A few days into Donald Trump’s second term, Emily Williams, a public-health professor at the University of Washington, e-mailed a program officer at the National Institutes of Health, a division of the Health and Human Services Department. “I wanted to touch base with you in light of several recent Federal Executive Orders,” she wrote. Trump had just prohibited “diversity, equity, inclusion, and accessibility” in government programs, and Williams had a grant to investigate how Black and Latino military veterans were accessing treatment for opioid-use disorder, compared with their white peers. The program officer oversaw this grant.
Williams is an expert in substance-use disorders and inequities in the delivery of health care. Like most senior research scientists, she is responsible for fund-raising, year by year, to pay herself and the members of her team. She currently relies on a combination of big N.I.H. grants, teaching, and a fractional salary from the Department of Veterans Affairs, making her both a federal and state employee.
She worried that her opioid-treatment grant was at risk, given its focus on race. On the other hand, it aligned with the President’s agenda: Trump has said that his Administration will “not rest until we have ended the fentanyl epidemic in America once and for all.” The subjects and beneficiaries of Williams’s research were patients receiving care through the V.A., all of whom were using opioids, including fentanyl. Besides, Williams had not seen politics meaningfully intrude on her work in more than twenty years of doing federally funded research, she told me. In fact, the N.I.H., under the first Trump Administration, had mandated “the inclusion of women and minorities as subjects in clinical research.” But her program officer offered no reassurance, replying, “Unfortunately, we are not able to provide guidance on any of these things at this time.”
Williams and her team were three years into a five-year grant term. At the start of each year, they had to submit renewal paperwork to keep the money flowing. The process was so routine that the University of Washington usually paid out these funds in advance. This year, that process was upended. In late January, N.I.H. froze all grants, then temporarily lifted the freeze under court order; after that, the agency capped “indirect” costs that help grantees cover fringe expenses, then delayed the implementation of the cap, owing, again, to litigation. The vice-provost for research at U.W. warned faculty “of the crippling effect” the cut to indirects “would have on universities across the nation.” Lawsuits proliferated. Meanwhile, in mid-February, Williams’s colleagues at the Puget Sound V.A. began to get laid off. “I am seeing my community of researchers decimated right now,” she told me. She was especially close to one of the terminated scientists, a health-systems researcher named Christian Helfrich, who had spent twenty years at the V.A. and who was also affiliated with the university. His work had improved the use of electronic health records and sped up access to care for patients with heart disease. The impact of the layoffs, he said, would be felt for years. “It’s preventable suicide deaths going up, substance use going untreated,” he told me.
In late February, the vice-provost for research stated that U.W. could no longer distribute grant money in advance. “It is simply not possible for departments or the university to cover the costs currently funded by federal awards,” her e-mail said. “Further, the state of Washington is facing significant budget shortfalls.” In 2023, about $1.4 billion of the school’s $1.7 billion in research awards came from the federal government. Williams reached out again to her N.I.H. program officer. “[I] can’t promise that I will be able to answer your questions,” the officer responded. “We’ve still been given very little information.”
Williams wrote to her team in mid-March. “It seems we do not have the resources we need to continue as is with staffing,” her e-mail said. “We are in unprecedented times in which the University no longer trusts the Federal Government to make good on its commitments.” An associate dean sent a termination notice to a young researcher named Julia Dunn, who was responsible for analyzing a data set of more than a hundred and ten thousand patients with opioid-use disorder at the V.A. Dunn had built her career around disparities research: urban versus rural; why some people, but not others, could access mental-health care. “When I have gotten laid off in the past, it was very easy to find a new job,” she told me. “Now it feels like everyone is getting laid off.”
Williams’s department, in the School of Public Health, made offers to half the usual number of Ph.D. candidates for the next academic year. (It fared better than some other universities, whose medical and public-health programs were forced to rescind offers.) Current students lost grant funding to get them through graduation. There were fewer slots for research assistants. “When I speak with my scientist mentees, I feel shocked and disappointed,” Williams said. “I don’t think change is always a bad thing, but I can’t imagine how we will harness these brilliant young minds.”
Inside the N.I.H., staff members and programs were disappearing. A month into Trump’s Presidency, Josh Fessel, a high-ranking director at the National Center for Advancing Translational Sciences, one of the N.I.H.’s two dozen centers, submitted his resignation letter after more than six years of government service. In it, he explained his decision to leave:
A spreadsheet of cancelled grants—now fifty-one pages long—has been posted to the H.H.S. website. Many titles include forbidden terms such as “diverse,” “equity,” “Black,” “vulnerable,” “gender minorities,” “gender-affirming.” Grants related to COVID, vaccines, and global health have also been terminated in large numbers. Others on the list seem random: “Molecular Biomarkers in Pathogenesis of Lymphangioleiomyomatosis,” “Harnessing the Power of Peer Navigation and mHealth to Reduce Health Disparities in Appalachia,” “Social Convoys, Cognitive Reserve and Resilience, and Risk for Alzheimer’s Disease and Related Dementias.”
Another cancelled grant was titled “Looking Back to Look Forward: Social Environment Across the Life Course, Epigenetics, and Birth Outcomes in Black Families.” The study aimed to analyze a thousand births to Black women in Detroit to better understand why some babies are born pre-term, based on an epigenetic measure of age. Mothers agreed to share current blood samples and allow access to the pinprick blood spots that had been collected when they were born. The lead scientists were epidemiology professors at the University of North Carolina and Michigan State University who had studied maternal disparities for decades. It had taken them four years to get the grant approved. “Now we have blood samples from five hundred and seventy women sitting in a box that can’t be analyzed,” Dawn Misra, a professor and department chair at Michigan State University, told me. The termination e-mail from N.I.H. read:
“This is killing me,” Misra said. “It’s not about the universities and our careers being harmed. It’s about the communities.” At the end of March, she laid off Mercedes Price, the study’s research coördinator and her longtime collaborator. Price herself is a Black mom, born and raised in Detroit. “It feels dramatic to say, but I feel like research as a whole is going to be compromised,” she told me. “When basic science is being attacked for things that help people, what project could I jump to?” Price dreaded having to relay the news to the study’s recruiters and subjects. “Black folks and other people of color have been historically excluded from medical research, and when they were included it was unethical,” she said. “This just throws another wrench in the game. ‘Oh, your study got shut down.’ I can only imagine what people are thinking.”
In early April, I visited the U.W. School of Public Health and the Puget Sound V.A. My trip coincided with nationwide reductions in force across H.H.S., including at the N.I.H. and the Centers for Disease Control and Prevention. Thousands of workers were fired and escorted out of their buildings by security. Staff at the V.A. had just had their collective-bargaining rights eliminated by executive order and were expecting more firings. At the V.A. hospital, I saw many aging veterans in wheelchairs, some of whom were missing limbs. There were portraits of Trump and Vice-President J. D. Vance in the entryway, but also Tuskegee Airmen hats for sale at a gift kiosk and a “WALL OF HEROES” celebrating the careers of Black, Latino, and women veterans, despite new restrictions on how the history of those groups was presented. In the lobby, patients read books in the Veterans Lending Library and ordered coffee at the Patriot Brew café. Next door, in a building dedicated to research and addiction care, where Williams’s colleague Helfrich had worked, I noticed a lot of outreach materials to L.G.B.T.Q.+ veterans and racial minorities.
On the U.W. campus, the cherry blossoms and magnolias were in full, fragrant bloom. The academic quarter had just begun. Williams and her colleagues were working out of a new light-filled building named for the public-health futurist Hans Rosling, but they looked anxious and wan. In a first-floor classroom, a man was explaining how to recognize officers from the Department of Homeland Security; ICE and Border Patrol uniforms were projected onto a giant screen. U.W. has many international students, faculty, and staff. A lab technician who emigrated from the Philippines five decades ago and who has a green card was taken into custody at Seattle–Tacoma International Airport in late February. She is being held at a detention center in Tacoma, and no charges have been announced.
Williams was still waiting for an update on the V.A. opioid-treatment grant, and wondered if her program officer at N.I.H. had been fired. She had moved Dunn onto an unrelated project to give her a few more weeks of employment—and to comply with a university rule that requires advance notice of firing. They weren’t sure what they would do with the millions of data points and dozens of interview transcripts on their computers. So far, they had observed that Black and Latino veterans with opioid-use disorder were less likely than their White peers to be treated with buprenorphine, an alternative to methadone. This was noteworthy because methadone is highly stigmatized and often requires a daily clinic visit, whereas buprenorphine can be taken home, in batches, like other medications. Williams shared some interview snippets:
I sat in on a class that Helfrich was teaching, a graduate lecture on survey methods. The twenty or so students included physicians and public-health professionals, and they, too, had federal funding on their minds. A Ph.D. candidate in the back raised his hand and started a question by saying, “I’m on an N.I.H. dissertation grant, knock on wood. They may or may not take it away.” Helfrich had received his last paycheck from the V.A. in February, but the agency had yet to provide the paperwork he needed to apply for both unemployment and an extension on his family health insurance. He was nervous about maintaining care for his wife, a breast-cancer survivor, and had started to look for full-time jobs. But cuts at H.H.S. had hit every part of the scientific establishment: not only the federal government and universities but also states, counties, cities, and the private sector. On April 1st, a coalition of states sued H.H.S. for abruptly withdrawing eleven billion dollars in grants, causing “immediate harm to public health initiatives and the termination of large numbers of state and local public health employees and contractors.” The State of Washington had been forced to fire two hundred workers, most of whom focussed on vaccinations and “emerging outbreaks for mpox, measles, and H5N1.”
A conference Helfrich was helping to plan for next year had just been moved from Iowa to Australia, in light of concerns related to Trump’s border policies. Everything felt tenuous. “There’s the human cost of treating people like garbage, and then there’s the loss of talent, knowledge, and expertise,” he told me. He has a relative who also works for the V.A., as a mental-health counsellor, and has managed to keep his job, so far. Their childhood friend from eastern Oregon is now a Republican congressman who has dutifully supported Trump’s agenda. Helfrich was feeling angry toward him, betrayed. The families’ annual Christmas dinner had been awkward, and that was before the V.A. and H.H.S. reductions began. “He should know better,” Helfrich said. “He does know better.” ♦
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