Trump Administration’s New Plan Threatens CDC’s Global Health Role

Even as the world races to contain the deadly Ebola epidemic in the Democratic Republic of Congo, the Trump administration is moving ahead with a plan that could significantly reduce support for programs that detect and stop such outbreaks.

The State Department‑proposed plan seeks to overhaul the Centers for Disease Control and Prevention’s work on a landmark global HIV program that also helps countries manage surveillance for emerging diseases, strengthen laboratory networks, and support childhood immunizations.

If implemented on Oct. 1 as scheduled, the plan would effectively remove the agency from overseeing many global health programs and shift control of most funds and decisions to the State Department.

The changes could sideline the nation’s leading global‑health experts and potentially close about a third of the CDC’s 60 overseas offices within three years, according to officials familiar with the programs.

“This is the end of autonomy, independence, and long‑term capacity at the CDC for work in global health,” said Dr. Atul Gawande, former head of global health at USAID and Harvard Medical School professor.

The proposal aims to diminish the agency’s authority in the President’s Emergency Plan for AIDS Relief (PEPFAR), a program credited with saving 26 million lives since its creation in 2003. Before 2025, USAID managed more than half of PEPFAR’s budget, with the CDC handling much of the remainder.

The shift may jeopardize the health of the more than 12 million people on HIV treatment supported by CDC funds, said Dr. Michele Montandon, who led the agency’s mother‑to‑child HIV transmission team until her layoff in August.

“This will completely destabilize HIV work abroad,” she said. “We’ve seen service disruptions, deaths and babies born with HIV after shutting down USAID, and we can expect more if the CDC is also excluded.”

The State Department asserts the plan will not adversely affect the CDC or its overseas work.

“The State Department and Health and Human Services are working together to preserve the CDC’s critical capabilities while modernizing how foreign assistance is delivered,” State Department spokesman Tommy Pigott said. “The facts are straightforward: the State Department expects CDC overseas funding to increase—not decrease—under the America First Global Health Strategy, and no CDC offices are being closed because of State Department decisions.”

Health and Human Services spokesperson Andrew Nixon added, “What is underway is a modernization of a fragmented system that for years tolerated duplication, overlapping investments and poor coordination across agencies.”

Under the current system, the State Department typically provides the CDC with a budget of about $2 billion each year, which the agency then uses to set health priorities with partner countries and allocate funds to ministries and organizations.

The new plan replaces this budget with a “fee‑for‑service” menu, requiring countries to select and pay for specific CDC assistance, such as wastewater and environmental surveillance.

“Global health response should be based on need and threat level, not whether a government signed up for a tiered service package in advance,” Dr. Montandon said.

More than a dozen current and former CDC and State Department employees anticipate that, for financial or political reasons, many countries will opt for minimal services, forgoing investments in areas with less immediate impact but still important. Many spoke anonymously out of fear of retaliation.

They warned that the transactional model could further destabilize relationships with foreign governments, unravel public‑health programs, and increase Americans’ vulnerability to infectious‑disease threats.

“It’s contrary to U.S. interest not to maintain a substantial CDC presence in these countries,” said John Blandford, who led the State Department’s CDC division from 2013 to 2016 and oversaw CDC offices in Vietnam and South Africa before retiring.

Blandford added that the State Department “does not have the expertise or capacity to know what they should be doing in these programs.”

Over the decades, PEPFAR’s work extended beyond HIV to support infrastructure and personnel essential for other public‑health activities, often with little additional overhead. The funds helped sustain roughly 1,500 overseas employees, 1,700 labs, and a program that trains local disease detectives for outbreak response.

For example, PEPFAR built skills in diagnostics, contact tracing, and data analysis that helped countries combat COVID‑19. More recently, South African researchers rapidly decoded the genetic sequence of the hantavirus that caused an outbreak, and the CDC office in Congo is actively engaged in the current Ebola response.

CDC officials have cultivated trust with health ministries, relationships that become crucial during emergencies, Blandford said. “I worry those relationships are not being respected when you move to a menu approach and treat the CDC as just a contractor.”

Some CDC scientists stationed abroad described the State Department’s “rent‑an‑epidemiologist” proposal as demeaning. Neither they nor their Atlanta leaders were consulted before the plan was presented on May 6.

In a call that day, CDC global HIV division director Hank Tomlinson said he first saw the document outlining the changes on May 1 and had no input beforehand. He added that over the weekend his team managed to raise a few “serious issues.” (The New York Times obtained a recording of the call.)

The Trump administration’s dismantling of USAID last year led to sharp declines in new HIV testing, diagnosis, treatment, and preventive drug use. According to a recent Clinton Health Access Initiative report, the number of children beginning treatment fell by 15 percent.

In Haiti, the abrupt aid halt forced some clinics to close, leaving patients without HIV treatment. The CDC contributes $112 million—about 80 percent—to Haiti’s HIV budget, and any reduction could jeopardize more clinics, said Dr. Alain Casséus, who leads infectious‑disease work at Zanmi Lasante, Haiti’s largest health‑care provider.

Political instability further prevents people from traveling to open clinics, Casséus warned, adding, “In areas where that’s not possible, we will see deaths piling up.”

This year, the administration delayed transferring PEPFAR funds to the CDC by months, holding back money already appropriated by Congress and eventually disbursing only $1.3 billion. Now, the new plan will “basically destroy PEPFAR,” said Dr. Thomas Frieden, former CDC director under President Obama.

The administration is shifting away from disease‑specific programs like PEPFAR toward bilateral agreements with governments, often with strings attached.

These new agreements do not set goals for eradicating polio, reducing HIV and tuberculosis, or improving child‑mortality rates, Dr. Gawande said. “Instead, they’re just individual transactional deals with no larger purpose.”

The CDC’s new service model is highly specific. For example, the seventh item of 34 on the menu—“integrated country surveillance for emerging and zoonotic infectious diseases”—costs $105,372 annually for the lowest tier, $150,190 for the second tier, and $418,898 for the highest tier.

Any country receiving U.S. aid must pay for minimal administrative support, and those receiving more than $125 million must purchase a minimum package of services, including population health surveys and training for disease detectives, but not integrated surveillance for emerging diseases. Only nine countries with U.S. agreements meet that threshold.

Even those nine may skip support for polio eradication, emergency vaccination, and other menu items. “They’ll be hard‑pressed to make choices when they have other spending priorities,” Dr. Blandford said.

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