U.S. Senate Health, Education, Labor and Pensions Chairman Bill Cassidy speaks with Health and Human Services Secretary Robert F. Kennedy Jr. after Kennedy's confirmation hearing on Jan. 30, 2025. (Photo by Kevin Dietsch/Getty Images)

WASHINGTON — Bipartisan leaders of a U.S. Senate committee dealing with health policy expressed alarm with the direction of the country’s top public health agencies after President Donald Trump fired the director of the Centers for Disease Control and Prevention and other high-level officials resigned. 

Louisiana Republican Sen. Bill Cassidy — chairman of the Health, Education, Labor and Pensions Committee — posted on social media late Wednesday that the “high profile departures will require oversight by the HELP Committee.”

Cassidy separately called on the Advisory Committee on Immunization Practices to indefinitely postpone its September meeting.

“Serious allegations have been made about the meeting agenda, membership, and lack of scientific process being followed for the now announced September ACIP meeting,” Cassidy wrote in a statement. “These decisions directly impact children’s health and the meeting should not occur until significant oversight has been conducted. If the meeting proceeds, any recommendations made should be rejected as lacking legitimacy given the seriousness of the allegations and the current turmoil in CDC leadership.”

Vermont independent Sen. Bernie Sanders, ranking member on the committee, called for a bipartisan investigation into the reasons Trump fired Susan Monarez as CDC director less than a month after she received Senate confirmation.

Sanders said that Health and Human Services Director Robert F. Kennedy Jr., Monarez and the handful of high-ranking CDC officials who resigned this week should be able to testify publicly about what’s happening inside the agency. 

“We need leaders at the CDC and HHS who are committed to improving public health and have the courage to stand up for science, not officials who have a history of spreading bogus conspiracy theories and disinformation,” Sanders wrote.

White House press secretary Karoline Leavitt said during a briefing that Trump had every right to fire Monarez and that he expects to pick a new nominee “very soon.”

“Her lawyers’ statement made it abundantly clear themselves that she was not aligned with the president’s mission to make America healthy again,” Leavitt said. “The secretary asked her to resign. She said she would and then she said she wouldn’t. So the president fired her, which he has every right to do.” 

Kennedy is scheduled to testify before the Senate Finance Committee next week, that panel’s chairman, Idaho Republican Mike Crapo, announced Thursday.

Kennedy “has placed addressing the underlying causes of chronic diseases at the forefront of this Administration’s health care agenda,” Crapo wrote on X. “I look forward to learning more about @HHSGov’s Make America Healthy Again actions to date and plans moving forward.”

Cassidy key vote for RFK

Cassidy was an essential vote to confirm Kennedy as director of HHS, which oversees the CDC, though he expressed concerns throughout that process that Kennedy’s past statements about vaccines weren’t rooted in reputable medical research.

Cassidy said during a floor speech in February after voting to advance Kennedy’s nomination that Kennedy assured him he will protect “the public health benefit of vaccination.” 

“If Mr. Kennedy is confirmed, I will use my authority of the Senate committee with oversight of HHS to rebuff any attempt to remove the public’s access to life-saving vaccines without ironclad causational scientific evidence that can be accepted and defended before the mainstream scientific community and before Congress,” Cassidy said at the time. “I will watch carefully for any effort to wrongly sow public fear about vaccines between confusing references of coincidence and anecdote.”

In this photo illustration, a pharmacist holds a COVID-19 vaccine. States and clinicians are working on getting correct information on vaccines to vulnerable groups amid shifting federal guidance. (Photo illustration by Joe Raedle/Getty Images)

Heading into the respiratory illness season, states and clinicians are working to encourage pregnant patients to get COVID-19 vaccinations, even though the U.S. Department of Health and Human Services no longer recommends that they should.

Along with being older and having an underlying health condition, pregnancy itself is a risk factor. Pregnant women are more vulnerable to developing severe illness from COVID-19. They’re also at high risk for complications, including preterm labor and stillbirth. The vast majority of medical experts say getting the shot is safe and effective — much safer than having the illness.

But HHS Secretary Robert F. Kennedy Jr. announced in May that the agency would no longer recommend that pregnant women get the vaccine. Before testifying before Congress in June, Kennedy circulated a document on Capitol Hill claiming higher rates of fetal loss after vaccination. But the authors of those studies told Politico that their work had been misinterpreted.

Experts say the federal shift puts the onus on state health agencies to ramp up vaccine guidance and outreach. Clinicians and public health organizations are trying to dispel misinformation and make sure information reaches low-income people and people of color, who had higher maternal death rates during the pandemic. During the first two years of the pandemic, the virus contributed to a quarter of maternal deaths, according to federal data.

“We are severely disappointed,” said Dr. Neil Silverman, a professor of clinical obstetrics and gynecology at the University of California, Los Angeles David Geffen School of Medicine. He has studied vaccines and pregnancy for the past 15 years and specializes in high-risk pregnancies.

Silverman called the federal shift a “public health tragedy on a grand scale.”

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Vaccinations against COVID-19 help prevent severe illness in pregnant people as well as their newborns, who are too young to get vaccinated, Silverman said. In what’s called passive immunity, vaccinated mothers pass on antibodies to their babies through the placenta and through breast milk.

“State public health agencies are probably going to have to implement vaccine guidance that differs from the federal recommendations. And that’s going to be an interesting can of worms,” said OB-GYN Dr. Mark Turrentine, a professor of obstetrics and gynecology at the Baylor College of Medicine in Texas.

Turrentine serves on a board of the American College of Obstetricians and Gynecologists that focuses on immunization and infectious diseases. He said his recent pregnant patients who had COVID-19 hadn’t gotten the vaccine.

“The change in guidance on the federal level just really makes a lot of confusion, and it makes it very challenging to try to explain to individuals why all of a sudden the difference,” Turrentine said.

A slew of public health organizations have been making a concerted effort to dispel vaccine myths. They include the Society for Maternal-Fetal Medicine, a Washington, D.C.-based nonprofit organization of maternal-fetal experts. At a news briefing the society held this month, clinicians stressed the safety and long-standing science behind COVID-19 vaccines, as well as the shots for RSV and the flu. Cases of RSV and the flu tend to peak in the winter months, while in recent years COVID-19 cases have spiked in the summer and the winter.

Dr. Brenna Hughes, an OB-GYN who chairs the organization’s infectious diseases and emerging threats committee, pointed to survey data from the federal Centers for Disease Control and Prevention showing that less than a third of eligible pregnant patients received COVID-19 shots, and only 38% received RSV shots for the 2023 to 2024 season. Less than half — 47% — received flu shots, and 59% received TDAP (whooping cough) vaccines.

CDC data shows that for last year’s and this year’s season, only between 12% and 14% of pregnant patients got the COVID-19 vaccine.

“The complications from the infection are so much greater than the complications and the very few and typically minor adverse events that might occur from the vaccine,” said microbiologist Sabra Klein, a professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health.

In June, the American College of Obstetricians and Gynecologists and 30 other professional health organizations signed a letter urging insurers to continue covering the COVID-19 shot for pregnant women, and have continued to urge coverage since then.

CVS Caremark, one of the nation’s three major pharmacy benefit managers, told Stateline it will continue covering the vaccine for pregnant women. The Arizona, California and North Carolina state Medicaid agencies also told Stateline they are still currently covering COVID-19 vaccines for pregnant women.

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Dr. Kimberly Fortner, president-elect of the Infectious Diseases Society for Obstetrics and Gynecology, said during the maternal-fetal medicine briefing that she hopes medical groups’ joint messaging will bolster insurers.

“Hopefully by us linking arms, that can then help develop consistency so that insurers will continue to pay for the vaccine,” she said.

Exacerbating disparities

Dr. Ayanna Bennett, director of the District of Columbia Department of Health, said the federal government’s new stance has upended “a system that’s been stable for a very long time.”

Bennett said her agency used federal pandemic aid to shore up vaccine outreach efforts to communities of color. Now that flow of money is ending.

The changes in federal guidance and funding will “almost certainly exacerbate” maternal health disparities, said Marie Thoma, a perinatal epidemiologist and an associate professor in the University of Maryland Department of Family Science who researches pregnancy and COVID-19.

Black and Indigenous women died at higher rates. The virus exacerbated existing racial disparities in maternal health — and created new ones: Latina mothers, who generally see low rates of maternal mortality, saw deaths surge to 28 per 100,000 in 2021. Their rate was about 12 per 100,000 in 2018, according to federal data.

“We are going in with some exposure already that we didn’t have during the start of the pandemic. So, there will be some protection, but now that will erode,” said Thoma. “If we’re not getting vaccines, or if people are hesitant to take them, we could see some increase.”

Silverman said the administration’s efforts to strip mentions of race from government policies makes it difficult for institutions to reach populations at greatest risk. He called the dismissal of decades of data “saddening and infuriating.”

“The politicization of the vaccine process, or access to it, is what concerns me the most,” said Dr. Yvette Martas, a Connecticut OB-GYN who chairs the board of directors of the Hispanic Health Council.

Many women “are trying to navigate an economic system that’s not always in their favor in terms of also providing access to the kind of educational material that they need,” she said.

Not just COVID-19

In June, Kennedy ousted all 17 members of the CDC’s vaccine advisory committee, replacing them with some members who are vaccine skeptics.

The change is creating chaos. Some states have vaccine laws, such as mandates for kids and coverage statutes, that are specifically tied to the committee’s decisions.

The Vaccine Integrity Project at the University of Minnesota called on frontline health workers, health officials and professional societies to “counter the spread of inaccurate and confusing vaccine information.”

At a news briefing this month held by the Association of State and Territorial Health Officials, representatives from Alabama, Connecticut and Washington, D.C., said they will continue to recommend vaccines.

Alabama’s state health officer, Dr. Scott Harris, said clinicians will be instrumental in getting correct vaccination information to patients.

“We don’t think that we necessarily have the same authoritative voice that we might have had a decade ago in trying to guide people in what to do, but we do believe that people trust their health care providers in most cases and are certainly willing to listen to them,” he said at the briefing.

Bennett said she is hopeful that strong, consistent messaging from respected medical organizations will help combat confusion.

“Having established groups like the American Academy of Pediatrics or the American College of Obstetrics and Gynecology make very firm recommendations that keep us essentially not changed from where we have been, I think, should reassure families,” she said.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

A medical worker prepares to vaccinate people at a pop-up COVID-19 vaccination clinic in a rural Delta community in April 2021 in Leland, Miss. The Mississippi State Department of Health, like other state health departments, is concerned about the potential loss of federal funding. (Photo by Spencer Platt/Getty Images)

Between 2016 and 2022, as congenital syphilis cases rose nationally and especially in the South, Mississippi saw a one thousand percent increase — from 10 to 110 — in the number of newborn babies who were hospitalized after contracting the disease, known to cause developmental issues, intellectual disabilities, and even death.

So in 2023, the state Department of Health mandated that all medical practitioners screen for the disease in pregnant mothers, and it has been running advertisements to spread awareness.

Annual congenital syphilis cases in Mississippi rose from 62 in 2021 to 132 in 2023, according to state data. The number fell to 114 last year. There have been 33 cases so far this year.

That work won’t stop despite potential budget cuts, Dr. Daniel Edney, Mississippi’s state health officer, said in an interview. “We’re going to keep doing what we have to do, you know, to keep it under control.”

State by state, public health departments take a similar approach: They monitor, treat and try to stem preventable diseases, alongside their host of other duties. But in the coming year, health department officials — with their agencies already strapped for cash — fear they’ll find it much more difficult to do their jobs.

President Donald Trump’s budget proposal for fiscal year 2026 would cut the federal Centers for Disease Control and Prevention budget by more than half, from $9.3 billion to $4.2 billion. The proposal serves as a wish list from the administration, a blueprint for the Republican-controlled Congress as it works through upcoming spending legislation.

If lawmakers hew to Trump’s vision, then state and county public health departments would be hit hard. States contribute to their own health departments, but a lot of them rely heavily on federal funding.

And around half of local public health department funding comes from federal sources, primarily the CDC, as noted in a 2022 report from the National Association of County & City Health Officials.

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“The federal government provides a lot of funding, but the actual implementation of public health programs happens at the state and local level,” said Josh Michaud, associate director of global health policy at KFF, a health policy research group. “Each state has its own approach, in many ways, to how public health programs are overseen, how they’re funded, how they are implemented.”

In announcing his department’s share of the proposed budget, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. said Trump’s goals align with “new priorities in reversing the chronic disease epidemic.”

But many local health leaders point to the longtime mission of state public health departments in preventing the spread of disease.

“Local public health is on the front lines preventing communicable disease, operating programs to prevent chronic disease, ensuring our septic and well water systems are safe,” said Dr. Kelly Kimple, acting director of North Carolina’s Division of Public Health within the Department of Health and Human Services.

“I’m very concerned,” Kimple said, “especially given the magnitude of funding that we’re talking about, as we can’t keep doing more with less.”

Clawing back COVID-era grants

Other federal budget cuts also have states worried.

Many state public health departments grew alarmed when the Trump administration announced in March that it would be clawing back $11.4 billion in COVID-era funding for grants that were slated to extend into 2026.

Twenty-three states and the District of Columbia sued. A federal district court in Rhode Island temporarily blocked the cuts, and the case remains tied up in court.

The court’s preliminary injunction may not protect temporary staff or contractors, though. Public health departments have been laying off staff, cutting lab capacity and reducing immunization clinics, said Dr. Susan Kansagra, chief medical officer for the Association of State and Territorial Health Officials.

Historically, public health departments receive funding in “boom and bust” cycles, meaning they tend to get more federal support during emergencies, said Michaud, of KFF. But “since the Great Recession of 2008, there was a general decline in public health support funding until the COVID pandemic.”

For example, KHN and The Associated Press reported that between 2010 and 2019, spending on state public health departments declined by 16% per capita and spending for local health departments fell by 18%.

Nationally, syphilis cases reached historic lows in the 2000s, thanks to robust prevention efforts and education from public health officials. By 2022, however, cases reached their highest numbers nationally since the 1950s.

“In the wake of the COVID emergency, you’ve seen a sort of backlash to what people had been calling the overreach of public health and imposing vaccination requirements and lockdowns and other public health measures,” Michaud told Stateline.

Smallpox, cholera and typhoid

Public health departments and officials go back to the 19th century, when there was a greater emphasis on sanitation efforts to prevent spread of diseases such as smallpox, cholera and typhoid, which were rampant at the time.

By the end of the century, 40 states had established health departments, which to this day are responsible for water sanitation, tracking the spread of disease, administering vaccinations, furnishing health education, providing screenings for infants and some prenatal care for moms at local clinics, offering family planning services, and tracking and treating sexually transmitted infections, among other things.

Kimple pointed to measles as a current example of a disease that’s spreading fast. When North Carolina’s health department detected a case in the state, she said, the department “identified and contacted everyone who might have been exposed, helped people get tested, worked with doctors to make sure they knew how to respond.”

That’s the legacy of local public health, Michaud said.

“The federal government cannot decide, ‘This public health program will happen in this state, but not that state,’ that kind of thing. And cannot declare a national lockdown. The COVID pandemic tested a lot of those boundaries. It really is a state and local responsibility to protect public health. And that’s always been the case, since the beginning of our country,” Michaud said.

“And what we’re seeing now is a complete upheaval of the funding going into public health.”

A major cut in services

Kimple said she’s seen recent progress in her state in the support for funding public health.

“North Carolinians viewed our work as highly important to improving health and well-being in the state, and appreciated the local presence, the reliable information, the role in prevention and efforts to protect, in particular, vulnerable communities,” she said.

Similarly, Edney said that Mississippi state lawmakers were showing more support, despite some setbacks in 2016 and 2017. New federal cuts could throw a wrench in the health department’s economic plans and its ability to reach small communities.

“Now the federal rug is being pulled out from under us,” he said.

Edney said he expects the federal share of his department’s public health funding to fall from its current 65% to around 50%.

Edney said he’s been trying to strengthen Mississippi health department’s longevity by diversifying its revenue streams by, for example, accepting private donations.

The state will not stop doing its “core” work, he said, regardless of federal funding.

“We’re not going to cut back on services at the county health department, because what we do now is all mission critical,” Edney said.

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.