Scary Times for Public Health in the U.S.

“We must get ourselves out of this scary time by continuing to push for clear, evidence-based research and policies.”

Shari M. Erickson, MPH, Chief Advocacy Officer and Senior Vice President, Governmental Affairs and Public Policy, American College of Physicians

“It is like trying to fly a plane and you have no speed gauge, you have no altimeter, you don’t know your elevation, you don’t know how far it is to the nearest airport. You have none of the information that you need.”

Susan Mayne, former director, Center for Food Safety and Applied Nutrition, US Food and Drug Administration

Last Friday, we celebrated Halloween, the origins of which lie in an ancient Celtic festival that blurred the boundary between the living and dead. While Halloween is meant to be scary and even terrifying, it is just a celebration.

What we are facing in the U.S. right now, however, is truly terrifying and it is real. A prime example is the enormous destruction of our nation’s public health systems. Public health is one of those things that we all take for granted—until it is lost. In this week’s Germ Gems post, I remind the readers of what has been lost, but also point to some hopeful developments.

What is public health? “Public Health” is the science and practice of protecting and improving the health of people and their communities. This discipline focuses on disease prevention, prolonging life, and promoting health through organized efforts of communities. (This is in contrast to treating illness in individual patients which is the bailiwick of medicine and the primary responsibility of physicians.)

The key aspects of public health include disease prevention (through vaccinations, sanitation, and surveillance of outbreaks), health promotion, environmental health (clean air, safe water), epidemiology (studies of causes and risk factors of poor health), setting health policy, and designing systems that make healthcare more effective and equitable. This is a huge mandate shared by a large number of organizations including federal, state and local public health agencies and global organizations.

What’s been lost? On January 20, 2025, the first day of his second term in office, President Trump put a wrecking ball to public health; he signed an executive order withdrawing the U.S. from the World Health Organization (WHO). Then he began dismantling the United States Agency for International Development (USAID) and by July 1, 2025, USAID ceased to exist. (See, Cavalcanti, D. M., et al., “Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis,” The Lancet, July 19, 2025, an article that reviews the profound contributions of USAID and the impact of its closing). These two events will have global consequences disrupting “global health governance, threatening disease surveillance and reversing progress made in combating HIV/AIDS, tuberculosis, and malaria…” (Auwal, A.R., et al., “The global implications of U.S. withdrawal from WHO and the USAID shutdown; challenges and strategic policy considerations,” Frontiers in Public Health, June 2, 2025).

But, the Trump decision having the most impact on public health in the U.S., is the nominating and then appointing of Robert F. Kennedy, Jr. as Secretary of Health and Human Services (HHS).  In my opinion, February 13, 2025, the date that Kennedy was sworn in as Secretary of HHS, will go down in history as the day that triggered the mass destruction of public health in the U.S.

The Centers for Disease Control and Prevention (CDC) is the national public health agency charged with the protection of the public health and safety through the control and prevention of disease, injury and disability in the U.S. and worldwide. The CDC is, however, an agency of the Department of HHS and falls under the control of Secretary Kennedy–an infamous anti-vax champion.

Since Kennedy took the helm, there has been an almost complete annihilation not only of the CDC itself but also of trust in the CDC’s recommendations. Countless articles published over the past nine months document the collapse of the CDC’s Advisory Committee on Immunization Practices (ACIP) and of public trust in the CDC itself. (See, e.g., Rasmussen, S.A., et al., “The Consequences of Silencing the ‘Voice of CDC’,” New England Journal of Medicine, February 12, 2025; Jaffe, S., “CDC is ‘in the ICU right now’ former officials say,” The Lancet, September 13, 2025; Hughes, R., Gostin, L., “Trusted Vaccine Guidance Has Collapsed—Along With the Rule of Law,” MedPage Today, October 4, 2025; Soucheray, S., “Chaos following mass firings, rehirings at CDC,” October 13, 2025).

In addition to the gutting of the CDC, other HHS-related institutions are either also under threat or been gutted. The US Food and Drug Administration, an agency charged with protecting public health by ensuring the safety, efficacy, and security of a wide range of products for human and veterinary health, is reeling from the destructive influences of the Trump administration. (Klyer, J. “The need to strengthen the US Food and Drug Administration: US cuts threaten health care at home and abroad,” The Lancet, June 21, 2025.) The HHS terminated all 17 people running the National Survey on Drug Use and Health, crippling this country’s only nationwide survey of drug use, addiction and mental health. (Wade, G., “US public health system is flying blind after major cuts,” New Scientist, October 28, 2025). It eviscerated the National Center for Health Statistics and laid off employees responsible for planning the National Health and Nutrition Examination Survey, one of the most comprehensive assessments of health, diet and illness in the U.S. And, the list goes on.

Will the current public health nightmare ever end? To me, it’s totally incomprehensible that RFK Jr. remains in office given the huge outcry and demand for his resignation by virtually every credible medical and public health organization in the U.S. (See, e.g., Rudd, T.,  “Multiple Medical Societies Demand RFK Jr.’s Resignation,” MedPage Today, September 4, 2025; Helmore, E., “Six former US surgeons general warn RFK Jr is ‘endangering nation’s health,’” The Guardian, October 7, 2025). Nonetheless, there is nothing to suggest that the current administration will get rid of Kennedy anytime soon and put an end to this public health nightmare.

 As Peter Marks, MD, PhD, commented in a recent New England Journal of Medicine article, “The current situation, in which public health has been woefully undermined, must change; that will happen only if we all individually do something about it…Because public health is critical for sustaining human well-being, all of us must have the courage to take on its current challenges.” (Marks, P., “Restoring Confidence in Public Health,” New England Journal of Medicine, October 8, 2025). Some organizations are showing such courage and taking on the challenges.

In June 2025, Secretary Kennedy removed all 17 members from the ACIP—the committee charged with making vaccine recommendations for the entire U.S. (Fryhofer, S.A., “Unpacking the ACIP Overhaul: Chaos and Controversy,” Medicine Matters, July 11. 2025). In response to this chaos and controversy, the American Association of Pediatrics and the American College of Physicians stepped up to the plate by providing expert guidance on vaccine recommendations to physicians and other healthcare providers.

In addition to these professional health organizations, there are 67 accredited public health programs in U.S. In these programs, there are many creative, talented, and courageous public health professionals who remain deeply committed to their calling—safeguarding the health of the public. They too are doing something.

For example, Michael Osterholm, MPH, PhD, a colleague at the University of Minnesota School of Public Health and Director of the Center for Infectious Diseases Research and Policy (CIDRAP), and a robust number of like-minded public health experts have built the “Vaccine Integrity Project” which provides thoroughly evidence-based recommendations on vaccines for professional organizations. (McKay, B., et al., “The Doctors Building a Public-Health Universe Outside the Government,” Wall Street Journal, September 23, 2025).

Moreover, in response to the destruction of the CDC’s flagship weekly publication, Morbidity and Mortality Weekly Reports, CIDRAP has partnered with the New England Journal of Medicine in a new publication—Public Health Alerts. Additionally, on October 30, 2025, CIDRAP launched a partnership with the Coalition for Epidemic Preparedness Innovations.

It is going to take time for health professionals and Americans to get over the current public health nightmare. But, the examples cited above are hopeful signs that America is waking up and recovery is on the way.