The Trump administration is advancing a plan that would significantly reduce the Centers for Disease Control and Prevention’s (CDC) role in overseeing global health programs, including those aimed at detecting and controlling infectious disease outbreaks abroad. The proposal, initiated by the State Department, is set to take effect on October 1 and would transfer much of the decision-making authority and funding control from the CDC to the State Department.

The plan affects the President’s Emergency Plan for AIDS Relief (PEPFAR), a flagship global health initiative launched in 2003, which has been credited with saving millions of lives. Historically, USAID and the CDC have managed most of PEPFAR’s budget and implementation. The changes could potentially shutter about one-third of the CDC’s 60 overseas country offices within three years, according to several officials familiar with the programs.

Critics warn that the shift may undermine longstanding public health infrastructure that supports more than 12 million people on HIV treatment with CDC assistance. Dr. Michele Montandon, who led the CDC’s efforts to reduce mother-to-child HIV transmission until her recent layoff, expressed concerns about a potential increase in service disruptions, deaths, and new HIV infections in children.

Under the current system, the State Department typically allocates about $2 billion annually to the CDC, which collaborates with partner countries to set health priorities and allocate funds to local ministries and organizations. The proposed model would replace this with a “fee-for-service” approach, requiring countries to select and finance specific CDC services individually, such as environmental surveillance or laboratory network support.

Several current and former CDC and State Department officials interviewed expressed apprehension about the transactional nature of the new system, fearing it would destabilize critical relationships with foreign governments and weaken global disease detection and response capabilities. John Blandford, a former CDC division head with extensive overseas experience, warned that the State Department lacks the technical expertise to effectively manage these programs and that treating the CDC as a contractor disregards established trust and collaboration built over decades.

Supporters of the plan, including the State Department and the Department of Health and Human Services, contend that it represents a modernization effort aimed at reducing duplication and improving coordination in foreign assistance. A State Department spokesperson stated that CDC funding overseas is expected to increase under the new “America First Global Health Strategy” and denied any office closures due to the plan.

The CDC has played a critical role beyond HIV programs, contributing to the detection and response to outbreaks such as Ebola, hantavirus, and COVID-19 through laboratory support, data analysis, and training of local disease detectives. The agency’s embedded presence in many countries has been credited with enabling swift outbreak response.

Experts caution that the shift to a menu-based funding model, which includes tiered service levels with specific price points, may incentivize countries to opt for minimal packages, potentially neglecting less visible but vital health measures like polio eradication or integrated disease surveillance. With political and financial constraints, some fear that crucial preventive and emergency response capacities could erode.

In recent years, disruptions linked to the dismantling of USAID’s global health programs have already led to declines in new HIV diagnoses, treatment initiations, and preventive drug uptake. Clinics, such as those in Haiti, have closed amid funding cuts, putting vulnerable populations at increased risk.

The CDC’s global health leadership stresses that sidelining their agency may weaken the United States’ ability to preempt and respond to emerging infectious disease threats, a concern echoed by public health officials who warn that moving away from coordinated, goal-driven programs toward isolated bilateral aid agreements could jeopardize long-term progress in controlling pandemics and improving child health outcomes worldwide.