In 2021, a beachfront condominium near Miami, Champlain Towers, collapsed, killing 98 people. Although the deadly crash was both spectacular and newsworthy, the actual cause of the collapse was decades of silent erosion and corrosion from unchecked water penetration. Essentially, over time the very foundation of the structure was eroded to the point that the building was left without any support and, inevitably, came down.

Although an awful tragedy, this scenario is an apt metaphor for what I witnessed happening to public health in the United States over the last two decades of my career at CDC. Every year, every single year, public health programs would have to go to their legislative funding bodies (both Federal and State) and defend their programs. And every year, barring some well-publicized outbreak or crisis, small and large funding cuts would inevitably appear in the following year’s budget. Eroding not only those current programs, but also the resources of the public health community to respond to the inevitable crisis on the horizon. The best example of this was the problematic initial public health response to COVID in this country.

You may legitimately ask, “What is so wrong with having to defend your programs for continued funding?” Nothing. Explaining your programs to Congress is an entirely legitimate request. The problem is that almost all of public health is based on the concept of prevention and when prevention is working well, there is no resultant disease. There is nothing to actually show. Disease prevention is essentially a negative and, as we all know, you can’t prove a negative. Of course, there are methods to show the effectiveness of public health interventions, but these are mostly mathematical projections that require a certain level of intelligence and scientific curiosity on the part of the audience to understand. And this is Congress after all. You mention models to the average Congressman and his mind immediately goes to Cindy and Naomi. You never get him back. No wonder funding gets cut.

I now look back on that period as “the good old days”. The nonsensical, cruel cuts of 20,000 Federal public health jobs and pulling $11 billion of public health funding by people with no expertise or experience in public health. Almost $9 billion of that was for epidemiology and laboratory capacity for infectious diseases and another $2 billion was for immunizations. Those cuts leave us incredibly vulnerable to the next outbreak or pandemic. Gearing up again, if even possible, takes time and costs lives. Keep in mind that approximately 650,000 Americans died in the first 12 months of COVID.

This loss of funding is not just a Federal problem. Over 80% of CDC’s funding goes out to state and city health departments. The Chicago health department lost 51% of its funding when this administration cut the funding. Mecklenberg County, North Carolina was forced to fire 180 public health workers. Everywhere from large cities to rural counties will feel the effects. The CDC staff that were cut provided expertise in worker safety and health, drownings, drug overdoses, environmental exposures and diseases, lead poisoning, chronic disease prevention, sexually transmitted diseases, laboratory methodologies, and on, and on.

The CDC personnel cuts were random and foolish, but using those adjectives belies the evil that was underlying all of this. There was no rational reason for firing these people – intelligent, professional, caring, and competent. They were informed that day by email when they came to work and no one in the CDC Director’s office had been told who would be fired or why. To help make this clear to everyone: imagine wherever you work (or worked) and a small group of early 20-somethings, with no knowledge of your industry and who have accessed your firm’s personnel records, come in one morning and tell your CEO and corporate officers that these people have already been fired and these divisions and groups have been eliminated. And then they leave. To add insult to injury, a few days later some guy with a giant head and a worm in his brain (RFKjr) goes in front of Congress and denies that anything like what I described transpired.

There will be more storms to weather. The Trump administration is promising to cut CDC’s budget in half. There will be more outrageous staffing cuts. There will be the silliness that we will witness as Kennedy attempts to develop health programs directly from his office at HHS. Essentially, though, the die is cast. Science and logic are not factors in the administration of the national public health programs for the next 3.5 years. Not for CDC. Not for NIH. Not for FDA. I cannot imagine the damage that these fools will do in that time period. The wreckage will be considerable, long lasting, and perhaps irreparable.

All the King’s horses and all the King’s men…

ps. As an example of that wreckage, my next essay will be on Kennedy’s cancellation of the mRNA research funding. Perhaps the worst human health decision in the last 100 years.