What Trump's presidency could spell for the CDC: 5 notes

The CDC could face budget cuts and restructuring under Donald Trump's second presidential term, according to reports from NPR and Politico

The CDC wasn't a central topic of discussion during the election cycle, though calls from Republican lawmakers and officials who worked in the Trump administration during his first term as president offer hints at what may be in store for the 78-year-old agency's future. 

Five notes: 

  1. House Republicans have called for cuts to the agency's budget and the elimination of some programs. Downsizing efforts, should they materialize, would be felt most acutely by state and local public health authorities, which receive 70% of the CDC's federal dollars.

    "When they cut those dollars at the federal level, they're cutting the funding for local communities," Georges Benjamin, executive director of the American Public Health Association, told NPR. "Local elected officials and their legislative sessions, they're going to have to make up the difference or let people go."

  2. Project 2025 — a collection of conservative federal policy proposals from the Heritage Foundation that the president-elect has distanced himself from — calls for splitting the CDC into two separate entities. One would oversee epidemiological data collection and surveillance, while another would be responsible for public health, "with a severely confined ability to make policy recommendations." The two would operate as separate agencies "with a firewall between them." It also calls for eliminating the agency's reporting networks on vaccine safety and data collection on gender identity. Authors of the policy proposals outlined in Project 2025 include former Trump administration officials. 

  3. Conservative criticism of the CDC is largely centered on the agency's broad scope of responsibilities and early missteps in managing the COVID-19 pandemic. One expert at a conservative think tank who was granted anonymity to speak about what reform under the Trump administration might look like told Politico that the administration would likely review all CDC operations and determine which programs could be shifted to other departments.

    The CDC has had "massive mission drift in the past 30 years," the individual told Politico. One example of what program restructurings might look like: Housing the National Institute for Occupational Safety under the Department of Labor. During the pandemic, the NIOSH issued facemask recommendations to prevent illness among employees.

  4. Splitting up the agency would essentially diminish its authority in shaping public health policies that state and local authorities adopt during disease outbreaks like COVID, public health experts say. 

"If you have different agencies, you're not going to make it easier to deal with an outbreak," Tom Friedman, MD, who served as CDC director during the Obama administration, told Politico. "You're going to make it harder to deal with an outbreak and you're going to reduce the likelihood that Americans will be resilient and healthy enough to withstand it." 

  1. Under a new law passed in 2023, CDC directors will now require Senate confirmation. Previously, they were appointed by the president. Mr. Trump's transition team has not yet announced a pick to lead the agency. On Nov. 14, Mr. Trump announced Robert F. Kennery Jr. as his pick to serve as secretary of HHS, which oversees the CDC, the National Institutes of Health, FDA and CMS.  

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