Since taking office, President Trump has signed a barrage of executive orders taking aim at major programs, agencies, and institutions, ranging from healthcare and public health to global health and international development. These orders, which can be used to implement but not override laws, run contrary to U.S. health and security interests. Alongside these orders, the administration has taken action that will harm public health, including mass firings and budget cuts at public health agencies.
Many of these orders and actions violate legal statutes — or even the Constitution — with several already being challenged in court and likely to be struck down. Despite having a 6-3 conservative majority, the Supreme Court has already ruled against President Trump on a key effort to dismantle global aid, and rulings against other orders could follow. Still, the immediate and longer-term consequences may be damaging to public health and science itself. We discuss three key measures below.
Dismantling Foreign Aid
On his first day in office, Trump signed an executive order pausing U.S. foreign aid disbursements for 90 days, allowing time to review activities for consistency with his foreign policy. Then on Jan. 24, Secretary of State Marco Rubio issued a stop-work order for existing foreign assistance (with narrow exceptions). These and additional measures effectively dismantle the U.S. Agency for International Development (USAID), which has provided lifesaving global health assistance for over 60 years. Other measures include putting senior officials on leave, laying off thousands of contractors, canceling some 5,800 contracts, and gutting the agency so that only about 600 staff — out of over 10,000 — would remain.
The Congressional Research Service (CRS) found these actions unlawful because Congress established USAID as an independent entity (Section 1413 of the Foreign Affairs Reform and Restructuring Act), and the president does not have unilateral authority to abolish, move, or consolidate USAID. We agree with the CRS conclusion. Yet, on Feb. 26, Chief Justice John Roberts temporarily froze a federal court order that would have required the Trump administration to pay nearly $2 billion in foreign-aid reimbursements for work already completed.
In a turn of events this week, the Supreme Court issued an emergency ruling that rejected the Trump administration’s request to lift the lower court’s order. The Supreme Court asked the lower court to clarify the Trump administration’s obligations, given that the initial deadline for the $2 billion payout had passed.
Meanwhile, the funding freeze and stop-work order have had devastating effects. USAID provides patients in the world’s poorest countries with lifesaving prevention and treatment for diseases like HIV and polio, and helps prevent children in war and famine-stricken areas from starving to death. USAID and State Department programs have promoted democracy and global stability, providing pathways for partnerships and diplomatic relations, and enabling the U.S. to conduct key global health security initiatives such as critical disease surveillance. Even the shortest pause in this work has already brought death, lost livelihoods, and loss of trust in U.S. partnerships, as well as loss of vital personnel, supplies, and data collection.
Limiting NIH Funding for Indirect Costs
On Feb. 7, the Trump administration announced a policy stating that the percentage of NIH research grant funding that goes to pay grantees’ indirect costs would be cut to 15%. With a $48 billion budget, NIH is the largest public funder of biomedical research in the world. Indirect costs, which are categorized into “facilities” and “administrative” costs, cover research essentials like buildings, lab equipment, electricity, clerical staff, IT support, and regulatory compliance.
Funding for indirect costs is typically negotiated between NIH and researchers, averaging around 27% of grants. The government defended the 15% cap — which would apply to existing and future grants — by saying that funds should go toward “…direct scientific research costs rather than administrative overhead.”
Yet, as 22 states point out in a lawsuit filed against the policy (set to take effect just one business day after it was issued), slashing NIH funding for indirect costs would “devastate critical public health research at universities and research institutions,” bring cutting-edge work to a halt, and give other countries a competitive advantage. Medical, pharmacy, and public health schools, as well as hospitals in New York and Boston, filed a second lawsuit against the policy.
In that second lawsuit, Judge Angel Kelley of the U.S. District Court for the District of Massachusetts issued a temporary restraining order to block the policy on the day it was to take effect, based on a finding that schools and hospitals would suffer “immediate and irreparable injury.”
As the lawsuits argue, the 15% cap is likely illegal. During the first Trump administration, Congress passed an appropriations rider that banned HHS and NIH from modifying the negotiations process for determining funding for indirect costs, to block the administration’s attempt to impose a 10% cap in 2017. The rider has stayed in effect. Aside from contravening Congress’s intention through the rider, the policy also violates the Administrative Procedure Act as being “arbitrary and capricious” — failing to account for researchers’ needs that are weighed during funding negotiations. Further, the NIH likely exceeded its authority by failing to provide a period for notice and public comment.
Capping indirect funding would decimate biomedical research, which has been the engine of the U.S. economy and the envy of the world. It will cost the jobs of thousands of highly trained researchers and will leave patients enrolled in clinical trials without access to the cutting-edge treatments already supported by their tax dollars.
The policy on indirect costs comes alongside other blows to NIH (e.g., impeding the agency’s ability to consider new grant applications), possibly indicating Trump’s efforts to overhaul the long-standing agency.
Slashing HHS Staffing
In accordance with a Feb. 11 executive order on “workforce optimization,” the Trump administration has undertaken mass layoffs of HHS personnel, as part of efforts to “restructure and streamline the federal government.” Initial reports conveyed that up to 5,200 HHS employees (out of about 80,000) would lose their jobs. This includes researchers, scientists, health professionals, and other officials at the CDC, FDA, and NIH.
The layoffs have largely targeted “probationary” staff — those who are relatively new in their position, recently changed positions, or recently received a promotion — as this status makes it easier to fire them without violating civil service protections. The “probationary” status does not make these employees any less vital to public health and safety. In fact, the administration appeared to recognize this and started trying to hire back certain staff soon after.
Former heads of HHS sub-agencies under the Biden administration have condemned the mass layoffs. Labor unions representing federal workers across agencies have filed various lawsuits against the Trump administration (including one appealed to the Supreme Court), arguing that the firings violate statutes passed by Congress governing civil service.
The administration counters that the firings are authorized by law and within the president’s authority. On Feb. 20, a federal judge in one case sided with the Trump administration, finding that it “lacks subject matter jurisdiction” and should instead be brought before the Federal Labor Relations Authority. On Feb. 19, labor unions brought another case against the Office of Personal Management (OPM) for conducting the mass terminations under false pretexts of poor performance to reduce the size and spending of the federal government. The lawsuit points out that “Congress, not OPM, controls and authorizes federal employment and related spending by the federal administrative agencies, and Congress has determined that each agency is responsible for managing its own employees.”
Last Friday, on Feb. 27, a federal judge ruled that the mass firings of federal probationary employees were likely unlawful and temporarily blocked the layoffs in favor of the plaintiff labor unions and organizations.
While this swirl of litigation proceeds, it is clear that the Trump administration is failing its obligation to keep the American people — and our overseas allies — healthy and safe. The administration has made it obvious that the fight for U.S. and global health will require the legal, public health, and medical communities to come together stronger than ever before.
Sarah Wetter, JD, MPH, is a senior associate with the O’Neill Institute. Lawrence O. Gostin, JD, is Distinguished University Professor, Georgetown University’s highest academic rank, where he directs the O’Neill Institute. He is also director of the World Health Organization Collaborating Center on National & Global Health Law. He is the author of the book Global Health Security: A Blueprint for the Future.
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