After cuts to federal agencies and multiple disease outbreaks nationally and abroad, hospitals are working to fill the gaps in public health preparedness and prevention.
The threat landscape
The federal government cut roughly 17,000 jobs across 17 HHS agencies. The Agency for Healthcare Research and Quality saw a 65% reduction, from 298 employees in fiscal 2024 to 103, as of December 2025, the steepest decline. The three largest agencies by headcount — CDC, FDA and the National Institutes of Health — saw workforce declines of roughly 20%.
Beyond layoffs, the Trump administration has canceled more than $12 billion in grant funding that had supported state health departments’ ability to track infectious diseases and modernize surveillance systems.
The budget environment is unlikely to improve quickly. The Trump administration’s fiscal 2027 budget proposal requests $41 million in NIH research funding — roughly $5 billion below 2026 levels — and calls for the elimination of the National Institute on Minority Health and Health Disparities, the Fogarty International Center and the National Center for Complementary and Integrative Health. Between January 2025 and February 2026, science and health agencies shed approximately 15,000 STEM and health positions, at a rate that outpaced the broader federal government’s average job cut rate.
Federal cuts trickled down to state-level health departments. Arkansas, Utah and Texas have laid off workers or halted certain outbreak response efforts after the federal funding was cut. These reductions have impacted relationships, networks and coordination mechanisms used for effective outbreak response.
Amid these cuts, the U.S. has been grappling with low vaccination rates, measles outbreaks that reached 910 cases by early 2026, increasing rotavirus infection rates, and a recent cluster of hantavirus cases from the MV Hondius cruise ship.
At the same time, an Ebola outbreak in the Democratic of Congo with 363 confirmed cases and 62 deaths, has put American hospitals and health departments on alert. Internationally, public health experts point to U.S. cuts to the World Health Organization and the elimination of U.S. Agency for International Development as barriers to containing the outbreak.
Combined, these pressures have left hospitals and leaders trying to fill infrastructure gaps.
What hospitals can do to respond
The answer to shrinking federal capacity is not to wait for it to be restored, but to invest more deliberately in the external relationships and regional networks that preparedness depends on, leaders from two of the top biocontainment units in the nation said.
“In times of fiscal constraints and reduced funding, there can be a tendency for people to turn inward, become insular and take a more defensive or protective approach to threats,” Robert Belknap, MD, chair of the public health institute at Denver Health, told Becker’s. “But that approach ultimately costs more for everyone. Staying open to dialogue, even difficult conversations about limited resources and leveraging existing resources like the Regional Disaster Health Response Systems and Special Pathogens Programs, is essential. If an outbreak occurs, it will impact all of us.”
Preparedness cannot be activated at the moment of a crisis, Christa Arguinchona, MSN, RN, manager of the Special Pathogens Program at Providence Sacred Heart Medical Center and Providence Children’s Hospital in Spokane, Wash., told Becker’s. Coordination with public health agencies, emergency medical services and other regional facilities with special pathogen capability must already be in place.
Nationally, 12 health systems are federally designated Regional Emerging Special Pathogen Treatment Centers, meaning they are equipped and trained to treat patients with Ebola and other high-consequence pathogens. They are part of the National Emerging Special Pathogens Training & Education Center, which provides education and training across the U.S. and can accommodate cases of highly contagious diseases like hantavirus or Ebola. During active outbreaks, representatives of this network of hospitals meet twice weekly to stay informed on the current state of outbreaks. These calls include the 13 NETEC systems, CDC colleagues and international partners, Ms. Arguinchona said.
This close connection is a model other systems can replicate with their regional treatment center, state and local health departments and local facilities, so that if a cluster emerges nearby, the logistics of patient placement and care coordination don’t need to be worked out under pressure, Ms. Arguinchona said.
During disease outbreaks such as the COVID-19 pandemic, communities where health systems, public health agencies and local organizations had established relationships and trust are able to mount faster and more effective responses than those attempting to forge those connections in real time, Dr. Belknap said.
“We think of preparedness and prevention as being, in many ways, one and the same — certainly closely tied,” he said. “We would rather prevent something from happening than have to respond to it. If it does happen, we want to respond effectively and efficiently. Both preparedness and prevention can get lost at times, because effective work in those areas means that events that could have happened don’t happen — and that can be easy to overlook. Shifting resources toward things that seem urgent right now risks leaving us underprepared. If we aren’t preventing the spread of diseases, and we aren’t adequately prepared to address an outbreak, it will ultimately be worse for everyone.”
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