How the Trump administration is affecting health, here and abroad : Short Wave : NPR

EMILY KWONG: 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.

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SPEAKER 1: The ad hoc Department of Government Efficiency team is one of the defining initiatives of President Trump’s term so far.

SPEAKER 2: The Trump administration has posted a new online tracker that describes what it says are the dollars saved by the Department of Government Efficiency.

SPEAKER 1: The Department of Government Efficiency has made it a priority to gain access to computer networks across the federal government.

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KWONG: 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 Short Wave 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.

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KWONG: OK, 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 Gabrielle Emanuel, who’s been covering global health and foreign aid. Hi, everyone.

SELENA SIMMONS-DUFFIN: Hi. Good to be here.

GABRIELLE EMANUEL: Hi.

KWONG: OK, so let’s start with the Department of Health and Human Services, which you have been covering, Selena.

SIMMONS-DUFFIN: Yes.

KWONG: 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. At 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?

SIMMONS-DUFFIN: 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.

KWONG: So what is the rationale for all of these cuts?

SIMMONS-DUFFIN: 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.

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ROBERT F. KENNEDY JR.: You know how bureaucracies work. Every time a new issue arises, they tack on another committee. This leads to tremendous waste and duplication and, worst of all, a loss of any unified sense of mission.

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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–

KWONG: Yeah.

SIMMONS-DUFFIN: –this plan that Kennedy outlined in late March and that these RIF notices were executing takes HHS from an agency of 82,000 employees down to 62,000 employees. That is a 25% reduction in the workforce.

KWONG: 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?

SIMMONS-DUFFIN: 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–

KWONG: Crowdsourcing.

SIMMONS-DUFFIN: –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, that are made in countries that are not always doing their own inspections. So sometimes American regulators are the only people doing these inspections. And a lot of that has slowed down.

KWONG: OK. What about other parts of HHS?

SIMMONS-DUFFIN: Well, there’s also the Human Services part.

KWONG: Yeah.

SIMMONS-DUFFIN: 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 is being sued over that. But in the meantime, some of these public health departments, like 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.

KWONG: OK. So these are deep cuts, and they’re broad cuts.

SIMMONS-DUFFIN: Yes.

KWONG: OK. And what is the potential impact long term, though, of losing these programs and these teams?

SIMMONS-DUFFIN: I think we have yet to see exactly how this is going to play out. And one reason for that is that some of these cuts haven’t fully taken effect yet.

KWONG: Why?

SIMMONS-DUFFIN: So the people who were fired on April 1 don’t officially lose their jobs until June 2. 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. OK, so here’s an example– food safety.

KWONG: OK.

SIMMONS-DUFFIN: You know when you hear about, be careful, there’s salmonella. It’s on the onions and–

KWONG: And the broccoli–

SIMMONS-DUFFIN: Yeah.

KWONG: –or the spinach.

SIMMONS-DUFFIN: Exactly. And it’s being sold in these stores. And if you bought it between these dates, just–

KWONG: Throw it out.

SIMMONS-DUFFIN: 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.

KWONG: This is all forecasting into the future, but these are the kinds of things that this cut could make possible.

SIMMONS-DUFFIN: Exactly.

KWONG: Gabrielle Emanuel, you are on the Global Health and Development Desk.

EMANUEL: Yes.

KWONG: 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?

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.

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

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.

KWONG: 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 of the World Health Organization. Plus, 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?

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.

KWONG: OK.

EMANUEL: I just got back from Zambia in 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.

KWONG: Wow.

EMANUEL: So for example, I met one 10-year-old girl. Her name’s Dorcas. And she hasn’t had her medication for over a week. And she was developing flu-like symptoms– fever, chills, sweats, classic signs that HIV levels are rising. I also spoke with a doctor there named Oswald Sandaza. 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.

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OSWALD SANDAZA: And I’m just alone. I’m, like, moving like a headless chicken, just to try and make things happen.

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EMANUEL: 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.

KWONG: Right. And I assume that’s if nothing like USAID gets put back.

EMANUEL: It’s a good question. The US HIV/AIDS program is kind of one of the flagship USAID efforts. Some of it’s done through USAID, some through CDC, 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.

KWONG: And what I’m hearing from you, Gabrielle, is just that a lot of these Jenga blocks were pulled out overnight.

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.

KWONG: 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 and US-allied countries losing HIV medication. At the end of the day, what do you both think this means for everyday people?

SIMMONS-DUFFIN: 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.

KWONG: Gabrielle, what do you think?

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. And 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.

KWONG: That’s Gabrielle Emanuel and Selena Simmons-Duffin. Thank you so much for joining me.

SIMMONS-DUFFIN: Thanks for having us.

EMANUEL: Thank you.

KWONG: Short Wavers, 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 look out for that. This episode was produced by Hannah Chinn. It was edited by Rebecca Ramirez and fact-checked by Tyler Jones. Special thanks to Rebecca Davis and Carmel Wroth. Beth Donovan is our senior director. And Collin Campbell is our senior vice president of podcasting strategy. I’m Emily Kwong. Thank you for listening to Short Wave, the science podcast from NPR.

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