Robert F. Kennedy Jr.’s grand plan for Making America Healthy Again is taking shape. It centers on dismantling the public health systems that have kept Americans safe for decades.

The damage from sweeping cuts this week at the Department of Health and Human Services, which Kennedy oversees, will be felt within public health, the biomedical sciences, and, yes, by ordinary Americans.

We take for granted much of the good work done at agencies like the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health. And that’s how it should be. Those who work in public health like to say that when everything is going right, their work is invisible.

But we benefit daily from the tens of thousands of people working behind the scenes. We grab food out of the fridge without worrying that it might make our kids sick. We go into the medicine cabinet for our cholesterol medication without wondering if the capsule is contaminated — or if the drug works. When a family member is diagnosed with cancer or a rare disease, we trust that somewhere out there, scientists are working on a cure. When there’s a flu outbreak, we assume that health officials will keep us informed — and do whatever possible to make sure it’s contained. The list goes on and on.

Some 10,000 employees are expected to have been purged from the various agencies under the HHS umbrella. When combined with earlier firings and voluntary exits, the overall size of HHS will have shrunk by 24%.

The bloodletting has wiped out everyone from high-ranking officials at the FDA and NIH to the support staff essential for keeping these hulking ships running. The impact on areas such as the prevention of sexually transmitted and infectious diseases, research for neurological disorders like Alzheimer’s, and improving maternal and infant mortality will be particularly devastating.

“The revolution begins today!” Kennedy captioned a video he posted to X to welcome Jay Bhattacharya and Marty Makary, his new heads of the NIH and FDA, respectively.

Revolution is one way to describe swinging an indiscriminate axe at institutions responsible for keeping Americans healthy.

And as with earlier waves of firings across the federal government, this one unfolded with a callousness that belittles the service of career public health workers. People received early morning emails that they’d been “RIF’d” (part of a “reduction in force”) — and were put on immediate administrative leave. Some didn’t get an email and showed up at work to discover their credentials were disabled.

Imagine standing in the long lines seen forming outside security at HHS buildings on Tuesday to find out with a swipe of your badge that you’d lost the job lottery. It’s demeaning to the people who were let go and demoralizing for those spared.

The deepest cuts were felt at the FDA, which was expected to lose some 3,500 employees. Last week, Peter Marks, who oversaw vaccines and cutting-edge treatments, was ousted. This week, the agency’s chief tobacco regulator, director of the Office of New Drugs, and chief medical officer were all let go. More than 130 workers in the agency’s veterinary center were eliminated, including the veterinarians keeping tabs on the bird flu outbreak.

In a LinkedIn post, former FDA commissioner Robert Califf bluntly stated, “The FDA as we've known it is finished, with most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed.”

Meanwhile, the 2,400 employees expected to be laid off at the CDC include hundreds from the division overseeingHIV prevention. The division charged with environmental health and responding to climate change was expected to be eliminated, Politico reported.

NIH had already undergone painful cuts, but this latest round brought leadership-level changes. Directors of at least five of the agency’s 27 institutes were pushed out, including Jeanne Marrazzo, who in 2023 replaced Anthony Fauci as director of the National Institute of Allergy and Infectious Diseases.

Across HHS, the elimination of support staff, including human resources, lawyers, communications teams and lab managers, along with the ongoing depletion of supplies, is paralyzing. One FDA employee who works on the food side of the agency was told at an all-hands meeting that "the processes to do our daily activities are gone.” Non-scientific staff were eliminated entirely from some parts of NIH, leaving researchers to figure out how to function without necessities.

Because little information has been shared about the cuts, including the reasoning behind the decisions or even details of who is gone (a situation in direct opposition to Kennedy’s vow of “radical transparency”), it will take time to grasp the true scope of the damage. But what’s already clear is that it runs deep and that what’s left cannot be easily cobbled back into a functional health infrastructure.

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This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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