2025年4月4日｜Fatma Tanis 撰寫｜NPR
美國疾病管制與預防中心（CDC）位於喬治亞州亞特蘭大的總部校區。4月1日，數千名CDC員工被美國衛生與公共服務部部長小羅伯特·甘迺迪（Robert F. Kennedy Jr.）裁撤。
自4月1日起，CDC已關閉「母嬰健康分支」，該部門長年與其他國家合作，確保感染或暴露於 HIV 風險下的母親與兒童能獲得治療。該分支的22位全體員工均遭解雇。
這只是這波裁員影響全球衛生領域的冰山一角。此次整頓行動包含裁撤25%的人力與削減35%的合約，為甘迺迪部長所推動「縮減官僚機構規模」政策的一環。
作為美國國內外衛生政策的主導力量，衛生與公共服務部（HHS）對全球健康具有深遠影響。美國前總統川普所提名的小羅伯特·甘迺迪於2月13日獲參議院通過，成為該部門的新任部長。
雖然CDC在美國境內任務繁重，但其「全球健康中心」同樣擁有約550名員工，負責全球範圍內的疫苗、監測與HIV防治工作。
這次重整也波及該中心的領導層。主任Kayla Laserson與其他幾位CDC主管被調往「印地安衛生服務署」（Indian Health Service），全球健康中心目前暫由副主任接手。
裁撤內容為何？
儘管HHS與CDC並未對裁撤詳情發表聲明，但《NPR》採訪了6位CDC／全球健康中心現任員工。他們因未獲授權發言而要求匿名。
據悉，全球健康中心旗下有三大部門。其中兩個部門未受影響：
- 「全球疫苗接種部門」，負責小兒麻痺與其他疾病的疫苗分發；
- 「全球健康保護部門」，負責疾病監測與資訊彙整，並利用全球實驗室網絡作為後援。
然而，「全球 HIV 與肺結核部門」則遭重創：15個分支中有7個被裁撤，所有員工與主管全數解職。
被裁的「母嬰健康分支」特別受到關注
三位受訪CDC員工表示，母嬰健康分支的解散令他們震驚。該團隊由流行病學家與醫師組成，專責預防HIV垂直感染（母嬰傳播），並確保感染HIV的孩童能持續接受治療以壓制病毒。
兩位曾於該分支任職的科學家指出，CDC在2024年為超過30萬名兒童提供HIV治療，並為超過38萬名HIV陽性的孕婦與哺乳期婦女提供服務。
這支團隊同時也是聯邦政府跨部門協作的重要力量之一，與國務院、現已被解散的國際開發署（USAID）共同執行「PEPFAR」（總統防治愛滋計畫）。該計畫自小布希總統於2003年啟動以來，據國務院統計已拯救超過2500萬條生命。
「我們是目前PEPFAR唯一具備母嬰健康與HIV專業的團隊，特別是在USAID遭裁撤後。」一名科學家說：「這次裁員不只影響CDC，連整個PEPFAR都會受到衝擊。」該名科學家本週被安排行政留職至6月2日，屆時將正式離職。
另一名來自該分支的研究人員也指出政府訊息混亂：「年初國務院才說我們的工作是『關鍵且能救命的』，結果我們卻被HHS裁掉，這顯示政府內部嚴重缺乏協調與溝通。」
《NPR》就此詢問HHS對CDC全球健康裁員一事的評論，截至截稿尚未獲得回應。
衝擊評估
所有受訪CDC員工皆表示，對全球健康中心與其HIV部門的裁撤，恐帶來「災難性後果」。
一位來自母嬰健康分支的科學家表示，這對其個人與職涯都是沉重打擊：
「我們投入一生，只為確保母親與孩子獲得必要的HIV服務，也為孩子發聲，爭取他們活下去的機會。如今我擔心，這些原本就常被忽視的族群，將再無人為他們奔走，他們的生命風險將大幅提升。」
一名未受影響的流行病學家也指出，儘管這是「全球健康」計畫，但其終止也將影響美國自身：
「HIV不分國界。若全球HIV疫情再度升溫，將在病毒變異、抗藥性與傳播率上引發長期效應，最終傷害全球經濟。」
全球發展中心（Center for Global Development）副主任 Janeen Madan Keller 補充，美國長年於全球健康扮演要角，尤其在疫苗接種與HIV治療領域拯救無數生命。
「但當其他國家也因各種因素陸續縮減國際援助預算時，這樣規模的行動來得太突然、影響太大。」
她進一步指出：「我們現在面臨的最大問題是——還有誰能承擔起美國曾經扮演的角色？」
「我不認為我們現在有答案。」
至於未來是否還會有更多裁員？
根據一位現任CDC官員表示：「HHS與CDC目前的說法是『這波裁員就此結束』，但針對全球健康領域，我們聽到的說法卻是『還不一定』。」
How will the deep cuts at the Centers for Disease Control affect global programs?
April 4, 20255:35 PM ET
By
The main campus of the Centers For Disease Control and Prevention (CDC) in Atlanta, Georgia. Thousands of its employees were among those laid off by Health and Human Services Secretary Robert F. Kennedy Jr. on April 1.
Elijah Nouvelage/Getty Images
As of April 1, the Centers for Disease Control and Prevention has shut down its Maternal and Child Health Branch, which works with other countries to ensure that mothers and children at risk of or infected by HIV receive treatment. All 22 staff were terminated.
That’s one of the ways that global health will be affected by the 25% reduction in staff and 35% reduction in contracts for the agency — ordered on April 1 by Secretary of Health and Human Services Robert F. Kennedy Jr. as part of an effort to “reduce bureaucratic sprawl.”
Goats and Soda
RFK Jr. will have a vast global reach at Health and Human Services
Although CDC has a sweeping domestic agenda, it also focuses on worldwide issues through its Global Health Center, which has about 550 employees.
As part of the restructuring, the director of the center Kayla Laserson was one of several CDC directors transferred to the Indian Health Service, leaving the Global Health Center in the hands of deputies.
What was cut?
Neither HHS nor CDC released further information on the cuts, but six current CDC/Global Health Center employees gave details to NPR. They asked for anonymity because they are not authorized to speak to the press.
The Global Health Center has three divisions. Two of the divisions were unscathed: global immunization, which supports vaccine distributions for polio and other diseases, and global health protection, which is responsible for disease surveillance, gathering information and drawing on their network of labs.
The third division, Global HIV and TB, however, had seven of its 15 branches eliminated, terminating all of their staff and leadership.
Three CDC employees who spoke to NPR said they were especially shocked by the elimination of the Maternal and Child Health Branch. The team was made up of epidemiologists and physicians who focused on preventing babies from getting HIV from their mother and keeping children with HIV around the world alive and on treatment to suppress the virus.
Two scientists who worked at Maternal and Child Health said CDC was “providing HIV treatment for over 300,000 children, and we provided treatment for over 380,000 HIV positive pregnant and breastfeeding women in 2024.”
Those employees have been one of several federal teams — including from the State Department and the now dismantled USAID — that were critical in carrying out the programs of PEPFAR — a widely hailed government initiative to control HIV, started by President George W. Bush in 2003, that the State Department credits with saving 25 million lives since its inception.
“This team is especially critical right now, because with the recent cuts to USAID, our branch was the only team left in PEPFAR that had maternal and child health HIV expertise,” one CDC scientist told NPR. “So our cuts impact not just CDC but PEPFAR as a whole.” The scientist, who was part of the Maternal and Child Health Branch, was this week placed on admin leave until June 2, when their job will be terminated.
Another CDC scientist from the team complained about mixed messages from the government: “HIV treatment for pregnant women and children was identified as critical and lifesaving by the State Department earlier this year because without it, many lives would be lost,” the scientist said. “It seems like maybe this is an indication of the lack of coordination and chaos in the government, where the State Department is saying our work is critical, yet we’re cut by HHS.”
NPR reached out to HHS for comment on the CDC global health cuts and their impact but did not receive a response.
Assessing the impact
All CDC sources who spoke to NPR agreed with one individual’s characterization that the cuts to the Global Health Center and its HIV branches would have “catastrophic consequences.”
One of the scientists with the Maternal and Child Health team said the cuts were a major blow personally and professionally.
“My colleagues at the branch and I have really dedicated our careers to ensuring that mothers and babies receive the HIV services they need, and we serve as advocates for children to get the services they need so that they can be healthy and stay alive,” the scientist said. “I personally am just worried that no one will be advocating for these populations that are often overlooked anymore, and that that puts them more at risk for dying.”
One epidemiologist who was not affected by these cuts said even though this was a global health program, its elimination could have a direct impact on the lives of Americans.
“HIV knows no boundaries. If we see a resurgence of HIV globally. It’s going to have long term consequences everywhere, with what we know about mutations of HIV, resistance to drugs, transmission rates. It’s just going to be detrimental. It’s going to harm economies around the world,” the epidemiologist said.
The U.S. has played a major role in global health and helped save millions of lives around the world with its support for global immunization efforts and HIV/AIDs treatments, says Janeen Madan Keller, the deputy director of the global health policy program at the Center for Global Development, a Washington, D.C., think tank.
“I think one of the challenges that we’re really confronting is that these sweeping and unprecedented actions that are being taken by the current administration are coming at a time when many other governments are also cutting their foreign aid budgets for many different reasons.”
That raises a big question, Keller says: “is there anyone who can step into the role the U.S. played?
“I don’t think we have an answer.”
There’s another as yet unanswered question: Will there be future cuts to the Global Health Center?.
“The message [from the leadership] in HHS and CDC is that this is it for the reduction-in-force. But for global health, we have been told that may not be the case,” a current CDC official told NPR.
原文網址:https://www.npr.org/sections/goats-and-soda/2025/04/04/g-s1-57788/centers-for-disease-control-global-health-hiv-maternal-health
