A Self-Inflicted Wound: How DOGE Dismantled America’s Public Health Infrastructure — and Who Is Paying the Price
Five Alerts, One City
As a million international visitors prepare to descend on New York City for the 2026 FIFA World Cup, the city’s public health authorities are managing five concurrent Infectious threats: the ongoing hantavirus quarantine of state residents; an active measles outbreak; an Ebola preparedness posture following the WHO’s declaration of a Public Health Emergency of International Concern for the Bundibugyo strain; a new COVID-19 sub-variant; and West Nile virus. Five separate pathogen threats and a federal public health infrastructure that has been systematically stripped of a quarter of its workforce, its institutional memory, and much of its moral authority to lead.
How the United States arrived at this moment is a story of choices: about what to cut and whose lives to treat as expendable.
The CDC: A Warning System Deliberately Degraded
In February 2025, the Trump administration’s Department of Government Efficiency (DOGE) began its assault on the Centers for Disease Control and Prevention. Approximately 1,270 staff — close to 10% of the agency’s workforce — were dismissed in the initial wave. Among those let go were fellows from the Laboratory Leadership Service, the specialist corps responsible for training public health laboratory leaders and supporting outbreak response. The Epidemic Intelligence Service — the CDC’s elite “disease detective” programme, whose officers are deployed to investigate outbreaks across the US and globally — was initially threatened with the loss of its entire first-year cohort, though those officers were ultimately spared after significant public protest.
Other fellowships were not spared, and the pipeline they represented — the next generation of CDC leadership — was severed. “Even if EIS was spared, there are multiple other fellowships that were not,” one senior CDC official told reporters. “We’re being cut off at the knees. It is going to cripple public health for decades.”
The cuts did not stop there. Since January 2025, the CDC has lost close to 3,000 employees in total — nearly a quarter of its entire workforce — through layoffs, forced retirements, and resignations triggered by the chaos of political interference and leadership instability. In August 2025, HHS Secretary Robert F. Kennedy Jr. fired CDC Director Susan Monarez after she refused to accept political interference with the agency’s scientific mission, prompting multiple senior leaders to resign in protest. The agency has now operated without Senate-confirmed leadership for almost the entire period of the measles crisis. A survey of 433 current and 191 former CDC staff conducted between February and April 2026 documented the effects: communication freezes, scientific interference, and an institution whose systems and institutional memory have been hollowed out even as its remaining staff try to hold the line.
The former CDC Chief Operating Officer Robin Bailey, speaking publicly in June 2026, was measured but unambiguous: “We lost a lot of talent. Many of the things that we put in place — I’m not sure that they’re operating in the same way.” He had spent years building the operational infrastructure to deal with multi-pathogen crises like the CDC was now facing — the hantavirus cluster, the Ebola outbreak, the measles surge. The reforms have been put in place but the workforce responsible has been dismantled.
The Measles Catastrophe: Policy, Misinformation, and Preventable Deaths
Robert F. Kennedy Jr., confirmed as HHS Secretary in February 2025, is the founder of Children’s Health Defense, one of the most influential anti-vaccine organisations in the United States. His record of spreading vaccine misinformation stretches back decades: false claims linking the MMR vaccine to autism, assertions that “there is no vaccine that is safe and effective,” and sustained campaigns to erode public confidence in childhood immunisation schedules. His appointment placed the person most responsible for the ideological conditions enabling the measles resurgence in direct control of the agencies charged with stopping it. This seems to be a pattern.
The results were immediate. On 26 February 2025 — the day after Kennedy was confirmed — the first measles death in the United States in more than a decade was reported in Texas: an unvaccinated eight-year-old girl. Kennedy’s response was to tell the White House Cabinet meeting that measles outbreaks were “not unusual.” A fortnight later, a second child died. Kennedy told Fox News that the MMR vaccine “kills people every year,” causes “the same symptoms as measles,” and “does not appear to provide maternal immunity.” Texas state health officials confirmed both deaths were caused by measles, Kennedy falsely implied otherwise.
By March 2026, more than 3,800 measles cases had been reported across US states since January 2025 — the largest sustained outbreak in a generation. The Americas as a whole recorded over 21,000 confirmed cases in the first five months of 2026, a 234% increase on the same period in 2025. In January 2026, the CDC reduced its childhood immunisation schedule from 17 recommended vaccines to 11, removing six from universal recommendation at the direction of President Trump and Kennedy. Legal experts questioned the administration’s authority to implement this change without Senate approval. Public health experts warned it would further erode vaccine uptake at the worst possible moment.
The United States has held measles elimination status since 2000 (no sustained domestic transmission for twelve consecutive months). PAHO’s Regional Monitoring Commission has now invited both the US and Mexico to review their elimination status. If the US loses it, the achievement of a generation of public health work will have been undone in under two years.
USAID and the Global Retreat
On 20 January 2025, President Trump signed an executive order initiating the United States’ withdrawal from the WHO and imposing a 90-day freeze on all USAID activities globally. Within weeks, DOGE had effectively dismantled USAID as an operational agency, absorbing its remnants into the State Department. By March 2025, 83% of USAID’s approximately 6,200 global programmes had been permanently terminated.
HIV clinics across sub-Saharan Africa received immediate “work stop” letters and closed within days, cutting approximately 20 million people supported by PEPFAR off from antiretroviral medicine. Measles mass vaccination campaigns, running in regions already experiencing surging outbreaks, were halted without notice. Malaria vaccine rollouts were disrupted. Nutrition programmes ended. The WHO, which had received approximately 18% of its funding from the United States, was forced to begin cutting staff and programmes to close a 25% budget shortfall that it has not yet recovered.
Conservative academic estimates calculated that USAID programme cancellations could contribute to 500,000 to 700,000 additional deaths annually. A year on from the cuts, a whistle-blower writing in the Boston Globe placed the confirmed toll at 750,000 additional deaths in 2025, and noted that for the first time in a generation, more children died in a single year than in the year before. The same article observed that the Bundibugyo Ebola outbreak, now a PHEIC (Public Health Emergency of International Concern), took far longer to identify than previous outbreaks because the US retreat from the global health stage had removed critical early warning and surveillance infrastructure from the region where the outbreak began.
The US withdrawal also directly undermined the outbreak response tools available for Bundibugyo. DOGE’s cuts included the NIH Vaccine Research Centre, the institution responsible for discovering the Ebola vaccines now deployed against the more common Zaire strain. Bundibugyo has no approved vaccine or treatment. The US was the world’s largest source of funding for the global health architecture that might have accelerated countermeasure development. That architecture has been dismantled.
The World Cup as Diagnostic
New York’s five concurrent public health alerts, viewed in context, are diagnostic: an example of what happens when you systematically degrade public health surveillance, outbreak response capacity, vaccine confidence, and global early-warning systems simultaneously, and then host a mass gathering of one million international visitors.
The pathogens themselves (measles, hantavirus, Ebola, West Nile, COVID) are not novel. What is new is the environment in which they are now operating. Measles has an R0 of 12–18; in a population where vaccination coverage has been eroded by eighteen months of mixed and misleading messaging from the country’s most senior health official, a mass gathering is not a contained risk. Hantavirus is normally a sporadic zoonosis; the quarantine management of the cruise ship cluster has been competent, but the outbreak response capacity that would normally back this up has been thinned. Ebola preparedness is only as reliable as the surveillance systems and those systems have been cut.
Public health infrastructure is not visible until it fails. It does not appear on a balance sheet as an asset. Its value is measured in the crises that do not happen, the outbreaks that are caught early, the deaths that are prevented rather than mourned. DOGE’s idiotic logic was that you could measure government efficiency by counting headcount and cutting it. The logic of infectious disease is different: the cost of dismantling a warning system is paid later, by people who had no say in the decision.
In the US, the measles outbreak has fallen hardest on unvaccinated children in low-income and marginalised communities where vaccine access was already uneven and misinformation spread readily. Globally, the populations most affected by USAID terminations were those already carrying the greatest burden of preventable disease: sub-Saharan Africa, South and Southeast Asia, conflict-affected, and poor, regions where US-funded health infrastructure was often the only infrastructure available.
The fiscal justification for DOGE’s cuts rested upon treating global health spending as discretionary foreign largesse. What it actually was, and what the past eighteen months have demonstrated, is a form of collective insurance: investment in outbreak detection and containment in regions far from the US border that directly protects the US from the pathogens those regions would otherwise export. Cutting it did not eliminate the risk. It transferred the cost — from the federal balance sheet to the children in Texas, patients in African HIV clinics, and a global surveillance system now operating with a structural gap where the world’s largest contributor used to be.
The World Cup will pass. The five alerts will be managed, one way or another. But the institutional damage to the CDC, the erasure of a generation’s worth of global health infrastructure, and the active promotion of vaccine misinformation from within the US government will outlast any tournament. The question for the next administration is how long it takes to rebuild what has been destroyed by the Trump administration, and how many preventable deaths will occur between now and the return of a sensible health policy.
Further Reading.
1. KFF. Measles Elimination Status: What It Is and How the U.S. Could Lose It. April 2026.
2. Fortune. We lost a lot of talent: The man who overhauled the CDC before the DOGE cuts. June 2026.
5. STAT News. Federal health officials slash recommended childhood vaccinations. January 2026.
6. FactCheck.org. A Timeline of RFK Jr.’s Mixed Messaging on the Measles Vaccine. May 2026.
7. Offit P. Another Child Dies from Measles. Substack. April 2025.
8. Contagion Live. Public Health Wake-Up Call: Will the US Lose Measles Elimination Status? 2025/2026.
10. Health Policy Watch. One Year Later: The Effect of US “Chainsaw” on Global Health. January 2026.
11. Center for Global Development. Update on Lives Lost from USAID Cuts. December 2025.
12. Boston Globe. I blew the whistle on DOGE’s dismantling of USAID. June 2026. (Paywall)
13. PMC. USA’s exit from the WHO and freeze on USAID funds globally. Frontiers in Public Health. 2025.
14. The Lancet. The perils of RFK Junior’s anti-vaccine leadership for public health. December 2024.