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00:00We're going to turn our focus now to plans from the Trump administration to lay off tens of thousands of employees at the Department of Health and Human Services.
00:08The move would shrink the HHS workforce by approximately 62,000, that's around a quarter of employees.
00:15Well the administration says the overall is aimed at streamlining operations, bringing them directly under the leadership of Health Secretary Robert Kennedy Jr.
00:24Well let's cross live to Martin McKee, he's a professor of European Public Health at the London School of Hygiene and Tropical Medicine.
00:31Martin, thanks so much for joining us on the programme.
00:34So this restructuring comes as the US grapples with one of the worst measles outbreaks in more than two decades.
00:40Is this really the time to be laying off tens of thousands of Health Department employees?
00:46Well clearly not. We've just come through a pandemic and if we have learned anything we need to have preparedness because there will inevitably be another one.
00:56We don't know what it will be. So this is tremendously damaging but it's only part of a whole package.
01:03I mean we've been particularly concerned about the damage being done to the National Institutes of Health within the United States and of course their global footprint as well.
01:11That's devastating and in fact I think we're seeing a sustained campaign of attacks on universities, on science and scientists and so on that will take years to recover from.
01:24Well Martin, let's take a look at the global impact.
01:27This overhaul in the US comes after the government's decision to also terminate thousands of humanitarian aid programmes which experts are warning puts public and global health at risk.
01:37What do you see the wider impact of these layoffs being on the world at large?
01:42So the United States is a tremendously important funder of global health and it has contributed both through USAID, the President's Emergency Fund from George W. Bush's time, and HIV, PEPFAR.
01:57But also it puts a lot of money into the United Nations Specialized Agencies. It said that it's going to withdraw from the World Health Organization.
02:04It's cutting its funding to the Food and Agriculture Organization which of course has a particular interest in agriculture and the health consequences of that.
02:13So there's a whole series of consequences of all of this and it's going to be very difficult for the rest of the world to fill that gap.
02:22Now primarily this is actually damaging to the United States' interest.
02:27The research that is done in the United States is incredibly important for the American economy.
02:33It's estimated that every dollar that is spent by NIH yields about $2.6 in economic growth.
02:40This underpins the American biotech industry which has been so successful.
02:45About 75% of the drugs that are authorized by the Food and Drug Administration have been partially funded by NIH.
02:54So looking ahead you're going to be losing all of that.
02:57But I think what's particularly worrying is that you have a generation of young people who were trying to develop careers in health research who are now being cut off.
03:09You put together a grant for a doctoral program or a postdoctoral program.
03:13It takes a long time to do. You invest in that.
03:16And then you just get your funding taken away overnight.
03:19It's going to be very difficult to encourage the next generation to go into this area given the huge degree of uncertainty.
03:27So primarily this is going to be damaging for the United States.
03:30But when we look more broadly, of course, then we can see that it's going to be devastating for health of those people who have been depending on this treatment.
03:40The most immediate ones, I think, are those people who are in clinical trials that are funded by the U.S. government.
03:49Many of them have been started on new drugs that are being evaluated or even having things implanted into them.
03:55And the trial has been stopped. So there's no long term surveillance.
03:58They may even have difficulty having things removed that need to be removed at the end of the trial.
04:04But beyond that, the PEPFAR, the Emergency Fund for AIDS Funding, it's been estimated that that could lead to 1.65 million deaths this year.
04:16UNAIDS have estimated that the impact of this could be 6 million deaths.
04:21This, of course, assumes that other people don't come in to make up the deficit.
04:26But of course, we know in Europe that governments are also facing pressure to increase their defence expenditure and then to increase their funding for global health too.
04:36Martin, I was really worried what you're describing there. You talked about those shortfalls.
04:42I mean, both Canada and the EU have sort of framed the U.S. withdrawing from the world stage when it comes to health as an opportunity for them to now step up and make up for those shortfalls.
04:52Do you think they can fill the gap?
04:54It's going to be very difficult to fill the gap given the other pressures on, as I mentioned, defence, because clearly we have to do that in Europe too.
05:03But I think it's not just the money. It is the disruption to young people's careers, to scientists' careers.
05:09It's the waste of money when a project has been undertaken, a clinical trial is almost complete and you have to stop it.
05:16You lose all of that, all of the investment.
05:19The other concern is that many of the, much of the research we do involves taking, following up people over long periods of time, keeping in touch with them, maintaining the contact so you can look at what happened throughout their life.
05:33And if those get disrupted and you lose people, you can't find them again.
05:37The danger of losing biological samples that have to be kept frozen if the laboratories close, again, huge amount of infrastructure.
05:46So the money is important, but it's the disruption, the damage that's being done that is as important.
05:53Martin, great to get your insight. Thank you so much for joining us on the programme. It was really good to get your analysis.