The State Department Say Foreign Countries Will Decide on US CDC Budget for Global Work

Secretary Rubio: Does this make America safer?

Countries receiving funds under America First Global Health Strategy agreements will have the final say in how much money the US CDC has for specific global health activities, according to a statement by a spokesperson for the US Department of State reported in Politico earlier this week.¹ The position makes the United States highly dependent on sovereign nations to decide that a robust CDC presence matters within their borders.

The statement was shared via email, apparently in response² to a request for comment on concerns raised by six former CDC directors³, myself⁴ and other journalists.⁵ These pieces all pointed out issues with the State Department’s new approach to funding the CDC from its Global Health Program account.

Rather than transferring USD$2 billion in funding for crucial laboratory, human resource, and technical assistance functions tied to HIV programming but supportive of a range of health security interests, the State Department has developed a ‘fee schedule’ for CDC services. Countries can choose from these services; many are required to purchase a minimum package.

The State Department spokesperson sounded downright hopeful that countries would opt in for services, rather than holding on to the money for other purposes. “If countries select even a modest share of those optional services, CDC funding for direct technical assistance goes up — not down,” they said to Politico. “We believe CDC provides valuable expertise, and we expect countries will continue to rely on it.”

Recent events suggest this optimism may be misplaced. Today, a Kenyan court put a hold on US plans to build an Americans-only Ebola quarantine facility.⁶ Last week the Ugandan Minister of Health called out USForeignAssistance on X about a post about America’s plans to help with the regional Ebola response.

Alt text: A screenshot of an original social media post dated May 19 from USForeignAssist saying that the US was funding up to 50 treatment clinics in Ebola-effected regions of the DRC and Uganda, and a reply from Ministry of Health Uganda saying, in so many words, We have not been engaged, we do not know where these clinics are and we do not know what you are talking about. Sometimes I need to do some work in the caption to surface the dark humor in these strange days. Sometimes I do not have to do anything at all except remind you to please become a paid subscriber, or a plain old subscriber, and to tell your friends.

Responses to a “To End a Plague: Again” all points bulletin asking country-based folks about the implications of the shift, reinforces cause for concern. (There’s a footnote about how to find me, in case you didn’t get the APB!)

I’ve heard reports about national governments seeking to negotiate down costs (for example by changing “tiers” based on size, complexity and need), requests to shelve the fee schedule because of the ways it will obviously undermine CDC presence, and repeated confirmation that purchase of the minimum package will result in substantial cuts to both headquarters and country level program.

Since the fee schedule and other implementation guidance were introduced after many countries had completed their MoUs and done substantial work on, or completed, their detailed implementation plans, the funds for CDC services will need to be reallocated from budget lines the country has already decided on. This makes it exceedingly hard to imagine how the State Department spokesperson’s prediction that, “under the new model, CDC funding could very well increase,” will come to pass.

Next week, Secretary of State Marco Rubio will be at hearings with both the Senate and the House of Representatives to address questions and concerns about US foreign policy. Amidst all of these competing and urgent concerns, I hope that an elected official asks Secretary Rubio, “How does putting foreign governments in control of the US CDC overseas presence make America safer, stronger and more prosperous?” And—because he will come prepared with an answer—“Secretary Rubio, what will happen if you’re wrong?”

1. https://www.politico.com/newsletters/politico-pulse/2026/05/27/the-nih-animal-testing-debate-rages-on-00936353

2. Oooh, that smarts. State Department public affairs will comment about reporting in this Substack but not to this Substack, which has been stonewalled on everything from “will you be celebrating World AIDS Day 2025?” to “is this close out schedule for your entire supply chain contract ferreal?” As it is, I’ve largely stopped whacking the request for comment ball over the net…but we all know where to find each other. (Hint: LinkedIn DM). In the meantime, ICYMI, for a $1500 subscription donation, you can have your very own copy of To End a Plague’s Alternate Side Parking “Call Me Maybe” karaoke dedicated to the Bureau of Global Health Security and Diplomacy. You know where to find me if you’re picking up what I am laying down. (Hint: Substack message). https://www.msn.com/en-us/news/world/a-court-in-kenya-blocks-us-plan-to-quarantine-ebola-patients/ar-AA24lqNG

3. https://www.statnews.com/2026/05/26/pepfar-state-department-plan-dismantling-hiv-cdc/

4.

5. https://www.science.org/content/article/trump-administration-cuts-cdc-s-key-role-global-program-stop-hiv

6. https://www.msn.com/en-us/news/world/a-court-in-kenya-blocks-us-plan-to-quarantine-ebola-patients/ar-AA24lqNG