Last updated: March 24, 2025

It has now been just over two months since the 2nd Trump administration took office, bringing sweeping reforms to the government and federally-subsidized programs. In just these past several weeks, Trump has signed over 100 executive orders [1], successfully confirmed 21 out of 22 Cabinet members [2], and, in conjunction with Elon Musk and the Department of Government Efficiency (DOGE), enacted a plethora of other policies to diminish or devolve government agencies.

These changes have greatly impacted the public health sector. Major federal health agencies have been threatened with large budget reductions, mass employee layoffs, and more edicts, the effects of which trickle down the far-reaching stream of funding to grant-seeking research labs and government-run science programs. This article will summarize and analyze the implications of these recent developments, particularly at the NIH and CDC.

Context

In order to comprehend the significance of these executive actions, it is necessary to first have a basic understanding of the history and functional roles of these government agencies.

The National Institutes of Health (NIH) is the world’s biggest contributor to biomedical research [3]. NIH funds much more than in-lab research, also supporting career training, infrastructure building, loan repayment, and scholarly competitions [4]. Structurally, the NIH is subdivided into 27 specialized Institutes and Centers (ICs), each of which receives its own annual budget from the Appropriations Committee of Congress, which is given constitutional control over the federal budget [3]. The department as a whole has received over $40 billion per year in appropriations for the last four years [5]. Most of this money is then awarded through grants to researchers nationwide (and even worldwide).

The NIH receives around 60,000 grant applications each year. Among those, a little over 20% are accepted [7]. How does the NIH decide who to fund? The process begins when a group of scientists familiar with the relevant concepts and current research gather in what is called a “study section” to review the potential impacts of the proposal [8]. The proposal is then reviewed by the advisory council of the respective IC, after which the IC director makes the final call. Past major successes in public health contributed to by NIH funding include development of new drugs to treat rheumatoid arthritis, implementation of water filters to reduce toxic chemical exposure, and more [9].

 Another major government health agency, the Center for Disease Control (CDC), is responsible for mitigating the damage and scope of disease in the US by tracking global data, conducting/funding research, and educating the public on how to maintain a healthy lifestyle. They act to abate not only infectious disease, but also environmental hazards (eg: lead exposure, airborne pollutants, etc.), mental health crises, drug overdoses, interpersonal violence, and more. It is thanks to the CDC’s comprehensive ongoing investigations and quick implementation of responses that the US was able to avoid/overcome major health threats such as swine flu and measles epidemics (the latter of which was declared eliminated from the US in 2000 after an extensive vaccination initiative, but is now seeing a resurgence). See here for more CDC milestones since its establishment in 1946 [10].

Policy Changes Under The New Administration

New executive actions have been releasing rapid-fire since Trump took office. A whirlwind of new memos, rescinded policies, court challenges, and more has contributed to an environment of much confusion and chaos. This section will recap the major happenings under the new leadership and examine the effects on the state of research and public health.

NIH Turmoil

A memo issued on January 21st implemented a communication and travel ban for the entirety of the Department of Health and Human Services (HHS; encompassing the NIH, CDC, FDA, and more), citing the need for presidential appointees to review documents and notices to ensure they comply with the administration’s policies [13]. This abruptly halted all NIH study sections, putting grant reviews on hold.  It also prevented staff from meeting with patients for clinical trials.

While the travel ban has since been lifted and grant reviews have now resumed, a new threat has come into play: mass cancellation of grants that “no longer align with the agency’s priorities.” As of now, these terminations are targeting projects relating to the broad categories of DEI, the LGBTQ+ community, and vaccine hesitancy [14]. Despite facing court injunctions, the slashes seem to be ongoing [15]. It is unclear how many grants have been defunded, but at least several dozen have been confirmed.

Additionally, a recent policy affecting all projects, regardless of focus, is the limitation of indirect cost rates to 15%. Indirect costs, also known as F&A (facilities and administration) costs or overhead costs, are the administrative and infrastructural costs associated with conducting research, such as utility bills, building and equipment upkeep, accounting, and paying support personnel. The rate is calculated as a percentage out of the direct costs (It is important to note this definition, as a lowered indirect cost rate does not mean that direct costs will be increased to compensate). While the range varies greatly from grant to grant and must be negotiated individually, the self-reported previous average was between 27-28%. This means that for each dollar awarded in direct funds, an additional $0.27 is awarded for indirect expenses. To be more precise, the stated rate is not calculated out of total direct costs, but of modified direct costs, which may leave out certain expenses in the grant, such as equipment, scholarships or fellowships, and capital expenditures. This results in an even lower actual rate – usually around 20-30% of the total grant [16].

In their memo, the NIH cited how private foundations often award grants with a 0% indirect cost rate, or a cap at 10-15%, and expressed hopes that the new limits would allow for greater oversight of expenditures and more directly support scientific progress [18]. They estimated that the cap would help save an annual $4 billion [19]. For now, a court injunction has stopped this change from taking effect.

The University Experience

Since it is impractical to determine the exact F&A costs for each individual project (many facilities are shared), the university calculates and negotiates an average standard rate for the whole campus. As it is, this rate is already less than the actual costs incurred at most universities [17].

Universities across the nation are anticipating the budget slash by implementing hiring freezes or even laying off staff. Dr. Szumlinski of the Neuroscience Research Institute at UCSB reported that she regrettably would not be able to keep any undergraduate students in her lab. “There’s just not enough money,” she said. “Everything has to be highly focused and cheap.”

In Dr. Szumlinski’s lab, which works with rats to study the neurochemical interactions behind drug addiction, indirect costs cover salaries for the veterinarian and animal care staff, equipment repairs, cage washers, and more. She says she understands why they might want to limit the rate, but “dropping it to 15% without any warning would require every single institute that receives NIH money to completely have to rebudget everything.” She worries about the possibility of the animal care facility being shut down entirely, ending her research.

When asked if there were any alternative ways to save money while mitigating harm, Dr. Szumlinski brought attention to how much companies charge for equipment and suggested people lobby for laws to regulate these prices. She explained that the cost of acquiring a lab rat is currently $77, compared to only $15 when she started her project.

Another UCSB professor, Professor Craig Montell, said the recent policy changes are “devastating for science.” His lab is currently working on investigating the mechanisms by which mosquitoes locate humans and how to leverage this to control the spread of viruses such as malaria and dengue. For fiscal year 2025, he received a total of $485,141 in an NIH award, $173,153 of which was for indirect costs (the standard rate for UCSB is 55.5%, recently negotiated to 56.5%) [20]. Over 90% of his funding comes from the NIH. Professor Montell emphasized that reduced funding “would not only have an immediate impact on research productivity, but discourage trainees from choosing biomedical research as their career path,” thinning out the field in the long term. He also expressed concerns over the Trump administration’s directives to destroy DEI initiatives, which he highlighted are “essential so that the university is supportive of everyone, especially groups that are underrepresented.”

Many graduate students are already having their career paths thwarted by the funding cuts. One student, who had received a fellowship for diversity in science covering one year to finish her PhD and four years for a postdoc, had her program terminated. Students are scrambling to find alternative research opportunities, but everything is clouded by an air of uncertainty.

“We just don’t know the status of anything,” said Dr. Szumlinski.

Reductions in Force

On February 13, RFK Jr.’s Senate hearing ended in a 52-48 vote, confirming his place as secretary of the HHS. On Kennedy’s first day in office, according to his long-standing vows to downsize the department, thousands of HHS employees were fired. The majority of those laid off were probationary employees, but the group also included several senior scientists. Furthermore, some leading figures have resigned or were forced into resignation, including the top spokesperson at the HHS; a former director at the NIH; and the director of the ARPA-H, another major biomedical research contributor under the HHS. The termination notices of many employees stated that they were fired for poor performance despite having received several good performance reviews [22]. The list of targeted employees started at over 5000, but some of those initially set to be let go were later spared, and in a confusing turn, many were suddenly reinstated weeks after. Some employees were even asked to exit the building and denied access to work materials without ever receiving an official termination notice. A court injunction soon followed, ordering all affected employees to be reinstated and admonishing the government to ensure its “RIF agenda…[acts] in compliance with federal law” [23].

 Amid all the back-and-forth disarray, concerns grow about managing public health concerns with a significantly reduced workforce. For example, at the CDC, where an estimated 750 employees were fired, the remaining workers are grappling with the recent outbreaks of the bird flu and measles, as well as trying to contain ebola, polio, and other diseases in foreign countries. Several teams, such as those working on border checkpoint screening, outbreak monitoring, and lab test development, have faced severe personnel cuts [24]. During such a critical period, a delayed or messy response could be fatal.

Moreover, the economic burden of an epidemic, in the long term, could outweigh the cost of preventionary measures. Factors such as GDP losses, the setback in education, the workforce reduction from deaths, and, in cases like COVID, government relief checks and the complications of long COVID, all contribute to the costs associated with managing disease and are exacerbated the less prepared we are [25].

Impacts of Other Trump Administration Policies

Even aside from all the direct attacks on science, some of Trump’s new policies could indirectly hinder research. For instance, the increased tariff rates on China, Canada, and Mexico would also raise the prices on lab and medical equipment manufactured/assembled in these countries. The US relies on China as one of the primary exporters of lab glassware, technical instruments, and electrical components; Mexico contributes greatly to our supply of plasticware often used in the medical field as well as metal parts; and Canada accounts for a large portion of our imports of biomedical and environmental testing equipment, among other devices [26]. A potential additional threat is facing economic retribution from these countries through retaliatory tariffs or bans. Many labs are stocking up on necessities in anticipation of these price hikes.

The US in a Global Context

It is crucial to consider that such detriment to the US public health and research sectors would not remain confined within these borders, but rather propagate internationally. As shown in the previous map, US agencies fund research and clinical work to help people all over the world. Countries currently struggling against epidemics, such as South Africa, where over 13% of the population lives with HIV, would be left particularly vulnerable if faced with funding cuts [28].

Perhaps most devastating are the attempts to dismantle the US Agency for International Development (USAID). With an average annual budget of around $40 billion, USAID provides humanitarian aid and medical services to over 130 countries, including Ukraine, Palestine, Yemen, Ethiopia, and more [29]. However, met by a funding freeze and a decimation of workforce (over 10,000 workers reduced to just over 290 deemed “designated personnel responsible for mission-critical functions, core leadership and/or specially designated programs” [30]), the agency has had no choice but to cancel tens of billions of dollars of aid. The list of terminated projects now stands at 368 pages [31]. These include projects that combated food insecurity and viruses, improved infrastructure, and advanced agricultural methods. Without this aid, it is estimated that tens of millions will die from malnutrition and diseases such as tuberculosis, malaria, dengue, and HIV [27].

Public Response

What are people doing in response to this pandemonium? Besides the several ongoing court cases that will, no doubt, get appealed and make their way up the chain, vehement protests have been occurring around the nation. Federal workers gathered outside the HHS on February 19th to fight against the workforce reduction. Stand Up for Science rallies took place in dozens of locations, where protesters made demands to stop censorship of LGBTQ+ topics on government health agencies, unfreeze funding, reinstate employees, and more. Prominent figures, including former NIH director Francis Collins, Congressmen, and famous science TV personality Bill Nye showed up in DC to deliver speeches.

“Science is under siege,” one speaker declared.

Conclusion

The cost of healthcare has been a growing topic of dismay to voters, as proven by the public reaction to the recent murder of UHC CEO Brian Thompson. Despite repeated campaign promises to lower healthcare costs for Americans, based on Trump’s budget cuts so far and his intentions to decentralize several federal programs, it is reasonable to assume that Medicare, Medicaid, and the Affordable Care Act will be downsized, and the price of prescription drugs will continue to rise [33].

Furthermore, while the NIH has been the main focus of the recent bedlam, other agencies are also taking hits. Many NSF REUs (Research Experiences for Undergraduates) have already been canceled, and if the agency is further culled, departments such as physics, engineering, and chemistry may be added to the chopping board.

The US is among the major forces paving the way in economic development, technological innovation, and standard of living. Analysis by the organization United for Medical Research calculated that for every $1 invested in NIH funding, $2.46 of economic activity is returned. Investment in research creates jobs and improves quality of life, and the arbitrary cuts to federal science departments, while appearing to reduce budget expenditures in the moment, will have disastrous economic effects down the line [34].

In a post-WWII letter to President Franklin D. Roosevelt, director of the Office of Scientific Research and Development Vannevar Bush wrote that “since health, well-being, and security are proper concerns of Government, scientific progress is, and must be, of vital interest to Government. Without scientific progress the national health would deteriorate; without scientific progress we could not hope for improvement in our standard of living or for an increased number of jobs for our citizens; and without scientific progress we could not have maintained our liberties against tyranny” [35].

It is not only vital to our country’s prosperity to support scientific research and public health initiatives, but also an imperative as part of the US’s responsibilities as a global leader.

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References

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