The United States maintains more than 750 military bases around the world—not just to fight wars, but to prevent them. That same principle has guided U.S. investment in the global footprint of the Centers for Disease Control and Prevention (CDC)—the agency tasked with protecting the health and security of Americans—to build and “forward deploy” critical defenses against biological threats worldwide.
For decades, CDC’s global network of over 60 country offices and regional hubs have functioned as forward-deployed biodefense bases. These bases provide early detection and rapid response capabilities at the source of biological threats—before they can reach U.S. shores. Built on the foundation of longstanding U.S. health investments abroad, like the President’s Emergency Plan for AIDS Relief (PEPFAR) and global polio eradication efforts, this system operates as a global early-warning system for biological threats. The system is powered by a highly trained workforce and partnerships with trusted allies who serve as America’s first line of defense against biological threats, whether naturally occurring, accidental, or deliberately engineered.
This biodefense system is so central to U.S. national security, and the biological threats are so acute and constant, that the U.S. Government has worked for the last decade, across administrations, to develop a playbook for biological threat response. That playbook, finalized in the Biden administration and handed over to the Trump administration, directs CDC to lead U.S. government responses to biological threats emerging outside of the United States. CDC has exercised that role regularly, leading government-wide responses to Marburg, Ebola and Mpox outbreaks in the last six months alone. This system kept Americans safe during four years of the Biden administration, through dozens of emerging threats, many of which were unknown to most Americans.
Over the last few months, the Trump administration has weakened or eliminated the layers of the U.S. biodefense system – dismantling the U.S. Agency for International Development’s programs around the world, eroding the National Security Council’s real-time coordination capability during threats, eliminating the White House pandemic office, and most recently, cancelling proactive investments in safeguards like pandemic influenza vaccines. Amid those changes, one of our strongest defenses against biological threats abroad has been the enduring partnerships and systems maintained by the CDC. However, with the release of President Trump’s budget request earlier this month, the administration signaled an intent to weaken — if not entirely dismantle — this critical safeguard that allows the U.S. to detect outbreaks at their source, leaving Americans and the world more vulnerable to biological threats.
CDC’s Biodefense Bases
The CDC’s mission is to protect the health, safety, and security of the United States. Its presence around the world is critical to delivering on that mission. Through its forward deployed biodefense bases, which we define here as global public health “bases” designed to detect threats and contain them early, the CDC doesn’t just respond to crises—it builds systems worldwide to prevent them. Those systems, which are always monitoring threats and ready to deploy, are sustained in peacetime through ongoing U.S. health investments to address HIV/AIDS, polio, measles, and other ongoing infectious disease threats.
For example, PEPFAR, which was launched in 2003 by President George W. Bush in response to the HIV/AIDS crisis in Africa, has long played an essential role in sustaining CDC’s biodefense bases around the world. Since its inception, the United States has invested more than $100 billion in the global HIV/AIDS response through PEPFAR, saving 26 million lives, enabling 7.8 million babies to be born without HIV infection, and helping to build stronger health systems around the world to detect and respond to new threats. The CDC—PEPFAR’s scientific engine—delivers roughly 62% of its treatment services, strengthens laboratory systems and disease surveillance, trains public‑health workforces, drives data‑guided program improvements, and leads implementation science and evaluations. These interventions don’t just combat HIV—they fortify health systems, enhance outbreak detection, and bolster global health security. That capacity has proven essential in responding to Ebola, COVID‑19, and other emerging threats.
Through health preparedness programs in more than 80 countries, and offices in more than 60 countries, CDC has trained thousands of field epidemiologists in disease surveillance and emergency response, established biosurveillance labs, forged enduring relationships with ministries of health, and equipped local governments with the training and capacity to respond to threats when they occur.
For example, CDC has long partnered with the government of Nigeria to build their capacity to respond to biological threats. In 2023, Nigeria experienced an outbreak of anthrax, a zoonotic disease that can cause severe illness in people and animals. Drawing on CDC training, Nigeria quickly activated national response teams to coordinate across the human and animal health sectors and reduce the risk for further transmission. After containing the outbreak, Nigeria then passed on the training, working with the government of Ghana to share strategies for anthrax prevention and control.
CDC has also had a longstanding partnership with the Ministry of Health in Cambodia. So when Cambodia detected six human cases of H5N1 avian influenza in 2023 that raised suspicions of human-to-human transmission of the virus – a change that would dramatically boost the virus’ pandemic potential – they called the CDC. Within hours of the first case being detected, Cambodia began a comprehensive investigation with the support of World Health Organization and the U.S. Government. Through field epidemiology and genomic sequencing, capabilities built in partnership with the U.S. government, the Cambodian government quickly determined that the virus had not spread between people. If the results had shown human-to-human transmission, the U. S. government would have had an early warning of the next potential pandemic, and a chance to quickly contain the threat in partnership with Cambodia’s government.
There are hundreds of stories like these, most of which are never known to the American public because the threats are quickly contained at their source. This biological defense capacity is why, despite nearly a dozen Ebola outbreaks over the past decade, the U.S. has avoided even a single case of Ebola in the homeland. CDC officials often learn about outbreaks before they are made public—because local health officials trust them and call first. That trust is built over decades, not days.
What Is At Stake
The administration’s proposed budget would severely weaken this biodefense infrastructure by weakening or eliminating CDC’s forward-deployed biodefense bases. If the budget is implemented, CDC will begin to shutter its offices around the world, including their network of regional and country offices spanning more than 60 countries. Those offices are the ones that receive the first call in Nigeria, Cambodia, or anywhere else a biothreat emerges. This destruction of CDC’s global leadership would be coupled with the more than 60% cut to the State and USAID global health budget, including cutting State’s global health security budget from $700 million to $200 million, and cutting global work on tuberculosis and malaria in half. The President’s budget also proposes a 40% cut to PEPFAR, potentially eliminating or scaling back another core foundation of CDC’s presence around the world. CDC’s remaining global health security funding—flat at about $300 million—will no longer be controlled by experts, nor guaranteed to support CDC’s global operations. The CDC’s global readiness—its trained workforce, in-country and regional operations, and real-time intel—could vanish. And with it, so could our ability to stop the next outbreak at its source.
In the coming weeks and months, the Trump administration and Congress will need to decide whether to preserve or quickly rebuild layers of our nation’s biodefense system. They face two decisions: will we maintain our global public health “bases” to detect threats and contain them early—or only respond once threats hit our shores?
Maintaining these “warm” bases will require a plan of action for continuing PEPFAR, polio and immunization programs, not just in theory, but in practice through offices and active presence around the world. The question facing the administration and congress is this: will we retain the skilled workforce, flexible funding, and operational authority needed to respond rapidly to outbreaks or other biological threats anywhere in the world? If so, doing so requires maintaining warm bases worldwide built on trusted partnerships, collaborations, and enhancements to other countries’ capacity to respond to threats when they emerge. If the U.S. fails to do so, outbreaks will spread further, last longer, and the threat of imported cases of Ebola and other diseases reaching U.S. shores will increase. And the risk of a catastrophic biological event, whether naturally occurring or manmade, will grow.
A National Security Imperative
We don’t close military bases in unstable regions and hope for the best—we maintain forward deployment to prevent emergencies. The same logic applies to public health.
Our adversaries also understand the value of forward deployment against biological threats. They have learned from watching what the United States does so well. After mass cuts to the federal public health workforce earlier this year, Chinese recruiters aggressively swooped in to attract US-based scientists and researchers, advertising high salaries and positions at prestigious companies and universities. As China targets American researchers from top universities and scientists dismissed by the NIH, the United States is faced with the risk of a brain drain, and the potential to hand over our global health talent and leadership to China. As we pull back, forces like China’s Centers for Disease Control (China CDC) are moving forward by filling the funding gaps, dispatching technical experts, training local public health staff, and partnering in laboratory diagnostics and early-warning systems, ensuring China will have a head start on threats that are surely to come.
CDC’s 2024 record speaks for itself: more than 3,200 experts trained and ready to deploy, monitoring more than 30 potential biological threats daily, and supporting 44 countries to respond to Ebola, mpox, measles, cholera, and more, in partnership with more than newly 11,000 trained health professionals around the world. You can’t rebuild that overnight. And you can’t surge trust.
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