Inside the Biggest U.S. Public Health Shakeup in Modern History

Summary

WSJ What’s News: Inside the Biggest U.S. Public Health Shakeup in Modern History

Podcast Information:

• Title: WSJ What’s News
• Host: The Wall Street Journal
• Episode: Inside the Biggest U.S. Public Health Shakeup in Modern History
• Release Date: April 27, 2025

Summary:

The Wall Street Journal's What’s News podcast delves into the profound transformations currently reshaping the United States' public health landscape. Hosted by Luke Vargas, the episode titled "Inside the Biggest U.S. Public Health Shakeup in Modern History" examines the sweeping changes initiated by the current administration, their underlying motivations, and the potential repercussions both domestically and internationally.

Introduction: A Transformative Shift

Luke Vargas opens the discussion by highlighting the significant restructuring within America’s public health system. He outlines the magnitude of the changes, including substantial layoffs, budget cuts, and the elimination of key departments within the Centers for Disease Control and Prevention (CDC).

"America's approach to public health is changing rapidly. Tens of thousands of federal health workers are poised to lose their jobs." [00:19]

Key points include:

• Massive Workforce Reduction: Approximately 20,000 employees are being cut from the CDC.
• Departmental Elimination: Entire divisions dedicated to HIV prevention, violence prevention, and injury prevention are being dismantled.
• Funding Withdrawals: Billions in federal grants to state and local health departments are being rescinded, affecting programs like infectious disease tracking and addiction treatment.

Administrative Rationale: Reassessing Public Health Priorities

The conversation shifts to the administration's justifications for these drastic measures. Jonathan Rockoff, the WSJ Health Business Editor, explains that the changes stem from criticisms of the pandemic response, particularly the extent of federal authority exercised during that period.

"There's a lot of criticism on the right about mandating vaccines and things like that. And so a lot of the cuts have been targeted at vaccines in particular." [02:17]

Betsy McKay, a senior writer for the Journal, adds that the administration is motivated by a desire for a smaller, more efficient government focus, particularly shifting attention toward chronic diseases.

"There are the philosophical changes. They view a smaller, more effective government and more focused on chronic diseases." [02:49]

Immediate and Long-Term Impacts on Public Health

Vargas raises concerns about the potential resurgence of diseases due to these cuts. McKay concurs, emphasizing the immediate disruptions and long-term consequences of halting public health programs.

"When you disrupt a public health program or any health program, you are going to have consequences, if not immediately, certainly down the line." [03:36]

Rockoff highlights ongoing and emerging health threats that necessitate robust public health responses:

"Right now we're seeing this measles outbreak in the Southwest and then some other states, and we're also dealing with bird flu." [04:06]

The administration's shift in focus from infectious diseases to chronic conditions raises alarms about the potential for these preventable diseases to resurge.

Vaccine Skepticism and Research Funding Cuts

The episode delves into the administration's stance on vaccines and research funding. Rockoff notes the administration's skepticism towards vaccine mandates and the consequent impact on public trust and vaccination rates.

"Robert F. Kennedy Jr. using mixed descriptions of the efficacy and safety of the vaccines..." [04:46]

Additionally, significant cuts to the National Institutes of Health (NIH) are causing concern among the scientific community. McKay explains that reduced government funding may jeopardize the progress made in medical research, particularly in combating diseases like cancer.

"The link between government funding and academic advances may be broken." [06:33]

The Role of Alternative Funding Sources

Vargas questions whether other entities within the U.S., such as state governments, philanthropies, or the private sector, can fill the funding gaps created by federal cutbacks. Rockoff responds by analyzing the potential and limitations of these alternative sources.

"Philanthropies have also funded medical research, and pharmaceutical companies and other healthcare companies have also funded research." [07:27]

However, he cautions that without stable government funding, basic research necessary for groundbreaking medical advancements may stall.

International Repercussions: USAID Cuts and Global Health

The conversation transitions to the international arena, where the U.S. government's reduction in funding through the Agency for International Development (USAID) is causing significant disruptions. McKay discusses how these cuts are affecting global health initiatives, particularly in Africa.

"Global health leaders have a lot of concerns about HIV, tuberculosis and other infectious diseases resurging." [10:22]

Rockoff elaborates on the strategic shift from using USAID as an instrument of soft power to a more self-serving funding approach, aiming to ensure that international aid aligns with American interests.

"USAID was sort of the epitome of the United States exercise of soft power internationally... And the Trump administration has completely rethought that approach." [09:46]

Countries like Nigeria and South Africa are grappling with these changes, striving to mitigate the impacts of funding cuts through domestic measures and seeking new international donors.

Concerns and Future Outlook

Experts express apprehension that the U.S. is undermining its own and global public health progress. Rockoff warns of the potential return to pre-pandemic health challenges, including measles and tuberculosis outbreaks, if preventive measures wane.

"What public health folks argue we don't want to do is to go back to a place where the threat of polio was prevalent... Where we are dealing with measles outbreaks spreading around the country..." [12:08]

McKay emphasizes the interconnectedness of global health, highlighting that setbacks abroad can quickly translate into threats domestically.

"That matters to us because as we saw from the pandemic. We live in a global world." [10:22]

Conclusion: Balancing Change with Stability

As the episode wraps up, Vargas underscores the delicate balance the U.S. must maintain between restructuring its public health approach and ensuring that critical health protections do not regress. The experts collectively convey a sense of urgency in safeguarding both national and global health infrastructures amidst these transformative changes.

"Optimism isn't sunshine and rainbows. It's fixing things, changing the way we fix things." [06:46]

The What’s News episode provides a comprehensive analysis of the current public health upheaval, presenting a nuanced perspective on the implications of reduced federal involvement and the challenges of transitioning to a new funding and operational paradigm.

---

Notable Contributors:

• Jonathan Rockoff: Health Business Editor, The Wall Street Journal
• Betsy McKay: Senior Writer, The Wall Street Journal

Production Credits: Produced by Charlotte Gartenberg and Anthony Bancy, Supervising Producer Sandra Kilhoff, and Deputy Editor Chris Sinsley.

Transcript

[Luke Vargas]

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[Betsy McKay]

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[Luke Vargas]

Hey, what's news, listeners? It's Sunday, April 27th. I'm Luke Vargas for the Wall Street Journal, and this is what's News Sunday, the show where we tackle the big questions about the biggest stories in the news by reaching out our colleagues across the newsroom to help explain what's happening in our world and this week at home and abroad, America's approach to public health is changing rapidly. Tens of thousands of federal health workers are poised to lose their jobs. State health departments are seeing billions in funding from Washington being zeroed out. And foreign aid cuts are interrupting programs for malaria prevention and treatment of hiv. But along with cuts, new programs and new priorities are rising up in their place. So what's in store as the US Embarks on its biggest public health shakeup in modern history? Let's dive in. Well, we can't list all of the changes that are being made to the US Public health system, but let me run through a few of them very quickly. The Department of Health and Human Services is shedding around 20,000 employees within the Centers for Disease Control and Prevention. Entire departments are being eliminated, including for HIV prevention, violence prevention and injury prevention. Also gone at the CDC is a team that maintained a database of injuries and violent deaths, which was widely relied upon by policymakers and researchers. And in a move that will be felt beyond the Beltway, the administration has cut off billions of dollars in federal grants that were awarded to state and local health departments for a range of programs like tracking infectious diseases or treating addiction. That is being challenged in the courts. But in the meantime, some state health departments have already begun layoff. With me today are Wall Street Journal health business editor Jonathan Rockoff and senior writer Betsy McKay. Jonathan, lots of changes clearly afoot here. What reasons is the administration giving for this shakeup?

[Jonathan Rockoff]

A lot of this comes from this criticism of the pandemic response and how overarching the public health response to the pandemic was. And this feeling that because the public health authority sort of overstepped their authority, we need to rein it back. We see this most saliently in vaccines. There's a lot of criticism on the right about mandating vaccines and things like that. And so a lot of the cuts have been targeted at vaccines in particular.

[Betsy McKay]

Yeah, John is absolutely right. We are at the tail end of a very bruising, pandemic, very bruising to public health in the sense that there was a lot of anger and backlash and that remains. And the view that government was not efficient. More broadly speaking, the administration says chronic diseases are worsening and changes need to be made. So there's two things here. There are the philosophical changes. They view a smaller, more effective government and more focused on chronic diseases. Then there is the immediate impact of the changes being made suddenly and the disruption that that causes.

[Luke Vargas]

Though obviously the long term ones are not too difficult to conjure up. Possibly a reemergence of certain diseases or at least slowed to try and cure others, right?

[Betsy McKay]

Yeah, absolutely. Because when you disrupt a public health program or any health program, you are going to have consequences, if not immediately, certainly down the line. You know, an important part of fighting HIV is not treating people already infected with hiv, but preventing people from getting it, giving them access to pre exposure, prophylaxis, education, Many other programs, and most of them seem to be targeted for cuts.

[Jonathan Rockoff]

We already see right now that no matter who's in charge that there are going to be public health threats and that whoever is in charge is going to have to deal with them. Right now we're seeing this measles outbreak in the Southwest and then some other states, and we're also dealing with bird flu. So these threats remain. I think part of what the Trump administration and Robert F. Kennedy Jr. Are doing is sort of rethinking what the balance should be. And as Betsy has sort of laid out, I think there's a. There's a different sense of what we should invest our preventative resources in and whether that should be in something like HIV or whether it should be in chronic diseases.

[Luke Vargas]

Yeah, take us into what we're seeing around chronic disease. A pullback in monitoring, maybe. And yet Robert F. Kennedy Jr. Very focused on what he believes to be the root causes of certain health issues in the United States.

[Jonathan Rockoff]

Well, it's a little unclear. He's definitely been out front about how he thinks we need to do more to prevent chronic diseases, but we haven't necessarily seen a lot of specifics around how he would do that. So that's tbd. What we have seen is skepticism about vaccines and about some of the other sort of infectious disease prevention efforts. And then we see Robert F. Kennedy Jr. Himself, using mixed descriptions of the efficacy and safety of the vaccines and agencies in hhs, beginning efforts to take a look at the safety and efficacy of the vaccines, even though most researchers say that's already been settled and that vaccines are really good and they prevent diseases like measles and they don't cause autism. One other thing to note here is the other sort of early tangible impact that we're seeing in the public health healthcare spaces and research. There's been cuts to NIH and other funding of medical research. So for the last generation, a lot of the progress that we've seen against serious diseases like cancer has started in government funded academic laboratories which have found the causes of the diseases, insights that lead to drugs to treat those diseases. And what may happen, but we aren't sure yet, is that that sort of link between government funding and academic advances may be broken.

[Luke Vargas]

We have got to take a short break, but when we come back, we will look at what happens when the US Pulls back on public health spending domestically and abroad. Stay with us.

[Jonathan Rockoff]

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[Luke Vargas]

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[Jonathan Rockoff]

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[Betsy McKay]

All.

[Luke Vargas]

Right, before the break, we were talking about some of the changes coming to public health priorities and funding in Washington. And John, I just want to ask you before we start looking abroad, aren't there other entities in the US that could step in here, be it states, philanthropies, the private sector, to cover any funding gaps that emerge?

[Jonathan Rockoff]

This gets at the underlying debate. We've been doing things for the past generation a certain way, but there's no reason why we have to do them that way. And I think the Trump administration, to its credit, is taking a hard look at how we've been doing things. And the government has been this huge funder of medical research. But philanthropies have also funded medical research, and pharmaceutical companies and other healthcare companies have also funded research. And perhaps with the Trump administration's prodding, that will get rejiggered and we'll see a different amount of life sciences industry funding of academic labs, for instance. What people say in the academic world, for instance, is that without that government funding, we might not see a lot of the basic research that has led to advances against cancer, against high cholesterol, against other diseases, because there needs to be sort of a minimum level of government funding of basic research before industry and philanthropy is willing to step in.

[Luke Vargas]

Betsy Something similar is happening abroad, John, referring there to going back to square one on the domestic public health funding model and challenging old assumptions that is kind of what's happening as the U.S. namely, pulls back U.S. agency for International Development Projects for Public health around the world.

[Betsy McKay]

Yeah, it's another rethink. The State Department and the administration have said there's a lot of waste in our funding. We're funding a lot of things around the world. We need to rethink this, and we need to reevaluate exactly what we want to fund. Secretary of State Marco Rubio has said that some of the health programs that USAID funded will be continued, but they must qualify as serving American interests, which is a pretty broad definition.

[Jonathan Rockoff]

USAID was sort of the epitome of the United States exercise of soft power internationally. It didn't have direct benefit to the United States. It didn't help us erase trade deficits or in trade deals or have any sort of direct benefit. And the Trump administration has completely rethought that approach.

[Luke Vargas]

We are already seeing just on the African continent, health systems racing to try and respond to a change in US funding. Nigeria announcing measures to try and soften the impact of these USAID cuts and finding other ways they can fund their health programs. In South Africa, scientists maybe trying to find a silver lining here saying this maybe is the opportunity the continent needed to break its dependence on foreign aid. Betsy, do we have an idea of what that alternate model would be? I know you've spoken to a lot of people as you try to understand the effects of these cuts, specifically abroad. What's their thinking?

[Betsy McKay]

Well, it's difficult to understand what that model would be right now. Certainly every country that has lost money, I mean, some African countries are heavily, heavily dependent on donors abroad. They have two things they're looking at. One, how much money can they themselves put up? Many of these countries are servicing a lot of debt and so don't have as many funds as are needed to keep everybody on HIV prophylaxis or to combat tuberculosis in the way that they need to. The second thing is, can they find other donors abroad? The US has been a leader not only in giving most of the governmental funds and pulled other countries along with it. We're going to give this much money. How about you step up, too? With that gone, there's less incentive. So it's a real problem. The goal has always been to help these countries ultimately become independent. But what global health advocates argue is we're just not there yet. Global health leaders have a lot of concerns about hiv, tuberculosis and other infectious diseases resurging. And while that would happen in other countries, it matters to us because as we saw from the pandemic. We live in a global world. Anything that starts in Africa, Southeast Asia, wherever can come to us very quickly. And so that's a really big reason why we have helped build up health systems and surveillance capabilities around the world.

[Luke Vargas]

Jonathan that seems like kind of a theme as well, present in some of the changes happening stateside as well. Right. You know, you can get a problem under control, but then you ease off, declare victory too soon, and you risk needing to spend a lot more resources in the future to get things back under control.

[Jonathan Rockoff]

We've grown comfortable with a United States where measles hasn't run rampant, where there isn't polio, where we're not dealing with tuberculosis, tuberculosis outbreaks all over, where children are drinking fluoridated water and avoiding a lot of cavities and tooth decay. There are, as we've discussed, reasons why we would want to take a look at how we've done all these infectious disease and other public health efforts in the United States and whether the mix of federal and state funding for those efforts needs to change and whether philanthropies and industry needs to step up more. But what public health folks argue we don't want to do is to go back to a place where the threat of polio was prevalent, where we are dealing with measles outbreaks spreading around the country, where we are seeing more and more people developing hivaids. And so the worry that they have is while we take a look at how we've done public health for a generation, are we going to go back to the place that we thought we had left behind?

[Luke Vargas]

Jonathan Rockoff is The Wall Street Journal's Health Business Editor and Betsy McKay is a senior writer for the Journal. John Betsy, thank you both so much.

[Jonathan Rockoff]

Thank you.

[Betsy McKay]

Thank you.

[Luke Vargas]

And that's it for what's new Sunday for April 27th. Today's show was produced by Charlotte Gartenberg and Anthony Bancy, supervising producer Sandra Kilhoff and deputy Editor Chris Sinsley. I'm Lu Vargas and we'll be back tomorrow morning with a brand new show. Until then, thanks for listening. Viking committed to exploring the world in comfort. Journey through the heart of Europe on an elegant Viking longship with thoughtful service, cultural enrichment and all inclusive fares. Discover [e-mail].