Day 10 of the Trump administration's war on US public health in review. Trump retreats on federal grant freeze, puts DEI-related programs in the crosshairs.
Another very busy day in the struggle for the future of US public health. I again want to express my appreciation for your feedback and support. Inside Medicine is free but is sustained by contributions from a small percentage of regular readers. If you value the science-based, level-headed information you’ve been reading here, please consider upgrading to a paid subscription. Thanks! —Jeremy
Trump Administration walks back the federal grant freeze. For now.
The good: The Trump Administration abruptly withdrew its previous memo freezing all federal grant funding (with some exceptions) yesterday. That means that the Trump-generated crisis around the status of federally funded scientific and medical research is, for the moment, over. On Tuesday, a judge halted Trump’s action until at least February 3rd. With the memo’s recall, the American Public Health Association (and co-plaintiffs) case against the Trump Administration is now concluded, as there is no legal battle to fight.
The bad: There is little doubt that the Trump Administration will try a different tactic, with an eye toward targeting projects that reflect (in their words) “woke ideologies.” (See the next story for more on that.)
The ugly: Confusion once again reigned yesterday as everyone tried to figure out what was actually happening. The White House announced that the memo ordering the grant funding freeze had been rescinded, and yet (per CNBC) “the White House also said a ‘federal funding freeze’ remains in ‘full force and effect’ to give agencies time to review programs for their compliance with President Donald Trump’s agenda.”
According to my friend Steve Vladeck (a Georgetown Law professor and CNN legal analyst), the White House assertion that the freeze was still in effect was simply incorrect. Here’s his summary of events (in response to a post by White House Press Secretary Karoline Leavitt) on Bluesky:
Steve’s newsletter on Substack is a great resource, including a post on Monday explaining the legal issues around the executive orders and memos.
On top of everything, it was reported last night that the memo that set off this entire debacle was never even cleared by the White House. When I asked Steve why government lawyers even bothered showing up to defend an Office of Management and Budget memo that the White House never approved, he said it was not unusual for the Department of Justice to defend actions it had nothing to do with. Basically, his read is that Team Trump “never intended to pick this fight in such a clumsy, un-nuanced way,” but it took a couple of days to sort it all out. Professional!
Trump focuses funding attack on DEI. CDC programs under threat.
President Trump’s obsession with ending any government project that have to do with Diversity, Equity, and Including (DEI) was made clear on the first day of his term. Yesterday, an apparent draft of a memo directed at CDC award recipients was circulated online (and posted on at least two major university websites and on InsideHealthPolicy.com) explicitly directing then to stop all US government-funded programs and activities that are considered (or “promote”) DEI—and, if possible, fire anyone involved, without any further analysis, guidance, or process. Some (but not all) of these programs only have a small DEI component. So, whether you believe in the importance of DEI work or not, remember that many projects that serve our collective interests are under fire here, and with little justification. Lovely.
The next legal frontier will likely be whether the administration can terminate these funding agreements via an out-of-the-blue memo. Time will tell.
USAID experts take to social media looking for jobs.
President Trump abruptly canceled all foreign aid last week and reportedly laid off many top civilian employees of USAID, including career officials with deep expertise and relationships with US partners all around the world. (Here’s my impromptu Q&A with Dr. Atul Gawande, who ran global health for USAID until President Biden left office, in which we discussed the implications. Atul now has a piece in The New Yorker explaining the context of the developing news surrounding the budget freeze.)
Today, I saw posts from former USAID leaders, including one who is now out of a job, and another whose team’s work will be affected by the cuts. I want you to read two posts from LinkedIn so that you can see for yourself the superb public servants—one of whom the Trump Administration saw fit to dismiss, and the other who had already left USAID—who have carried out important work for US and humanitarian interests for many years:
Global Health Community and USAID Family,
Just a few weeks ago, I was sitting in a waiting room for a mobile clinic in Eswatini, chatting with women who had graduated from DREAMS — an immensely effective PEPFAR partnership aimed at reducing HIV/AIDS and empowering adolescent women and young girls. USAID assistance moves through numerous mechanisms, implementing partners, and locally led organizations before reaching the communities we serve—making the administration’s decision to freeze foreign aid programming all the more confusing and harmful for the millions of people who depend on us.
Yesterday, as I packed up my office, I held out a sliver of hope that the new administration would realize that medical treatment and aid cannot simply be “paused” without disastrous immediate and long-term global consequences.
Today, I am heartbroken at the permanence of this decision. As a direct result of the hashtag#StopWorkOrder, I was laid off—effective immediately. No continuation of pay or benefits, with health care ending in just two days. Alongside hundreds of my friends and colleagues, we were let go without warning—a decision that in no way reflects the meaningful work we have done.
I am endlessly proud of the work I carried out in the USAID Bureau for Global Health / Office of the Assistant Administrator, supporting the Office of HIV/AIDS (a key partner in implementing PEPFAR), the Office of Country Support, emergency Marburg virus response efforts, the Locally Led Development Working Group, AI and machine learning initiatives, multilateral and donor engagement, the Youth Working Group, and the humanitarian-development-peace nexus team. I love my colleagues, and I will forever be thankful for this opportunity. Until this week, I would have told you that I genuinely hit the global health job jackpot and that I planned to stay with USAID for the rest of my career.
Now more than ever, there is work to be done to make the world a better place. I'll need to pivot careers: If you are hiring or aware of public/global health, epi, humanitarian, climate, or policy positions in Washington DC, remote, or internationally, please reach out.
For those who don’t know me, a few quick facts:
🔬 Graduate of Yale School of Public Health with an MPH in Epidemiology of Microbial Diseases (Global Health Concentration)
🌐 Passionate about and experienced in outbreak response, epi, climate and health work, policy and diplomacy, multisectoral coordination, One Health, WASH, humanitarian crisis and disaster response, HIV/AIDS, health system strengthening, program development and implementation, emerging technologies, and data-driven impact.
🌎 Diverse experience with USAID, Pan American Health Organization, Yale School of Medicine, Save the Children US, Team Rubicon, Partners In Health, Florida Department of Health - Broward County, Adventure Medics, and more.
Thank you, and please reach out via LinkedIn chat or email me.
Gratefully,
Sydney
The second LinkedIn post outlines some of the logistical work USAID and its partners do, including an important and enlightening examples describing supply line issues overcome during Covid-19.
“With very, very few exceptions, the entire COVID Response Team in USAID's Global Health Bureau was made up of institutional support contractors (ISCs), who do jobs nearly indistinguishable from USAID direct hire staff. On our phenomenal team, ISCs (among other things): worked through sticky supply chain issues, arranging for life-saving vaccines and syringes and cold storage to be rushed to places that needed it; worked hand in hand with partner country counterparts to understand what countries needed and where, and then to make it happen; tracked data on what the U.S. was delivering, how fast, and how effectively; dramatically increased the availability of medical oxygen in several countries; coordinated with other U.S. agencies to ensure a streamlined, whole-of-government approach to problem solving; and catalogued lessons learned so we'll be ready for the next pandemic. These were teammates who were just out of college, beginning their careers in public service and global development. And they were folks with decades of experience around the world who had earned the trust of partner health ministries. Many of them were laid off today, and with them goes their invaluable expertise, creativity, extraordinary work ethic, and dedication to mission. The American people will miss out, and so will those with whom we work around the world.”
We are not only now bereft of the ongoing work that USAID carries out, but we are now markedly more exposed to danger if another pandemic occurs.
RFK Jr., hearings. Thoughts and analysis.
You may have noticed that I’ve largely refrained from commenting on Trump’s nominees for major roles in the public health infrastructure.
Two reasons. First, most of what I have to say has been said by others, and I try to keep things here more original. Second, assuming these individuals get confirmed, there’s a chance I might eventually lobby them on a shared area of interest down the road. I’m not interested in making new enemies and scoring points for a news cycle in exchange for sacrificing the ability to make a positive contributions down the road.
That said, RFK Jr. had his first Senate confirmation hearing yesterday and here are a few resources and commentaries.
MedPage Today summary of what the hearing.
A tweet by Martina Navratilova pointing out that virtually every reasonable thing RFK Jr. has ever said was already said by other people (in this case, Michelle Obama). Indeed, the places that RFK Jr., may be right are not controversial and they are not new. The American Heart Association has been screaming about lifestyle modifications as the core of heart health since time immemorial, to name one. Meanwhile, where he’s wrong (on vaccines), he’s seemingly unusually and dangerously misinformed. As a MedPage Today column pointed out “A Broken Clock: RFK Jr. Gets Two Things Right on Health— That doesn't make him qualified to lead HHS.”
The “he seems like a smart guy” argument does not track. Dr. Paul Offit—a vaccine expert and highly reasonable individual (I have found) described his own experience trying to have a productive conversation about science with RFK Jr. and it did not go well. It’s not just that RFK Jr. did not “get it”, but he apparently conducted the conversation in bad faith and did not represent it accurately after. That’s concerning.
A major concern (which several Senators made clear) is that RFK Jr. would take actions that make life-saving vaccines less available. This would eventually become a tragedy measurable in pediatric mortality. But sure, ban red dye that caused cancer in mice (but has never been shown to do so in people).
As someone who has studied infectious diseases and Covid-19 pandemic epidemiology, I am deeply concerned about RFK Jr.’s plan for NIH researchers to “give infectious disease a break for about eight years.” By the way, there’s currently a major tuberculosis outbreak in Kansas.
That’s all for today. Please contribute your comments and questions in Comments section and…
Always appreciate your time in trying to weed and translate through the latest "fire" thrown out by this administration of obfuscation. On the first topic of funding grants, though I appreciate Steve's law expertise, for those of us with experience working with Fed and state gov, and also living with someone (my husband) for 45 years including a Director's level position, knows this one event has far more reaching destruction in a massive org. My husband knew where this memo likely came from immediately. The Office of Management and Budget. He says OMB, though a small office, is extremely powerful. Every dept deals with them. The damage is done and in a massive bureaucracy the threat alone will slow the entire machinery down. You can’t plan for staffing, allocation of resources, $$, time, objectives, training with so much uncertainty. We see this with more recent constant threat of shutdowns. How much chaos Trump creates that’s conscious is debatable, but no doubt it follows him everywhere. What isn’t debatable is that he doesn’t care if gov fails for the most part and no interest in how gov works excepts how it benefits him. In his first weeks in office in 2016 he hosted the leaders of China and brought in his son-in-law, and daughter who had NO SECURITY CLEARANCE. This is how he operates. But this time he does understand more and he DOES have more “soldiers” so destruction and fear will be much deeper, broader, faster, and lasting. We are going to have to figure out how to help our folks that remain on the inside with support, and avenues of communication, safely. We are so unprepared.
OMG RFKjr conveyed that he did not understand the difference between Medicare and Medicaid. This ignorance will have as much if not more effect on there future of medical services for the sick, disabled, poor, and elderly than his vaccine opinions. Disaster awaits.