Flying Blind

The Systematic Dismantling of U.S. Disease Surveillance and the Growing Threat to Global Health Security

For decades, the United States built a sophisticated network of programs designed to catch dangerous diseases early — before they spread, before people died, before outbreaks became crises. That network is now being dismantled. Since January 2025, the Trump administration has eliminated or gutted dozens of federal health surveillance programs, withdrawn from the world’s leading disease-monitoring body, and cut the agencies responsible for keeping American workers, families, and communities safe. The consequences are already being felt — and experts warn the worst may be yet to come.

Leaving the Global Early Warning System

Think of the World Health Organization as the world’s disease radar system. When a new virus emerges in a remote village, or a familiar pathogen starts behaving dangerously, the WHO’s global network is often the first to know. On January 20, 2025, President Trump signed an order pulling the United States out of that system; the withdrawal was finalized on January 22, 2026 (Executive Order 14155). As the WHO’s single largest financial supporter — contributing USD 1.284 billion in 2022–23 — the U.S. departure left a massive hole. Vaccination programs in Sub-Saharan Africa and disease tracking in Southeast Asia have already been disrupted.

Experts were blunt about the stakes. Northeastern University health economist Aleksandra Jakubowski warned that without WHO membership, the U.S. would “lose its ability to tap into a really large surveillance system” — meaning slower detection and slower response when the next outbreak hits. Writing in the New England Journal of Medicine, researchers Yamey & Titanji (2025) said the move “will have catastrophic effects on both domestic and global health.” In an almost absurd twist, the administration subsequently proposed spending $2 billion a year to build replacement surveillance systems — far more than the cost of WHO membership it just abandoned.

The administration went further, ordering researchers to stop surveillance work on emerging animal and human pathogens, calling it “unsafe for Americans,” and banning U.S.-funded pathogen research in countries like China — one of the world’s most important locations for tracking new viruses. While the U.S. stepped back, other countries stepped forward: Europe launched a €150 million, six-year emerging pathogen research program in January 2026 and Japan committed $8 billion to biomedical research through 2032.

Gutting the CDC: What America Has Lost

The Centers for Disease Control and Prevention is the country’s frontline defense against disease outbreaks. In the administration’s first 100 days alone, more than a dozen of its tracking programs were shut down — programs that monitored lead poisoning in children, workplace injuries, maternal deaths, and youth smoking. The entire staff of the Pregnancy Risk Assessment Monitoring System, the country’s most important tool for understanding why mothers die in childbirth, was let go. The proposed federal budget for 2026 would cut CDC funding by 44% and the entire Department of Health and Human Services by 26%.

One of the clearest examples of what this means in practice is what happened to the nation’s food safety surveillance. For 28 years, a program called FoodNet actively tracked eight dangerous foodborne pathogens — regularly reaching out to laboratories across 10 states to catch outbreaks early. In July 2025, it was reduced to monitoring just two pathogens: salmonella and one strain of E. coli. The six that were dropped — including listeria and campylobacter — can be lethal, especially for babies, pregnant women, the elderly, and people with weakened immune systems. Dr. J. Glenn Morris, one of FoodNet’s original designers at the University of Florida, put it plainly: “If you want to make foodborne disease go away, don’t look for it”. The practical consequence: outbreaks that would previously have been caught and traced will now go undetected for longer, and more people will get sick before anyone knows why.

Additionally, the CDC’s National Institute for Occupational Safety and Health (NIOSH) capacity to conduct occupational disease surveillance has been significantly destabilized with the Trump administration’s 2025 decision to eliminate roughly 870 of 1,400 agency positions. Despite partial restoration, the agency faces continued structural uncertainty, as HHS’s FY2027 budget proposes folding NIOSH into a newly formed National Center for Chemicals and Toxins, while also targeting for elimination the National Occupational Research Agenda (NORA) and its $120.5M budget, a framework that has long coordinated research across 10 industry sectors. At the state level, NIOSH currently funds 23 states to conduct occupational safety and health surveillance, collecting data to understand job-related injuries, illnesses, exposures, and fatalities and to identify trends in high-risk worker populations though the durability of this network remains contingent on the outcome of ongoing federal restructuring.

The Ripple Effect: States and Cities Left on Their Own

Federal cuts don’t stay in Washington — they flow directly into communities. About 80% of the CDC’s budget is passed through to state and local health departments. When that money disappears, so do the people and programs those departments depend on.

In Chicago, pandemic-era federal grants made up more than half the city health department’s entire budget. When those funds dried up, the city faced staffing levels below even pre-COVID levels — meaning slower response to everything from food poisoning outbreaks to disease clusters. In Mecklenburg County, North Carolina, 180 public health employees were cut and a wastewater monitoring system that could detect COVID variants — and could have been used to spot emerging threats like bird flu — was shut down. These are not abstract losses. They are the difference between catching an outbreak in a neighborhood and catching it after it has spread across a city.

The Military Exception — and Why It Still Isn’t Enough

Not everything is being cut. The military’s health surveillance system has been largely shielded from the administration’s reductions — and in some areas, expanded. The Pentagon’s FY2026 health budget was actually increased by 0.2%, reaching $64 billion, while the CDC was being slashed by 44%. The reason is straightforward: the administration frames military health as a national security issue, not a public health one.

The military’s disease-tracking arm — the Armed Forces Health Surveillance Division (AFHSD) — remained fully operational. It maintains a massive database of every health event in a service member’s career and runs the Global Emerging Infections Surveillance (GEIS) program, which operates disease-detection labs in 111 countries. As of September 2025, GEIS was actually growing — expanding its ability to identify unknown pathogens through genomic sequencing and adding wastewater surveillance. Its flu data helps determine what goes into the annual influenza vaccine for the entire Northern Hemisphere.

But here’s the problem: military and civilian disease surveillance are not separate systems. They share data, laboratories, and response capacity. When the CDC’s programs collapse and the U.S. exits the WHO, the military’s own surveillance network loses the inputs it depends on. Testimony before the Senate Armed Services Committee (CSIS, July 2025) warned that the National Disaster Medical System — designed to surge civilian and military health capacity together in a crisis — “has been allowed to atrophy.” The specialized hospital centers built to treat patients with highly contagious diseases like Ebola now have “very limited bed capacity,” and the agencies they relied on for patient transport and coordination “apparently have been eliminated.” Protecting the military while gutting civilian health infrastructure is not a complete strategy — it is a dangerous illusion of safety.

What Comes Next — and Why It Matters

Infectious disease expert Michael Osterholm has spent his career studying pandemic risk. In his 2025 book The Big One: How We Must Prepare for Future Deadly Pandemics (Little, Brown Spark), written with Mark Olshaker, he makes a sobering case: COVID-19, as devastating as it was, was not the worst-case scenario. A pathogen that spreads as easily as COVID but kills at a far higher rate is a realistic future threat — and the window to prepare is closing. His assessment of where things stand today: “We have basically destroyed what capacity we had to respond to a pandemic.”

The surveillance gaps are now wide and growing. Programs that tracked HIV spread have been disrupted by the gutting of PEPFAR. The $178 million global tuberculosis monitoring system, funded through USAID, has been cut. Research networks that were finding new viruses — in Nepal, in Missouri, in Liberia — are facing suspension. These are not bureaucratic abstractions. They are the tripwires that exist to give the world enough warning to act before a new disease becomes unstoppable. Without them, the world is flying blind — and the next outbreak may be well underway before anyone knows it has begun.

About the Author

Dr. Janie Gittleman is an occupational epidemiologist, public health policy advocate, and researcher in global disease surveillance and analysis. As the former Chief of Safety, Health, and Environmental Compliance at the Defense Intelligence Agency, she oversaw health and safety policy development, operations, and emergency response worldwide. She previously served as Executive Director of Global Health Technology for the ManTech Corporation, the Association of Occupational and Environmental Clinics, and as Associate Director for the National Construction Center.

Janie has served on committees for the Centers for Disease Control and Prevention, the National Academies, the World Health Organization, and Johns Hopkins School of Medicine. A former, Epidemic Intelligence Officer and representative on the American Public Health Association Science Board, Janie has published extensively in the field of occupational safety and health.

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