The advance of H5N1 bird flu reminds us that novel pathogens remain a stubborn threat. Although a full-blown pandemic doesn’t appear imminent, the virus’s ability to infect a wide range of species — from migratory birds to dairy cattle — heightens the chance that it could evolve into a strain that spreads more readily to and among humans.
This risk underscores the urgent need for robust surveillance of emerging disease threats. Such tools aren’t merely central to our public health infrastructure; they also enable our national health security and prevent critical disruptions in health care services.
The Centers for Disease Control and Prevention should remain squarely focused on this core mission. New emphasis on chronic disease priorities, championed by the incoming Trump administration, shouldn’t dilute this national security imperative.
There is a path forward for achieving this dual mandate, in which basic public health protections help augment our national security protections. Funding for some of the surveillance initiatives established after the Covid-19 pandemic is advancing partnerships with frontline health care providers to build tracking of health threats into our health care system. However, that funding is slated to lapse, and the investments could be scrapped altogether in response to a broader political backlash against public health measures.
Growing these monitoring programs is vital to our frontline national security.
The risks we face from emerging biological threats have never been more acute. Rogue states maintain formidable biological weapons programs, and the know-how and equipment for modifying microbes into terrorist agents continue to spread. After Covid, many countries rushed to build high-security biological laboratories — often in poorly governed regions — claiming that the capacity to study dangerous pathogens would bolster their public health infrastructures. This frantic expansion means more nations are venturing into high-risk experimentation, each becoming a possible flashpoint for a catastrophic lab leak.
The scope of the danger was recently underscored by 38 scientists working in nine countries, who warned in an extraordinary article published in the journal Science of the prospect of “mirror bacteria” — synthetic organisms whose molecular structures are reverse-engineered to render our current armament of anti-infective drugs useless. Until not long ago, such synthetic engineering lay beyond our scientific reach. Now, these novel and potentially deadly pathogens could be crafted in labs within a decade.
The best bulwark against these risks is a robust system in the homeland to detect such threats before they take hold in our population. Covid-19 showed disease surveillance is vital. The U.S. failed to detect the virus as it first took root or to map where and how extensively it had seeded itself in some cities, accelerating the pandemic’s impact. Even when the Covid pandemic was in full swing, the nation lacked the infrastructure to determine which specific regions were bearing the brunt of infections or facing new variants, and which remained comparatively untouched. This prevented the U.S. from better targeting responses to reduce infections while limiting burdens on Americans.
Since Covid, the U.S. has broadened its routine surveillance tools. However, many of these programs are still being built and require supporting investment, and some funding for existing efforts will need to be renewed starting in 2025 for the programs to continue.
The growing partnership between the CDC and the health care delivery system now sifts through patients’ symptoms and diagnoses in emergency departments to detect unusual patterns of illness — signs that an outbreak may be brewing. By relying on anonymized electronic medical records, with standards for data sharing and privacy protections, the surveillance platform and its algorithms can spot subtle signals of an emerging threat in near real time. This National Syndromic Surveillance Program was expanded after Covid-19 and now collects secure data feeds from more than 6,500 health care facilities, covering about 80% of emergency rooms.
Another key prong of this public-private partnership is daily data streams from five commercial labs responsible for roughly 80% of all blood tests in the U.S., enabling the CDC to monitor for worrisome new outbreak signals in more than 200 communicable diseases. The CDC has also developed a broad system to monitor wastewater in sewage facilities, enabling tracking pathogens and measuring their spread across the nation.
This approach offers a more comprehensive view of infection prevalence, serving as an early-warning local tripwire for tracking seasonal epidemics as well as identifying novel threats like bird flu. These capabilities also provide a foundation for much more transparency and informed local decisions by health care organizations, providers, and consumers to mitigate risks in their own communities, as well as bolster our national responses.
To maintain these modernized, public-private defenses against natural and deliberate threats, sustained funding from Congress is needed. Some of these efforts were launched with a one-time post-pandemic funding boost and could vanish if that support isn’t renewed. For example, wastewater surveillance was funded in fiscal year 2024 by remaining Covid supplemental funds, but there’s no appropriation line for these efforts, making it unfunded under the Continuing Resolution. The Center for Forecasting and Outbreak Analytics (CFA), which uses data analytics to predict and prepare for potential infectious disease outbreaks, was funded through a joint budget line that included funds for the CDC’s Data Platform. However, in 2025, CFA will need approximately $55 million in dedicated funding to continue.
The CDC’s central mandate is to curb infectious diseases and support state and local responses, a mission that fortifies our national security. While political winds currently favor a shift to investments in health and wellness, we can’t allow one priority to come at the expense of the CDC’s core responsibility to mitigate infectious threats.
These same systems that make it possible to monitor and contain infectious disease threats can also help communities track and respond to noninfectious risks. Emergency room data are already being used in some communities to detect and mitigate new synthetic opioids responsible for surges in overdoses, and data from innovative pediatric practices can provide timely data on local trends in childhood nutrition gaps and obesity.
These and related initiatives are a vital pillar of our national security and the foundation for an effective and prevention-oriented health care system. As novel viruses become more prevalent, and the tools for engineering dangerous new strains become easier and more widespread, the aperture of risk widens. Ensuring we can swiftly spot a pathogen’s first incursion into the homeland and halt its advance is a key tripwire against these rising perils.
Dr. Scott Gottlieb is a senior fellow at the American Enterprise Institute and former commissioner of the FDA. He’s a partner at New Enterprise Associates and a board member to Pfizer and Illumina. Dr. Mark B. McClellan is director of the Duke Margolis Institute for Health Policy and former FDA commissioner and administrator for the Center for Medicare and Medicaid Services. He’s a board member to Alignment Healthcare, Cigna, and Johnson and Johnson.