Even before Robert F. Kennedy Jr. was confirmed as health secretary on Thursday, the Trump administration started bludgeoning the U.S government’s healthcare infrastructure — including the Centers for Disease Control and Prevention and the National Institutes of Health — with one shuddering impact after another.

The resulting fear among employees could reshape the government as much as the actions themselves.

“If I were bird flu or whatever the next pandemic pathogen will be, this would be my exact playbook — decimate the federal science and health infrastructure,” said Holly Fernandez Lynch, a bioethicist and lawyer at the University of Pennsylvannia. 

The news has been bad enough. Dramatic cuts were made to the grants the NIH pays institutions, and on Friday the HHS as whole, which includes the CDC and NIH as well as the Food and Drug Administration and the Centers for Medicare and Medicaid Services, was set to cut 5,200 employees who were still in a probationary period,  meaning that they are relatively new hires. The director of the new Advanced Research Projects Agency for Health (ARPA-H) and a slew of other top officials were let go or suddenly resigned.