The Centers for Disease Control and Prevention, the nation’s leading public health agency, has faced significant challenges since Jan. 20, 2025.

“When the administration came in and started talking about chronic disease, we were really excited,” said Karen Hacker, former director of the National Center for Chronic Disease Prevention and Health Promotion.

“Honestly, for the first time, we thought we’re going to get some love,” she said Tuesday during an APHA 2025 session “Discussion with Former CDC Leaders: The Way Forward.” “And then things changed.”

The session brought together a panel of three former CDC leaders to discuss how to move forward amid the Trump administration’s ongoing dismantling of the agency.

In April, the division led by Hacker was dissolved following a new wave of layoffs ordered by the administration, leading to her transfer to the Indian Health Service.

The CDC has endured multiple rounds of firings throughout the year. On Feb. 13, the agency lost approximately 1,300 employees during the administration’s first major round of cuts — an event now referred to as the “Valentine’s Day Massacre.” The additional layoffs in April followed that initial purge.

More recently, on Oct. 10, the Trump administration issued termination notices to another 1,300 employees, then revoked roughly 700 of those firings the next day.

“Here we are at a time of great uncertainty,” Judith Monroe, president and CEO of the CDC Foundation, said. “But also a time of great opportunity.”

Moving forward, public health needs to think strategically about creating public value to amplify the importance of the field and its workers. 

The effort to drive public value and importance comes at a pivotal time; more than 40% of Americans rated the CDC as “poor” in a September poll from Axios. 

“We’ve got to embrace digital literacy,” Monroe said. “We’ve got to realize the algorithms that folks are using and the influencers (they are following) … we’ve got to lean into communication models that we’ve never seen before.”

As the Trump administration continues to weaken the federal public health infrastructure, the role of state and county public health departments becomes increasingly critical.

Across the country, roughly 3,500 local public health departments work to protect community health. However, many depend heavily on CDC grant funding, which can limit their flexibility and long-term impact.

“We are going to really be focusing on the local and the state jurisdictions in terms of where the action is,” Hacker said. 

Kevin De Cock, former director of CDC Kenya and the founding director of the CDC’s Center for Global Health, urged the next generation of public health professionals not to lose hope despite the ongoing challenges facing the public health infrastructure.

“I would simply say that we cannot lose faith because the needs for public health services — for people — will have a place,” he said.