As former directors of the Centers for Disease Control and Prevention, we are deeply concerned that recent recommendations to pare back the CDC would cost lives and damage the economy.
One misguided narrative is that the CDC should focus only on a “core mission” of combatting infectious diseases. In fact, the core mission of the CDC is to save lives and protect Americans from all health threats — not only infectious diseases but also cancer, environmental risks, injuries, and the conditions that are the leading causes of death among Americans.
The agency has contributed to saving millions of lives through reduced tobacco and alcohol use, diabetes prevention and control, injury prevention including reducing traumatic brain injury, healthier pregnancies with lower maternal mortality, and many other health protection programs. Limiting our health defense to just some threats would be like allowing our military to protect us from only some types of attack, telling the National Weather Service to warn people about tornadoes but not hurricanes, or allowing doctors to treat only some diseases.
Like other organizations, the CDC is not perfect — we know that better than anyone. But it needs to be strengthened, not hamstrung. To empower people and their communities to protect themselves from a wide range of health threats, CDC reforms should strengthen our nation’s early warning systems with sustained investments in laboratory networks, genomic sequencing, and wastewater surveillance; ensure timely and practical health information; and augment personnel and resources to support state and local health agencies. The CDC needs authority and resources to provide many more staff to state and local agencies; increasing on-the-ground partnerships will improve CDC understanding of day-to-day challenges communities face. Bringing staff to the CDC after years in the field will foster a workforce that approaches public health from a practical, community-oriented perspective.
Often, epidemiologists don’t initially know if a disease outbreak is infectious, toxic, a false alarm, or a new disease. Sometimes it’s an agent never recognized before, as with Legionella and Ebola; sometimes it’s an old agent taking advantage of new products, as with toxic shock syndrome; and sometimes it’s from an environmental toxin or developments, such as the epidemic of cigarette mortality that leads to more than 1,000 funerals a day in this country. The CDC sounded the alarm on the opioid epidemic, provides evidence-based guidance for clinicians and policy-makers, and supports communities to respond. Having experts across multiple domains with deep subject matter expertise work under one roof means that guidance to individuals and physicians can protect those at highest risk.
Sustaining the CDC’s comprehensive approach to health protection ensures that the capabilities necessary to address an emerging threat can be mobilized quickly. For example, during the 2016 Zika virus outbreak, CDC scientists with expertise in reproductive health, virology, child development, mosquito control, environmental health, and risk communication collaborated across the agency to create a comprehensive response that protected mothers and their babies.
Separating infectious diseases from other causes of avoidable illness would set public health back, forgetting the hard-won lessons of the past century. Ensuring food and water safety requires understating infectious agents, toxins, engineering, hydrology, and even the materials used in pipes. Reducing the risk of liver and cervical cancers requires collaboration between oncology and infectious disease, as both cancers are products of infectious diseases — hepatitis B and HPV, respectively — and both can be prevented by vaccination. Other viruses that cause cancer and other conditions don’t yet have vaccines that can prevent infection, highlighting the need for ongoing work, including at the CDC, to better protect health.
Restricting CDC’s efforts to only infectious diseases would ultimately increase health care costs. The CDC’s tobacco program is unique and complements the regulatory work of the FDA. The CDC tracks, analyzes, and disseminates epidemiological data on the use of tobacco products in youth and adults, studies and acts on findings of tobacco-related illness and death, and supports state and local health departments to implement comprehensive tobacco control programs. These efforts have protected millions of kids from tobacco addiction and helped millions more quit and therefore not need expensive medical care for lung disease, cancer, strokes, and heart attacks. CDC support for newborn screening programs prevents disability, reduces health care costs, and supports families. Likewise, the CDC’s many successful injury prevention programs reduce disability, improve productivity, and cut health care costs.
The CDC is the cornerstone of public health in the United States and a global resource. Americans deserve a comprehensive health protection system that addresses the leading causes of disability and death, not limited to infectious diseases. The health of Americans — and the world — depends on a robust and well-funded CDC.
The authors are prior directors of the Centers for Disease Control and Prevention: Drs. William Foege (1977-1983), William Roper (1990-1993), Jeffrey Koplan (1998-2002), Julie Gerberding (2002-2009), Tom Frieden (2009-2017), Brenda Fitzgerald (2017-2018), Robert Redfield (2018-2021), and Rochelle Walensky (2021-2023).
