Analysis: How a 2nd Trump presidency might cut back the CDC

The CDC was founded in 1946 to fight malaria, but over the decades, “diverse and fashionable concerns” such as environmental justice and health equity have crept into the agency’s portfolio, Zinberg said. Those programs should be moved to other agencies, he said, so the CDC can focus solely on preparing for the next pandemic.

Scott Gottlieb, former commissioner of the Food and Drug Administration under Trump, has sounded this theme repeatedly. In his most recent essay published this month in JAMA Health Forum, he wrote that transferring some CDC responsibilities, such as its annual survey of middle and high school students about tobacco use, to the FDA, which regulates tobacco products, could help the CDC gain more money and authority.

“The only way to properly resource the core functions of CDC is to get a broader political compromise around the scope of the agency’s mission,” Gottlieb said in an interview.

But the proposals to refocus the agency have prompted an unusual outcry from eight former CDC directors who served in Democratic and Republican administrations. They warned in a recent letter that restricting CDC’s efforts to only infectious diseases would cost lives and damage the economy. The agency’s tobacco control program, for example, protects millions of people from addiction and cuts the need for expensive smoking-related medical care for lung disease, cancer, strokes and heart attacks, they said.

“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,” the former directors wrote in the Sept. 5 letter to the editor published in STAT.