It's been a little over 10 months since the second term began, starting with a raft of executive orders – 26 on Day 1, then 143 by Day 100. Sweeping changes to agency leadership followed, with new policy announcements appearing as quickly as their reversals. Budgets have been cut, litigated, reinstated, and then cut again.
Such a relentless flood of change is considered part of the design: so many actions in such a short timeframe make it difficult to keep track. Polarising rhetoric and misinformation are features of the same strategy, which are best cut through with a simple presentation of facts. The magnitude and breadth should speak for themselves.
Hopefully some holiday hygge provides a little respite.
- US withdrawal from the World Health Organization (WHO)
One could be forgiven for forgetting this after everything else that followed. Executive Order 14155 directed the withdrawal of the United States from WHO on Day 1, limiting US engagement with global cooperative public-health responses. -
Drastic, fast-moving and heavily litigated reductions in foreign aid and global health funding
Another early one, but not easily forgotten. Executive Order 14169 directed a pause of all foreign aid and halted most existing programs at the US Agency for International Development (USAID). The timeline of events cannot be sufficiently explained in a sentence or two, so read the KFF timeline instead. An Oxfam modelling study suggests this could lead to over 3 million additional preventable deaths per year (dependent on assumptions). - Massive restructuring of the US Department of Health and Human Services (HHS)
First proposed in March and partly upheld by the US Supreme Court (SCOTUS) in July with litigation continuing. A total of 28 divisions are being folded into 15 under the new Administration for a Healthy America, with HRSA, SAMHSA, OASH and NIOSH being subsumed. -
Large-scale workforce and capacity reductions at HHS and subordinate agencies
This has been nothing short of chaotic, with various waves of fires and rehires, layoffs and court-ordered reversals. Some 20,000 were originally slated for layoffs across HHS divisions such as the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) and National Institutes of Health (NIH). Current numbers are hard to discern amid ongoing litigation.
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Severe cuts to public-health and prevention programmes at HHS and CDC
Important and impactful programmes have been cut, covering maternal & child health, reproductive health, environmental health, chronic disease prevention, HIV/STD prevention, drug overdose prevention & addiction treatment, and COVID-19 & infectious diseases. Around 53% of the CDC budget was proposed to be cut, but some of this awaits appropriation or faces litigation.
- Elimination and restriction of family-planning and reproductive-health resources
Reinstatement of the Hyde Amendment and cuts to programs like Title X caused Planned Parenthood clinics to close in many areas. The Mexico City policy has also been reinstated and extended to include DEI and “gender ideology”. KFF have another comprehensive and important resource on this, showing state-level disparities. - Withdrawal of federal funding and support for gender-affirming care for minors
Executive Order 14187 instructed agencies to stop funding, support or promotion of gender-affirming medical treatments (hormones, surgeries, puberty blockers) for people under 19. The language in this order was particularly abrasive. -
Institutionalisation of vaccine-scepticism in federal health leadership and policy
Secretary RFK Jr. is a long-time and well-known vaccine sceptic and actions since his appointment have closely aligned with those views. He handpicked members of the CDC Advisory Committee on Immunization Practices, leading to routine immunisations being placed 'under review', expansion of the Vaccine Injury Compensation Program (VICP), and $500m in funding for mRNA vaccines being cancelled. The CDC also now states that a link between vaccines and autism "is not an evidence-based claim because studies have not ruled out the possibility". - Reduction or elimination of research into social determinants, health equity, DEI, minority health and environmental health
As with HHS and CDC programmes, many research grants and programmes focused on disparities, equity, community health, environmental justice, and social determinants have been proactively cut and slated for termination. - Removal or downgrading of public health datasets, guidance documents, and education materials
The administration removed many publicly available resources and has suppressed research and guidelines on topics like contraception, HIV, maternal mortality and sexual/reproductive health, limiting access to evidence-based information for clinicians and the public. - Significant and ongoing cuts to biomedical research funding, principally at the NIH and the National Science Foundation (NSF)
Some big ones to finish. According to GrantWitness, a community-led project to track terminated NIH and NSF grants, over 7400 research projects have been frozen, terminated, or flagged and just under $3 billion in funding has been lost. Nature estimated at least $4 billion. Ongoing lawsuits (e.g. APHA v. NIH) leave the status of many NIH grants in limbo. - Suspension and politicisation of grant review, approvals and research funding
Beyond cancellation, sweeping changes have been made that have significantly slowed the federal grant review process. Freezes on indirect cost rates have reduced institutions’ ability to support labs. Political appointees from the Executive Branch ensure that awarded grants "demonstrably advance the President’s policy priorities" and new language makes cancellations easier if grants do not meet this threshold. A New York Times investigation suggests 100s of words are being flagged during review. - Disruption and halting of clinical trials
Budget and staff cuts have led to the cancellation of at least 383 clinical trials, affecting some 74,000 participants due to 'misalignment' with policy priorities. Trials involving cancer, cardiovascular disease, infectious diseases, mental health conditions and reproductive health have been cancelled. The recent government shutdown also caused ClinicalTrials.gov to go offline, leaving both US and international patients unable to search for potentially life-saving clinical trials. -
Significant disruption to the pipeline of future researchers and loss of early-career expertise
Cancellations of T32-style NIH training grants have led to many early-career scientists losing their funding and both postdocs and PhD students have been forced to look elsewhere for employment. Some institutes withdrew offers and put applications on hold. Even if only short-term, the initial impact will have severely impacted the pipeline of future researchers. -
Freezes and restrictions on agency communications, scientific advisory boards and external research collaborations
Various health agencies had abruptly-ordered bans on external communications and travel imposed within the first weeks of the presidency. Training workshops, conference travel and grant review panels were cancelled last-minute. Some cancellations were temporary but other restrictions persist.
Unfortunately, this list isn't exhaustive. There are a few other significant, cross-cutting, high-impact policy changes that affect many of the people mentioned above. In brief:
- EPA panels were fired en-masse and climate scepticism was institutionalised, with a rollback of R&D, air- and water-quality rules and climate-disclosures.
- Skilled-immigration pathways have been tightened with J-1 and H-1B visa processing significantly impacted.
- Data-privacy and AI protections have been paused or reversed, affecting academic-industry cooperation and computational research.
- Elimination of federal DEI requirements across both agencies and universities (often through pressure).
There are reasons for cautious optimism in 2026. Some state and local governments are stepping in to preserve services; foundations and professional societies are providing bridge funding; coalitions between universities are keeping collaborations alive; numerous policies face active litigation; and researchers, clinicians and patient groups are documenting impacts with unprecedented coordination to prepare for recovery. The research ecosystem in the US is resilient and meaningful repair is possible.
The Harm Reduction Journal has commissioned a collection to compile evidence-based strategies – grounded in science, dignity and practical outcomes – to inform more effective, humane public health responses. Keep an eye out for future publications and contact Guest Editor, Prof. Thomas J. Stopka, MHS, PhD, to discuss contributions.
Okay, that's enough now. Take a break. Watch some live streams of bird feeders provided by the Cornell Lab of Ornithology.