BALTIMORE — Dr. Theodore “Jack” Iwashyna was in Chicago this week for a medical conference, but his thoughts weren’t far from his work at the Hopkins research and treatment facilities that now face federal funding cuts.

“Next Monday, I’ll be back at Bayview (Medical Center), taking care of patients with sepsis, bringing the research to the bedside,” said Iwashyna, a critical care physician and researcher at the Hopkins medical and public health schools.

“But it’s very challenging to maintain my focus on science when it feel like a small group of people without an electoral mandate are trying to destroy the public-private partnership that has made the U.S. biomedical system the envy of the world, and why so many people from around the world come here to get care.”

He is among the researchers working under a cloud of uncertainty these days as the Trump administration, through adviser Elon Musk and his Department of Government Efficiency, slashes the federal spending that Hopkins, more than any other institution, depends on to understand and treat ailments from cancer to Alzheimer’s to traumatic brain injuries and beyond.

Hopkins President Ron Daniels, in a letter recently posted on the university’s website, warned of “a fast and far-reaching cascade of executive orders and agency actions” that “may result in a significant reduction in research work.”

Any cuts in federal funding will have an outsized effect on Hopkins, which comes in first of all universities in federally funded research — and by extension, Baltimore and Maryland, where it is the city and state’s largest largest private employer.

From the salaries it pays to the local businesses that construct its buildings or stock its supply closets, Hopkins says it accounts for more than $15 billion in economic output in the state

“It is difficult to overstate the significance of Johns Hopkins University as a cornerstone of Maryland’s economy,” Carter Elliott IV, spokesman for Gov. Wes Moore, said in a statement to The Baltimore Sun.

“As one of the state’s largest employers, Johns Hopkins is not only a vital source of jobs but also a powerful engine for economic growth, innovation, and technological advancement,” Elliot said. “Its influence extends far beyond Baltimore, shaping industries across the state and driving Maryland’s reputation as a global leader in research, healthcare, and education.”

Saying the administration “strongly opposes these funding reductions and the devastating impact they will have on Marylanders,” Elliott decried the “immediate and profound” consequences of funding cuts.

“Students, faculty, and researchers at Johns Hopkins will bear the direct burden of these reductions, but the ripple effects will extend far beyond campus.”

The prospect of losing some of its federal money, which Daniels said accounts for nearly half of JHU’s incoming funds, comes at a time when the state is facing a budget deficit. That is expected to be exacerbated by cuts in the federal workforce, a sizeable portion of which lives in Maryland.

Already, Hopkins researchers have been hit by the dismantling of the USAID agency, which has also led to layoffs and cutbacks at the multiple global humanitarian groups that are headquartered in Baltimore.

One Hopkins researcher, who asked not to be named because of the sensitivity of the situation, said they expected to be let go soon now that their USAID-funded project on a new regimen to treat children with an infectious disease has been terminated.

“It’s been hard to sleep for many of us for several weeks now,” the researcher said. “Everyone that works in global health does this because we want to make the world a better place. We want to save lives, and we believe in the power of science. We’re concerned how that work will be funded now.”

Hopkins receives more money from the National Institutes of Health than any other institution, and has joined litigation challenging cuts to the Bethesda-based agency’s fund. (JHU, including its Applied Physics Lab, also tops the list of the National Science Foundation’s annual survey of federally financed higher education research and development expenditures at more than $3.3 billion for fiscal 2023.)

Hopkins received more than $1 billion from the NIH in fiscal 2024, according to a court filing by Laurent Heller, the university’s executive vice president for finance and administration. A federal judge has temporarily blocked those cuts.

The federal grants allow Hopkins to conduct “critical and cutting-edge medical research, which millions of Americans benefit from and depend on,” Heller wrote. There are currently 600 NIH-funded clinical trials currently underway, he wrote, and funding reductions would have “immediate and devastating” consequences.

In its own filing in support of the legal action against the NIH cutbacks, the City of Baltimore called Hopkins “a cornerstone institution.”

“A drastic reduction in funding would significantly harm the economy of Baltimore City, a majority-minority urban area that is already fiscally disadvantaged, and it would derail the incredibly important medical research performed by a world-class institution,” the brief said.

Iwashyna currently has NIH grants supporting his research, including one to help patients recover from the prolonged effects of pneumonia. He said he believes Trump administration statements on cutting fraud and waste is “a distraction,” because there was never a systematic review of programs to see if there actually could be cost savings.

“Was that ever a good faith rationale?” he said.

Daniels’ letter said the scope of the cutbacks, and how the various branches of the university will address them, remains to be seen.

“We have little choice but to reduce some of our work in response to the slowing and stopping of grants and to adjust to an evolving legal landscape,” he wrote. “There are difficult moments before us, with impacts to budgets, personnel, and programs. Some will take time to fully understand and address; others will happen more quickly.”

But, Daniels noted, the loss of foreign aid funds has led to the end of most of the programs funded by USAID, which totaled more than $800 million, at Jhpiego, which focuses on women’s health; the Bloomberg School of Public Health’s Center for Communication Programs; and the School of Medicine.

“Because of these funding terminations, we are in the process of winding down USAID grant-related activities in Baltimore and internationally,” he wrote, “including impactful work to provide maternal and infant care, prevent the spread of diseases, and provide clean drinking water.”

For Hopkins, the cuts hit close to the bone. Research is baked into the school’s DNA, which as Daniels noted in his letter, is the nation’s first research university. Approaching its150th birthday next year, the school was founded to provide what was then deemed lacking in the U.S. educational landscape: “a place where research would flourish and knowledge was expanded,” according to the book “Leading the Way: A History of Johns Hopkins Medicine,” by Neil A. Grauer.

Over the years, Grauer writes, “the federal government’s influence was pervasive.”

He notes that the Hopkins medical school received more than $2.6 million in federal grants in 1947, a figure that grew to $7 million a decade later and $28 million by 1968.

Today, with Hopkins’ NIH grants exceeding $1 billion, finance officials are working closely with deans to plan for how to continue its work even amid whatever funding cuts are on the way, Daniels said

“Research is our hallmark,” he wrote, “and its essential instruments — freedom of inquiry and expression, academic excellence, marshaling of evidence, rigorous and open debate, and an embrace of diverse backgrounds, experiences, and viewpoints — form our core values.

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