Missouri’s public health efforts left reeling after feds abruptly rescind funding

JEFFERSON CITY — The Missouri Department of Health and Senior Services began sending emails immediately upon learning a week ago that the federal government was clawing back tens of millions of dollars that were supposed to go to public health departments and efforts across the state over the next year.

One email to a grant recipient, sent March 25, explained that state health officials were suddenly notified that morning by the U.S. Centers for Disease Control and Prevention that three funding streams for pandemic-preparedness were terminated — effective at midnight the day prior.

The recipient must submit all outstanding invoices for reimbursement by March 31, DHSS advised. Anything spent after March 24 would not be repaid.

“This unexpected termination of awards by the CDC leaves the department and our valued partners in a very difficult situation,” the email read. “As you work through the impact of this information, please know we are doing the same.”

The three funding sources total $255 million for the state, according to DHSS spokeswoman Lisa Cox. The termination impacts a number of projects currently underway, totaling about $135 million.

An additional $119 million, which had yet to be earmarked for projects, was also cut, Cox said in an email Friday to the Post-Dispatch. The majority of the funding was not supposed to expire until July 2026.

“DHSS is working to understand the full impact of this federal action and searching for options to carry on some of this work,” Cox wrote. She did not provide details of the projects underway that are now cut off.

The loss is hitting many hard, especially small, rural health departments where the funding made up large chunks of their budgets, said Cooper County Public Health Center Administrator Scott Clardy, who also serves on the board for two statewide public health associations where he gets an earful from other directors across the state.

Clardy said the loss of funds is affecting health departments that were in the middle of renovations to upgrade their facilities and information technology systems. Others say they will not be able to pay staff members.

“We’ve got some health administrators that are really struggling. … There’s no time to transition, there’s no time to do any of that,” Clardy said. “The funding is gone.”

The St. Louis County Department of Public Health faces losing seven community health workers who connected residents to services such lifestyle changes, blood pressure monitoring and mental health counseling, as well as an employee in its communicable disease response division, said Sara Dayley, the health department’s public information officer.

State and county laboratories will also face challenges with maintaining staff and equipment, Dayley said.

“These funding reductions create real challenges for protecting public health in St. Louis County,” she said.

The St. Louis Department of Health is still assessing the full impact, said director Dr. Mati Hlatshwayo Davis, “but as a department that relies on grants for 55% of our funding, any cuts threaten our ability to provide essential services.”

Immunization group at risk

Another casualty is the Missouri Immunization Coalition, which had to cancel its annual conference at the end of this month, lay off half its staff and is in danger of shuttering altogether.

The nonprofit coalition works to reduce the spread of vaccine-preventable disease by educating families and collaborating with providers.

Nearly 300 people were expected at MIC’s two-day annual conference, April 24-25. Former U.S. Surgeon General Dr. Jerome Adams, who served during President Donald Trump’s first administration, was scheduled to be the keynote speaker, and groups were expected to strategize how to turn around Missouri’s falling and dangerously low vaccination rates and discuss the latest updates in infectious diseases.

Dr. Ken Haller, emeritus professor of pediatrics for St. Louis University, is a longtime volunteer with MIC. He described the conference cancellation as tragic.

It was an opportunity to share ideas such as how best to talk to hesitant families about vaccines, Haller said. It was also a much-needed source of support and inspiration for health care workers, especially those in small communities, who have felt isolated and besieged by increasing anti-vaccine sentiment.

The loss may not seem like much in the fallout from the Trump administration’s effort to reduce government spending by as much as $1 trillion and streamline bureaucracy by firing tens of thousands of federal workers.

“Still,” Haller said, “this is the sort of small, local cancellation that brings this to our front door.”

The MIC was founded in January 2020, after health care workers recognized the need for a coordinated effort to improve vaccination rates and form a coalition much like other states had. Then the COVID-19 pandemic hit.

The organization spent the next few years as an important resource during the rapidly changing effort to combat the novel coronavirus. It organizes virtual quarterly meetings and frequent webinars for its 300 members, provides continuing education credits for workers and conducts community outreach.

The organization had finally reached a point where it could focus on securing other funding sources and even expand staff, said Lawrence Simonson, the executive director. Instead, the sudden loss of funding leaves the MIC with nothing.

Three of six employees have been laid off, and money that was already invested into hosting the conference will be lost.

“Unless something happens in the next month or two … we may have to make the hard decision of dissolving,” he said.

Cutbacks amid rising health risks

The funds are among $11.4 billion the CDC is pulling back nationwide, which was allocated to state and community health departments in response to the COVID-19 pandemic, as first reported by NBC News and confirmed by the U.S. Department of Health and Human Services. The money also went to addiction and mental health programs.

“The COVID-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago,” HHS Director of Communications Andrew Nixon said in a statement. “HHS is prioritizing funding projects that will deliver on President Trump’s mandate to address our chronic disease epidemic and Make America Healthy Again.”

Attorneys general and other officials from 23 mostly Democratic-led states sued the Trump administration on Tuesday to block the decision, arguing the cuts are illegal and put states “at greater risk for future pandemics and the spread of otherwise preventable disease and cutting off vital public health services.”

Clardy, the Cooper County health administrator, said the Congress-approved funds have been available since 2021 to help the nation’s public health infrastructure respond to the pandemic but also prepare for future outbreaks.

“We’ve always been underfunded, and we’re still underfunded,” Clardy said. “This was trying to help us get ready for the next time this happens, so we aren’t as unprepared as we were for COVID.”

The cuts come in the midst of a loss of 20,000 workers at HHS — 10,000 through layoffs and 10,000 who took early retirement — amounting to nearly a quarter of its staff. About 2,400 worked at the CDC, the agency under HHS that tracks disease outbreaks and works with public health agencies nationwide.

The U.S. is also experiencing its worst measles outbreak since 2019. As of April 1, at least 560 measles cases in more than 20 states have been reported this year — already surpassing the 285 cases for all of 2024. One child has died and another death is under investigation.

No cases have been reported in Missouri, but health officials fear it’s just a matter of time. Vaccination coverage must be above 95% for communities to be protected against the highly contagious disease.

But data shows that among Missouri public school kindergarteners last school year, less than 91% were vaccinated against measles, down from 95% in the 2019-2020 school year. Among private school kindergarteners, about 85% are vaccinated, down from 92%.

And the state has pockets of places where rates are as low as 70%, said Lynelle Phillips, a nurse in Columbia who serves on board for the Missouri Immunization Coalition.

“Measles is knocking at our doors,” Phillips said. “These are all the things that we wanted to mobilize our workforce and our partners to address, and now we don’t have the mechanism to do that.”

In addition, neighboring Kansas has recently experienced one of the largest outbreaks of tuberculosis in the U.S. in the past 30 to 40 years.

And bird flu is widespread with U.S. outbreaks in poultry and dairy cows, resulting tens of millions of ducks and chickens that have had to be euthanized. As many as 70 humans have been infected, but no human-to-human transmission has been reported — yet.

“Our job is to be out there and educating people about these things, trying to get them to get themselves and their kids immunized, and we’re just not going to have the staff to do that,” Clardy said. “That staff is being pulled away right at the crux of when we may need them the most.”

Davis, the St. Louis health department director, agreed that funding cuts could not come at worse time.

Robert F. Kennedy Jr., the new head of HHS, has given inconsistent messages about vaccine safety. Kennedy has promised to investigate the childhood vaccine schedule. Public meetings by the CDC who make recommendations on vaccines have been canceled. And the CDC is preparing to research autism and vaccines, despite numerous studies concluding no link between the two.

Davis said, “Growing skepticism about vaccines, fueled by misinformation and disinformation, is creating confusion and fear when accurate public health guidance is needed most.”