Why we keep going

Today thousands of health workers at the CDC and FDA lost their jobs—effective immediately. Some found out when they tried to badge in, only to be denied entry. Twelve senior leaders were offered reassignment—with just 24 hours to decide. In other words, fired without being formally fired.

It’s cruel and unnecessary—and that’s the point. It’s also dangerous.

Health divisions are gone, and programs are gutted

• HIV prevention? Gone.

• Asthma and air quality team? Gone.

• Environmental hazard response? Gone.

• Gun violence prevention? Gutted.

• Communications? Gutted.

• Worker safety? Gone.

• Reproductive health? Gone.

• Birth defects? Gone.

• Disability health? Gone.

• TB prevention? Gone.

• Blood disorder programs? Gone.

• National survey on drug use and mental health? Gone.

• Lead poisoning prevention? Gone.

• Water safety? Gone.

• Tobacco control division? Gone.

And that’s just CDC. FDA has a list. Same with NIH. Check this crowdsourced document—because federal leadership has been silent. This isn’t the radical transparency.

There’s no question that health institutions can be run more efficiently. I spent the last three years inside the CDC pushing for change—fighting for innovation, better systems, and clearer communication. I agree with some cuts and reorganization. Reimagining public health is essential. But tearing it down with no plan to rebuild isn’t transformation. It’s sabotage.

The ultimate justification for these cuts is cost savings. But these cuts do not make financial sense. Federal workers make up less than 1% of the HHS budget. And, public health programs are all about prevention—which is not only good for our health but can be much cheaper than treating disease. For every $1 spent on flu vaccines for the elderly, $60 are saved. For every $1 spent in NIH funding, $4.25 is added to the local economies. Cutting these programs may save a dollar today, but when people start to get sick because of eliminated programs, we’ll pay many times more in health care costs down the road, much out of the government’s pocket for Medicare. We’re borrowing from our future selves with far too high an interest rate: in dollars, in health, and in lives. In the meantime, the U.S. is giving a big gift to huge corporations that will either step in and privatize or take advantage of this moment, like Big Tobacco.

Figure by YLE; Numbers come from a host of peer-reviewed articles and reports (e.g., here, here, here, here)

What is becoming clear

Federal systems are being hollowed out and reduced to a shell. At CDC, it’s as if only some of infectious disease matters, and the rest of public health is expendable. This is hard to reconcile, given RFK's previous messaging about the importance of chronic disease. It also ignores that chronic and infectious diseases are deeply linked. Zika and pregnancy. Obesity and Covid. Health doesn’t exist in silos.

Furthermore, these cuts also affect service to the most vulnerable: people living with sickle cell disease or disabilities, communities with suboptimal access to resources like oral health, and those exposed to environmental hazards. With these cuts, for example, a health response won’t be ready for a train derailment toxic spill, like in Ohio a few years ago.

Viruses don’t stop when the government does. Neither do bacteria, natural disasters, gun violence, rising rates of depression, suicide, or health emergencies. Public health isn’t something you can pause and expect to pick back up later. It’s built on decades of momentum and lessons learned.

I think destruction will continue to come. More jobs cut. More reorganizing. And more people will leave because the mission doesn’t align with their value system.

But here’s the thing

Public servants don’t do this work for prestige or money. Every one of the thousands who lost their jobs—over the past two months and in the months to come—is motivated by one mission: to serve their communities. We don’t fight for science or agencies. We fight for people. We fight for kids. For the right to survive and the hope to thrive.

Right now, we’re completely burned. Gutted. Knee-deep in moral injury. Sitting on couches, crying into pints of ice cream. Some Americans are scared, too—watching the systems that protect their health be dismantled in real time. Other Americans are cheering it on without a second thought about what these total “savings” numbers actually mean.

You can push people down, fire them, or ignore them altogether. But here’s the thing: that doesn’t mean they’ll stay down. For those in public services, it’s literally not in their DNA.

So, even as these systems are dismantled or privatized, the fight for public health continues—with camaraderie, with hope, and with the quiet (and not-so-quiet) resilience of millions of people who will never stop fighting for the public’s well-being.

That will never change. And it can’t be taken away.

Bottom line

So tonight, I’m still trying to understand: How does this make America healthier? Because from where I sit, this isn’t about health at all. It’s about dismantling the very systems designed to protect it. This will eventually course correct, but in the meantime, it’s doing a whole lot of damage for little short-term gain.

Love,
YLE

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Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. Dr. Jetelina is also a senior scientific consultant to a number of non-profit organizations. YLE reaches over 340,000 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: