Trump's early actions on health agencies roil medical researchers

State of play: Health and Human Services this week halted most outgoing communications, travel and grant reviews among its agencies — a directive that even prevented National Institute of Health researchers from purchasing supplies for clinical trials.

• Trump also blocked the disbursement of funds for global HIV work through the President's Emergency Plan for AIDS Relief, or PEPFAR.
• The administration called for the exit from WHO, directing staff to stop working with the global health agency.
• A purge of diversity, equity, inclusion and accessibility programs is expected to sweep up efforts aimed at narrowing health disparities and improving diversity in clinical trials.

The tensions are likely to intensify this week as vaccine critic Robert F. Kennedy Jr. faces confirmation hearings to be the nation's top health official.

What they're saying: "Right now, it sort of feels like we are drinking from a fire hose, and I know that a lot of that is the intention of the administration," said Darya Minovi, a senior analyst at the Union of Concerned Scientists.

• "We have just seen a complete rejection of science," she said.
• The organization is mobilizing its network of roughly 20,000 members and maintaining a database of attacks on science.

An ad-hoc coalition of public health workers, researchers and patient advocates called Defending Public Health has circulated a letter with more than 700 signatures calling on senators to vote down Kennedy's nomination.

• The all-volunteer group is still sizing up where to best focus its efforts, said Gregg Gonsalves, an associate professor at the Yale School of Public Health.
• Liberal-leaning advocacy groups like Protect Our Care are also activating to oppose the Kennedy nomination.

Between the lines: Some scientists see Trump's early moves as payback to experts inside and outside the government who criticized his first administration's response to the COVID-19 pandemic.

• They're particularly concerned about an envisioned overhaul of NIH, a frequent target of conservatives, which funds tens of billions of dollars of work at universities. The agency saw its grant review "study sections" frozen last week, and had to pull job ads and rescind offers, per Science.
• "This is just vengeance, as far as I'm concerned," said Jim Alwine, an emeritus professor of cancer biology at the University of Pennsylvania and a member of Defending Public Health. "I think Trump … saw the whole pandemic as a personal affront to him, and I think he's out to hurt science."

Mainstream research groups and universities so far are holding their fire.

• The Association of American Medical Colleges is reviewing the Trump orders and assessing which weigh heaviest on its members, chief public policy officer Danielle Turnipseed said in a statement.
• "I think academic research centers will speak out, but also with hesitation, because they know that their funding comes from the federal government," Lawrence Gostin, a global health law expert at Georgetown University, told Axios. "Even industry wants to be on the good side of the president."
• For his part, Gostin said he's doing what he can to foster connections between WHO leadership and members of the administration like Secretary of State Marco Rubio and RFK Jr. "How can we get a win-win?" Gostin said. "There's a deal to be made here."

To be sure, every new administration needs time to get settled, and communications pauses and policy reviews following an inauguration aren't unprecedented.

• HHS did not respond to Axios' request for comment.
• "The people voted for a different direction, so it is wise for the incoming Trump team to review and reconsider all decisions that don't reflect the incoming president's agenda," David Mansdoerfer, former deputy assistant secretary for health during the first Trump administration, told Axios.

Yes, but: Putting the brakes on NIH's work, even in the short-term, "can have a devastating effect on our nation's longer term research productivity and success," Monica Bertagnolli, NIH director under the Biden administration, wrote on LinkedIn.

• The actual impact of the freeze will depend on how long it continues, but the freeze itself may still erode researchers' trust in the administration, said Elizabeth Jacobs, a professor emeritus at the University of Arizona.

Science and civil rights groups anticipate possible legal challenges to future administration rules in the same vein, experts say.

• They'll also seek to spell out the ripple effects while clarifying how they affect medical providers, to avoid unnecessary self-censorship of research topics and medical care.

Friction point: It's notable that Trump hasn't trained his sights on the Affordable Care Act, drug prices or Medicaid, opting instead to focus on cultural flashpoints, said Larry Levitt, executive vice president for health policy at KFF.

• "Rolling behind the scenes is this potential tsunami of cuts to Medicaid, which would have big implications for the entire health care system," Levitt said.