Interview with Dr. Scott Harris, State Health Officer, Alabama

TFAH: Let’s begin by setting the stage. Would you briefly describe your department and its priorities?

Dr. Harris: We are the governmental public health agency for the state. A lot of what we do is core public health, including immunizations and disease control. We care a lot about population health, they are not our largest programs, and we get federal funding to support those programs, but they are very important to us.

TFAH: What percentage of your department’s budget is supported by federal funding?

Dr. Harris: We are about two-thirds federally funded. If you also consider clinical revenue, mostly through Medicaid, we are about 90 percent federally funded. State money accounts for less than 10 percent of our overall budget.

TFAH: How does federal funding and expertise help your state address public health issues? Are you concerned about not being able to call on federal expertise in ways you have been able to in the past?

Dr. Harris: Yes, that’s a big concern for us. We have great people working in public health, but we generally don’t have subject matter experts on many of the issues that we are called to work on. We work on the front lines to implement policy that gets pushed down from the feds. We rely on them very heavily for guidance and instruction. Whether we are talking about congenital syphilis or avian influenza or any other topic, we certainly need the world’s experts who reside at CDC or sometimes at other federal agencies to help us.

TFAH: What program/staffing cuts has your department had to make or anticipate having to make due to federal funding recissions?

Dr. Harris: The cuts that we learned about in April amounted to about a $190 million hit to our agency that happened overnight and without any warning. We came to work on a Tuesday morning and found out that a number of grants had been taken away the day before, which meant that we had about 140 FTEs [full- time equivalents] showing up for work that we no longer had a funding source for their salaries. In many instances we were able to find places for these employees to move to—other grants or other programs—but we did have some reductions-in-force and the work that was being done had to stop because programs were no longer funded. These were grants that we first received as part of COVID funding, but they weren’t just COVID grants. They were grants that applied to epidemiology, laboratory capacity, and infection control. For example, we were working with nursing homes on infection control practices; we worked with hospitals around the state to help train their teams on infection control. These were all appropriate types of work that we were approved to do, and all that work had to stop.

TFAH: Are you worried you will be less prepared for the next public health emergency due to these cuts?

Dr. Harris: We will be less prepared. I don’t think there’s any question about that. Most of what we do in public health is behind the scenes. We are doing things to keep people healthy that the public doesn’t know or think about. People go out to eat and don’t worry about getting sick or drink tap water and aren’t concerned about it being unsafe. The reason for all of these things is public health. When we lose the ability to do these things because our funding goes away, there will be negative consequences.

We are also worried about emergencies. Human history has shown us that there is going to be something coming down the track. It’s inevitable that we will need to have another large-scale response. We can’t predict what it will be. Without people working here to plan for these events, we are not going to be as well prepared.

TFAH: In addition to your Alabama duties, you are the current president of the Association of State and Territorial Health Officials (ASTHO). In this role, what concerns or solutions are you hearing from other public health officials?

Dr. Harris: State and territorial health officials understand the importance of using science for population health. That’s what we do and although we all work in different states and every jurisdiction has different priorities and different political realities, there’s not a lot of disagreement about what works. We believe it’s challenging when science isn’t the most important criteria in making health recommendations. A lot of people are worried about what will happen with immunization guidance, for example. A lot of us are unsure what to make of a new agency that is going to move programs that were traditionally housed at CDC.

You would think that it will need to use the subject matter experts who were once employed at CDC. That’s who the subject matter experts are, but it’s really unclear. We don’t know if those people are still employed; we don’t know what funding is going to be attached to specific programs.

We don’t know what the future is going to look like. We wish we had more communication from the feds and more opportunities for our input. We understand frontline public health and how dollars can be spent most efficiently. We understand what programs will and won’t work in our own jurisdictions.

TFAH: Going forward, will states need to be more self-reliant in addressing the public’s health?

Dr. Harris: We have statutory responsibilities in Alabama that my department has to carry out, so we are always going to do that work. But it’s not even possible to think that my state is going to replace the amount of federal funding that seems to be at risk.

Yes, states are going to need to be more self- reliant, but what they are going to be able to do is going to be diminished.

TFAH: What’s at stake? What are your concerns regarding how budget cuts and other changes are going to affect health in Alabama?

Dr. Harris: At the most fundamental level, it’s the operations of the department. At this point, we’re not sure if funding will be available or when it will be available. It’s almost impossible for any agency to plan in that kind of an environment.

In terms of our actual public health programs, our population health programs were the ones getting the most federal money, and they are not necessarily statutorily required by the state. This is important work, and I believe we should be doing it, but if we lose two- thirds of our funding, we are going to have to focus on our core county health department functions.

We have wonderful men and women who are public health professionals who are passionate about what they do. They really want to make a difference, they want to help their community, and they do. If we lose those people because we can’t afford to pay them, there is going to be less good accomplished than if they were still here.

TFAH: Are you worried that health risks and outcomes will worsen?

Dr. Harris: Well, clearly if we throw less resources at a problem, we are going to get more of that problem. An illustration is tuberculosis programs. Tuberculosis programs are famously on those boom-or-bust funding cycles. You have a tuberculosis outbreak, it gets a lot of attention and funding, you handle that outbreak. Soon afterwards people say, “There isn’t any tuberculosis; why are we sending money to that program?” And so, you are back to square one with the next outbreak.

TFAH: What’s your message about public health for your state legislators?

Dr. Harris: Public health is for everyone in our state. The public health system needs sustainable, predictable funding for us to be able to keep all Alabamians safe and healthy. Like any large organization, you need some degree of predictability in order to make things function. We need people to understand the importance of what we do and why it’s a great investment to fund public health in an appropriate way.

TFAH: Any closing thoughts?

Dr. Harris: We fully expect that when there’s a transition at the national level there will be changing priorities. That’s how our system works. The new administration gets to set the agenda. We respect that and want to work with that. But what we need is something orderly, and what we would love is for someone to consult with us.

This interview was conducted in August 2025. It has been edited for length and clarity.

Read TFAH’s full report Public Health Infrastructure in Crisis: HHS Workforce Cuts, Reorganizations, and Funding Reductions: Impacts and Solutions.