In addition to reductions at agency personnel, federal regulators are demanding $2.9 billion in contract cancellations, The Times has learned.Alongside extensive reductions to the staff of the Centers for Disease Control and Prevention, the Trump administration has asked the agency to cut $2.9 billion of its spending on contracts, according to three federal officials with knowledge of the matter.The administration’s cost-cutting program, called the Department of Government Efficiency, asked the public health agency to sever roughly 35 percent of its spending on contracts about two weeks ago. The C.D.C. was told to comply by April 18, according to the officials.The cuts promise to further hamstring an agency already reeling from the loss of 2,400 employees, nearly one-fifth of its work force. On Tuesday, the administration fired C.D.C. scientists focused on environmental health and asthma, injuries, violence prevention, lead poisoning, smoking and climate change.Officials at the White House and the Department of Health and Human Services did not immediately respond to requests for comment.Abruptly cutting 35 percent of contracts would be tough for any organization or business, said Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, who advised the Biden administration during Covid.“Sure, any manager can find small savings and improvements, but these kinds of demands are of the size and speed that break down organizations,” he said. “This is not the way to do good for the public or for the public’s health.”The C.D.C.’s largest contract, about $7 billion per year, goes to the Vaccines for Children Program, which purchases vaccines for parents who may not be able to afford them. That program is mandated by law and will not be affected by the cuts, according to one senior official who spoke on condition of anonymity.But other C.D.C. contracts include spending on computers and other technology, security guards, cleaning services and facilities management. The agency also hires people to build and maintain data systems and for specific research projects. Over the past several years, contracts have also supported activities related to Covid-19, one official said.Separately, H.H.S. last week abruptly discontinued C.D.C. grants of about $11.4 billion to states that were using the funds to track infectious diseases and to support mental health services, addiction treatment and other urgent health issues.At least some of the contracts D.O.G.E. is now asking the agency to discontinue may no longer be implemented because the people overseeing them have been fired. This is not the first time D.O.G.E. asked the agency to cut funding. It previously asked the C.D.C. to cut grants to Columbia University and University of Pennsylvania, saying those institutions had failed to take action against antisemitism on campus. “Funding grants and contracts are the mechanism by which we get things done,” said one C.D.C. scientist who asked to remain anonymous because of a fear of retaliation. “They are cutting off our arms and legs.”

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The reorganization that began on Tuesday will scale back an agency that has been a public health model around the world.The extensive layoffs of federal health workers that began on Tuesday will greatly curtail the scope and influence of the Centers for Disease Control and Prevention, the world’s premier public health agency, an outcome long sought by conservatives critical of its handling of the Covid-19 pandemic.The reorganization of the Department of Health and Human Services shrinks the C.D.C. by 2,400 employees, or roughly 18 percent of its work force, and strips away some of its core functions.Some Democrats in Congress described the reorganization throughout H.H.S. as flatly illegal.“You cannot decimate and restructure H.H.S. without Congress,” said Senator Patty Murray, Democrat of Washington, and a member of the Senate health committee.“This is not only unlawful but seriously harmful — they are putting Americans’ health and well-being on the line,” she added.Ms. Murray noted that the Trump administration had not detailed which units are being cut at the C.D.C. and other health agencies. Robert F. Kennedy Jr., the health secretary, said last week the layoffs would affect primarily administrative functions.But according to information gathered by The New York Times from dozens of workers, the reductions were more broadly targeted. Scientists focused on environmental health and asthma, injuries, lead poisoning, smoking and climate change were dismissed.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The agency’s injury center was among the departments that were largely gutted in Tuesday’s wave of dismissals. Read a staff member’s letter to colleagues while they awaited their fates.When every email inbox in the division pinged with a new message at 5:07 p.m. on Friday, the staff collectively held their breath.A love letter to the Division of Violence PreventionRead Document 2 pagesBut it wasn’t the dismissal notification that these employees of the Centers for Disease Control and Prevention had been waiting for. Quite the opposite: It was, the subject line said, a “love letter.”As I sit down to write this letter, I am not sure what the future holds. However, I do know how important it feels for me to send these words. So here goes….Full document: Read the letterThe author was Sarah Roby, a health communications specialist in the C.D.C.’s injury center, and the note would be read and reread throughout the weekend by her colleagues as they awaited their fate. The recipients worked in the injury center’s division of violence prevention, which focused on driving down rates of child abuse, sexual violence and gun deaths by collecting data, funding research and rolling out state and local programs that used evidence-based strategies.I imagine most of us are filled with anxiety and fear right now. As my own anxiety and fear ebb and flow, I am also filled with an immense sense of gratitude and love.Full document: Read the letterWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The court will decide whether Medicaid beneficiaries may sue to receive services under a law that lets them choose any qualified provider.The Supreme Court heard arguments on Wednesday in a case arising from South Carolina’s attempt to deny funding to Planned Parenthood. But the question the justices grappled with was a relatively narrow one, focused on whether individuals may sue the state to obtain medical services from Planned Parenthood unrelated to abortion.In 2018, Gov. Henry McMaster of South Carolina, a Republican, ordered state officials to deny Medicaid funds to Planned Parenthood, saying that “payment of taxpayer funds to abortion clinics, for any purpose, results in the subsidy of abortion and the denial of the right to life.”Medicaid gives federal money to states to provide medical care for poor people, but it sets some conditions. One is that eligible participants may receive assistance from any provider qualified to perform the required services.Abortions are banned in South Carolina after six weeks of pregnancy, and, even then, federal law prohibits the use of Medicaid funding except in life-threatening circumstances or in cases of rape or incest. But Planned Parenthood clinics in Charleston and Columbia provide services unrelated to abortion, including counseling, physical exams, contraception and screenings for cancer and sexually transmitted infections.Planned Parenthood and a patient who sought contraception sued under a federal civil rights law, and a federal trial judge blocked the South Carolina directive, saying that it ran afoul of Medicaid’s requirement that patients may choose any qualified provider.The litigation that followed was convoluted and circuitous, focusing largely on whether that provision created a right that individuals could enforce by filing lawsuits. The Supreme Court has said that federal laws like Medicaid, which give money to states but only if they accept certain conditions, must “unambiguously confer individual federal rights” to give affected individuals the right to sue.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The justices handed a win to the Food and Drug Administration in its rejection of applications from makers of flavored liquids used in e-cigarettes.The Supreme Court handed a victory to the Food and Drug Administration on Wednesday, tossing out an appeals court decision that had found the agency acted unlawfully in rejecting applications from two manufacturers of flavored liquids used in e-cigarettes with names like Jimmy the Juice Man Peachy Strawberry, Signature Series Mom’s Pistachio and Suicide Bunny Mother’s Milk and Cookies.In a unanimous decision written by Justice Samuel A. Alito Jr., the justices upheld an F.D.A. order that prohibited retailers from marketing flavored tobacco products, sending the case back to the U.S. Court of Appeals for the Fifth Circuit.Justice Alito wrote that the agency’s denials of the applications were “sufficiently consistent” with agency guidance on tobacco regulations. The justices rejected a ruling by the appeals court that the agency had acted arbitrarily and capriciously and had tried to change the rules in the middle of the approval process.In the opinion, Justice Alito highlighted the possible dangers of the flavored products appealing to middle and high school students, writing that “the kaleidoscope of flavor options adds to the allure of e-cigarettes and has thus contributed to the booming demand for such products among young Americans.”“Flavors lure kids, which is why Congress gave F.D.A. the authority to make science-based decisions on what is appropriate for our nation’s health,” said Erika Sward, the assistant vice president for nationwide advocacy at the American Lung Association, who applauded the court’s ruling.The decision comes at a fraught turning point for the agency.In recent months, leaders celebrated a 10-year low in the percent of adolescents using e-cigarettes. The F.D.A. has attributed the decline to effective messaging targeted at teenagers and to aggressive enforcement against those who market illicit vapes in flavors like Unicorn Shake and watermelon bubble gum.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Women in England and Wales are likely to continue having babies later in life, and having smaller families, than previous generations, according to Office for National Statistics (ONS) projections.

A growing body of research suggests that preventing the viral infection can help stave off cognitive decline.Getting vaccinated against shingles can reduce the risk of developing dementia, a large new study finds.The results provide some of the strongest evidence yet that some viral infections can have effects on brain function years later and that preventing them can help stave off cognitive decline.The study, published on Wednesday in the journal Nature, found that people who received the shingles vaccine were 20 percent less likely to develop dementia in the seven years afterward than those who were not vaccinated.“If you’re reducing the risk of dementia by 20 percent, that’s quite important in a public health context, given that we don’t really have much else at the moment that slows down the onset of dementia,” said Dr. Paul Harrison, a professor of psychiatry at Oxford. Dr. Harrison was not involved in the new study, but has done other research indicating that shingles vaccines lower dementia risk.Whether the protection can last beyond seven years can only be determined with further research. But with few currently effective treatments or preventions, Dr. Harrison said, shingles vaccines appear to have “some of the strongest potential protective effects against dementia that we know of that are potentially usable in practice.”Shingles cases stem from the virus that causes childhood chickenpox, varicella-zoster, which typically remains dormant in nerve cells for decades. As people age and their immune systems weaken, the virus can reactivate and cause shingles, with symptoms like burning, tingling, painful blisters and numbness. The nerve pain can become chronic and disabling.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

We interact with people every day: A brief nod to a neighbor. A friendly chat in the school pick-up line. […]

A new survey found that 11 percent of Americans said they could not pay for medication and medical treatments.It’s not just the high price of eggs or the rising cost of housing that is contributing to Americans’ unhappiness over the cost of living. Health care remains stubbornly unaffordable for millions of people, according to a new survey released Wednesday that underscores the struggle many people have in paying for a doctor’s visit or a prescription drug — even before any talk of cutting government coverage.In the survey, 11 percent of people said they could not afford medication and care within the past three months, the highest level in the four years the survey has been conducted. More than a third of those surveyed, representing some 91 million adults, said if they were to need medical care, they would not be able to pay for it.The survey, conducted from mid-November to late December 2024 by West Health and Gallup, also showed widening disparities for Black and Hispanic adults and for those making the least amount of money. A quarter of those with an annual household income of less than $24,000 said they could not afford or access care within the past three months.“The extent to which that has broadened and expanded really exposes how vulnerable these classes of individuals are,” Dan Witters, a senior researcher at Gallup, said.White adults and high earners said they experienced no real change in their ability to pay. Eight percent of white adults reported being unable to afford care, the same share as in 2021, according to the survey.Higher premiums, the added cost of going to the doctor and the recent rollback in Medicaid coverage have all contributed to making it harder for people to afford care. Health care costs continue to rise, and dramatic cuts to Medicaid and the elimination of tax subsidies that lower the cost of Obamacare plans, as discussed by the Trump administration and Republican lawmakers, will likely exacerbate the problem, according to experts.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.