Rebuilding health and human services: a call to strategic planning and action

Abstract

The capacity of the U.S. Department of Health and Human Services (HHS) has been substantially reduced since early 2025. This has included staffing cuts on a scale not seen in decades, delays in implementing billions of dollars in grants, and other disruptions to normal operations, all of which have received considerable public coverage and attention. To date, far less public attention has been given to rebuilding efforts. This commentary presents recommendations for rebuilding HHS’ lost capacity, following a series of roundtable discussions convened by a network of former senior HHS appointees. The roundtables included former HHS political appointees, career program staff and division leaders, and health policy researchers from universities, think tanks, and policy organizations. Based on common themes in these discussions, we propose 5 recommendations to rebuild HHS capacity: (1) treating and funding the rebuilding of federal health and health research capacity as an urgent national security priority; (2) shifting from reactive crisis management to coordinated forward planning; (3) continued documentation of what capacity has been lost and why; (4) establishing an independent, nonpartisan science advisory body across HHS; and (5) drafting legislation now so that policy windows are not missed when they open.

Key Points.

1. The capacity of the U.S. Department of Health and Human Services has been severely degraded, resulting in the loss of expertise, data continuity, and research infrastructure.

2. Efforts to date have focused on documenting what has been dismantled; sustained effort is now needed to plan for rebuilding HHS.

3. Professional, academic, and philanthropic organizations should hasten to publish and critique implementation-ready appropriations memos, job position descriptions, and commission charters. Waiting to prepare these materials risks missing a window of opportunity as many rebuilding priorities jockey for limited attention.

The Trump administration, working through Elon Musk's now-shuttered Department of Government Efficiency (DOGE) office and using the authority of U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., has weakened the federal health workforce and the nation's medical and scientific infrastructure. A restructuring announced March 27, 2025, reduced HHS staffing from roughly 82 000 to 62 000,¹ consolidated 28 operating divisions into 15, and closed 5 of 10 regional offices. The National Institutes of Health terminated $1.81 billion in grants,² disrupting 383 clinical trials that had enrolled more than 74 000 participants. In August 2025, the White House fired Centers for Disease Control and Prevention (CDC) Director Susan Monarez 27 days after she was sworn in, prompting 4 senior CDC scientific leaders to resign. One wrote that he could not serve in an environment that, in his view, treated the CDC as a tool to produce materials that do not reflect scientific reality.³ The Agency for Healthcare Research and Quality (AHRQ) staff has fallen from nearly 300 staff under the Biden administration to 74.⁴ As of August 2026, AHRQ had canceled all research funding opportunities,⁵ along with 117 active research grants worth $264.2 million across 32 states.

The administration's staffing and operations decisions jeopardize American healthcare, public health, and research infrastructure. These problems cannot be solved by the 12 000 employees the administration says it intends to hire. Not all staff can be hired with the same expertise and institutional knowledge as the people they replace. Terminated multi-year medical trials cannot resume where they stopped. Public health surveillance systems that have been shut down cannot suddenly identify outbreaks⁶ at the speed and precision the nation once took for granted. These losses affect communities⁷ across the United States and are distributed unevenly, falling hardest on rural and under-resourced populations most in need of these services.

Considerable effort has gone into documenting⁸ and speaking out against the dismantling of HHS. There has been less discussion of what rebuilding requires, who would do it, and in what order. The HHS Impacts Group (the Group), a network of former senior HHS political appointees focused on rebuilding lost capacity, was formed in part to address this gap.

Windows for major policy changes are open only briefly in Congress. They are often filled by whoever arrives with ready-to-implement memos. Drawing on 3 roundtable discussions the Group convened in 2025, we call on the nation's leaders and scholars in science, medicine, and health policy to act beyond the cycle of daily emergency response that has defined the past 18 months. We urge them to join in a national effort articulating concrete, realistic options that lawmakers and future HHS leaders can execute quickly to restore federal health and human services capacity. We set out 5 priorities for restoring federal health capacity, and we argue that this work must be finished before the next window opens.

What should be done? We asked the experts

In early 2025, former senior HHS appointees who served in the Obama and Biden administrations, including the authors, formed the HHS Impacts Group to connect displaced federal staff with resources and to help journalists interpret agency actions.⁹ In late 2025, the Group convened 3 roundtables gathering approximately 30 participants identified through the authors’ professional networks, including former senior appointees, career program leaders from across HHS operating divisions, and health policy researchers at academic and policy organizations, many of whom had not served as political appointees. Discussions were facilitated under the Chatham House Rule and not recorded. Participants were asked what they had done or observed to sustain HHS staff and programs then thought to be at risk, and what responses to Trump administration cutbacks a future administration should consider. The authors identified recurring themes and developed them into the priorities below. This was a structured professional discussion rather than a Delphi process or systematic qualitative research. The priorities are our synthesis and interpretation, rather than positions endorsed by participants.

Recommendations for rebuilding a future department of health and human services

Treat, and fund, rebuilding federal health and health research capacity as an urgent national security priority

HHS has core responsibilities to keep the American people safe and healthy through research, healthcare financing, public health protection, and human services. Congressional leaders and policy organizations should frame federal health infrastructure as a key element of national security and emphasize the need for increased investment in research, preparedness, and service delivery. This would mean guaranteeing funding levels for public health and health services research monitoring, infectious disease research, and vaccine availability. Certain nationally vital functions, once funded by Congress, should not be subject to administrative discretion.

Interested experts should shift from reactive crisis management to coordinated forward planning

While immediate challenges require attention, an exclusive focus on short-term problems makes it difficult to restore long-term institutional capacity. National policy leaders should establish structured working groups encompassing governmental, academic, professional, policy, and philanthropic stakeholders to agree on the most feasible plans for workforce rebuilding, data system restoration, and research continuity. Professional societies, academic journals, and policy forums should publish and debate these proposals. Proposals with broad support carry the most legitimacy in Congress, where most funding and staffing changes must be approved.

Continue documenting what has been lost and examine why

Federal agencies and external partners should continue to document workforce reductions, the hiring of political staff in career roles, interruptions to services and research funding, and restrictions on public health and surveillance infrastructure. Policy researchers and professional associations should examine these policies, administrative structures, and operational vulnerabilities and continue to publish findings. Thorough documentation now will make it easier to support future investments, protections for career staff, more secure data systems, and better-designed programs.

Establish an independent and nonpartisan science advisory body across HHS

Advisory bodies inside the executive branch are vulnerable to disruption. The Trump administration had no trouble dismissing all 22 members¹⁰ of the National Science Board in April 2026. Congress should charter a new, independent federal health science commission with staggered, fixed-term appointments, whose members report to Congress rather than the executive branch. Such a nonpartisan body, which would offer recommendations to improve HHS management and service delivery, could be modeled on the Medicare Payment Advisory Commission. Science and health policy experts should explore the tradeoffs of such a commission.

Prepare now for a policy window, in both model legislation and public remarks

The window for policy change will open and close quickly. Policy organizations and academic associations should begin drafting implementation-ready transition packages that restore research funding, rebuild public health data infrastructure, and stabilize human services programs. These packages should contain executive orders, draft appropriations and authorizing language, and a reconstruction sequence for the first 30, 60, and 100 days, along with position descriptions and direct-hire authority requests for key vacancies. Advocates should be supported with relevant media training. The case for rebuilding must be made broadly in hearings, in the press, and in congressional offices.

Conclusion

Without a concerted HHS reconstruction effort defined by restored funding, a rebuilt workforce, significant training, and new guardrails against executive interference in HHS operations, public health outcomes will likely continue to decline.

The work we propose cannot be done all at once by a handful of individuals. The work products we call for will need to be developed carefully and debated in detail. They will draw general public attention only at the end of a long process. When the policy window opens again, the professional community must provide thoroughly vetted rebuilding plans and be ready to engage with supporting testimony and public remarks. Groups that begin drafting this content now, rather than waiting to see what happens in November, will be best positioned to support HHS.

We call on professional societies, academic associations, policy organizations, and philanthropic funders to carry out this work with urgency and to produce implementation-ready documents that future executives and legislators can use. Our recommendations mark the beginning of this process. We must begin it together, and we must begin it now.

Funding

None.

Author Bio

Sean Bruna, MA, MA, PhD, is a staff scientist in the Embedded Human Factors and Clinical Safety Science Laboratory in the Department of Anesthesia and Perioperative Medicine at the Medical University of South Carolina (Charleston, SC). From 2023 to 2025, he served as a Senior Advisor to the Director at the Agency for Healthcare Research and Quality. Trained in health policy at the University of New Mexico's Robert Wood Johnson Foundation Center for Health Policy, his work spans health services research, health policy, and medical anthropology.

Adam Sarvana was director of communications for Rep. Raúl M. Grijalva (D-Ariz.) from 2009 to 2014 and for the House Committee on Natural Resources Democratic staff from 2015 to February of 2022. He was director of communications and public engagement for ADM Rachel Levine, the HHS Assistant Secretary for Health, from March of 2022 until January of 2025. He now lives in Tucson, Arizona, where he was director of communications and community engagement for Mayor Regina Romero until April of this year. He is currently a private consultant.