Q&A with Barbara Ferrer: L.A. County Public Health braces for impact under Trump

As President Trump vows to rein in government spending and saddle federal money with new restrictions, the Los Angeles County Department of Public Health has a lot at stake — including about $1 billion in federal grants, according to its director, Barbara Ferrer.

Federal grants make up roughly two-thirds of its budget, funding efforts to detect avian flu and other infectious diseases, control HIV/AIDS and tuberculosis, and provide services for chronically ill children, the department said. Ferrer spoke with The Times about how the Trump administration has affected the L.A. County Public Health Department so far and what could be ahead.

This conversation has been edited for length and clarity.

Question: How has the Public Health Department been affected at this point by the changes underway since President Trump took office?

Answer: The biggest impact is there’s a level of uncertainty about the direction the federal government is moving in. ... I don’t want to speculate where we’ll be with the new fiscal year 25-26 budget. But we’re aware that there could be significant risk to our budget, and that’s creating uncertainty.

Q: Have you had any funding that has been frozen?

A: We lost one person who was terminated who was a public health associate. These are CDC folks who are on loan to us. This person was on loan to us for two years, and she sadly received a termination notice. Her employer is the CDC, not the local public health department.

We have 12 additional employees here who are assigned to us from CDC. Some of them have received some verbal notifications that their jobs are being terminated, but nobody else has gotten an official letter of termination. ... It would be a significant gap should those people actually lose their jobs. ...

We have received — almost every day — some notification on some grant or another around needing to be in compliance with executive orders. ... Our sense is that there’s a lot of confusion about how to interpret these orders and when these orders actually apply. ...

We have about 54 people here who are AmeriCorps volunteers and we received notification about that grant application. I’ve already certified that the AmeriCorps volunteers that are assigned to us, in fact, are in full compliance with all the executive orders, but we’re going back and forth on that.

Q: Is there anything that the department has done in reaction to those notifications?

A: Not to date. We have existing contracts with grant deliverables. We’re adhering to those grant deliverables. ... We’re just moving forward with the work. We’re going to do high-quality work, and we’re hopeful that by doing high-quality work, we continue to get the bipartisan support we’ve depended on in the past.

Q: What are your top concerns right now as we start to see the ways in which health policy is being reshaped?

A: There is a really important role for government in ensuring public health. ... I know that the new administration takes very seriously that they have a mandate to reduce government, to make sure that government is efficient. And I think we have always shared the goal that these are taxpayer dollars and we need to be accountable for them. We need to be transparent about how we’re using them, and most importantly, we need to be as efficient as possible in accomplishing goals that really protect the public.

But my hope is that as the administration gets settled, they take time to learn about the important work that’s happening and why it really benefits everyone to continue this work. I think the biggest concern would be that in the haste to deliver on campaign promises, there’s not the due diligence to actually better understand the breadth and the depth and the importance of public health work that’s done through the government agencies at the federal level, at the state level and at the local level.

Q: The CDC halted one of its flu vaccination campaigns, the “Wild to Mild” campaign. How do things like that affect the efforts at the county level to encourage vaccination?

A: My hope is that these are very short pauses and that we’re going to get on with the business of making sure that people have good information about the importance of vaccines. I mean, vaccines save thousands of lives, and we can’t really be backtracking on this.

Q: One of the other big things happening federally right now are these proposed cuts to Medicaid. What would the impact be on your department?

A: It would have immediate impact for us in two huge ways. We do have services that we bill Medicaid for. We’re also a healthcare provider through our clinic services. ... The other is that when people’s access to healthcare is reduced, public health services are in higher demand. We also need to then worry about poorer outcomes. ... Let’s just look at cancer: If people delay seeking care and they end up being diagnosed with late-stage cancers, the impact on their lives and their family’s lives are huge, but also we’ve lost this opportunity to provide less costly, more appropriate care early on.

Q: With all the worry about bird flu, are there any anticipated effects in that area from the change in administration?

A: I want to avoid speculating because I don’t really know, but I do want to say we get millions and millions of dollars every year that allows us to have a public health lab here so we can quickly test specimens, do genomic sequencing and help build the knowledge base around what we’re seeing for all kinds of infectious diseases. So I’m really counting on continued support for the public health lab. But we also have people in the field. We have wastewater surveillance.

These are all activities that are supported in large part through our federal grants. ... They won’t be able to do the level of work we do at all if the federal grants don’t continue. And it’s not just around avian flu. For the first time, we have locally acquired dengue cases here. ... Dengue is a dangerous disease. It can cause serious illness and even death, and you don’t really want something that we’ve never seen here to become endemic.