NEW YORK — A federal program responsible for coordinating health care for people sickened by the Sept. 11 attacks and the toxic conditions at Ground Zero remains short-staffed as the 25th anniversary of the attacks is observed. The World Trade Center Health Program had 93 employees at the beginning of 2025 and 83 by the spring, amid federal layoffs, buyouts, hiring freezes and other efforts to reduce the government workforce. Although two rounds of layoffs were later reversed, advocates say departures and administrative disruptions have continued to affect the program’s work. The program oversees medical monitoring and treatment for more than 140,000 first responders and survivors with conditions linked to their exposure, including respiratory diseases and cancers. Its staff generally do not provide direct patient care; they manage contracts, enrollment, research grants and decisions about whether illnesses qualify for coverage. The Department of Health and Human Services authorized the program in April to fill 37 vacant positions. But Ben Chevat, executive director of Citizens for the Extension of the James Zadroga Act, a responder and survivor advocacy group, said only four people had been hired so far, with additional candidates under consideration. The White House said nearly 40 positions had been filled and that HHS Secretary Robert F. Kennedy Jr. had reversed earlier cuts. HHS did not respond to a request for additional details. “Those cuts were reversed, but the systemic problems were not fixed,” Chevat said. Dr. David Prezant, chief medical officer for the New York City Fire Department, said the program’s clinical work is largely continuing, but rebuilding the workforce is proceeding slowly. He estimated that the program is replacing only two to four employees every few months, a pace that could take years to restore lost capacity. The staffing shortage has reportedly slowed contracting and decisions on coverage. Requests for program changes requiring federal approval have also remained unanswered for months, according to a person familiar with the program’s operations who was not authorized to speak publicly. Leadership uncertainty added to the strain. Dr. John Howard, who has led the program since its creation, was nearing the end of his six-year term without confirmation that he would remain. Kennedy reappointed Howard this week, before the term was scheduled to expire in November. The continuing health burden is especially visible within the FDNY. A city Fire Department report released ahead of the anniversary found that more than 10,000 department members had been certified with a physical health condition related to 9/11. Prezant and other clinical leaders have sought recognition for additional illnesses, including ischemic cardiovascular disease, systemic autoimmune diseases and cognitive and memory impairments. The government rejected the cardiovascular disease petition in June; an appeal and separate petitions involving the other conditions remain pending. “The time for them to evaluate conditions has and continues to be a very long process,” Prezant said, adding that delays can mean patients are denied treatment. The program also distributes about $20 million annually in research grants on 9/11-related illnesses. Chevat and Prezant said staffing problems have disrupted that work, which helps doctors track emerging diseases, evaluate treatments and determine whether additional conditions should be covered. A planned transition between outside contractors that help administer care is adding to concerns. Chevat said the depleted federal workforce may not have enough capacity to oversee the change safely. Rep. Andrew Garbarino, a New York Republican who pushed the administration to reverse the earlier cuts, said restoring positions and reappointing Howard were important steps but that the program still needs adequate staff and resources. Congress has provided the program with permanent funding, but advocates say funding alone does not ensure that responders and survivors receive timely decisions and care.