After the Trump administration laid off hundreds of health workers during the ongoing government shutdown, the Centers for Disease Control and Prevention has now lost one-third of its staff this year. States are forming public health alliances in direct opposition to the changes being made by Health Secretary Robert F. Kennedy Jr. Only half of Americans say they trust the CDC to deliver reliable information about vaccinations.

The consequences of the CDC’s gutting will be diffuse, given the agency’s many different functions, and they could take some time to materialize. Public health trends are measured in decades, not in months.

But to get a sense of where the agency stands after the chaos of the past year, I went to somebody who knows the place inside and out. Dr. Tom Frieden, the president and CEO of Resolve to Save Lives, a nonprofit global health organization, was CDC director from 2009 to 2017 under President Barack Obama. Our conversation is below, edited for clarity and length.

Which specific CDC functions do you worry about the most? What hasn’t gotten enough attention?

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