The Department of Health and Human Services announced drastic cuts that would gut 20,000 jobs on March 27—FDA (3500), NIH (1200), CDC (2400), and more from other agencies.
A leaked draft budget released by the Washington Post and Politico on April 10 shows that the Office of Management and Budget plans cuts of $40 billion to HHS. The NIH and CDC will each face reduction of more than 40%. How will that affect the public?
CDC
Cuts at the CDC emphasized programs looking at smoking, gun violence, and climate change—topics that this administration has devalued.
Under discussion are plans to eliminate the domestic HIV prevention program, although HHS officials told Politico this was part of streamlining programs for efficiency and not actually eliminating them. The $1 billion spent on the program is largely funneled to the states for testing, surveillance, offering PrEP prophylaxis to prevent HIV, and outreach. What will states do now to make up for the shortfall?
Although costly, the HIV prevention programs pay for themselves. Each newly diagnosed person accrues $500,000 in lifetime healthcare costs. In 2022 alone, 31,800 people were newly diagnosed, which would translate to $15.9 billion in cost.
Journalist Marisa Kabas has a running list of HHS departments that have already been gutted to the point of non-functionality. They include the
Cuts at CDC:
- viral hepatitis lab,
- TB Communication, Education, and Behavioral Studies Branch
- STD Prevention Lab and Disease Intervention branches
- HIV prevention
- National Institute for Occupational Safety and Health
- Development and Disability, Disability and Health Promotion Branch
- Division of Blood Disorders and Public Health Genomics
- Office of Health Equity (All: OD, Office of Women’s Health, Office of Minority Health)
- Office of Equal Employment Opportunity
- Traumatic Brain Injury team
- National Center for Chronic Disease Prevention and Health Promotion
- Smoking reduction
- National Center for Emerging and Zoonotic Infectious Disease, discontinuing funding for Lyme Disease, Prion Disease, Chronic Fatigue Syndrome,
Cuts at FDA:
- Vaccines and Related Biological Products Advisory Committee (VRBPAC)
- Center for Drug Evaluation and Research (CDER)
- Call center phones are off.
- Media affairs is gone (there is no one for journalists to call for interviews or to verify information. Staff are not supposed to have any communication with outsiders)
- The FOIA office is gone.
Cuts at NIH:
- National Institute of Allergy and Infectious Diseases
- Office of the Director
- Much of the Office of Communications and Government Relations
- Office of Minority Health (entire office is gone)
These are just a smattering of the planned agency cuts. Some have already been implemented; others have not.
One other notable cut is that the Head Start program, which provides early child care and education, has lost all of its funding from HHS’s Administration for Children and Families.
What might the public notice?
The FDA will no longer investigate food outbreaks. They just suspended a quality control program that tests milk and cheese for bird flu and other pathogens.
The administration says that the states will pick up that work. Given how strapped state public health departments are now, it’s hard to envision how this will happen. Also, many outbreaks cross multiple states and require extensive cooperation. A prime example is the outbreak of Cronobacter infections from powdered infant formula in 2022.
Vaccines might not be as available.
A novel treatment for deadly pancreatic cancer, using an mRNA vaccine, is threatened by grant “purity”tests for mentioning a “forbidden” word, “mRNA.”
Robert F. Kennedy, Jr, now the head of HHS, has been vocal in his criticisms of mRNA vaccines. Because of this, scientists have reportedly been warned to scrub the word mRNA from their grant proposals for cancer trials. RFK Jr. has previously called mRNA COVID-19 vaccinations “dangerous.” He also tried to have their approval rescinded in 2021 when deaths from Covid were rampant.
The NIH has also axed research in vaccine hesitancy, with acting Director Matthew Memoli saying the agency is not interested in exploring ways to “improve vaccine interest and commitment.”
When we have widespread bird flu infections, we will likely be in trouble because mRNA vaccines can be developed faster than most egg-based vaccines.
The Novavax vaccine, which is not mRNA-based is also in distress because of RFK Jr’s mistrust and lack of knowledge. The FDA was slated to transition Novavax’s COVID-19 vaccine from emergency use authorization to full licensure on April 1. But both RFK Jr and Tracy Beth Høeg, now a special assistant to Marty Makary (head of FDA), have opposed Novavax. RFK Jr. said, “It is a single antigen vaccine. And for respiratory illnesses, the single antigen vaccines have never worked.” RFK Jr is wrong. Paul Offit, a leading vaccine researcher, immediately challenged this, as did Peter Marks, the former head of the FDA’s biologics center, who was recently ousted, and other prominent physician researchers. RFK Jr. is neither a physician nor a scientist.
Hoeg has promoted incorrect information about COVID-19 vaccines, including misinterpreted data, multiple people with vaccine expertise said. Further, in 2022, Novavax explained that their bivalent BA.1 + wild type formulation performed no better than single antigen formulations. Previously, Marty Makary, now head of the FDA, said, “Novavax may be the best Covid-19 vaccine to date. It uses a tried and true mechanism of action and can be easily stored and transported. Needs a better PR firm.”
Novavax’s COVID-19 vaccination has far fewer side effects than the mRNA vaccines. Given all the expert opinions and data supporting its use, why did the FDA not approve its full licensure?
Will we have access to any Covid vaccines next year? It appears increasingly doubtful for many. The Advisory Committee on Immunization Practices met last week and is leaning towards recommending “risk-based” boosters, with semi-annual boosters for those over 65 or immunocompromised (by whose definition?) and no vaccination needed otherwise. That ignores that even “mild” Covid infections can cause long Covid and years of side effects, including cognitive impairment. If ACIP doesn’t recommend vaccination, insurers are unlikely to pay for it.
Drug development will be slowed
Are you hoping for a new drug for your cancer? Don’t hold your breath! Did you know that funding from the NIH, totaling $187 billion, contributed to 354 of 356 drugs (99.4%) approved from 2010 to 2019? This is not an extravagant waste— the return was $2.56 for each dollar invested.
A number of clinical trials, done to test new drugs or treatments before approval, have already stopped when HHS abruptly canceled funding. So many leaders at the NIH were fired that there is no one left to sign off on grants for funds that Congress already approved. (This means the administration is ignoring the will of the people by not dispersing these funds already allocated by Congress).
There is an upcoming Senate Appropriations Committee hearing on April 30: Biomedical Research: Keeping America’s Edge in Innovation. This title is clearly an oxymoron. Should you wish to share your thoughts, you can reach your senators at 5Calls.org or here.
