Over the past year, the Centers for Disease Control and Prevention (CDC) has been battered by political interference that would have been unthinkable a decade ago. Scientists and staff endured mass firings followed by partial rehiring, leaving employees describing themselves as “dead men walking”. In August, 180 shots were fired at the CDC’s Atlanta headquarters, shattering 150 windows, scarring the building and shaking the morale of a workforce already under siege.
Yet, the deepest wound to public health has been the replacement of science with politics
Under the leadership of Robert F. Kennedy Jr., the CDC’s scientific integrity has been deliberately weakened. A respected federal vaccine advisory panel was dismantled and replaced with individuals who have promoted vaccine skepticism, leading to abrupt changes in guidance on COVID-19 and varicella vaccines and the reversal of recommendations for universal infant hepatitis B vaccination. These decisions contradict decades of rigorous evidence affirming vaccine safety and effectiveness. 
The damage does not stop at CDC headquarters. In some states, national misinformation is amplified by state leadership. Florida offers perhaps the clearest example, where Surgeon General Joseph Ladapo—who has compared school-entry vaccine requirements to slavery—has used his office to undermine routine childhood immunization and publicly reject former CDC guidance.
Meanwhile, senior federal health policy roles have increasingly been filled by individuals lacking scientific or clinical expertise, further shifting national priorities away from population health and toward ideological grievance. The result is a weakened and unreliable national public health apparatus—one that can no longer be assumed to offer evidence-based guidance on even its most basic functions.
Faced with this reality, what is public health to do now?
The answer begins with a simple truth: most public health is local.
More than 2,800 local health departments across the United States conduct frontline disease surveillance, outbreak response, environmental health enforcement, and community prevention programs. These departments inspect restaurants, monitor drinking water, operate immunization clinics, and respond to emergencies ranging from measles outbreaks to wildfire smoke exposure.
When federal guidance falters this local work does not stop. And when federal funding for public health–which accounts for about half of state and local health department budgets–is threatened, the local public health infrastructure and workforce certainly suffers. But local activities continue because they must, even if reduced in scope and scale.
This decentralization of public health is not a flaw. It is perhaps the public health’s greatest source of resilience in this political moment. While national agencies set standards and fund specific priorities, the daily work of protecting communities happens block by block, school by school, and clinic by clinic. Even in periods of deep federal dysfunction, most local public health remains operational, trusted, and indispensable.
Recognizing that public health is local offers a path forward
First, trust is built closest to home. Americans consistently report greater confidence in local health authorities and personal clinicians than in distant federal institutions. In an era saturated with misinformation, that proximity matters. Local health departments capitalize on this delivering public health messages through trusted community institutions. Then can also coordinate with local clinicians, nurses, and health officers to be the public face of health recommendations.
Second, local institutions also retain meaningful discretion. Local public health departments continue to make daily operational decisions that shape community health. They determine how to promote vaccination, whether to align with or distance from federal messaging, and how to communicate risk. Through immunization clinics, school partnerships, health advisories, and local surveillance systems, health departments can preserve evidence-based practice even when national leadership falters.
Third, local public health is a line of defense against institutional erosion. While national leadership regularly flip-flops, local health departments remain steady stewards of professional public health standards and workforce competence. In Los Angeles County, for example, the Department of Public Health (LAC-DPH) operated large-scale COVID-19 vaccination clinics, issued detailed local health orders, and publicly reported hospitalization data even as federal guidance weakened. This continuity allows public health to recover after political disruption.
Acting locally when national institutions fail
At California State University, Los Angeles, where I’m based, faculty and students recently launched a four-week respiratory virus outreach campaign. Using established public health communication principles and insight from genuine partners at the LAC-DPH, our students engaged community members on staying safe from influenza, COVID-19, and RSV in community spaces. More on this next week.
This effort did not require federal permission. And we refused to cower at dramatic federal pushback on vaccination. But it did require expertise, commitment, and trust. These resources exist in great abundance across local public health agencies, community organizations, and academia nationwide. The resilience is tangible. We gained momentum from taking action ourselves rather than waiting for a new administration.
Public health was never about a single federal authority. When national institutions fail, the work does not vanish. It has always been carried out by those closest to the problem. The current moment is dangerous, but it is not hopeless. The erosion of scientific and policy integrity at the federal level is real and consequential. But the practice of public health in the U.S. has always been the domain of professionals working far beyond Washington.
Public health is not lost. It remains meaningfully and powerfully local.
Gregory Stevens