There’s momentous debate about healthcare going in the United States—but little attention is being paid to protecting Americans from preventable threats. Unfortunately, as Rep. Tom Cole, a Republican from Oklahoma and chairman of the subcommittee that oversees CDC’s budget, says, “You’re much more likely to die in a pandemic than in a terrorist attack, and so that’s part of the defense of the country as well. The CDC … protects you.”
The budget for the Centers for Disease Control and Prevention (CDC)—an agency I led for the past eight years—now faces unprecedented and potentially catastrophic cuts. That's bad news because the CDC is America’s health security agency.
It’s not just about how much money is available to protect public health, but also how that money is spent. The CDC’s “Pledge to the American People,” for instance, begins with the commitment to “be diligent stewards of the funds entrusted to it.” One of the details in the new Administration’s budget proposal is to switch some state funding to block grants: capped sums of money given to local governments with few requirements attached about how that money get spent.
In short: block grants make it impossible for the CDC to continue its diligent stewardship of funds. Instead of targeting areas in need with programs that work—for example, funding efforts to stop the spread of the “nightmare bacteria” CRE, which is resistant to virtually all antibiotics and can kill half of the people who have serious infections with it—CDC would be limited to shipping money out to states and hoping they do the right thing with it.
The emergence of multidrug resistant tuberculosis in the 1980s, which infected thousands of Americans (including doctors, nurses, and prison guards), was a direct result of this kind of funding model. It resulted in cuts to tuberculosis control programs, resulting in preventable, deadly outbreaks of drug-resistant TB that infected thousands of Americans and cost more than $1 billion in hospital care of patients with serious, avoidable infections.
Block grants also undermine accountability. CDC doctors and other specialists work closely with state and local governments to agree on a proven plan to address major health programs—and that includes how funds should be spent. The CDC then provides hands-on assistance and oversight to make sure these precious federal dollars are used effectively. With a block grant, none of that is possible: States can use the money to replace their own spending, or use it on programs that don’t have a need or benefit. In fact, they can spend it on anything they like without reporting what they’ve done with the funding. In the public health space, block grants are bad government.
One positive proposal in the budget is to create a fund for public health emergencies. Structured well—including sensible ways to function in an emergency that don’t delay action—such a fund could allow the CDC to stop outbreaks before they become epidemics; the equivalent of stopping an earthquake or hurricane before it reaches full force. This is an important proposal, with strong bipartisan support.
Americans will be safer and healthier if the final budget supports CDC programs that protect Americans, save money, and most importantly, save lives.
Dr. Tom Frieden, MPH, is a physician with training in infectious diseases. He worked for the Centers for Disease Control and Prevention, first as an Epidemic Intelligence Service Officer, then posted to New York City and India, where he let efforts to control tuberculosis, and, most recently, from 2009 until January, 2017, as Director. He also served as New York City Health Commissioner.