How HHS cuts could hurt emergency response

The U.S. Health & Human Services Department is losing a quarter of its workforce amidst a sweeping reorganization, and that could undermine the ability to respond to new threats, critics say.

Tom Cotter, CEO of the Health Response Alliance, says job cuts and the reorganization of the U.S. Health & Human Services Department could hurt efforts to respond to future threats.

Tom Cotter, CEO of the Health Response Alliance, tells Chief Healthcare Executive® that he’s worried that the health department’s job cuts and reorganization could hurt the federal response to future pandemics and emergencies.

“This is a good day for any kind of emerging pathogen,” Cotter says.

“When we inevitably get another massive outbreak or pandemic, we're going to find ourselves really short-staffed, as we did during the last pandemic, before all of these cuts were made,” he says. “So instead of bolstering and investing in our public health infrastructure and our health care infrastructure, we're pulling funding from it, when we just saw what happened at our current levels of funding and resourcing. So I have a lot of concerns.”

U.S. Health & Human Services Secretary Robert F. Kennedy Jr. says the department will lay off 10,000 workers. The Food and Drug Administration and the Centers for Disease Control and Prevention are each slated to lose nearly one-fifth of their staffing.

Combined with other moves to reduce the HHS workforce, such as buyouts and early retirements, the department’s workforce is shrinking from 82,000 to 62,000. The department is also reorganizing, with 28 divisions being realigned into 15 divisions.

“We cannot afford to lose capabilities, even in the short term,” Cotter says. “It doesn't mean that this work of efficiencies and consolidation can’t be done. It just needs to be done in a really thoughtful, purposeful way that ensures we're not leaving anyone behind from services and resources they count on to stay healthy.”

‘Recipe for disaster’

The health department’s reorganization and job cuts were announced days after the Trump administration said it’s pulling back $11 billion in Covid-related funding to state and local health departments. Public health leaders say the withdrawal of the funds will make it harder for states to detect and prevent outbreaks and plan for other emergencies.

“I think that's pretty plain to see that withdrawing state funding at the same time we're reducing federal funding is really a recipe for disaster,” Cotter says. “And it is going to leave states really vulnerable, not only for the next potential disease outbreak, but for any disaster, and also for maintaining their citizens' health from chronic diseases.

“All of this funding is used to strengthen a public health system that addresses disasters as well as everyday illnesses,” he adds. “So pulling any amount of funding is really going to have a systemic weakening of our public health systems.”

Cotter says some aspects of the health department’s reorganization could have unintended consequences.

He says he’s concerned about the plan to move the Administration for Strategic Preparedness and Response, which leads federal efforts to manage and react to public health emergencies, into the CDC. The health department said it would create more efficiency and strengthen the CDC, but Cotter says he has concerns about the move.

“Let me put it this way. The two entities were separate for a reason,” Cotter says.

While the CDC focuses on infectious diseases and outbreaks among its many duties, the Administration for Strategic Preparedness and Response has a different role.

“ASPR is designed to be the cross-cutting emergency management entity that can pull resources and expertise from across HHS to solve particular problems during emergencies,” Cotter says. “And so putting it under another agency really robs them of that cross-sectoral expertise.”

“I think there's going to be a lot of potentially cultural friction between these two entities, now that one is superior to the other in how they approach emergency response,” he adds.

The Administration for Strategic Preparedness and Response operates the Hospital Preparedness Program, which provides aid to hospitals to plan and respond to public health emergencies. Cotter says he’s concerned if the funding for that program will be affected.

Cotter said it “essentially is the funding stream for all things emergency preparedness at health care facilities. Is that going to be folded into other CDC funding mechanisms … Is that funding going to remain level?”

The timing of the health department’s reorganization also poses some challenges, Cotter says.

“We're just over 60 days out from hurricane season starting,” Cotter says. “So we have the public health and medical agency being absorbed by another agency when they are supposed to be leading response efforts in the health and medical space for the federal government. What is that going to look like when our first hurricane comes in a couple months?”

‘Reduction of capability’

Kennedy just began serving as health secretary six weeks ago, winning Senate confirmation despite concerns about his long record of assailing the safety of vaccines and his lack of experience running any kind of large health organization.

Cotter says he is worried about the reorganization of the health department being done so rapidly.

“I welcome any process that goes in and does a thoughtful and relatively detailed analysis of where there are redundancies over where things can be consolidated,” Cotter says. “But starting with … ‘We need to lay off this many people," really does invite a sort of haste that doesn't really fit in the world of protecting America's health from disaster and outbreak. It's really concerning when that's how the conversation starts, with the end goal of cutting this many positions.”

“The reduction of capability in a few years after we have just undergone a pandemic that took millions of lives, and we're cutting capabilities left and right,” he says.

In explaining the rationale of the reorganization, Kennedy said the health department needs a new approach. He said he’s aiming to reduce administrators and employ more physicians and scientists. Kennedy also stressed that the alignment reflects the focus on chronic diseases, and touted savings of $1.8 billion in taxpayer money.

But Cotter says those projected savings could be wiped away if more people are sickened due to emerging diseases that aren’t being tracked.

But more importantly, Cotter says the moves could undermine the health department’s mission.

“The government is not a business,” Cotter says. “The government provides critical services for everybody, and the people who will be disproportionately affected by all of these decisions are people who don't have access to as many resources, who live in rural areas, who are in underserved communities, who are suffering in pharmacy deserts, for example. All of those people are going to feel this first, and at some point, when we get another big event, we're all going to feel it.”