The uncertainty surrounding future research grants is unnerving for researchers, given that universities rely on those grants to support students, faculty, and innovation.
This doesn’t just affect careers; it impacts the systems that keep our communities healthy and safe.
Emerging threats don’t wait: Pausing public health communications and research means delays in responding to emerging threats, like H5N1.
Economic impact: Public health protects more than health—it safeguards our economy. Disruptions in systems can ripple across industries, as we’ve already seen with avian flu and egg prices.
Staying grounded
I’m already overwhelmed. And it’s only been 5 days. But public health has weathered challenges before, and while the road ahead may be uncertain, there are reasons to stay focused:
This is a marathon, not a sprint. Burnout won’t help anyone. I’m pacing myself for the long game. Stay steady.
We aren’t alone. Public health doesn’t operate in isolation. Powerful counterbalances exist and are strategically playing in the background, whether we like it or not. The NIH has academic institutions to push back. The FDA has counterbalances in the pharma and food industry. The CDC has insurance companies and health systems. Bureaucracy is slow for a reason: it avoids whiplash.
Public health is local. A strong national leadership is needed to help drive the ship and see the big picture of what is going on, but much of the groundwork of public health is still functioning. These teams remain vital anchors for our communities.
Science wins. Ignoring public health has consequences—resurgent diseases, overwhelmed hospitals, and unmet needs. Reality always catches up, and the importance of public health will become undeniable.
Be strategic. Attention and political capital are as scarce as financial resources. Right now, we're only hearing from the top. After this week of shock and awe, we have to leave room for more nuanced conversations with the reasonable voices in the new administration who share the values of caring for the health of all Americans. It’s in those conversations that critical decisions about our health system will be determined.
Bottom line
This is a moment of uncertainty, but public health has always been about more than federal leadership. It’s about the local communities, the health workers, and the scientists who step forward when systems falter. There are a lot of unknowns, but what we do know is that public health is needed today, tomorrow, and every day after that.
Stay steady, stay engaged, and keep your eye on the ball. The health of 330 million Americans depends on it.
Love, YLE
Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. YLE reaches more than 305,000 people in over 132 countries with one goal: “Translate” the ever-evolving public health science so that people will be well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:
Instead of feeling “shock and awe“ I think most of us are experiencing “predictability and disgust.“
This is all about centralizing the flow of information, as authoritarian regimes do. The enforcement of collective fictions comes next, which will result in more Covid, polio, measles, and maybe just another devastating pandemic via H5N1.
As long as we don’t know what’s happening, maybe it’s not happening. Doesn’t matter. Blind fealty to the great leaders does matter.
Thank you, I needed to read this today. State health department epidemiologist here, watching all my CDC meetings and calls get canceled well into February, and feeling pretty scared about it. It’s good to remember the longer view.