Ex-CDC chief opposes public health block grants in Trump budget


CHICAGO Burried in the cuts to science and public health in President Trump’s newly released budget blueprint is a longtime conservative proposal to award lump sums of money to states – block grants – to let them decide how to respond to public health issues such as the Zika virus.

That proposal is “a really bad idea,” according to Dr. Tom Frieden, who until this past January was director of the U.S. Centers for Disease Control and Prevention.

Currently, the CDC experts work with state and local governments to devise evidence-based plans to respond to public health issues, such as foodborne and infectious disease outbreaks.

With a block grant, states can use the federal money to replace their own spending in certain areas or spend the money unwisely, “and never have to report what they have done or be held accountable for it,” Frieden said.

Although the president’s 2018 budget – a slimmed down blueprint of his spending goals – provides no specifics, the Association for Public Health Laboratories, a national group representing state and municipal public health laboratories, estimates that, if approved by Congress, it could cut as much as $1.8 billion from CDC’s budget from various programs, which was $7 billion in 2016.

The cuts were part of a wider push by the administration to beef up defense spending by $54 billion and slash spending at many other domestic agencies, such as the Environmental Protection Agency and the State Department. The blueprint would also cut $5.8 billion, or some 18 percent, in funding for the National Institutes of Health, a proposal that was met with widespread opposition by health and science advocates.

The proposal does not specify where the $500 million in public health block grants to states would come from. Frieden said in an email he believes the intent is to cut existing CDC grant programs and pass them along to the states.

Frieden said block grants are often a precursor to funding cuts. Such was the case in the 1980s, when block grants for tuberculosis control programs gave rise to “deadly outbreaks of drug-resistant tuberculosis that cost more than a billion dollars,” he said, spending that could have been prevented.

Rob Smith, an analyst with Capital Alpha Partners, sees the block grant proposal as part of an overall theme in the Trump White House “to get healthcare out of the hands of D.C. bureaucrats.” The proposal is similar to the Republican’s Obamacare “repeal” bill being considered by the U.S. House of Representatives that gives states a set amount of money to cover people on the Medicaid program for the poor.

In public health, however, Smith said allowing states to devise their own response to infectious disease threats, such as Zika, could mean it takes longer to get an outbreak under control.

Although the Trump budget does create a new public health emergency fund to allow the United States to quickly respond to outbreaks, such as Zika, it does not say where those funds would come from, and some groups, including the Infectious Diseases Society of America, fear that money would also be taken from the CDC’s budget.

Frieden lobbied hard for the emergency fund after a nine-month struggle least year to get U.S. lawmakers to approve $1.1 billion in emergency funds for Zika, a delay that experts said hurt the U.S. effort to fight the virus.

He said it was good to see the Emergency Response Fund in the Trump budget, but added, “the devil will be in the details.”

(Reporting by Julie Steenhuysen; Editing by Bernard Orr)


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