The numbers coming out of Washington right now are difficult to absorb, even for those of us who work in this space every day. The administration's proposed FY2026 budget would cut the Centers for Disease Control and Prevention's total funding by 53 percent. Buried inside that figure is something more specific and more alarming: the CDC's Public Health Emergency Preparedness (PHEP) program, the cooperative agreement that funds state and local readiness infrastructure across the country, faces a proposed 52 percent reduction.

At the same time, $11.4 billion in CDC cooperative agreement grants have already been clawed back from state and local health departments, creating gaps no state budget can fill on its own. HRA has been tracking this funding trajectory since last year; the FY2026 proposal has made the picture sharper and more severe. For practitioners in public health and emergency management, this is not a policy debate. It is a structural change to the systems we rely on when things go wrong.

What the Numbers Actually Mean

The PHEP program has been the primary funding mechanism for state and local emergency preparedness capacity since 2002. Through this cooperative agreement, CDC funds epidemiological capacity, public health laboratory networks, emergency operations centers, and risk communication infrastructure. These are not overhead items. They are the mechanisms through which we detect disease outbreaks early, maintain surge capacity, and facilitate communication across jurisdictions. A Trust for America's Health assessment of public health infrastructure documents what happens when this capacity erodes: slower outbreak detection, weakened surge capacity, and degraded interoperability between federal, state, and local systems.

A 52 percent funding reduction does not produce a proportionally weaker system. It produces a qualitatively different one. When you cut half the capacity out of an emergency operations center, you do not get a smaller version of the original. You get something that cannot perform its core functions under surge conditions. This distinction matters when we are trying to communicate with policymakers and the public about what is actually at stake.

The broader HHS restructuring compounds the picture. The department's plan to consolidate 28 divisions into 15 eliminates what officials have described as redundant units. Under the proposed structure, CDC's separate infectious disease programs for opioids, viral hepatitis, sexually transmitted infections, and tuberculosis would be folded into a single $300 million grant program, a fraction of their combined previous funding. For anyone who has worked a complex emergency where multiple disease vectors were simultaneously in play, this logic is hard to follow.

The Workforce Problem Nobody Is Talking About

Approximately 2,400 CDC employees face layoffs under the current restructuring plan. Across HHS more broadly, the number approaches 10,000. Many of these are not administrative positions. They are the epidemiologists, laboratory scientists, and emergency preparedness advisors who have spent years building the institutional knowledge that makes response work.

That knowledge is not easily transferred to a reorganized chart. When a state public health officer calls Atlanta because an unusual cluster of cases requires interpretation, the value of that interaction depends on the person on the other end having context, history, and familiarity with the pathogen in question. You cannot replicate that through a restructuring memo.

Where the Work Goes When Federal Capacity Shrinks

For those of us working with NGOs, community health systems, and local emergency management agencies, the practical question is where the work goes. The threats that PHEP was built to address, disease outbreaks, natural disasters, mass casualty events, do not adjust their frequency or severity based on federal budget decisions. The demand does not shrink. The capacity does.

Much of that demand lands on the network of organizations that have long operated in the space between federal capacity and community need. State and local health departments absorb what they can. NGOs and community health centers fill gaps that do not fit neatly into agency mandates. Academic public health programs take on applied work that federal agencies can no longer staff.

This is worth naming clearly in conversations with funders and policymakers: the current moment is not a pause in federal leadership that will resolve itself at the next appropriations cycle. It represents a deliberate shift in where the federal government believes its responsibility begins and ends. The organizations best positioned to understand what that shift means are the ones that have been doing this work at the community level all along.

Making the Case Before the Next Emergency

For practitioners who spend most of their time on the operational side of emergency response, this is also a moment to engage in the policy conversation. The WHO's Exercise Polaris II, concluded in late April 2026, brought together 26 countries and 600 health emergency experts to simulate a major disease outbreak response. The exercise is a reminder that global pandemic preparedness remains an active operational challenge. The United States' ability to contribute to and benefit from that international preparedness architecture depends in part on the domestic capacity being built and maintained through programs like PHEP.

The case for sustained investment in public health preparedness infrastructure is not complicated. It is the same case we make for any critical national infrastructure: the cost of maintenance is far lower than the cost of failure. Making that case clearly and persistently, in committee rooms and conference rooms and community meetings, is part of the work right now.

Emergency preparedness infrastructure is not an abstraction. It is the system that determines whether the response to the next major disaster is measured in days or weeks, and whether it reaches the communities that need it most. The time to make the argument for sustaining it is before the next emergency, not after it.