The Trump administration reportedly plans to eliminate two essential CDC training programs, a decision that would weaken America’s public health defenses. The Public Health Associate Program (PHAP) and Laboratory Leadership Service (LLS) strengthen critical capabilities in local health departments and public health laboratories. Their elimination is shortsighted and risks public safety at a time when the nation’s ability to detect and contain health threats, including H5N1 avian influenza, is already strained.
The Centers for Disease Control and Prevention has played a critical role protecting public health, but it does have important weaknesses that have contributed to costly and deadly failures. The programs reportedly slated for cuts address two challenges: 1) the gap between federal guidance and local action, and 2) problems in laboratory management, quality, and biosafety.
The first problem — the gap between federal guidance and local action — can be traced to the 1990s elimination of Public Health Advisors as part of government downsizing efforts. Public Health Advisors started their careers at CDC embedded in local health departments, giving them years of frontline experience in implementation before they moved into national roles. As a result, for decades, CDC leadership included professionals who had worked in state and local health departments, ensuring that national policies and grants were practical and implementable. The loss of this training pipeline weakened CDC’s connection to local realities, leading to public health guidance that was sometimes difficult to implement in practice. This problem became clear during the Covid-19 pandemic, when CDC guidance was often unrealistic, confusing, or unworkable for local health agencies. For instance, initial guidelines to prioritize the use of limited vaccine supply used complex criteria rather than simply starting with the oldest people and vaccinating younger people as more vaccine became available. This simpler vaccine would have facilitated rollout and reduced deaths, since age is by far the strongest predictor of Covid severity.
The second problem — weak public health lab infrastructure and oversight — has led to biosafety failures, capacity shortages, and slow outbreak responses. Although private labs perform clinical and high-volume testing, public health labs are irreplaceable for outbreak detection, emerging threat surveillance, biosafety enforcement, and biothreat response. These functions simply won’t be performed by the private sector — there’s either no market or an insufficient market. But public health labs have struggled for years with contamination risks, poor management, and outdated infrastructure. This was most evident in 2020, when the CDC’s initial Covid-19 test failed due to laboratory quality control errors, delaying testing capacity and setting back the pandemic response. Public health labs at the state level have also faced capacity limitations, limiting our ability to track and respond to infectious disease threats. Compounding the problem, CDC and state laboratories have had multiple near-misses with deadly pathogens, including mishandling of anthrax, avian influenza, and Ebola samples — failures that underscore the need for stronger lab oversight and leadership.
These two fundamental weaknesses — CDC’s sometime detachment from local realities and laboratory challenges — are precisely what PHAP and LLS were designed to address.
PHAP restores some of the lost frontline public health expertise by placing trained professionals in state and local health departments. Associates gain hands-on experience in outbreak response, disease prevention, and emergency preparedness, narrowing the gap between CDC’s national policies and their real-world application. Many go on to leadership positions in public health, helping to rebuild the pipeline of professionals who understand both federal and local perspectives. Without PHAP, the CDC will become even more disconnected from the practical realities of state and local public health work.
LLS is designed to modernize public health laboratories by training the next generation of laboratory leaders in biosafety, quality control, and management. LLS fellows improve lab safety, efficiency, and capacity, addressing longstanding weaknesses that contributed to the Covid-19 test failure and past biosafety lapses. Without LLS, public health labs will remain vulnerable to safety incidents and operational failures, increasing the risk of future testing failures and pathogen containment breaches.
The decision to eliminate PHAP and LLS would be a dangerous rollback of public health capacity. Without PHAP:
- The disconnect between CDC and local health agencies will grow, leading to less effective health defenses.
- Outbreaks will spread further and faster due to reduced local public health workforce capacity.
- CDC will lose one of the few pipelines for training future operational leaders with real-world public health experience.
Without LLS:
- Public health laboratories will continue to struggle with quality control, increasing the risk of biosafety failures.
- Pathogen containment risks will rise, increasing the likelihood of lab accidents that expose workers or the public.
- The nation’s ability to detect and respond to outbreaks will be weakened, increasing delays in testing and containment.
CDC reform requires strengthening programs like these, not eliminating them. Public health reform should focus on building a stronger workforce, not dismantling the few programs that strengthen it. PHAP and LLS fill critical gaps in public health infrastructure, and no alternative programs exist to replace them. Cutting them is a short-term budget move that will have long-term and costly health and economic consequences for national security and public safety. If the goal is a healthier American and a better CDC, eliminating PHAP and LLS is the wrong way to get there.
Tom Frieden, M.D., is president and CEO of Resolve to Save Lives, a global health organization. He is the former director of the Centers for Disease Control and Prevention and former commissioner of the New York City Health Department.