Are DOGE Cuts Making America Healthy?

Summary

Short Wave Podcast Episode Summary

Episode Title: Are DOGE Cuts Making America Healthy?
Host: NPR's Emily Kwong and Regina Barber
Release Date: April 30, 2025

In this compelling episode of NPR's Short Wave, hosts Emily Kwong and Regina Barber delve into the significant budgetary and organizational changes enacted by the Trump administration's Department of Government Efficiency (DOGE). Led by Elon Musk as a special government employee, DOGE's initiatives over the first 100 days have sparked widespread debate, particularly concerning their impact on health and science sectors in the United States and globally.

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1. Introduction to DOGE and Its Initiatives

The episode opens with an exploration of DOGE, an ad hoc department established under President Trump's administration aimed at enhancing government efficiency. Selena Simmons Duffin introduces DOGE as a pivotal component of Trump's first 100 days, highlighting its aggressive measures to streamline federal operations.

Notable Quote:

"The ad hoc Department of Government Efficiency team is one of the defining initiatives of President Trump's term so far."
— Selena Simmons Duffin [00:18]

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2. Department of Health and Human Services (HHS) Under Scrutiny

The discussion shifts to the Department of Health and Human Services (HHS), where DOGE has implemented substantial workforce reductions and program cuts. Selena Simmons Duffin, covering Health and Human Services, provides an in-depth analysis of these changes.

Workforce Cuts: DOGE has executed a 25% reduction in HHS's workforce, slashing from 82,000 to 62,000 employees. This maneuver involved abrupt Reduction in Force (RIF) notices sent on April 1st, leaving many employees unaware of their job termination until they arrived at work.

Notable Quote:

"The communication around the cuts was very difficult to understand. So one example of this is that the RIF notices went out in the very, very, very early morning of April 1, and a lot of people missed them."
— Selena Simmons Duffin [03:35]

Programmatic Impacts: Several critical programs have been affected:

• Centers for Disease Control and Prevention (CDC): Elimination of centers focusing on violence prevention, tobacco smoke, reproductive health, HIV prevention, and workplace safety.
• Food and Drug Administration (FDA): Reduction in food safety labs, leading to potential delays in quality control and international inspections.
• Human Services: Cuts to agencies supporting the elderly and disabled, including programs like Meals on Wheels and LIHEAP.

Notable Quote:

"Whole centers at CDC were eliminated. Violence prevention, tobacco smoke, reproductive health, HIV prevention, workplace safety, including services for coal miners who get black lung disease."
— Selena Simmons Duffin [05:23]

Short and Long-Term Implications: While some operations remain active due to administrative delays, the long-term consequences could be dire. For instance, compromised food safety labs may lead to undetected outbreaks of foodborne illnesses, increasing the risk of public health crises.

Notable Quote:

"If they can't do their work well and quickly, that means when there is an outbreak... more people could buy those things that are contaminated and get sick and maybe even die."
— Selena Simmons Duffin [07:33]

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3. Global Health and Foreign Aid: A Wider Impact

Gabriela Emanuel, covering Global Health and Foreign Aid, discusses the repercussions of DOGE's cuts on international aid, particularly through the U.S. Agency for International Development (USAID).

Historical Role of U.S. in Foreign Aid: The United States has been a leading global health donor, providing aid to over 170 countries. This assistance has been pivotal in stabilizing regions, fostering goodwill, and preventing adversarial influences from nations like Russia, China, and Iran.

Impact of Cuts: DOGE's dismantling of USAID has led to significant setbacks:

• Healthcare Clinics: Closure of clinics supplying HIV medication in countries like Zambia, leaving thousands without essential treatment.
• Disease Outbreaks: Reduced capacity to respond to epidemics such as Ebola and mpox, increasing the risk of global health crises.

Notable Quote:

"The US Used to play a key role in stopping the spread of Ebola or mpox... and in many cases now the US is kind of missing in action as these outbreaks are happening."
— Gabriela Emanuel [10:16]

Personal Stories: Emanuel shares poignant accounts, such as that of a 10-year-old girl in Zambia who lost access to her HIV medication, highlighting the human cost of these policy changes.

Notable Quote:

"She hasn't had her medication for over a week and she was developing flu-like symptoms... the virus level is climbing in their body and they are getting sick."
— Gabriela Emanuel [10:16]

Long-Term Consequences: Experts warn of potential reversions in global health advancements, risking decades of progress against diseases like HIV/AIDS.

Notable Quote:

"Experts up to the highest level of people working in HIV/AIDS have said that we are at risk of going back decades in terms of the progress made against this disease."
— Gabriela Emanuel [11:54]

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4. Broader Implications for Public Health and Policy

The hosts discuss the broader implications of DOGE's actions on both domestic and international scales.

Domestic Effects: Cuts to HHS may lead to diminished public health infrastructure, resulting in fewer resources to manage health crises, reduced support for vulnerable populations, and potential increases in preventable diseases.

International Effects: Reduction in foreign aid undermines global health initiatives, jeopardizing efforts to control infectious diseases and support healthcare systems in developing nations.

Potential Backlash: There is concern that these drastic measures could backfire, undermining the administration's goal of making America healthier by weakening the very institutions that protect and promote public health.

Notable Quote:

"It seems like there is the potential that that could really backfire in terms of actually achieving what they say their goals are to make America healthy again."
— Selena Simmons Duffin [12:57]

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5. Future Outlook and Closing Thoughts

As DOGE's 130-day term concludes, the long-term effects of its policies remain uncertain. While some argue for potential efficiencies and self-reliance fostered by reduced federal intervention, others fear a regression in public health standards and global stability.

Gabriela Emanuel's Perspective: Emanuel reflects on the unpredictable future, pondering whether other nations will compensate for the U.S.'s withdrawal or if entirely new challenges will emerge.

Notable Quote:

"In the short term we could see some real death and devastation as a result. Long term it's a lot less clear what this means."
— Gabriela Emanuel [13:36]

The episode concludes with the acknowledgment that upcoming changes, especially in climate science, will continue to shape the landscape of public health and policy, hinting at future discussions in subsequent episodes.

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Production Credits:

• Produced by: Hannah Chin
• Edited by: Rebecca Ramirez
• Fact-Checked by: Tyler Jones
• Special Thanks to: Rebecca Davis and Carmel Roth
• Senior Director: Beth Donovan
• Senior Vice President of Podcasting Strategy: Colin Campbell

Closing Note: Emily Kwong signs off, reminding listeners to stay tuned for more in-depth analyses and discussions on pressing scientific and health-related issues on future episodes of Short Wave.

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Conclusion

This episode of Short Wave provides a thorough examination of the Trump administration's aggressive efficiency measures through DOGE and their profound effects on both American public health infrastructure and global health initiatives. By featuring firsthand accounts and expert analysis, the podcast underscores the delicate balance between governmental efficiency and the essential functions of health and science agencies. The potential repercussions of these cuts highlight the critical importance of maintaining robust health systems to safeguard both national and global well-being.

Transcript

[Emily Kwong]

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[Selena Simmons Duffin]

You're listening to short wave from NPR. President Trump's first 100 days in office have been defined, among many other things, by Doge, the Department of Government Efficiency. The ad hoc Department of Government Efficiency team is one of the defining initiatives of President Trump's term so far.

[Gabriela Emanuel]

The Trump administration has posted a new.

[Narrator]

Online tracker that describes what it says.

[Selena Simmons Duffin]

Are the dollars saved by the Department of Government Efficiency. The Department of Government Efficiency has made it a priority to gain access to computer networks across the federal government. At the direction of Elon Musk, the department has fired tens of thousands of federal employees, dismantled whole parts of different federal agencies, and made deep cuts to spending on foreign aid and scientific research. And it's hard to know which of these changes are temporary and which will ripple for years, even decades to come because many of Doge's initiatives have been reversed or delayed by the courts or because of public backlash. That's as Musk's 130 day term as a special government employee is winding down. So we on shortwave wanted to look around and ask what could this all mean to science in the long term? Today, with two of my colleagues on NPR Science Desk, we're going to recap the first 100 days of health and science under the current Trump administration. I'm Emily Kwong and you're listening to Short Wave, the science podcast from npr.

[Narrator]

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[Emily Kwong]

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[Selena Simmons Duffin]

Okay, so today is about the first 100 days of the Trump administration. And to help me out, I've got my colleagues, Selena Simmons Duffin, who's been covering Health and Human Services, and Gabriela Emmanuel, who's been covering global health and foreign aid. Hi, everyone.

Hi. Good to be here.

[Gabriela Emanuel]

Hi.

[Selena Simmons Duffin]

Okay, so let's start with the Department of Health and Human Services, which you have been covering, Selena.

Yes.

HHS is responsible for a lot, like a slew of programs that support everyday Americans health and well being. The CDC, the FDA, the NIH, many more. @ the beginning of the month, you know, there were a lot of cuts, like reduction in force messages that were sent to thousands of federal health agency staff. Selena, how did people respond to that?

It was so confusing. It was really unclear who had been cut, why they had been cut. The communication around the cuts was very difficult to understand. So one example of this is that the RIF notices went out in the very, very, very, very early morning of April 1, and a lot of people missed them. So they went to work as normal, tried to badge into the building, and found out their jobs had disappeared. There was no master plan showing this department's cut, and that one's not. There's no explanation for why this team was cut, and that one remains. So there was all of this crowdsourcing, trying to piece together who's still here, why, and what does it all mean.

So what is the rationale for all of these cuts?

Well, Robert F. Kennedy, Jr. Who's the secretary of Health and Human Services, has described the department as a sprawling bureaucracy. He points to the fact that American life expectancy is lower here than it is in other similar wealthy countries, which is true. But then he puts the blame for that on these federal health agencies.

[Narrator]

You know how bureaucracies work.

[Selena Simmons Duffin]

Every time a new issue arises, they.

[Narrator]

Tack on another committee.

[Selena Simmons Duffin]

This leads to tremendous waste and duplication and worst of all, a loss of.

[Narrator]

Any unified sense of mission.

[Selena Simmons Duffin]

So that is the context. Kennedy is coming in here with a lot of distrust of these agencies. He wants to dramatically reshape them. He also has Doge and the Trump administration asking for bold actions to shrink the federal workforce. So overall, this plan that Kennedy outlined in late March and that these RIF notices were executing takes HHS from an agency of 82,000 employees to down to 62,000 employees. That is a 25% reduction in the workforce.

And it's been a month since those notices went out. Do we have a better sense now of what programs have been cut and what programs remain?

Kind of. I mean, as I said, there's really no master list. So what we have come to understand has again been this kind of weird crowdsourcing process. Whole centers at CDC were eliminated. Violence prevention, tobacco smoke, reproductive health, HIV prevention, workplace safety, including services for coal miners who get black lung disease. At FDA food safety labs were hit. The agency warned that it had to stop doing some routine quality control tests. The travel teams that send inspectors around the world were cut throttling international inspections. So we here in America import a lot of food and medications, things that we consume. They're made in countries that are not always doing their own inspections. So sometimes American and regulators are the only people doing these inspections, and a lot of that has slowed down.

Okay, what about other parts of hhs?

Well, there's also the human services part. So there were cuts to the agency that helps elderly and disabled people live at home, supports for programs like Meals on Wheels and liheap, which helps low income people pay their heating bills. I should also point out that billions of dollars have been cut in grants to state and local health departments. So the federal government's being sued over that. But in the meantime, some of these public health departments, the one in Nashville, Tennessee, and Harris County, Texas, are warning that they have had to scale back tracking disease outbreaks, including the measles outbreak that began in West Texas.

Okay, so these are deep cuts and they're broad cuts. Yes. Okay, and what is the potential impact long term, though, of losing these programs and these teams?

I think we have yet to see exactly how this is gonna play out. And one reason for that is that some of these cuts haven't fully taken effect yet. Why? So the people who were fired on April 1st don't officially lose their jobs until June 2nd. Most people are on administrative leave, but some are actually working right now and kind of keeping wheels turning. That means that some things are still functioning for now, but not for long. Okay, so here's an example. Food safety. You know, when you hear about be careful, there's salmonella, it's on the onions and the broccoli.

And it's spinach.

Exactly. And it's being sold in these stores. And if you bought it between these dates, just throw it out. Yeah. So the labs that analyze those samples looking for those pathogens are really stretched right now. I talked to one scientist who says they're having trouble ordering supplies in a timely way so they can run experiments. Some equipment they rely on is overdue for maintenance, and that could affect the quality of their work. And they've lost staff, they're overworked. They're worried about making mistakes. And if they can't do their work well and quickly, that means when there is an outbreak of something like salmonella on veggies sitting on the grocery shelves, scientists might not be able to find it in time. Let people know. And more people could buy those things that are contaminated and get sick and maybe even die.

This is all forecasting into the future. But these are the kinds of things that this cut could make possible.

Exactly.

Gabriela Emanuel, you are on the Global health and Development desk. And all of these federal funding cuts are obviously making a huge splash domestically, but they're also affecting people outside of the US People who rely directly or indirectly on foreign aid. How has the US Historically contributed to foreign aid? And how many countries are really feeling these changes?

[Gabriela Emanuel]

Yes. So in the past, US aid dollars have gone to over 170 countries. So we are talking all over the world here. And much of that spending was through the US Agency for International Development, usaid. A lot of that investment was in global health. In fact, the US has been the top global health donor worldwide for a while.

[Selena Simmons Duffin]

Why has the US Historically put so many resources towards improving the health of people in other parts of the world?

[Gabriela Emanuel]

So the thinking historically has been that helping other countries creates goodwill, it builds relationships, it stabilizes countries so that they don't turn to our adversaries like Russia, China, Iran for support. It also reduces migration. It's one of the big reasons people flee is lack of food, lack of stability, diseases. You know, also at the same time as all of this, the US Gets a lot of information through these relationships. And of course, stopping diseases in one place helps make sure those outbreaks and those diseases don't come to our own shores.

[Selena Simmons Duffin]

Right. And the US Is pulling back from international aid efforts. At the beginning of this year, President Trump signed an executive order to take the United States out, out of the World Health Organization. Plus, we, we spoke earlier about the Department of Government Efficiency dismantling usaid. So how is this loss of aid going to impact people in countries around the world?

[Gabriela Emanuel]

It is already impacting them, and it's very hard to kind of underestimate the impact here. So, for example, clinics that treat malnourished children are running out of the therapeutic food that they used to give those children. The US Used to play a key role in stopping the spread of Ebola or mpox, formerly monkeypox. And in many cases now the US Is kind of missing in action as these outbreaks are happening. I just got back from Zambia and Southern Africa, where I met dozens of people who used to rely on US funded clinics that provided HIV medication. And many of those clinics closed their doors overnight. And these are HIV positive people who can no longer get the daily medication that they rely on. So without these pills, the virus level is climbing in their body and they are getting sick. So for example, I met one 10 year old girl named Dorcas and she hasn't had her medication for over a week and she was developing flu like symptoms. Fever, chill sweats, classic signs that HIV levels are rising. I also spoke with a doctor there named Oswell Sendaza. He used to run an HIV clinic with a team of 21 staff members. Now he is the only clinician left with over 6,000 HIV patients. And I'm just alone. I'm like moving like a headless chicken just to try and make things happen. Experts up to the highest level of people working in HIV AIDS have said that we are at risk of going back decades in terms of the progress made against this disease.

[Selena Simmons Duffin]

Right. And I assume that's if nothing like USAID gets put back.

[Gabriela Emanuel]

It's a good question. The U.S. hIV AIDS program is kind of one of the flagship USAID efforts. Some of it's done through usaid, some through cdp, some through the State Department. So pieces of it are still standing, but a lot has crumbled. It's almost like a Jenga tower or something. Like often the whole system collapses when you pull out a few pieces.

[Selena Simmons Duffin]

And what I'm hearing from you, Gabriela, is just that a lot of these Jenga blocks were pulled out overnight.

[Gabriela Emanuel]

Absolutely. That is key here. So what makes it so challenging is that there was no warning, there was no transition plan in place, nothing like that. So that has left these huge gaps.

[Selena Simmons Duffin]

What I'm hearing from you both is that access is going to change, whether it's local citizens no longer knowing whether their food is safe or folks internationally US allied countries losing HIV medication. At the end of the day, what do you both think this means for everyday people?

I don't think I can really truly answer that because I don't have a crystal ball. But I will say that I think that there are things that are going to be hitting people where they live that affect their quality of life in really profound and direct ways. You could have a lot of really angry people whose hospitals just shut down because Medicaid was cut or who got really sick because their veggies were contaminated and they didn't find out in time. It seems like there is the potential that that could really backfire in terms of actually achieving what they say their goals are to make America healthy again.

Gabriela, what do you think?

[Gabriela Emanuel]

So I think on a kind of global health scale. This question reminds me of a conversation I had with the Minister of Health in Zambia. He compared the situation to a major drought that Zambia has just gone through. What he said was in the short term there was a lot of pain, but in the long term there were some silver linings. And I think global health wise things are changing monumentally. In the short term we could see some real death and devastation as a result. Long term it's a lot less clear what this means. Will other countries step up? Will countries that had been receiving aid become more self reliant in a good sustainable way? It's very hard to tell.

[Selena Simmons Duffin]

That's Gabriela Emmanuelle and Selena Simmons Duffin, thank you so much for joining me.

Thanks for having us.

[Gabriela Emanuel]

Thank you.

[Selena Simmons Duffin]

Short Waivers There have been massive changes to climate science too under the new administration. We'll cover those developments in a future episode, so keep a lookout for that. This episode was produced by Hannah Chin, it was edited by Rebecca Ramirez and fact checked by Tyler Jones. Special thanks to Rebecca Davis and Carmel Roth. Beth Donovan is our Senior Director and Colin Campbell is our Senior Vice President of Podcasting Strategy. I'm Emily Kwong. Thank you for listening to Short Wave, the science podcast from.

[Narrator]

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