Trump Administration Plan Would Strip CDC of Global Disease Work, Hand Control to State Department

While the world watches an active Ebola outbreak unfold in the Democratic Republic of Congo, the U.S. government is considering a major overhaul that would pull America's top disease experts out of the driver's seat on global health. The plan, proposed by the State Department, could reshape — and significantly weaken — the country's ability to detect and respond to dangerous outbreaks before they reach American shores.

The proposal targets the Centers for Disease Control and Prevention's role in PEPFAR, the President's Emergency Plan for AIDS Relief. Originally created under President George W. Bush in 2003, PEPFAR is credited with saving 26 million lives. The CDC currently manages a large portion of the program's roughly $2 billion annual budget, working directly with countries to set health priorities and direct funds to local health ministries and partner organizations.

Under the new plan, which is set to take effect October 1, the State Department would take over control of funding and decision-making. The CDC's current budget for this work would be replaced by a "fee-for-service" menu system, requiring individual countries to select and pay for specific types of CDC assistance — things like wastewater surveillance or laboratory support — from a tiered pricing structure.

What This Means for Global Health Programs

Health experts warn the consequences could be severe. The CDC currently maintains about 1,500 overseas staff members, supports 1,700 laboratories, and runs a program that trains local disease detectives for outbreak response. The proposed changes could lead to the closure of roughly one-third of its 60 country offices within three years, according to officials with knowledge of the programs.

More than 12 million people receiving HIV treatment supported by CDC funds could face disruptions. Dr. Michele Montandon, who led the CDC's team on mother-to-child HIV transmission until she was laid off in August, put the stakes plainly.

"This will completely destabilize H.I.V. work abroad. We've seen service disruptions, deaths and babies born with H.I.V. after shuttering U.S.A.I.D., and we can expect more to come if C.D.C. is also shut out of this work."

Dr. Montandon also questioned the logic of the fee-for-service model itself, saying, "Global health response should be based on need and the threat level, not whether a government signed up for a tiered service package in advance."

The pricing in the proposed menu is oddly specific. For example, the seventh item on a 34-item list — "integrated country surveillance for emerging and zoonotic infectious diseases" — is priced at $105,372 per year for the lowest tier, $150,190 for the second tier, and $418,898 for the highest tier, intended for large, complex countries like the Democratic Republic of Congo. Critics say that cash-strapped governments will simply skip services they cannot immediately justify, leaving dangerous gaps in outbreak detection.

"They're going to be hard-pressed to make choices when they can think about other things they can spend the money on," said John Blandford, who directed the CDC division overseeing this program from 2013 to 2016 and later led CDC country offices in Vietnam and South Africa before retiring last year.

CDC Experts Say They Were Left Out of the Process

Adding to the frustration among public health professionals is how the plan was introduced internally. CDC staff were not consulted before the proposal was presented to them on May 6. Hank Tomlinson, director of the CDC division overseeing global HIV work, told staff on a recorded call that he had first seen the document outlining the changes on May 1 — just five days earlier.

"We didn't have input into them beforehand," Tomlinson said on the call, noting that over the following weekend, he and others managed to get a few "serious issues" addressed.

Some CDC scientists working overseas described what they called a "rent-an-epidemiologist" approach as demeaning to their expertise. Dr. Atul Gawande, a former head of global health at the U.S. Agency for International Development and a professor at Harvard Medical School, was direct about what the plan signals for the agency's future.

"This is the end of autonomy and independence and long-term capacity at the C.D.C. for work in global health."

Blandford echoed that concern, warning that the State Department lacks the specialized knowledge needed to manage these programs effectively. "It's contrary to the U.S. interest to not maintain a large, substantial C.D.C. program in these countries," he said, adding that the State Department "does not have the expertise or the capacity to actually know what they should be doing in these programs."

Real-World Impact: Haiti and Beyond

The effects of earlier funding cuts under the Trump administration are already being felt. The dismantling of the U.S. Agency for International Development last year led to sharp drops in the number of people newly tested, diagnosed, and treated for HIV globally. The number of children who started HIV treatment has fallen by 15 percent, according to a June report from the Clinton Health Access Initiative.

In Haiti, the sudden halt in U.S. aid forced some clinics to close entirely. The CDC contributes $112 million — roughly 80 percent — of Haiti's total HIV budget. Dr. Alain Casséus, who leads infectious disease work at Zanmi Lasante, the largest healthcare provider in Haiti outside of the government, warned that further reductions would be catastrophic. Political instability already prevents many patients from traveling to seek care, he said, adding, "In areas where that's not possible, we will see probably deaths piling up."

PEPFAR funding has also been delayed this year. The Trump administration held back money already appropriated by Congress for months before ultimately releasing only $1.3 billion of the expected funds. Dr. Thomas Frieden, who directed the CDC under President Obama, said the new plan would "basically destroy PEPFAR."

The broader shift in U.S. foreign aid policy moves away from disease-specific programs entirely, replacing them with bilateral government deals that experts say carry no measurable public health goals. Dr. Gawande described the new approach this way: "Instead, they're just individual transactional deals with no larger goal or purpose in mind."

The State Department defended the plan. Spokesman Tommy Pigott said in a statement: "The State Department and Health and Human Services are working together to preserve the C.D.C.'s critical capabilities while modernizing how foreign assistance is delivered. The facts are straightforward: The State Department expects C.D.C. overseas funding to increase — not decrease — under the America First Global Health Strategy, and no C.D.C. offices are being closed because of State Department decisions."

Andrew Nixon, a spokesman for the Department of Health and Human Services, added: "What is underway is a modernization of a fragmented system that for years tolerated duplication, overlapping investments and poor coordination across agencies."

Public health veterans remain unconvinced. The CDC's network of country offices has spent decades building relationships with foreign health ministries — connections that become essential during emergencies. Blandford said those relationships carry real value that a transactional model cannot replicate. "I really do worry that those relationships are not being respected in terms of what the payoff is when you move to a menu approach and basically treat C.D.C. as just a contractor to be utilized."