A cascade of outbreaks spanning measles, hantavirus, cyclospora and bird flu has exposed a decimated public health apparatus that former top CDC officials say is now less equipped to handle infectious disease than it was before Covid struck.
The cuts have been brutal and swift. The CDC lost roughly $40 million in funding for malaria and neglected tropical diseases when the Trump administration restructured foreign aid through USAID. That translated directly into layoffs: 35 of 73 employees in those divisions were terminated. The agency clawed back $4 million but faces continued pressure as the administration reshapes its international health commitments.
The damage extends far beyond dollars. Roughly 30 percent of the CDC's total workforce is simply gone. Among senior leadership, about 80 percent of positions remain unfilled with permanent appointees. The losses strike at expertise that cannot be quickly rebuilt, according to Dan Jernigan, former director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases.
Jernigan, now a critical voice warning about preparedness gaps, pointed specifically to parasitic diseases. "The laboratory methods you use and the expertise and the microscopy and all of that stuff is the same," he said. "So the expertise in parasitic diseases has dropped." The CDC's cyclospora laboratory, for example, contracted from 11 specialists to three. Similar attrition hit mpox and Ebola expertise on staff.
"Are we ready for the next big pandemic? My answer is no," Jernigan stated flatly.
Debra Houry, former chief medical officer of the CDC, amplified that warning. "Unfortunately, we're really moving in the wrong direction," she told the Guardian. The staffing collapse coincides with intensifying outbreaks. The US already exceeded last year's measles case count. Simultaneously, funding for mRNA vaccines, crucial for pandemic response, has been slashed. Over half of US states have passed laws restricting public health emergency powers.
The organizational chaos compounds the staffing crisis. Robert F. Kennedy Jr., now secretary of the Department of Health and Human Services, overruled a CDC medical officer's guidance on quarantine protocols for hantavirus patients aboard the MV Hondius, requiring some individuals to remain in biocontainment facilities despite expert recommendation for home quarantine. Similar contradictions plague Ebola response guidance, where travelers from the Democratic Republic of Congo face unclear, overlapping quarantine and monitoring requirements that create confusion for state health officials.
"When you have conflicting messages, how do states then respond to things like CDC guidance?" Jernigan asked. He framed the problem as ideological rather than scientific: leadership approaching crisis decisions through ideology rather than data, producing "wildly different answers" when clarity and hierarchy are essential for coordinated response.
Houry described the current moment as "precarious." States struggle to implement guidance "that isn't based on science and often not on logic, coupled with the staffing and budget cuts," she said. The workforce reductions came through multiple channels: layoffs under efficiency initiatives, early retirements, and positions left vacant. "We lost a lot of our lab scientists, and some of our specialized experts on things like rabies, those you can't replace overnight," Houry noted.
Rebuilding that capacity will take years. The CDC's pre-pandemic size, which officials once targeted as a restoration goal, is itself insufficient, according to Houry. "During the Covid pandemic, that's where we saw we didn't have enough staff to go around the nation to respond to outbreaks," she said. "It was a time to try to get right-sized, not oversized. And unfortunately, reverting back to more of the 2019 size leaves us woefully underprepared to respond to outbreaks."
In the vacuum of federal leadership and resources, state and regional organizations have begun filling gaps. The Association of State and Territorial Health Officers now coordinates regular calls for state health officials. Regional alliances like the Northeast Public Health Collaborative and the West Coast Health Alliance, for which Houry serves as a consultant, have emerged to coordinate vaccination and crisis management. These grassroots efforts underscore how far the system has fallen and how much the burden has shifted away from the federal level.
Author James Rodriguez: "When layoffs and ideological friction collide with new disease threats, the result is predictable and dangerous, and these experts aren't pulling punches about where this leads."
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