CDC Isn’t Answering the Phone. New York State’s Health Commissioner on What States Can Do to Fill the Gap.

Dr. James McDonald says things have gotten worse at the Centers for Disease Control and Prevention since the government shutdown. (Courtesy New York State Department of Health)

Key Points

• The White House’s proposed 2026 budget includes a 53% cut to CDC funding from 2024 levels, raising concerns for state health departments.
• State health departments are forming collaborations, such as the Northeast Public Health Collaborative, to address reduced federal support and expertise.
• New York’s Wadsworth Center is performing highly technical work, including testing and genetic sequencing, for 17 other states previously done by the CDC.

The turmoil the Trump administration has brought to the federal public health bureaucracy is creating big worries for state health departments, which rely on the Centers for Disease Control and Prevention for funding and expertise to fight diseases and protect their states.

Things have gotten worse in just the past few weeks with the government shutdown.

“There’s parts of the CDC that just aren’t answering the phone anymore,” says Dr. James McDonald, commissioner of the New York State Department of Health.

The CDC, which directed roughly $15 billion in federal dollars to state and local public health programs in 2023, is under pressure, and the problems may just be beginning for the agency. The White House’s proposed 2026 budget includes a 53% cut to the CDC funding from 2024 levels.

That’s left state health departments working to figure out how to patch up the holes. In recent months, a group of northeastern states announced the Northeast Public Health Collaborative, a partnership between their health departments. There is a similar effort on the West Coast. A group of Democratic governors this week said they had formed the Governors Public Health Alliance.

The question is how far these collaborations can go to fill in the spots where the federal government appears to be pulling back from public health work. While state health authorities have significant power, much of the money to do public health work, and the technical expertise to guide it, has come from Washington, D.C.

In a statement to Barron’s, a spokesman for the U.S. Department of Health and Human Services said: “It was Democrat-led states that imposed unscientific school closures, toddler mask mandates, and vaccine passports during Covid, eroding public confidence in public health agencies. Now those same officials are trying to rebrand their failures as ‘coordination.’ HHS remains fully engaged in protecting the health of all Americans through evidence-based policy and transparency.”

Barron’s spoke with Dr. McDonald on Thursday. Dr. McDonald has led New York state’s health department since 2023. This interview has been edited for length and clarity.

Barron’s: Historically, what’s been the balance between state and federal responsibilities for public health?

McDonald: When you look at federal agencies and state health departments, normally it was a partnership. CDC, they’re a recommending body. They don’t regulate or enforce. When you look at the state health department, we regulate and enforce laws, rules, and regulations.

Barron’s**: How has that changed this year?**

McDonald: We see significant cuts to our partners at the Centers for Disease Control and Prevention. So they’re just not as accessible. For a big state like New York, that’s not as problematic because we have our own experts. But I am concerned about how this is going to affect the country. We have resources, and I have a very supportive governor. We’re doing what we need to do to take care of the 20 million New Yorkers. But I don’t know that every state’s in the same position we are.

Barron’s**: New York has announced participation in two separate collaborations with other states, the Northeast Public Health Collaborative and the Governor’s Public Health Alliance. What role can they play?**

McDonald: When you think about the [Northeast Public Health Collaborative], it’s just state health departments collaborating. Not just sharing ideas about Covid vaccines and other vaccines, but how do we prevent other diseases? What are things we can do in the space of disaster preparedness? How do we leverage our public health labs? New York state has Wadsworth, really the premier public health lab in the whole world. There are things we can do for other states that they used to have done by the CDC, but now they come to us.

Barron’s**: You’re talking about the Wadsworth Center in Alban, your department’s public health laboratory. Is Wadsworth taking on work that was previously done by CDC labs?**

McDonald: Yeah, we are. Some of that is highly technical work. We have a working relationship with 17 other states right now. There’s things Wadsworth can do that, quite frankly, other state health departments can’t do. One example is, we reported the first case of locally acquired chikungunya in New York state earlier this week. We can do that test, but not every state health department can. There’s things we can do with genetic sequencing that not every state health lab can do yet.

Barron’s**: Are there other things that states are asking you to do now that they’ve relied on CDC for in the past?**

McDonald: Mostly it’s sharing of ideas. One of the things we do is we do something called the Global Health Update. This is something that we started doing over a year ago. We look around the world, what are the infectious diseases that are a concern to people? Whether it’s chikungunya, polio, measles. And then every Friday at noon, we publish a weekly update. CDC was doing that, but they weren’t doing it in the aggregated format we were doing.

Barron’s**: Is your agency feeling the impact from the changes at the CDC?**

McDonald: The Wadsworth doesn’t get the same type of collaboration with CDC that we used to. Right now, especially with the shutdown, there’s parts of the CDC that just aren’t answering the phone anymore right now.

Barron’s: New York has also joined the Governor’s Public Health Alliance, another new public collaboration. So far, only states with Democratic governors have joined these efforts.

McDonald: Some of the Collaborative states are more purple. I think of Pennsylvania as a purple state that joined the [Northeast Public Health Collaborative]. One of the things that we have to acknowledge, too, is that although we haven’t had the traditionally red state join us, sometimes people come to meetings and just listen in and share ideas. We certainly welcome any red state who wants to join us, that’s for sure.

Barron’s: In 2023, roughly a third of public health dollars New York state spent originated as CDC grants, according to data from the Trust for America’s Health. Most states are even more reliant on CDC. Can collaborations between states replace what’s at risk of being lost from the federal government?

McDonald: I think we might be forced to find that out, [depending on] what happens on the proposed 2026 federal budget. I think those states that collaborate are going to be in a better position to protect their populations than those that do not.

What I’m concerned about is not every state has the same resources financially. Sharing information is generally free. One of the things that you’re not gonna see the collaborative do though, is replace federal dollars. Because if we lose those federal dollars, they’re just lost.

Barron’s: Are we more or less prepared for the next pandemic than we were a year ago? I’m thinking now about bird flu, since the number of cases in poultry is rising again in the U.S.

McDonald: I think this is going to vary by state. You’re right, H5N1 is increasing because the birds are migrating. Individual states are going to have to do their own preparation. This is part of why collaboration is helpful. I’m concerned we have not learned one of the major lessons from the pandemic, which was that public health preparedness is critical.

Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com