The tumult of President Donald Trump’s second term has trickled down from federal agency headquarters in Washington, D.C., to state and local health departments, kicking off a new era fraught with uncertainty even as some of these leaders on the front lines of public health are still struggling to recover from the upheaval caused by the COVID-19 pandemic.

What began as a gutting of the federal health workforce has expanded into what some fear could be the upending of the nation’s public health infrastructure. Thus far, the Trump administration has moved to cut approximately $12 billion in funding that had been allocated to state and local health departments, though a federal judge has temporarily blocked cuts for multiple states.

As part of our series, Public Health Under Pressure, U.S. News is speaking with stakeholders and officials at local and state health departments around the country to get a better understanding of the impact of the administration’s actions.

In May, we talked with Lindsay Huse, director of the Douglas County Department of Health, in Omaha, Nebraska. She says the loss of nearly $1 million in federal grant funding has made it more challenging for the agency to fund the array of programs and services it has provided the community in the past.

“It’s very scary and very concerning to think about the level of impact for the people who live in these communities and are the direct beneficiaries of the programs and services that public health provide,” Huse says. “What’s going to happen in the short and the long term if we don’t have the funding available to continue the work that we do on a daily basis?”

The interview below has been edited for length and clarity.

How have the cuts in federal funding affected your work in Douglas County?
“There’s a whole lot of stress with kind of this continuous unknown for what’s going to happen in the coming months. There’s not a lot of communication, so planning is pretty hard. So far, we had this federal claw back that took back money related to COVID-19, and those funds for us here in Douglas County were more than $900,000, approaching $1 million that we lost.”

“Luckily, we had already spent down some of that funding, but one of the big pieces was something called the ELC grant, and this is really something that was given to health departments in order to build capacity. Going through COVID, we learned a lot about where we have foundational gaps and needs for departments to be well prepared to respond to future disasters, future pandemics and future public health threats. So that’s what that funding was really meant for. That ELC grant was to build lab and surveillance capacity, and to build local cadres of epidemiologists and disease investigators so that there’s a robust system in place to keep outbreaks from happening, but if one did occur, we would be better equipped to address that.”

“Here in Douglas County that is even a bigger threat because we have in our backyard a biocontainment unit that is operated by University of Nebraska Medical Center, and this is a really innovative, necessary space. Part of it is an isolation unit.”

“So we know that if special pathogens are brought into Douglas County, there’s an entire downstream response that has to happen. UNMC is doing their thing, but the public health department has to assure that we have of all our systems set up in order to do extra monitoring of the people who are taking care of those patients, or family members who may come to the area to be close by, or others who may have been exposed in some way.”

“Having a robust public health system that is able to respond alongside what’s happening at UNMC is extraordinarily important. So, losing $900,000 is a big deal when you’re trying to respond effectively to protect the public.”

What other programs or services have been impacted by the loss of federal funding?
“We’ve had some smaller impacts. We were building out a program to address mental health and stigma in our high-risk youth in the community, and part of the funding that we lost was going to that. We were lucky we were able to absorb that and fund it through another avenue, but it certainly impacts on our ability to do other things because we have to pull money away to keep this program going.”

What are your concerns regarding having future resources?
“We were lucky enough to get that COVID funding to kind of shore up cuts in funding we had experienced last year. Now that that funding won’t be coming on a regular basis, we are dealing with that decreased amount in funding. We already did not have a huge Vaccines for Children program, so if we continue to see cuts to that it’s a huge impact to those families whose kids are either not covered by insurance or they’re underinsured by a policy that does not cover immunization.”

Have you had to make cuts to staff?
“We have somehow lucked out, but I can’t say the same about other health departments around Nebraska. I have been very lucky in that we have been able to apply for some grants that other health departments were not eligible for because of the size of our community.”

“So far, I have not had to lay anybody off. Is it something that has been discussed? I mean, you have to look at everything when you’re looking at potential funding cuts, so certainly we have taken a very close look at what services we do offer. We prefer to maybe not fill a position that’s been vacated, so kind of saving through attrition. We’re hoping we can manage by going through some of these other routes, like cutting down on expenses in other places, cutting down on travel, cutting down on overtime and compensatory time, and really finding the places where we can tighten our belts because my first priority is always going to be the positions and people who are working in the agency. They are our greatest asset. They are some of the most brilliant minds and talented public health professionals, and if you lose that then it’s really hard to get back.”

What has been the reaction from state policy makers regarding the federal funding cuts?
“Having been to the capital and talked to a number of state senators, I think there are a handful of people who just really, essentially, don’t care for public health – probably what happened during COVID contributed to that. I think there is still somewhat of a misunderstanding about the good work that we do and the vital work that we do.”

“We have been in front of everybody, and sending information to all of our [state] senators here in Nebraska to try to make sure our legislators here have an understanding of the importance of the worm that we do and how it actually impacts the people who live in our community. So, I think there is probably better awareness now than even five years ago about what we do.”

“I think that many senators are probably sympathetic to the funding situation we’re in, but Nebraska is also facing a quite a large budget deficit that our legislators have been tasked with filling, so public health is certainly not the only thing that will be experiencing a cut. They are in a really hard situation.”

What impact has the uncertainty around funding had on morale?
“The last three or four months have been really trying for everyone in public health. There has been a lot of anxiety and there has been so much fear, and part of that has been because we’re not getting any information. We’ve seen that people showed up for work at the CDC and found out when they tried to scan their badge that they no longer worked there – these are the things we hear at the local level. We have no transparency or visibility on what’s actually happening and whether things are just being rearranged to a different agency, or whether funding is still going to be available.”

“We in many instances have literally just been left with a void, so when the federal rifts happened we literally just didn’t have anyone to call anymore in certain programs because they were just gone. That hasn’t even been the ability to talk to someone to ask what’s happening, or what we can expect for the next six months or a year.”

“This is a hard time, but we’ve done hard before – public health is great at hard."