Veterinarians, population researchers, records officers and neuroscientists were all swept up in a chaotic series of layoffs Tuesday that effectively ended the government's health establishment as we know it.

The big picture: The sheer breadth of the cuts and reshuffling may not be apparent for weeks. But in the immediate aftermath, health care industry players and former federal workers say the workforce reductions will almost certainly affect drug approvals, low-income assistance, disease tracking and biomedical research once held up as the gold standard.

Behind the scenes: Laid-off HHS staff told Axios they received email notifications that their roles had been terminated in the early hours of the morning. One employee said he got the email before 3:30am local time.

• Employees who kept their jobs said they're in the dark about what's coming next.
• "Our leadership used words such as shell-shocked, cruel and chaotic while describing the situation," one NIH employee told Axios.

What they're saying: Scott Gottlieb, who led the FDA during the first Trump administration, wrote on X that there was once a perception the U.S. lagged behind Europe in medical advances, but investments in federal expertise and hiring helped make the U.S. into the "global center of biopharmaceutical innovation."

• Tuesday's workforce reduction "threatens to swiftly bring back those frustrating delays for American consumers," he wrote.

Senate health committee leaders have asked HHS Secretary Robert F. Kennedy Jr. to testify on April 10 about the sweeping job cuts and reorganization of the department.

Related: FDA user fee hearing becomes referendum on HHS cuts (🔒Axios Pro)

While reductions in force were expected after Kennedy announced a sweeping reorganization last week, they were still stunning in their scope, as details about firings of top officials and the elimination of entire departments trickled out during the day.

What we know: Offices working on bird flu, reproductive health, tobacco control and occupational health were among those impacted by reductions in force, or RIFs.

• Divisions focused on food, drug and medical device policy also sustained deep cuts, the New York Times reported, and hundreds of positions from the Health Resources and Services Administration were affected, Federal News Network reported.
• In some cases, entire teams were wiped out. The team behind the National Survey on Drug Use and Health at the Substance Abuse and Mental Health Administration and the staff working on the Low-Income Home Energy Assistance Program were completely eliminated, sources told Axios.
• Infectious disease and minority health offices were told last week they were going to be eliminated, the Times reported while the CDC's Freedom of Information Act office was eliminated, NBC News wrote.

Several communications teams were also slashed across HHS, including the FDA's Center for Drug Evaluation and Research communications team, a staffer told Axios. That team keeps public-facing drug approval databases updated, fields questions from the public and industry and works with the media, they said.

The chaotic nature of the layoffs was reflected in a number of laid-off workers being given a name and number of an HHS employee to contact if they had discrimination complaints.

• That person died last year, the Washington Post reported.

What we don't know: It's unclear how many of the 10,000 intended RIFs were delivered and whether there are more to come.

• It's also widely speculated that some of those cut may be asked to return, as was the case in previous cuts of some probationary workers at HHS.

The White House is so frustrated by the lack of clear and fast communications by HHS that it has set up a parallel press shop, five top Trump administration sources tell Axios.

Driving the news: The problem surfaced in February, after it took two days for the department to acknowledge — by tweet — that a West Texas child had become the first person to die in the measles outbreak.

• White House officials blamed Stefanie Spear, a Kennedy adviser for more than a decade who RFK Jr. has empowered as his deputy chief of staff and gatekeeper.
• "The White House was like, 'Where the f**k is the statement?'" a White House official who was involved in the measles response said. "CNN was blaring this chyron about how Kennedy was silent, and there was just nothing from the department because of Stefanie."

Since the measles debacle, the White House communications team has handled more press relations on behalf of HHS than any other department, and often has acted as a contact between reporters and the agency.

• "This shouldn't be the White House's job, but here we are," a White House adviser said.
• Spear was unreachable by reporters last Friday after top vaccine regulator Peter Marks resigned and blasted Kennedy in a scathing resignation letter.
• The White House was left to approve the department's response, the adviser said. Pharmaceutical stocks plummeted as the industry grappled with Marks' departure.
• Spear did not respond to Axios' request for comment.

Go deeper

A Trump administration freeze on Title X family planning funds will limit or entirely cut off program support for reproductive health services in at least eight states, potentially affecting as many as 1.25 million people, per the Guttmacher Institute.

Why it matters: Health providers said the cutoff would create unnecessary barriers to contraception and other reproductive care. The administration said the purpose was to ensure program recipients are in compliance with the law and program guidelines.

State of play: Planned Parenthood announced Monday that nine of its affiliates had received notices from the Trump administration about plans to withhold their Title X funds starting Tuesday.

• "We know what happens when health care providers cannot use Title X funding: People across the country suffer, cancers go undetected, access to birth control is severely reduced, and the nation's STI crisis worsens," Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, said in a press release.

The White House didn't respond to a request for comment.

• Guttmacher, a research organization that supports abortion rights, said the freeze will fall hardest on low-income women, noting that in 2023, 83% of patients served by Title X–funded clinics had family incomes at or below 250% of the federal poverty level.

Related: Trump cuts Planned Parenthood funds while Alabama abortion doctors notch win (Axios)

🏛️ The Department of Justice is seeking the death penalty for Luigi Mangione. (Axios)

💵 A coalition of 23 states and D.C. are suing the Trump administration over HHS cutting $11 billion in public health funding. (CBS News)

❌ Millions of women in developing countries will lose access to contraception as a result of Trump aid cuts. (New York Times)