LISA DESJARDINS: The top vaccine official at the Food and Drug Administration has resigned.

On Friday, Dr. Peter Marks wrote that HHS Secretary Robert F. Kennedy, Jr. wants, quote, subservient confirmation of his misinformation and lies.

The Associated Press reports Marks had to choose between being fired or resigning.

That follows this week's announcement that HHS would fire some 10,000 workers.

Along with voluntary departures, that cuts the agency by almost a quarter.

ROBERT KENNEDY JR. HHS Secretary: We're going to streamline HHS to make our agency more efficient and more effective.

We're going to imbue the agency with a clear sense of mission to radically improve the health of Americans and to improve agency morale.

LISA DESJARDINS: What does this mean for the country?

Ali Rogin spoke with two former HHS leaders.

First, Tom Frieden, founder of the nonprofit organization Resolved to Save Lives.

He led the Centers for Disease Control and Prevention under President Obama.

Dr. Frieden, thank you so much for joining us.

I first want to ask about the departure of Dr. Peter Marks.

In his resignation letter, he cited a, quote, unprecedented assault on scientific truth that has adversely impacted public health.

Is that what's happening here?

DR. TOM FRIEDEN, Resolved to Save Lives: I think what we're seeing is extremely concerning.

Secretary Kennedy has repeatedly undermined confidence in vaccines, and vaccines are essential for health.

When the secretary says it's an individual choice, well, it's certainly the case that every vaccine is given after informed consent is signed.

It's also the case that whether one person gets vaccinated can very much influence whether another person, such as a child with leukemia, gets sick.

ALI ROGIN: Turning to the larger reduction in force, how is this going to affect public health in America?

TOM FRIEDEN: We don't yet have the details of what has been announced.

If we look at the Centers for Disease Control and Prevention, there are discussions of reducing our global work that's really dangerous.

It means that instead of finding and stopping threats where they emerge, which is less expensive, safer and more efficient, we'll have to fight them here within the United States at greater risk and greater expense.

There are also discussions of reducing programs that address tobacco and junk food and other problems at CDC.

CDC has deep experience and knowledge and data determining what's happening, what kind of cigarette or other tobacco products kids are using, what kind of junk foods people are eating, in fact, what kind of environmental contaminants people are being exposed to.

That's all deep experience at CDC.

And if we lose that, we lose the ability to protect Americans from the leading causes of death.

ALI ROGIN: And Secretary Kennedy has said that he wants HHS to be streamlined and really focus on its core functions.

He talks a lot about reducing chronic disease.

What do you say to that?

TOM FRIEDEN: There's no doubt that every organization could be more efficient, could be more effective when it comes to chronic disease.

There's not a mystery about most of the causes of chronic disease in the US.

Tobacco still kills close to a half a million Americans per year.

In addition, we have an obesity epidemic.

We have very poor treatment of diabetes and hypertension.

So sure, there's plenty of room to improve primary health care, to strengthen our public health system so that we can detect and respond to problems faster.

But going in and saying we're going to cut 20 or 25 percent of the workforce and make it better and safer for Americans.

Show me.

ALI ROGIN: I also want to ask about something that Secretary Kennedy continues to bring up and many observers of the health care system do, they talk about the so called revolving door between regulators that enter HHS and the pharmaceutical industry that they are charged with regulating.

Is that relationship a problem?

And if so, do cuts like these help address that problem?

TOM FRIEDEN: Well, cuts like these don't make government stronger.

Cuts like these are very disruptive for professionals who devote their lives to protecting Americans and advancing science.

What is clear is that Secretary Kennedy has repeatedly spread misinformation about groups like the Advisory Committee on Immunization Practices, what's called ACIP.

And this is part of a broader assault on vaccines, which is really terrifying because these are what stands between diseases and the health of the next generation.

Globally, we're seeing the administration apparently planning to pull out of the what's called gavi, the Vaccine Alliance.

These are changes which not only will make the U.S. less safe, less healthy, and with higher healthcare costs, but unless these changes are reversed, they will literally cause millions of deaths around the world.

ALI ROGIN: Dr. Tom Frieden, former head of the Centers for Disease Control and founder of Resolve to Save Lives, thank you so much.

TOM FRIEDEN: Thank you.

For a different perspective, we're now joined by Roger Severino.

He is vice president of Domestic Policy at the Conservative Heritage Foundation and served as director of the HHS Office for Civil Rights during President Trump's first administration.

Roger, thank you so much for joining us.

How are these staffing cuts going to, quote, radically improve the health of Americans, as Secretary Kennedy has said they will?

ROGER SEVERINO: Well, if we want to make America healthy again, we have to make HHS healthy again.

And there was so much fat in that agency.

I was there for four years.

I saw the inefficiencies firsthand.

This does not help in the delivery of health care.

And you saw that this budget ballooned beyond the Department of Defense.

It grew 38 percent under Biden to 1.9 trillion.

Yet at the same time, our health has gotten worse in every single measure.

And these cuts are going to help refocus the agency into what it should be doing, and that is restoring American health.

ALI ROGIN: On the issue that you mentioned of staffing administrative departments in many of these agencies, current and former HHS officials have told me that each department really needs its own administrative office because these are highly specialized positions.

And if you consolidate them, you're going to have the remaining staff in those agencies picking up the administrative duties and distracting them from their core missions.

What do you make of that?

ROGER SEVERINO: Don't believe it.

So, finally, the government sector is going to have some semblance of the same discipline of the private sector.

If the waste and abuses that happen in a federal government happened in, say, a major corporation, they would lose money year after year and eventually go bankrupt.

There is no price mechanism in the government.

What we have are measures of pure inputs.

How much money is going towards something, what we need to do is move it towards outcomes.

Are Americans getting healthier?

Is chronic disease going down?

Is childhood obesity going down?

These are the measures we should be looking at instead of okay, how many admin persons, how much paper is pushed, how many reports are made?

ALI ROGIN: A lot of folks who would disagree with what you're saying now will say that actually in order to improve tracking those outputs, tracking progress, tracking results, you actually need more experts, you need more people coming in, not less.

My question to you is how are these staff cuts going to lower the cost of health care for Americans, as Secretary Kennedy has also said, is their intended purpose?

ROGER SEVERINO: Well, if we improve Americans health, we'll reduce the cost of health care.

What RFK Jr. is pushing is making sure that Big Pharma is no longer in the driver's seat.

And this sort of revolving door of government bureaucrats and big pharma patting each other's back is getting in a way of prioritizing the delivery of health care.

Good health isn't necessarily the most profitable thing for big pharma and big medicine.

Healing people sometimes cost them money.

ALI ROGIN: You were the lead author of the HHS section of Project 2025, the Conservative blueprint for government.

And in some cases some of your recommendations included areas that specific agencies actually needed to be strengthened in terms of their authorities.

That includes the Office of Civil Rights which is now going to be under the oversight of a new HHS Assistant Secretary.

So are these across the board cuts and restructuring the most effective way to achieve this?

ROGER SEVERINO: Well, what I'm seeing is consolidation.

So with OCR, which I love, and they're doing fantastic work now, they have been consolidated with other enforcement agencies within HHS.

And you see this in other areas.

The problem is were siloed much of the agency.

You have your own little fiefdoms where each person in control has this temptation to continue to grow on their own.

And that gets in the way of communication across agencies.

It creates power struggles and turf wars.

I mean, look, people are human beings.

And you see that in the federal government as you see in other places.

And when you consolidate, you get people talking to each other, you see overlapping efficiencies, you learn from each other and you break down those silos and that actually helps the delivery of health care.

ALI ROGIN: Roger Severino, who served as director of the HHS Office for Civil Rights during the first Trump administration, now vice president of domestic policy at the Heritage Foundation.

Thank you so much for joining us.

ROGER SEVERINO: Thank you.