With two months to go before the end of the Biden administration, Centers for Disease Control and Prevention Director Mandy Cohen says she’s worried about the future of the public health agency and the people it serves.
House GOP appropriators are pushing a 22 percent cut to the sprawling public health agency. President-elect Donald Trump has nominated a vaccine skeptic, Robert F. Kennedy Jr., to lead the Department of Health and Human Services.
And years after the end of the COVID-19 pandemic, skepticism about public health agencies remains despite the agency’s work to restore trust in it and its efforts.
“I don’t want to go backwards and see children or adults suffer or lose their lives to remind us that vaccines work, and so I am concerned,” Cohen said. “Any misinformation coming from places of influence or power are concerning.”
Cohen’s replacement at the CDC — who will work under Kennedy, assuming Kennedy is confirmed — has yet to be picked. But he or she will play a key role in public health infrastructure, with a say in vaccine recommendations and a voice influencing whether the U.S. participates in global public health agreements.
She worries that whoever is picked, combined with Kennedy and a Republican-led Congress skeptical of the agency, will undo much of the progress the Biden administration made in upping vaccination coverage and reducing unnecessary deaths.
So she’s spending the last few months of her tenure climbing Capitol Hill, meeting with lawmakers to make the case for the CDC’s work in public health.
“I think the best defense is a good offense, meaning we do our job well and show our value,” Cohen said.
New direction at the agency
Public opinion toward the CDC shifted dramatically with the COVID-19 pandemic, making the agency much more politicized than it’s been in the past.
That gap in trust played out in the public sphere, in the form of vaccine skepticism, and on Capitol Hill, as Republicans repeatedly criticized the agency and proposed budget cuts.
In 2023, Congress passed a law to ensure that an incoming CDC director is confirmed by the Senate. The incoming agency director under Trump will be the first official to go through the confirmation process.
What that director does with the agency, however, is unknown.
Jennifer Kates, senior vice president and director of the Global Health & HIV Policy program at KFF, said the incoming administration, buoyed by a GOP Congress, has the authority to move in an entirely different direction.
“There’s a lot of discretion that the new administration’s going to have to decide what role it wants CDC to play,” Kates said.
The power is not without limits: Trump and his allies have suggested they’d remove vaccine mandates, but the CDC cannot do that — only state public health departments can.
Still, the CDC can change its recommendations, a decision that could have ripple effects.
The Trump administration could also decide whether to adhere to or ignore the advice of the CDC’s independent public health advisory committees, Kates said.
For example, the Advisory Committee on Immunization Practices makes recommendations on what new vaccines to approve and recommend to the population. The CDC director does not have to listen to these recommendations, and a new agency director can appoint their allies to the independent councils.
A new director could also decide not to renew the committees’ charters and can create a new structure for recommending vaccine usage, Kates said.
International agreements
U.S. involvement in international public health agreements could also be in flux, public health advocates worry.
Trump initiated a process to pull the U.S. out of the World Health Organization during his first term, but the Biden administration reversed course. Trump has not changed his position on the global body, and a U.S. retreat from WHO is expected to remain on the table, experts say.
WHO has been working to finalize an international agreement to prevent and combat future pandemics, a process that the Biden administration supports but many Republicans on Capitol Hill say infringes on the rights of American taxpayers.
GOP members of the House Oversight and Accountability Select Subcommittee on the Coronavirus Pandemic say that WHO has become too political and the treaty could result in U.S. taxpayer dollars going toward abortion or infringing on U.S. intellectual property rights.
In September the House passed legislation to require Senate ratification before the U.S. joins any future WHO pandemic accords. At the time, Texas Republican Rep. Keith Self called the WHO a “globalist cabal” that was pushing “tyrannical policies across the world.”
But Democrats and global health experts say an information-sharing pandemic pact could stop the next pandemic before it starts.
Negotiations over the treaty could conclude by May, members of the WHO intergovernmental negotiating body said during a November meeting — meaning the Trump administration will have the final say as to whether the U.S. is involved.
“One of the most important lessons from the COVID-19 pandemic is that viruses don’t respect borders,” said Richard Besser, president and CEO of the Robert Wood Johnson Foundation and former acting director of the CDC.
Congressional cuts
In an interview last week, Cohen also expressed worry about the agency’s budget. The fiscal 2025 House Labor-HHS-Education spending bill proposed a 22 percent cut across the board and would zero out the Injury Center, which includes prevention efforts for suicide, overdose and drowning.
Over the past several years, the CDC has emphasized lowering overdose deaths, and their efforts appear to have had an impact. Provisional data released in May show 107,543 drug overdose deaths in the U.S. in 2023, a decrease of 3 percent from the 111,029 estimated in 2022 and the first annual decrease in drug overdose deaths since 2018.
The prospect of eliminating the Injury Center, which may have contributed to that decline, Cohen said, “is very worrisome to me.”
Cohen said the agency has also expanded its ability to collect data to monitor ongoing threats to public health, including from state health departments and emergency rooms.
Democrats and public health experts often lament the “boom or bust” nature of public health funding.
“The United States tends to only prioritize public health funding and resources during public health emergencies, followed by letting funding lapse and resources dry up when the immediate threat is perceived to have passed,” Besser said.
Project 2025, a proposed policy platform written by conservative scholars and organized by the conservative Heritage Foundation, has suggested restructuring the CDC into two parts, and former Trump officials have proposed narrowing the agency’s work to only infectious diseases. But Trump’s former CDC Director Robert Redfield, mentioned as a possible CDC director again in this administration, called such a scaling back of the CDC “a prescription for disaster” in a recent op-ed in Stat News co-authored with his fellow past directors.
Incoming Senate Health, Education, Labor and Pensions Chairman Bill Cassidy, a Louisiana Republican, told CQ Roll Call he plans to continue his investigation into the CDC’s pandemic response and look for ways to overhaul the agency when he takes the gavel next year.
Cassidy has been looking into ways to modernize public health data and improve public health activities, training programs and coordination with stakeholders, among other things.
Between now and January
Cohen likes to say that the public health arena does its best work when it’s invisible. The American people don’t want to know about the crop of infectious diseases in the Congo or listeria outbreaks because of onions in McDonald’s hamburgers — they want the diseases stopped before they become a concern.
She said she’s been proud of the agency’s quick response to avian flu H5N1 and ongoing response to Marburg, an Ebola virus in Rwanda.
The agency, she said, “is not the same CDC that was here four years ago.”
Sen. Elizabeth Warren, D-Mass., a member of the Senate Finance Committee, said she’s worried the increased politicization of public health will ultimately put lives at risk.
During the lame-duck session, she says there’s not much Democrats can do to enshrine public health programs. All they can do is hope Republicans, when they control Washington, back public health funding as directed by past congressional authorizations.
“If the Republicans will follow the rules and fund the work that Congress has already authorized, then we don’t have to be afraid,” Warren said. “The problem is, they’ve indicated they don’t … plan to fund the work that has already been authorized.
“When the starting point is lawlessness, there’s no program that’s safe.”
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