Bri McNulty pictured when she was in Atlanta for training in the CDC’s Public Health Associate Program. She and all other members of the competitive program in her cohort, deployed around the country, were fired by the Trump administration earlier this month.
Bri McNulty
hide caption
toggle caption
Bri McNulty
Kathie Evenhouse has lived in cities, but what she loves about rural life is how people care for one another, helping drive neighbors to doctors’ appointments, for example.
Evenhouse herself is 73 and has had multiple cancers — in the soft tissue near her spine, as well as her thyroid, blood, and left leg. Most of her doctors work in Iowa City — an hour and a half’s drive from where she lives in Pella, the small town best known for manufacturing windows that go by the same name.
Care closer to home
Mahaska Health, on the other hand, is a 25-bed hospital that’s in Oskaloosa, relatively close to home. From there, Evenhouse can remotely access doctors from around the state to help her decide her care. Recently, for example, a team determined surgery on her back could be performed locally. “For me to go to Iowa City, my whole day is gone,” she says. And often it takes up her husband’s day, too, because sometimes Evenhouse cannot drive herself home after treatment. So she appreciates the ability to access nationally renowned specialists in her cancers close to home. “It’s really an advantage for me because I can see the experts; I can get their input.”
But the Iowa Cancer Affiliate Network, which connects Mahaska Health to a group of medical specialists, is funded by federal grants that face immediate, drastic cuts.
The National Institutes of Health and the Centers for Disease Control and Prevention did not respond to requests for comment on this story.
The funding and job cuts at NIH and CDC are part of a broad government restructuring by the Trump administration, directed by Elon Musk’s cost-cutting effort known as DOGE. The cuts are being challenged in multiple court cases.
Fighting cancer on multiple fronts
Iowa has the country’s second-highest incidence of cancer — a rate that’s accelerating. Only Kentucky’s rate is worse. Doctors, hospitals and policymakers have been trying to fight the threat on multiple fronts, from attracting much-needed health care talent, to trying to increase screening, especially across the state’s vast rural areas, where patients tend to get diagnosed later with late-stage cancers. But various Trump administration cuts, from contract freezes to funding caps on research institutions, could hamper or shut down such efforts, potentially leaving Iowans further behind in their fight against cancer.
The cuts have already affected Bri McNulty, who was terminated from her public health job by the Trump administration earlier this month.
The 23-year-old had moved to Iowa City on a prestigious fellowship from the Centers for Disease Control and Prevention a year and a half ago to help an under-staffed public-health group trying to coordinate the state’s cancer-prevention efforts. Now McNulty will likely need to go back home to Williamsburg, Va.
A dream job
McNulty grew up fascinated by the bubonic plague and hoping to one day work at the CDC. “Everyone knows about the CDC; you hear about them all the time,” she says, ” I think they’ve always been amazing and I’ve loved learning about the work they do. Even in movies like Contagion. I think those also shaped my dreams of working for them.”
Bri McNulty does public health outreach at a conference in Iowa.
Liz Orton
hide caption
toggle caption
Liz Orton
After getting her biology degree, McNulty applied for the agency’s elite Public Health Associate Program, and she says she was one of 66 people chosen out of more than 1,000 applicants. McNulty was assigned to the Iowa Cancer Consortium, and although she knew no one and had no connections to Iowa City, she cried with joy when she received the news.
She moved in early November 2023, and advocated for vaccines to prevent cervical cancer, maintained databases tracking local disease trends, spoke at events and created educational materials promoting cancer screening.
Just after Valentine’s Day, McNulty, who’d just received a positive performance review, received an email “removing” her from her job. Other associates in her program were also among the 1,300 people cut from the CDC, and they received the same emails, criticizing their performance using identical language: “Unfortunately, the agency finds that you were not fit for continued employment because your ability, knowledge and skills do not fit the agency’s current needs, and your performance has not been adequate to justify further employment at the agency.”
Good performance, though
Kelly Wells Sittig, executive director of the state cancer consortium where McNulty worked, disputes the email’s assertions about McNulty: “We were really happy with Bri’s performance and growth.”
McNulty’s was one of only 5.5 full-time positions, Sittig says, and if the CDC program sponsoring her fellowship disappears, Iowans will lose opportunities to attract the health care talent the state so desperately needs. “We need young people coming to Iowa, working in our public health and health care workforce and our cancer control workforce,” she says.
Personally, McNulty feels disappointed and betrayed for where the cuts leave her options: Graduate school she can’t afford, or trying to find work in her field.
“Job hunting is also intense now because you have these extremely highly educated, wonderful people who all just got let go at the same time and are all looking for a new job, and it’s just going to be even more competitive than it was before.”
McNulty says the irony is that there is a lot of demand for public-health expertise like hers, yet she worries many people don’t understand the critical role federal funding plays in their lives. “People hear that there are cuts being made in CDC and their thought is, ‘Oh, they’re only getting cut from DC or Atlanta’ — and that’s just not true,” she says. “Federal employees, field workers, specifically, we are in your communities and doing the help that we can.”
Hoping to expand, not shrink
Losing talent is one of the outcomes that will hamper all health efforts, says Mark Burkhard, director of the Holden Comprehensive Cancer Center at the University of Iowa, where he is among a group of cancer control experts trying to better address Iowa’s increasing cancer rates statewide. “It’s not just the funding, it’s the talent they’re bleeding, because you can’t get anything done without the talent.”
Burkhard says he had been hoping to expand use of centralized cancer specialists to patients in rural hospitals around the state. Rural hospitals historically haven’t been able to offer the kinds of support, therapy, transportation assistance, nutrition guidance and other ancillary cancer-care services some larger urban hospital centers can offer. “Advancing that network to deliver quality care will be interrupted if we need to focus on our budgetary needs,” he says.
Retracting those supports would also affect the work of people like Dr. Daniel Kollmorgen, Mahaska Health’s surgical oncologist.
Kollmorgen grew up and worked in Des Moines for 25 years before moving to Oskaloosa two years ago, hoping to fight Iowa’s especially high rural cancer rate from a 25-bed hospital that serves 16 counties, mostly in the southeastern part of the state.
“The reason we have more Stage 3 and 4 cancers in rural Iowa is oftentimes due to lack of screening or lack of awareness, lack of transportation,” he says.
To address those inequities, Kollmorgen relies on databases funded by the National Cancer Institute that track local disease statistics, which allow him to identify and target hot spots for outreach promoting screenings, for example.
Kollmorgen also worked to expand his hospital’s reliance on the Iowa Cancer Affiliate Network, the teams of disease experts who help him with cancer patient Kathie Evenhouse’s care, for example, and reduce patients’ transportation burdens. “We review complex cancer cases at our small hospital on a regular basis, but we can Zoom in pathologists and specialty surgeons and others from around the state, and we’re starting to try to build that so we can bring that care to the patients locally,” he says.
Kollmorgen says the myriad federal funding cuts to research institutions and through federal contracts could reverse some of the progress the state has made. “When we don’t have these funds to help reach out to those patients, I think we’ll see the numbers continue their upward trend.”
Cutting with scalpel instead of a hatchet?
That poses a conflict for Kathie Evenhouse. She voted for President Trump and supports, in concept, federal spending cuts. But now she also sees the downsides.
“It is hurtful to the good things to cut it off — but I do think that we have to do something,” she says. But she says she wishes the cuts were — like surgery, more precise: “I think it could have been done with a scalpel instead of a hatchet.”
