Daily, they addressed critical challenges with significant consequences:

The urgent need for donor organs for patients in desperate health situations.

Tobacco products crafted to attract young audiences.

Maternal and infant fatalities.

They were appointed following extensive deliberations among legislators and officials, who often took years to assign these vital issues to specific individuals for resolution.

However, earlier this month, they lost their positions in a sweeping dismissal of federal employees initiated by President Donald Trump. The continuity of their public health endeavors suddenly seemed uncertain.

While the White House has not disclosed the total number of dismissals, reports indicate approximately 750 individuals from the Centers for Disease Control and Prevention, which is essential for pandemic responses; over 1,000 from the National Institutes of Health, known for funding vital research; several at the Centers for Medicare and Medicaid Services, which oversees public healthcare initiatives; and numerous employees from the Food and Drug Administration, responsible for ensuring the safety of food, pharmaceuticals, and medical devices.

Secretary of the Department of Health and Human Services, Robert F. Kennedy Jr., has committed to reforming federal health centers, calling for cuts to “entire departments” at the FDA. Neither the administration nor the federal agencies have responded to ProPublica’s inquiries; however, a White House spokesperson previously asserted that they were eliminating newer personnel deemed “non-essential” to the mission.

“The consequences for public health are severe,” stated Susan Polan, an associate executive director at the American Public Health Association, who is currently taking legal action against the Department of Government Efficiency for violating federal transparency rules. “It’s incomprehensible that anyone perceives value in these cuts, which are purely performative.”

ProPublica journalists have spoken with numerous federal employees tasked with protecting American citizens. They expressed concerns about losing vital roles they had dedicated years to and worried about the future of their ongoing work.

ProPublica is documenting the fallout from this mass dismissal, emphasizing the extent of expertise and public health initiatives that are being jeopardized by the Trump administration’s aggressive strategy to downsize the federal government.

Guarding Children from Tobacco

For over ten years, Dustin Brace has held various roles in federal service, including serving as an emergency 911 dispatcher for the Navy and responding to significant chemical and oil spills as a Coast Guard member. “I loved contributing to the safety of the American populace,” he said. “I never anticipated leaving government service.”

When he joined the FDA last year, his mission remained unchanged. As a social scientist within the Center for Tobacco Products, he was responsible for monitoring e-cigarettes and similar products. Some were specifically crafted to mimic kid-friendly snacks, resembling colorful soda cans or adorned with playful characters like unicorns. In recent years, the number of young children ending up in emergency rooms due to liquid nicotine poisoning has surged. Occasionally, vaping devices have exploded in users’ hands or pockets, with tragic incidents including one death caused by shrapnel entering a man’s brain.

Every week, Brace meticulously reviewed new product applications to ensure they weren’t appealing to minors and that the devices were safe for consumers. This entailed a thorough examination of thousands of pages of documentation to identify potential hazards. “Properly conducting this work requires ample time and effort,” he remarked.

His position, along with the center’s establishment, was grounded in a bipartisan recognition of the necessity to regulate the tobacco industry. It wasn’t until 2009, after years of industry resistance, that the FDA secured broad legal authority for such oversight.

The agency has long struggled to attract sufficient scientists and specialists, who often prefer higher salaries in the private sector. “People don’t join agencies like the FDA and centers like CTP for financial gain,” stated Mitch Zeller, who directed the center from 2013 until 2022. “They join because they believe in the mission.”

Importantly, the center’s regulatory endeavors are financed through fees collected from the tobacco industry and do not depend on direct federal funding. “No taxpayer money is used for tobacco industry regulation,” emphasized Zeller.

Last Saturday, Brace received a termination letter along with fellow newer colleagues in his department. Similar to others across federal agencies, his letter included standard phrases indicating poor performance, despite having received commendable reviews throughout the year, as per his assessment records.

Brace estimated that over 10% of the staff in the center’s scientific department were let go that week.

“Productivity will decline,” Brace predicted. “Mistakes are more likely as the workload increases significantly.”

Preventing Maternal and Infant Mortality

When Arielle Kane joined a pioneering federal initiative last year aimed at enhancing childbirth safety in the U.S., she felt a deep connection to the mission.

Her work could potentially save lives.

The United States has the highest maternal mortality rate among affluent nations, with women in underserved areas facing significant risks. Their infants are also at risk if their mothers lack access to prenatal services or timely medical attention for complications, often due to living in areas lacking adequate obstetric care.

Kane’s program, part of CMS, was designed to assist mothers on Medicaid by improving access to birthing centers, midwives, and doulas, reducing unnecessary procedures like C-sections, and monitoring key outcomes such as low infant birth weight. Enhanced blood pressure tracking could avert dangerous conditions such as preeclampsia, while greater emphasis on mental health and substance use could prevent severe issues.

It officially kicked off on January 1, and Kane was eager about the potential it held.

However, after Trump took office, they were instructed to stop collecting data on race and ethnicity, which raised concerns for many team members. Racial disparities in maternal health are stark, as Black women are three times more likely to perish from pregnancy-related causes compared to white women, and over twice as likely to experience stillbirths. Kane also mentioned being advised against communicating with state officials or attending a forthcoming maternal health conference.

Then, just six weeks after the program’s launch, Kane and three of her peers were terminated. With two others planning to depart by the end of the month, their team was set to be cut by nearly 50%.

“I’m incredibly frustrated,” Kane expressed. “This model, brimming with potential, is undergoing drastic cuts. What does this mean for the impacts we could have achieved?”

Preventing Lost Donor Organs

For over ten years, Amy Paris has worked within federal agencies as a solutions-oriented professional, streamlining bureaucratic processes for better public access.

Last year, she joined the effort to reform the national organ procurement and transplantation system, a partnership that connects organ donors to patients in urgent need of transplants.

This program had recently come under scrutiny as thousands of patients languished on waitlists while some donor organs went unused. Investigations revealed instances where multiple kidneys had to be discarded due to transport mishaps, including one case where a donor organ was inadvertently left on an airport cart.

Following federal and Senate investigations that outlined numerous flaws, including outdated technology, the Health Resources and Services Administration announced a modernization plan in March 2023.

Paris joined the initiative last October as a deputy digital services lead, collaborating with transplant surgeons, tech professionals, and data scientists to implement improvements. “We were making significant progress,” she remarked. “We had bipartisan support, secured funding, and were expanding our team.”

As a relatively new hire, she expected to be among those let go in the federal staffing reductions. Nevertheless, the termination notice still left her feeling devastated.

Around half of her team faced layoffs, resulting in indefinite delays for reform initiatives. A planned investigation into the underlying technology of the network system has been called off following her dismissal.

“We’re systematically dismantling our government in a manner that will harm individuals and ultimately cost lives,” she cautioned. “That is the most alarming aspect of all.”