(Originally published by JAMA Network on March 6, 2025.)

The role of state governments in safeguarding public health has rarely been more important than it is today. The 2025 presidential turnover appears to be ushering in an era of reduced federal involvement, leaving states with the responsibility of being the primary engine of public health protection at a time when they already face grave challenges. In his first few weeks in office, President Trump announced a planned withdrawal from the World Health Organization; terminated thousands of workers from federal health agencies; and paused health grants, health program funding, and public communications from health agencies.

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