Trump's return could speed up federal scientist exits

State of play: Less than a week after the election, fears of a talent exodus — especially at the FDA — are already spreading.

• "If you start to have this big brain drain or experience where people say I'm not going to do this anymore, things kind of grind to a halt," one former FDA senior official said.
• But career scientists could opt to remain and push back against meddling by political appointees that could undercut the agencies' work.

Catch up quick: Trump has said he's going to let transition team member Robert F. Kennedy Jr. "go wild" on food and medicine, and Republicans more broadly have been chomping at the bit to reform the CDC and overhaul the NIH post-pandemic.

• RFK Jr. has, in turn, made statements that "entire departments" of the FDA "have to go," and that health agencies need to be cleaned up.

Flashback: His ascendence didn't happen in a vacuum. Career staff at the health agencies had a bruising experience during the first Trump administration, and the pandemic response writ large ushered in an invigorated wave of anti-science and anti-vaccine sentiment.

• Trump appointees interfered with federal agency reports, suppressed scientific information and meddled in guidance during the pandemic.
• "When I came in … the folks at FDA were still shaking," said a former Biden administration official who worked with the health agencies during COVID.
• "The effect of Trump — and again, this was intense, this was COVID, this was hydroxychloroquine — you cannot underestimate the extent to which they were truly shaken to the core. They were not functioning," the official added.
• Trump has also vowed to make it easier to fire federal employees, something he tried to do at the end of his first term. An executive order to that effect was reversed by President Biden when he took office.

The other side: "I think some of the things that are being discussed could be positive," said Tom Frieden, who served as CDC director in the Obama administration. "If you think about ... reining in undue corporate influences, getting junk food, including soda, out of supplemental nutrition programs, stopping direct-to-consumer advertising, those are positive."

As the next Trump administration takes form, some experts and agency watchers are bracing for the worst.

• "Career CDC scientists are not interested in going through the experience of another four years" under a Trump administration, said Lawrence Gostin, a global health law expert at Georgetown University. He predicts there could be "a mass resignation of career scientists."
• "The spirit and will to recruit and retain the best scientists is crumbling," he added.
• Even if they don't directly meddle, Trump and his allies could stack federal advisory committees and expert panels with like-minded individuals and use their recommendations to pressure the agencies on issues like nutrition or vaccines.

Others are less sure of a coming brain drain.

• "The CDC has been through a lot over the past few years with COVID and I would not be surprised if people decide to leave, but I don't think there is going to be a mass exodus because the vast majority of people when they come to the CDC, this is a career and a lifelong mission for them," said a former senior CDC official who is in contact with current employees.
• There are also guardrails in place to prevent political appointees from freelancing — policies and processes that career staff could try to adhere to, especially at the FDA.
• "The more likely scenario is they just undercut him and wait him out," Raymond James analyst Chris Meekins, who served in Health and Human Services during the first Trump administration, said of RFK Jr. "There are a gazillion ways you can slow walk and undercut things."

The big picture: The FDA is already struggling to maintain its workforce due to heavy workloads for staff and low pay, according to a 2023 report.

Reality check: Political appointees rely on career staff to enact their agenda, and knowing how to work within the federal bureaucracy is institutional knowledge that isn't easy to come by.

• And reliance on career staff is particularly acute in a crisis — and the threat of crises is all too real.
• In the past three months alone, there has been an E. Coli outbreak at McDonald's, the bird flu epidemic expanded from cows to pigs, and hospitals hit by hurricanes had a shortage of IV solution.
• "Who's the first person you're going to call if you're RFK? You're going to call the career folks and say, help me solve this," the former Biden official said.

What we're watching: One of the first signs of how the FDA will run could surround the availability of the widely used abortion drug mifepristone, which is a key target for anti-abortion conservatives.

• It will be an early indicator of the role politics will be allowed to play in regulatory decision-making and how much weight is given to years of accumulated scientific evidence.