The Centers for Disease Control and Prevention (CDC) were born in 1946, initially as an effort to fight malaria with a 10 million dollars budget and a staff of 400 employees.
The headquarters was established at a modest building in Atlanta, since the disease was a public health concern in southern states within the American Union. 80 years have passed since, and the CDC became a key institution, dependent on the US Department of Health and Human Services (HHS) to address a wide range of health issues, including infectious diseases, bioterrorism, and global health diplomacy. Its mandate has expanded so much that, to the eyes of many experts, it has lost focus on its original mission, adding agendas while it lacks the authority from the US Congress to fulfill its core mission of combating communicable diseases.
In fact, CDC was born by decision of the executive branch and has since expanded in the executive branch largely through unauthorized appropriations by Congress.
The CDC has 10 key locations including Cincinnati and Cleveland (Ohio), Fort Collins (Colorado), Hyattsville (Maryland), Morgantown (West Virginia), Pittsburgh (Pennsylvania), Anchorage (Alaska), Spokane (Washington), and Research Triangle Park (North Carolina) plus a territory office in Puerto Rico. Many institutions around the globe have modeled their health strategies on the CDC and not long ago, the institution had offices in more than 60 countries and regional offices that cover Eastern Europe and Central Asia, Middle East and North Africa, South America, Southeast Asia, Central America and the Caribbean and East Asia and the Pacific.
After its foundation, the CDC attracted numerous scientists under leaders who sought to broaden the range of solutions to public health challenges. With thousands of specialists—including physicians, veterinarians, microbiologists, economists, social scientists, and statisticians—conducting epidemiological research in laboratories worldwide, alongside volunteers lending their expertise to the cause of health and partnerships with academic institutions, industry, clinical practitioners, and state and local governments, the importance of the CDC is evident—and not only for public health in the United States, but the entire globe.
The CDC has been instrumental in improving the health of the populations both inside and outside the United States. It championed vaccination against infectious diseases. During the most terrible tensions during the Cold War, the Soviet Union proposed at the World Health Organization (WHO) a plan to eliminate, through vaccination, smallpox from the world. Viktor Shdanov, then Vice minister of health at the USSR was so convincing at the World Health Assembly that its plan was voted unanimously. A few years later, the Lindon B. Johnson Administration agreed on joining forces with Moscow to fight smallpox through vaccination. The Soviet Union donated millions of doses for immunization and the US via the CDC provided expertise, transportation logistics, and strategies to accomplish the mission. The American doctor Donald Henderson led the world vaccination campaign and another American expert, William Foege designed the so-called ring-vaccination strategy to fulfill the goal. The last smallpox case was documented in Somalia in 1977. After that, in 1980 the WHO proclaimed the eradication of smallpox. That was probably the most successful health diplomacy initiative that overcame the political and ideological confrontation between Washington and Moscow for the good of the world and the CDC was instrumental to it.
CDC however, has also faced challenges, some ethical, some others about its capabilities to respond to health emergencies. Speaking about ethical controversies, the Tuskegee Scandal, related to a case of untreated syphilis in the male Afro-American, was a 40-year (1932–1972) biomedical study by the US Public Health Service (a precursor of the CDC). Researchers deceived 600 low-income Afro-American men in Macon County, Alabama, withholding effective treatment like penicillin to track the fatal progression of syphilis. Although, as mentioned, the study began before the CDC was created, once it was established in 1946, the study continued. And then, a similar study abroad took place.
Between 1946 and 1948, scientists from the United States Public Health Service and later the CDC conducted unethical medical experiments in Guatemala. They deliberately infected more than 1 300 people—including soldiers, prisoners, psychiatric patients, and sex workers—with syphilis, gonorrhea, and chancroid without their consent. The goal was to test the effectiveness of penicillin and other chemicals as a preventive measure. This experiment was secretly justified on the grounds that former soldiers who returned from war to the US may have been infected with those diseases and possible treatments needed to be explored. As is well known, medical experimentation with human beings is subjected to, after the Nuremberg Trials and the Helsinki Declaration of 1964, the proper consent of patients who freely may accept or reject a certain treatment -.no coercion or torture allowed. The tests in Guatemala made huge headlines until 2010 and the then Obama Administration and State Secretary Hillary Clinton presented their regrets to the then Guatemalan president Alvaro Colom.
Of course, the 21st Century has been specially challenging for the CDC starting with the Amerithrax attacks through the postal service after the 9/11 airplane attacks in New York, Washington D. C., and Pennsylvania. CDC was accused of not processing properly the amount of information generated and continuous clashes with other institutions such as the FBI made it very difficult for the entity to produce satisfactory results
But the most difficult challenge the CDC has faced was the SARS-CoV2 pandemic. Previously, the CDC was very active and anticipated several health emergencies such as the 2002-2003 SARS-CoV; the 2009-2010 AH1N1 Flu; the 2015 MERS-CoV2; and certainly, the Zika 2015-2016 pandemic. CDC has also been instrumental in leading the response to the Ebola outbreak of 2012. Yet, as it has been recognized by WHO and most academics and scientists, no country was ready to respond to a challenged as the one posed by COVID-19. The fact that the US was the worst hit country in the world, with 1. 1 million deaths and a third of its population testing positive to the disease, put CDC at the center of criticism.
Several enquiries have been made to explain what went wrong at CDC during the COVID-19 pandemic. For instance, CDC's early attempts to design and distribute a diagnostic test kit for COVID-19 encountered manufacturing and contamination issues in its labs, significantly delaying widespread testing in the US. Then the agency frequently altered critical recommendations on high-stakes topics like masking, isolation periods, and school reopenings without clear explanations. An internal review later acknowledged that the CDC's communications often felt overwhelming, overly bureaucratic, and slow to adapt to plain language for the general public -it was not the only country that faced a bad communications strategy to the public since in Mexico there were also contradictions about the use of face masks, vaccination and the interruption of economic, school, touristic and political proselytism activities and even the then president López Obrador dismissed WHO recommendations, showing how difficult is for science to get along with politics.
According to the Paragon Health Institute the poor performance of CDC during the pandemic, besides overlapping with other agencies, is because only a small fraction of the agency’s budget is devoted to infectious diseases. Around eight percent of CDC workforce is devoted to identifying and controlling contagious biological threats. The rest of its work is composed by dealing with gun violence, smoking, neglectful parenting, addressing the social determinants of health which meant extending the CDC’s mission beyond its historical and founding scope into nonmedical areas that might influence health. As suggested before, part of the problem is that contrary to other bodies and agencies, Congress has never authorized the CDC. There is no single enabling statute that defines the agency’s mission and structure. Its programs are predominantly authorized by general and program-specific laws, mostly in the Public Health Service Act (PHSA), that give executive branch officials broad spending and organizational authority. CDC also regularly receives supplemental or one-time appropriations in response to public health emergencies. This makes CDC poorly supervised, lacking transparency and accountability and also exposed to political rather than scientific considerations.
To be fair, the CDC somehow has intended to translate the WHO concept of health into public health activities. One may remember that according to the Constitution of WHO, health is a state of complete physical, mental, and social well-being, and not just the absence of disease or infirmity. Formulated in 1946, this definition shifted global perspective from a purely medical view to a broad, holistic view of human well-being. The problem with CDC is that, without a clear mandate by the Congress very easily may overlap with other institutions. But the challenge is even more complex.
The United States health system is highly fragmented since it relies on a decentralized mix of private insurance companies, employer-sponsored plans, and government programs like Medicare and Medicaid. This structure separates financing, administration, and medical care delivery across thousands of independent and competing entities. This also makes it the most expensive in the world, since, for instance, Big Pharma decide the price of most medicines, making many of them non accessible to people. The other problem is that salaries of surgeons and physicians rank among the highest in the world -which explains the success of Mexico as a medical tourism destination for American patients, who encounter excellent facilities and affordable honoraria for different medical treatments and surgeries.
Now going back to the US, 35 percent of Medicare beneficiaries saw 5 or more physicians in 2019. Having multiple physicians may be appropriate -you know, a second opinion is always good-, but it may also lead to medical errors, unnecessary visits, avoidable hospitalizations, and suboptimal care if all of the physicians do not have complete information about the patient and each other’s care plans. The US according to sources like the Organization for Economic Cooperation and Development (OECD) and the Commonwealth Fund, consistently ranks last overall in health system performance among high-income, industrialized nations, despite spending by far the most money per person on healthcare. It also has the lowest life expectancy and the highest child-mortality rate compared to the other high income economies.
High out-of-pocket costs, complex insurance rules, and millions of uninsured residents create major barriers to getting timely treatment. The decentralized insurance and billing framework results in massive paperwork burdens for both patients and doctors. Low-income residents experience significantly worse access and outcomes compared to wealthier groups. The US is the major consumer of drugs in the world. So, with this in mind, clearly the CDC is not totally guilty but faces the consequences of a health system built on the grounds of liberal policies that assume health is the sole responsibility of patients.
The second Donald Trump administration has a revisionist strategy on health and through the secretary of HHS, Robert Kennedy Jr., has decided to dramatically reduce the budget, the personnel and the global health diplomacy capabilities of CDC. Because the Trump administration withdrew US membership at WHO, the CDC was forced to stop cooperation with the international body. CDC office in Zimbabwe was closed and others in South Sudan and Angola will follow next September, and its activities will be transferred to the US State Department's America First Global Health Strategy.
The federal budget proposals for fiscal year 2026 seek to cut the CDCs discretionary funding by roughly 50 to 54 percent—slashing the budget from roughly 9. 2 billion down to about 4. 24 billion dollars. These aggressive reductions involve eliminating dozens of specific programs and shifting various divisions into a newly proposed HHS agency, the Administration for a Healthy America (AHA). Proposes defunding or eliminating the National Center for Chronic Disease Prevention and Health Promotion, which handles programs targeting diabetes, heart disease, cancer, and Alzheimer's -diseases that are responsible for most deaths in the US. Faces steep reductions (around 20% to 63% depending on the specific line) for programs managing viral hepatitis, tuberculosis, HIV/AIDS, and sexually transmitted infections. Targets public health infrastructure grants, tobacco cessation initiatives, lead poisoning prevention, and the Prevention and Public Health Fund for total elimination.
One may argue that global health diplomacy may be best served with the US State Department involvement. Yet, as shown in the case of Mexico, whose foreign ministry has been experiencing more and more tasks with less and less budget, global health diplomacy may not be properly addressed since members of the foreign service are not necessarily experts on health besides formal relations with the WHO and so. It has been reported that at certain WHO meetings, the Ministry for Foreign Affairs has not consulted with the Ministry of Health. This is not to say that foreign policy practitioners do not know about WHO and international health regulations and such. After all, it was thanks to the work of the foreign ministry that during the COVID-19 pandemic Mexico secured vaccines from a large number of providers.
Besides that, the heart of the matter is more pandemics are on their way and neither the CDC, nor the US as a whole, and certainly not Mexico and other countries seem to be prepared for the forthcoming challenges. Speaking about CDC, a very bad precedent was established during the spring 2026 hantavirus outbreak aboard the MV Hondius cruise ship, which resulted in three deaths. Public health experts heavily criticized CDC for a slow, muted, and delayed public response. In fact, the agency waited for about 3. 5 weeks after the first death on April 11 before activating a formal, public response and issuing health alerts in early May. Compare this to Mexico’s response. The Ministry of Health through the National Committee for Epidemiological Surveillance (CONAVE) issued a prompt national epidemiological alert on May 13, 2026—just days after the World Health Organization was notified of the Andes hantavirus outbreak aboard the MV Hondius cruise ship on May 2. If Mexico, with much less financial and human resources than the US can conduct timely epidemiological surveillance, well, something needs to be done by the country ranked as number one on global health security.
Editor’s Note: The above guest column was penned by María Cristina Rosas, a professor and researcher in the faculty of political and social sciences at the National Autonomous University of Mexico in Mexico City. The column appears in The Rio Grande Guardian International News Service with the permission of the author. Rosas can be reached via email at: mcrosas@prodigy.net.mx
