America’s Disease Detectives Overseas Are Starting To Close Up Shop

The government agency charged with combating disease outbreaks abroad is shrinking as President Donald Trump’s "America First" approach to foreign policy takes hold.

Centers for Disease Control and Prevention offices in Angola and South Sudan closed Thursday, with the office in Zimbabwe set to shut its doors at the end of the year. Current and former CDC officials told POLITICO they expect more than a dozen other foreign offices will follow in the next few years.

It’s the latest blow to an agency that took a dual hit last year when Trump shut down the U.S. Agency for International Development, its partner in providing foreign assistance, and Elon Musk’s Department of Government Efficiency slashed staffing. The CDC has 30% fewer employees than when Trump took office.

The office closures “will result in preventable infections and death overseas," said Asia Russell, the executive director of Health GAP, a nonprofit advocating for access to HIV treatment.

“Who’s going to pick up the phone if there’s a Marburg outbreak and the Zimbabwe office has closed?” she said, referring to the severe hemorrhagic fever virus that has sparked outbreaks in several African countries recently.

The CDC has long been the lead agency tasked with responding to health threats abroad. Before the cutbacks, that included not only funding the distribution of tests and medicine but also encouraging people to seek treatment, training local health care providers and providing guidance to help foreign governments strengthen their health systems.

Now the CDC’s work abroad is dependent on deals the State Department is negotiating in which recipient countries promise to pay an increasing share of their own health costs and show progress on key health and development metrics, with the goal of weaning off U.S. assistance.

The administration insists that the CDC will get a boost. “Countries have now selected CDC services that will result in CDC overseas funding levels that are at or higher than prior years,” the department said in a statement. “This new model will help save lives and prevent the spread of infectious diseases globally, delivering better results for people in countries and for the American taxpayer.”

The deals the State Department has already reached with 35 countries took effect on Oct. 1. Foreign governments receiving U.S. global health funding have to choose what services they want the CDC to provide, and the State Department pays the agency for them.

Angola and South Sudan, where CDC offices are closing, have signed. Angola is set to receive $71 million by 2030, while South Sudan is set to get $146 million over the next three years.

But a combination of decreasing funding, operational restrictions from the State Department, and security challenges have made it hard to maintain the CDC offices there, said a current CDC official granted anonymity to speak candidly.

Meanwhile, the Zimbabwean government earlier this year rejected a deal with the U.S., saying it was concerned about sharing sensitive health data in exchange for American funding.

The State Department has not publicly released the details of how much CDC services will cost countries that have signed deals, and how much the CDC will receive. Leaked documents published by journalist Emily Bass show that countries receiving more than $125 million from the U.S. over five years are required to purchase a minimum package of CDC services.

The State Department said only deals with Kenya and Rwanda would result in “slightly lower” CDC funding because their governments have agreed to pick up a greater share of health costs.

HHS said in an emailed statement that the U.S. “will maintain a robust overseas presence to protect Americans from emerging health threats.” The CDC “will continue working with local health officials and sustain critical global health security capabilities through regional offices, headquarters staff, other U.S. government personnel and implementing partners,” it added.

Current and former CDC staffers interviewed by POLITICO said they expected the CDC cuts would prove broader and bigger. “I don't see the numbers adding up to a place where you can actually have a robust CDC presence in the same way,” said John Blandford, who retired last year after leading the CDC’s South Africa office.

For countries that eschew deals, the effects could be devastating, people who work in global health believe. Much of the CDC’s work abroad has been funded by the President’s Emergency Plan for AIDS Relief, which George W. Bush created in 2003 and is widely credited with saving millions of lives.

PEPFAR’s goal, shared with the United Nations, is to end the AIDS epidemic by 2030. Despite progress, that goal is slipping out of reach, the UN says, due in part to declining funding from the U.S. and other rich countries.

An assessment by AIDS activists and academics published in the Journal of Acquired Immune Deficiency Syndromes this month projects 75,000 new HIV infections in Zimbabwe resulting from the end of U.S. aid there.

Pamela Tremont, the U.S. ambassador to Zimbabwe,praised America’s cooperation with the African country, which she said led to a vast majority of Zimbabweans with HIV receiving treatment.

The priority now is to sustain that gain, she said, according to a Zimbabwe media report.

CDC cutbacks could also have repercussions for Americans. Agency staff abroad have served as an early-warning system for disease outbreaks that could reach the U.S. The CDC and its offices abroad are helping respond to the ongoing Ebola outbreak in central Africa.

When Trump withdrew from the World Health Organization, a United Nations agency that also fights pandemic threats, Department of Health and Human Services officials said the U.S. would rely on the CDC instead.

“This was the shining hope of CDC for a little while, that HHS was going to offer an alternative to the WHO, and that CDC would be in the driver's seat,” said a former Trump administration official familiar with the thinking granted anonymity to reveal internal conversations.

Some in Congress have sought to protect the CDC’s funding stream for global health work by pressuring the State Department and by writing it into law, taking away the administration’s discretion.

Congressional Democrats have called on Secretary of State Marco Rubio to continue to earmark $2 billion for the CDC’s PEPFAR work in letters over the summer from Rep. Robert Garcia of California, the ranking member of the House Oversight and Government Reform Committee, and Georgia Sen. Jon Ossoff.

In June, 24 Democratic senators and Bill Cassidy, a Louisiana Republican who chairs the Senate Health Committee, asked their colleagues in the Appropriations Committee to include the $2 billion transfer from the State Department to the CDC in the upcoming appropriations bill for the 2027 fiscal year or to directly increase funding for the CDC’s global work.

Tammy Baldwin of Wisconsin, the top Democrat on the Senate Appropriations subcommittee in charge of funding HHS, said she will “fight to invest in CDC’s global health programs to stop the spread of deadly diseases and save lives.” Sen. Susan Collins, the Maine Republican who chairs the Appropriations Committee and blocked PEPFAR cuts last year, did not respond to a request left with her office for comment.

The bill has not yet been released.