The CDC at a Crossroads: Budget Cuts, Public Health, and the Growing Threat of Infectious Diseases

CDC

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The CDC has historically been the backbone of US public health, delivering essential resources, guidance, and disease surveillance to state and local health departments. However, as the agency faces workforce reductions and funding cuts, public health experts warn about the unsettling future of infectious disease preparedness, response efforts, and access to vital health care programs. The consequences of these changes could be catastrophic, jeopardizing our safeguards against outbreaks and public health crises.

During a recent media briefing by SciLine, public health researchers and policy experts from leading institutions discussed the challenges ahead, the consequences of reduced federal support, and the crucial role of the CDC in ensuring national and global health security. With ongoing outbreaks of measles, avian flu, and other emerging infectious diseases, the agency’s ability to respond swiftly and effectively is more important than ever.

Speakers

• Ann Keller, PhD, professor of Health Politics at the UC Berkeley School of Public Health.
• Beth Resnick, DrPH, MPH, assistant dean for practice and training; practice professor, Johns Hopkins Bloomberg School of Public Health, department of health policy and management. She is also the principal investigator of the Consortium for Workforce Research in Public Health (CWRPH), University of Minnesota.
• Jennifer Nuzzo, DrPH, SM, BS, is the founding director of Pandemic Center, Brown University School of Public Health. Professor of epidemiology at Brown University.

The Role of the CDC in Public Health

The CDC is not just an advisory body but the nation’s public health infrastructure, supporting state and local health departments through funding, workforce development, technical assistance, and real-time disease surveillance. This infrastructure is crucial for responding to outbreaks, preventing chronic diseases, addressing health disparities, and ensuring safe public environments.

According to Resnick, the CDC’s impact extends beyond infectious diseases. The agency also plays a pivotal role in mental health, tobacco control, school health programs, environmental safety, and occupational health. Reducing funding would weaken the nation's ability to combat outbreaks and erode these essential services that protect public health daily.

Challenges in Infectious Disease Response

Responding to novel infectious diseases is inherently difficult because science must evolve rapidly to keep up with new threats. Unlike long-established health recommendations—such as the dangers of smoking or the benefits of seat belts—public health guidance on emerging diseases is based on evolving, sometimes incomplete evidence.

“It’s difficult to try…to try to write good guidance under those circumstances,” Keller said. “And if you fold in partisanship, politics, and divisiveness over what people think we should do, it makes that domain even harder.”

The experts emphasized that during disease outbreaks, the CDC must quickly analyze data, develop guidance, and communicate findings to the public. However, this process is fraught with challenges, including political interference, misinformation, and the expectation that the agency should have immediate, definitive answers. The experts pointed out that rather than viewing updates to CDC guidance as failures, they should be recognized as signs of scientific progress and transparency.

One key concern was the erosion of public trust in public health agencies, exacerbated by misinformation and inconsistent messaging. If the CDC’s role in guiding the nation’s response is diminished, state and local health departments may struggle to coordinate a unified response to outbreaks, leading to fragmented and less effective public health interventions.

“One of the things that happens is that if the organization puts out guidance and then something happens, [like] a new variant comes along, and the organization has to update its guidance,” Keller said. “[The organization is] often criticized as acting too quickly. If the organization takes…some amount of time to try to validate the information that it has, the data that it has before it issues guidance, it is often criticized for being slow and bureaucratic and not sharing with the public what it knows. Sometimes, even when organizations…professional public health organizations are trying to validate information, they can be accused of cover-up.”

Budget Cuts and the Impact on Public Health

While proposed cuts to the CDC’s budget are often framed as cost-saving measures, experts caution that cutting public health funding often leads to far greater financial and human costs in the long run. Resnick pointed out that public health spending follows a cyclical pattern: funding surges during crises (such as Ebola, Zika, and COVID-19) but dwindles once the immediate threat subsides.

This inconsistent investment leaves the country vulnerable when the next outbreak inevitably occurs. Public health experts warned that if cuts proceed as planned, the US could face weakened disease surveillance, reduced vaccination efforts, and staffing shortages that will impact everything from emergency preparedness to chronic disease prevention.

“What I think is happening now with the Trump administration trying to severely cut CDC staff and potentially CDC budgets is something that will, is something that could…very meaningfully erode CDC’s ability to do its normal functions, to monitor what’s happening with infectious diseases, to collect data about them, to analyze that data, to provide the best information they can come up with, to put that information into the hands of communities and individuals so they know how to protect themselves during a pandemic,” Keller said.

One of the most alarming consequences of these cuts is the potential reduction in funding for state and local public health departments, which rely heavily on CDC support. More than 80% of the CDC’s domestic budget goes directly to these departments, ensuring they have the resources necessary to manage outbreaks and provide preventive care. Without these funds, underserved communities—especially rural and low-income populations—will be hit hardest.

“In addition to the funding it provides in cases of surge protection, they might give staff to local and state health departments that can help in that surge capacity,” Resnick said. “They also provide tools and guidance, technical assistance, data analysis, research, and guidance. It’s a huge support to our state and local systems.”

The Growing Threat of Measles and Avian Flu

Two immediate public health threats—the reemergence of measles and the continued spread of avian flu (H5N1)—highlight the CDC’s critical role.

Measles cases are rising across multiple states, with recent outbreaks leading to the first US measles-related death in over a decade. In 2019, the US narrowly avoided losing its measles elimination status, and experts warn that the country is even more vulnerable now due to declining vaccination rates and weakened public health infrastructure.

Meanwhile, the H5N1 avian flu continues to infect birds, mammals, and farm workers, raising concerns about its potential to evolve into a virus capable of human-to-human transmission. While H5N1 has not yet shown sustained human spread, the virus is constantly mutating, and proactive monitoring is essential.

Keller’s major concern is the protection of farm workers who come into close contact with infected livestock. Many of these workers lack legal documentation and may hesitate to seek medical attention, increasing the risk of an undetected outbreak. Public health officials stressed the importance of outreach, education, and access to protective measures for these vulnerable populations.

“I think putting the fear in the hearts of people who are trying to do this work is not a great situation to try to give them information they need to come forward if they have symptoms, to give them information about how to protect themselves in the workplace, or to give them critical information that this is a really good season to get flu vaccine so that there’s less likelihood that this virus can mutate with seasonal influenza,” Keller said, “And that, to me, is one of the alarming things about trying to manage H5N1 in our particular climate.”

The Risks of Workforce Cuts

Beyond budget reductions, eliminating federal public health positions is another critical issue. Nuzzo highlighted the firing of Epidemic Intelligence Service (EIS) officers—highly trained disease detectives who are vital in tracking, investigating, and responding to outbreaks. She said, “EIS is a program that trains the best and the brightest, but trains them through experiential efforts, which means they work in our communities. In many cases, they’re the ones who are doing the outbreak investigations.”

Cutting these positions weakens real-time surveillance, outbreak investigations, and data analysis, all essential for early detection and containment of emerging diseases. Additionally, the loss of skilled personnel reduces the nation’s ability to analyze public health trends, prepare for future pandemics, and coordinate international disease responses.

Nuzzo worries about the chaos of the cuts. “When we talk about cuts, we’re often talking about budget. It’s also about the chaos. And we are seeing the letting go of whole categories of federal health personnel. That is detrimental, not just in our federal agencies, but also in the state and local communities [where] many of these individuals work. I don’t think people realize how much our communities rely on not just federal dollars and resources but also federal personnel who are working in our communities, supplementing our communities' workforce to make the systems work and keep us safe. Just letting those people go means fewer people are minding the shop in our communities. And that in and of itself is detrimental.”

The chaos also leads to uncertainty. “What is also detrimental is the chaos that we’re seeing, which is that nobody knows what’s coming next or how to interpret what is happening,” Nuzzo said. “And so you’re seeing a lot of paralysis that’s happening, a lot of concerns about whether functioning systems are going to be able to continue to function, whether there’s going to be funding or people to power those systems in the coming days.”

Nuzzo continues, “Remember, this is also happening on the backdrop of a public health workforce that has been systematically decimated over time. We started the COVID-19 pandemic with a dearth of personnel. Not enough people in health departments worked at the start of the COVID-19 pandemic. And that was partly because of budgetary declines due to the economic downturn of 2008 and just kind of a failure to replenish the workforce. We saw how incredibly challenging that was. And we suddenly saw a scrambling and billions of dollars spent to try to hire temporary workers to deploy to health departments and backfill them for the activities needed during the pandemic. Well, that’s not a great way to build a workforce. Once the federal money goes away, you see an erosion of that capacity.”

Surveillance, Transparency, and Public Trust

One key concern is the impact of CDC funding cuts on disease surveillance. Effective public health response relies on real-time data collection, and the CDC’s surveillance infrastructure includes:

1. Case tracking (e.g., counting confirmed measles or flu cases)
2. Wastewater surveillance (to detect early signs of infectious disease spread)
3. Environmental monitoring (e.g., air sampling for biothreats)

Without adequate funding, critical gaps in disease monitoring could emerge, reducing the nation’s ability to identify and contain outbreaks before they escalate.

Keller emphasized the need for transparency in CDC communications. While the public often expects immediate, definitive answers, disease response is evolving. When public health officials adjust guidance based on new data, it should be considered scientific rigor, not a failure.

Journalists play a crucial role in helping the public understand the complexities of public health decision-making. Rather than portraying changes in guidance as signs of CDC incompetence, the experts urged the media to highlight how science evolves and why flexibility in public health response is necessary.

The Path Forward

Public health officials and researchers stressed the need for continued investment in public health infrastructure, including:

• Maintaining and expanding the public health workforce
• Ensuring access to vaccines, screenings, and preventive care
• Strengthening disease surveillance and early warning systems
• Communicating scientific findings transparently and effectively

Nuzzo said she thinks highlighting the ramifications of the loss of these cuts. “I think if I had just to make a plea for going forward, I think making it real for everyday Americans and what it means for their lives. Because I think a lot of people who aren’t in the D.C. orbit or paying attention to the, these policies, hear it in the background and they’re like, “Ah, federal jobs. I mean, companies let go of people all the time.” But [explain] the forensics of what that means for your communities. Because I think that’s where the issue became quite clear: cutting the federal workforce isn’t just affecting blue states. Republican states [are starting] to see, “Oh, this affects us, too, as it turns out.” There are [many] federal workers in our states. For instance, I think some of the reporting we saw on what the USAID cuts mean for American farmers. I don’t think people understand how these programs touch their everyday lives.”

As new infectious disease threats continue to emerge, public health leaders warn that cuts to the CDC and related agencies will not only harm vulnerable populations but also increase overall healthcare costs, strain emergency departments, and put the entire country at greater risk.

Despite these challenges, there is hope that state and local efforts, private sector engagement, and scientific advancements can help mitigate some of the damage. However, experts emphasized that federal leadership is crucial to ensuring a coordinated, effective public health response that keeps the nation safe.

Resnick said that by firing the probationary employees, the federal administration is “getting rid of the new ones at lower salary rates. So even from a budgetary perspective, it doesn’t make sense to get rid of the best and brightest, youngest people that would be costing you less than some of your other employees.”

However, if the public and health care workers only focus on the budget cuts, Resnick reminds the listeners that “this is more expensive when we have to deal with the impact, the cost, and the long-term effects of some of these cuts, and what that would mean in our health care burdens and costs for our society.”

Keller brings one final thought about the federal worker stereotype: “We have a stereotype that bureaucrats are lazy or unproductive or in the bureaucracy because they’re not as competitive as people in the private sector. Otherwise, why wouldn’t they be in the private sector getting those higher-paying jobs? That stereotype is so inaccurate. I’ve never been researching people in the federal workforce my entire career, and I find that what draws them into the federal workforce is the mission and the dedication.”

Keller refutes that stereotype. “One of the things we see, especially in public health during both routine times and pandemics, is that people will work 24/7 if there’s an emergency. If you drive away those dedicated individuals motivated by meaning and mission, it creates a significant problem. This is an opportunity to challenge the long-standing stereotype of who is drawn to federal work and to share stories that accurately depict what the federal workforce truly represents.”

The future of public health in the US remains uncertain, but one thing is clear: investment in prevention and preparedness today will save lives and costs tomorrow.

Quotes have been edited for length and clarity.