WASHINGTON — First came Robert F. Kennedy Jr.’s ouster of a top official at the Department of Health and Human Services’ vaccine division. Then, the HHS chief axed the people overseeing new drug reviews and tobacco, while placing on leave Anthony Fauci’s successor at the National Institutes of Health.

The efforts to push out senior leaders overseeing scientific research and reviews of medicines and tobacco products go further than the effort to streamline the department that agency officials had publicly described.

The sweeping cuts also allow Kennedy to reshape the country’s health policy and communications, providing a road map for where the new health chief is directing his focus. Among the 10,000 people cut on Tuesday, some entire divisions were gutted including groups working on sexually transmitted diseases, environmental health, global health and birth defects, according to people familiar with the matter. Big swaths of the agency’s communications and federal records teams were also laid off.

The moves have already rattled investors, health officials and employees, many of whom lined up to enter their offices this morning only to realize that their access was cut off. The S&P Biotech ETF fell as much as 2.4% on Tuesday, following a 3.9% drop Monday after the resignation of top vaccine official Peter Marks.

HHS did not provide additional comment beyond an X post by Kennedy. The agency has previously said drug and medical device workers, along with food reviewers and inspectors will be spared from the cuts.

“Let’s restore @HHSgov health agencies to their rich tradition of gold-standard, evidence-based science to tackle the chronic disease epidemic and Make America Healthy Again,” he said in a video with the new heads of the FDA and NIH.

Dismissal notices coming from deputy assistant secretary for human resources Thomas Nagy notifying people they were terminated came around 5 a.m. in Washington, DC.

Among the most concerning to former government workers were those at the FDA, which regulate new drug approvals and oversee the health and safety for everything Americans eat and ingest.

“The FDA as we’ve known it is finished, with most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed,” former commissioner Robert Califf wrote in a LinkedIn post Tuesday. Califf, who led the agency during the Obama and Biden administrations, said he was inundated with messages about the cuts. “I believe that history will see this a huge mistake.”

Slimming down

Kennedy had announced sweeping cuts to HHS last week with plans to shrink to 62,000 employees from 82,000. The secretary had announced plans to consolidate the department’s 28 divisions into 15 and cut regional offices from 10 to five. HHS said these cuts will save the government $1.8 billion.

As the cuts unfolded Tuesday, a picture emerged of parts of health agencies being cut in ways that could upend things as core to the agency — and global business — as drug approvals.

Among those impacted were Peter Stein, a top FDA official who oversaw reviewers that evaluate new drugs, make approval decisions and decide whether the benefits of drugs outweigh the risks, according to an email viewed by Bloomberg.

“I received an email indicating that I’ve been removed as OND Director and offered a position in patient affairs — which I have declined,” Stein wrote.

Stein’s removal raised questions about Kennedy’s broader strategy. RBC Capital Markets analyst Brian Abrahams said in a note Tuesday that the mass layoffs appear to be happening “without regard for any particular policy, continuity, seniority level, or ability.”

Abrahams said the department associated with drug reviews was an area of the FDA that was once considered protected.

“It seems that at best new drug reviews and engagement with drug developers will slow,” Abrahams said, saying it could take months or even years to hire and train new personnel.

Any slowdown in drug approvals out of the FDA has the potential to undo work that the agency has done to speed up those processes in recent years, according to Scott Gottlieb, who was FDA commissioner during Donald Trump’s first term.

“Today, the cumulative barrage on that drug-discovery enterprise threatens to swiftly bring back those frustrating delays for American consumers, particularly affecting rare diseases and areas of significant unmet medical need,” Gottlieb said.

Stein’s departure followed the ouster of Marks, who oversaw the FDA division that approves vaccines, insulins and complex injectable medicines.

In his resignation letter, Marks cited Kennedy’s efforts to spread misinformation about the safety of vaccines. “I was willing to work to address the Secretary’s concerns regarding vaccine safety and transparency,” he said. “However it has become clear that truth and transparency are not desired by the Secretary, but rather he wishes subservient confirmation of his misinformation and lies.”

Sudden changes

The FDA’s chief tobacco regulator was also removed from his position Tuesday. “It is with a heavy heart and profound disappointment that I share I have been placed on administrative leave,” wrote Brian King, who served as director of the FDA’s Center for Tobacco Products, in an email to staff obtained by Bloomberg Law.

Also affected by dismissals were most of the FDA’s press office, according to people familiar with the cuts.

Employees affected by the reduction-in-force notice were locked out of HHS computer systems immediately, meaning the work on the programs they ran was effectively halted and they were unable to communicate with partners.

Besides shrinking the agency’s workforce, Kennedy is also working to reshape its structure by cutting the number of divisions almost in half. Those moves include combining units of HHS focused on public health, substance abuse, mental health and occupational safety into a new entity called the Administration for a Healthy America. The division of HHS responsible for preparing for pandemics will be relocated to the Centers for Disease Control and Prevention, and 1,000 employees will be transferred there as a result.

In some cases, whole units were culled, raising questions about how work is going to continue. For example, the entire CDC FOIA office — nearly two dozen people — received reduction in force notices stating that they would immediately be placed on administrative leave. All FOIA personnel at FDA and NIH were also dismissed, a person familiar with the matter told Bloomberg News. The CDC has seen a massive uptick in FOIA requests this year. It’s the second busiest year since Covid, the person said.

During his first address to HHS personnel after he was sworn in, Kennedy, who routinely used FOIA to obtain a wide range of records from the health agencies, promised a new era of “radical transparency” and remarked that the public wouldn’t need to use FOIA. HHS has received at least 2,000 FOIA requests this fiscal year and expects its backlog to grow to 9,000.

Democrats have blasted Kennedy’s plans, saying they will disrupt services and undermine medical research.

“Their plan is putting lives in serious jeopardy,” Washington Senator Patty Murray said.

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With assistance from Sophie Alexander, Ike Swetlitz, Nyah Phengsitthy, Zahra Hirji, Gerry Smith, John Tozzi, Anne Cronin and Jason Leopold.

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