Centers for Disease Control and Prevention (CDC) Funding Overview

Centers for Disease Control and Prevention
March 28, 2023July 16, 2024
(CDC) Funding Overview
Kavya Sekar
The Centers for Disease Control and Prevention (CDC) The Centers for Disease Control and Prevention (CDC) is a federalworks to protect public health public health agency thatby Analyst in Health Policy providing leadership, information, and scientific expertise in preventing and controlling diseases, including outbreaks of infectious diseases. The CDC also works to promote health and quality of life, by supporting and undertaking efforts that aim to prevent and control injury, disability, and For a copy of the full report, environmental health threats
Analyst in Health Policy
develops and supports community-based and population-wide programs and systems to promote

health and to prevent the leading causes of disease, injury, disability, and death, both
domestically and globally. In addition, the Agency for Toxic Substances and Disease Registry . In addition, the Agency for Toxic Substances and Disease Registry
For a copy of the full report,
(ATSDR) isplease call 7-5700 or visit (ATSDR), headed by the CDC Director headed by the CDC Director and, is tasked with identifying potential public health is tasked with identifying potential public health
effects www.crs.gov. please call 7-5700 or visit
effects from exposure to hazardous substances. This CRS report provides an overview of CDC’s from exposure to hazardous substances. This CRS report provides an overview of CDC’s
www.crs.gov.
budget and appropriationsbudget and appropriations, with a focus on with a focus on FY2023FY2024 enacted appropriations and the enacted appropriations and the FY2024
FY2025 President’s budget requestPresident’s budget request, including ATSDR. The report also discusses supplemental appropriations for CDC. The report also discusses supplemental appropriations for CDC and trends in state and local
funding for public health. ATDSR appropriations are included within the overall discussion of CDC funding. .
This report divides CDC’s This report divides CDC’s program level,, or annual funding from all sources of budget authority, into two categories, with a or annual funding from all sources of budget authority, into two categories, with a
focus on the first: focus on the first:
1. a• A core public health program level that funds most of the agency’s main public health programs. This is core public health program level that funds most of the agency’s main public health programs. This is made up of made up of
discretionary and mandatory appropriations that are mostly provided or allocated through the Departments of Labor, discretionary and mandatory appropriations that are mostly provided or allocated through the Departments of Labor,
Health and Human Services, and Education, and Related Agencies (LHHS) appropriations actHealth and Human Services, and Education, and Related Agencies (LHHS) appropriations act, and
2. other. • Other mandatory programs that include several CDC-administered health services, compensation-related, mandatory programs that include several CDC-administered health services, compensation-related, and user and user
fee programs. These include the World Trade Center Health Program and user fees for cruise ship inspection, among fee programs. These include the World Trade Center Health Program and user fees for cruise ship inspection, among
others. others.
CDC’s enacted CDC’s enacted FY2023FY2024 (P.L. 117-328) core public health program level is $9. (P.L. 117-328) core public health program level is $9.269248 billion, which represents a $ billion, which represents a $78721 million million
((+9.3%) increase-0.2%) decrease from the from the FY2022FY2023 final core public health program level. The Biden Administration has proposed an final core public health program level. The Biden Administration has proposed an
FY2024FY2025 CDC program level of $ CDC program level of $11.6679.768 billion, a proposed increase of $ billion, a proposed increase of $2.398 billion520 million over the over the FY2023FY2024 enacted program enacted program
level. The Biden Administration has separately proposed a new $20 billion in mandatory appropriations for pandemic
preparedness available for five years, of which $6.1 billion would be for CDC. Accounting for the proposed mandatory
pandemic preparedness funding in the FY2024-requested core public health program level total, CDC would receive an
increase of $8.498 billion (+91.7%) over the FY2023 enacted program level.
Fromlevel. Accounting for mandatory funding, including new mandatory funding proposed by the Biden Administration for FY2025, CDC would receive $25.753 billion as requested, an increase of $8.471 billion (+49%) compared with the FY2024 level inclusive of mandatory funding. In terms of trends, CDC has seen relatively flat funding until recently: from FY2011 to FY2021, CDC’s core public health funding level FY2011 to FY2021, CDC’s core public health funding level has remained between approximately $6.5 and $8 billion remained between approximately $6.5 and $8 billion
until the increases provided in FY2022 and FY2023 (not until the increases provided in FY2022 and FY2023 (not adjusted for inflation). CDC saw a decrease in its overall program level in FY2024. adjusted for inflation). The lowest funding level of $6.28 billion in
2013 included budget sequestration of nonexempt discretionary spending. CDC also frequently receives one-time CDC also frequently receives one-time
supplemental appropriations in response to specific incidents—such as infectious disease threats, natural disasters, or supplemental appropriations in response to specific incidents—such as infectious disease threats, natural disasters, or
screening and health support to refugees. In response to some incidents, such as the screening and health support to refugees. In response to some incidents, such as the ongoing Coronavirus Disease 2019 Coronavirus Disease 2019
(COVID-19) pandemic, supplemental appropriations are substantial and are tied to short-term funding increases for overall (COVID-19) pandemic, supplemental appropriations are substantial and are tied to short-term funding increases for overall
public health capacity at the federal, state, and local level. (These are not included in core public health funding as they are
not intended to fund the regular operating expenses and programs of the agency.)
In the United States, state and local governments are at the forefront of public health. A large portion of CDC’s annual
budget is awarded as external financial assistance to state and local health departments (typically in the form of grants or
cooperative agreements). In addition to CDC funding, funding trends at the state and local level have a significant impact on
overall U.S. public health capacity. There is no source of standardized and generally accepted data on public health funding
at the federal, state, and local level, which hinders analysis of public health funding trends. However, several sources indicate
that public health funding at the state and local level has remained flat or declined over the past decade.
public health capacity at the federal, state, and local level. Congressional Research Service Congressional Research Service

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Contents
Introduction ..................................................................................................................................... 1
Understanding CDC Appropriations Funding .......................................................................................................... 3
Core Public Health Program Level ........................................................................................... 54
Other Mandatory Programs ....................................................................................................... 9
FY2022-FY2024 Budget and Appropriations ............................................................................... 10
FY2022 .................................................................................................................................... 10
FY2023 Budget Request .......................................................................................................... 11
FY2023 Enacted ...................................................................................................................... 12
FY2024 Request ...................................................................................................................... 12
Funding Table ................................................................................................................... 13
8 Proposed Mandatory Programs ............................................................................................... 10 Funding Table ................................................................................................................................ 10 Trends in Core Public Health Program Level................................................................................ 1512
CDC Budget in Context ................................................................................................................ 1613
Supplemental Appropriations for Public Health Emergencies and Other Incidents ............... 1613
CDC Infectious Diseases Rapid Response Reserve Fund ................................................ 18
State and Local Funding for Public Health ............................................................................. 19
Trends ............................................................................................................................... 20
Other Funding-Related Challenges ................................................................................... 2215

Figures
Figure 1. Centers for Disease Control and Prevention Organization Chart ..................................... 32
Figure 2. FY2023FY2024 Enacted Centers for Disease Control and Prevention Program Level by
Category and Budget Authority .................................................................................................... 54
Figure 3. Example of CDC Appropriation Language ...................................................................... 65
Figure 4. Example of CDC Appropriations Report Language ........................................................ 76
Figure 5. Example of Prevention and Public Health Fund Allocations ........................................... 87
Figure 6. Trends in Core Public Health Program Level ................................................................ 16
Figure 7. Inflation-adjusted Trends in State Spending on Public Health by Category Per
Capita from Alfonso et al. (2021). .............................................................................................. 21

13 Tables
Table 1. Centers for Disease Control and Prevention (CDC) and Agency for Toxic
Substances and Disease Registry (ATSDR) Appropriations, FY2022-FY2024FY2023-FY2025 Request ........... 1410
Table 2. Appropriations History to the IDRRRF ........................................................................... 1916

Contacts
Author Information ........................................................................................................................ 2417


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Introduction
The Centers for Disease Control and Prevention (CDC) works to protect public health by The Centers for Disease Control and Prevention (CDC) works to protect public health by
providing leadership, information, and scientific expertise in preventing and controlling diseases, providing leadership, information, and scientific expertise in preventing and controlling diseases,
including outbreaks of infectious diseases. The CDC also works to promote health and quality of including outbreaks of infectious diseases. The CDC also works to promote health and quality of
life, by supporting and undertaking efforts that aim to prevent and control injury, disability, and life, by supporting and undertaking efforts that aim to prevent and control injury, disability, and
environmental health threats. Its stated mission is to “protect America from health, safety and environmental health threats. Its stated mission is to “protect America from health, safety and
security threats, both foreign and in the [United States].”1 In addition to its role supporting security threats, both foreign and in the [United States].”1 In addition to its role supporting
ongoing public health activities, the agency has played a major role in ongoing public health activities, the agency has played a major role in disease outbreaks and public health emergencies, including the federal response to the the federal response to the
Coronavirus Disease 2019 (COVID-19) pandemicCoronavirus Disease 2019 (COVID-19) pandemic and in other disease outbreaks and public
health emergencies. The Agency for Toxic Substances and Disease Registry (ATSDR), a separate . The Agency for Toxic Substances and Disease Registry (ATSDR), a separate
operating division headed by the CDC Director, is tasked with identifying potential public health operating division headed by the CDC Director, is tasked with identifying potential public health
effects from exposure to hazardous substances. effects from exposure to hazardous substances.
Two features characterize CDC’s mission and programs. First, CDC programs tend to focus on
prevention of adverse health outcomes, rather than treatment or clinical care after a health issue
arises. Second, CDC programs promote health on a population and communityCDC focuses on supporting science-based disease prevention and health promotion on a population-wide basis. CDC basis. CDC
also administers some health services and compensation-related programs as discussed later in also administers some health services and compensation-related programs as discussed later in
this report. CDC is organized into a number of centers, institutes and offices (CIOs) as shown this report. CDC is organized into a number of centers, institutes and offices (CIOs) as shown inin
Figure 1. Some of these CIOs focus on specific public health challenges (e.g., injury prevention), ome of these CIOs focus on specific public health challenges (e.g., injury prevention),
while others focus on general public health capabilities (e.g., surveillance and laboratory while others focus on general public health capabilities (e.g., surveillance and laboratory
services).2 services).2
CDC was established in 1946 as the Communicable Disease Center.3 Under authority provided by CDC was established in 1946 as the Communicable Disease Center.3 Under authority provided by
congressionally approved reorganization plans, CDC has since been reorganized and renamed.congressionally approved reorganization plans, CDC has since been reorganized and renamed.4
Most of CDC’s programs are authorized in the Public Health Service Act (PHSA).Most of CDC’s programs are authorized in the Public Health Service Act (PHSA).5 Many CDC Many CDC
programs and activities are not explicitly mentioned in the PHSA, but CDC carries out those programs and activities are not explicitly mentioned in the PHSA, but CDC carries out those
programs on the basis of general and permanent statutory authorities granted to the HHS programs on the basis of general and permanent statutory authorities granted to the HHS

1 Centers for Disease Control and Prevention (CDC), “Mission, Role, and Pledge,” https://www.cdc.gov/about/
organization/mission.htm.
2 CDC, “Official Mission Statement & Organizational Chart,” https://www.cdc.gov/about/organization/cio-orgcharts/
index.html.
3 CDC, “Our History-Our Story,” https://www.cdc.gov/about/history/index.html.
4 CRS In Focus IF12241, The Centers for Disease Control and Prevention (CDC), and Institute of Medicine (now
National Academy of Medicine), “Appendix H Statutory Framework for the Organization and Management of the U.S.
Department of Health and Human Services,” in HHS in the 21st Century: Charting a Course for a Healthier America,
2009, pp. 209-219.
5 For more information, see CRS In Focus IF12241, The Centers for Disease Control and Prevention (CDC).
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Centers for Disease Control and Prevention (CDC) Funding Overview

Secretary.6 Four CDC CIOs7 and numerous specific CDC programs8 are explicitly authorized.
CDC also has certain regulatory responsibilities.9
Secretary.4 Some CDC programs have specific authorizations, mostly in the PHSA. Given CDC’s mix of general and specific authorizations, appropriations play a central role in Given CDC’s mix of general and specific authorizations, appropriations play a central role in
guiding the agency’s policy priorities. guiding the agency’s policy priorities.
A large portion of CDC’s annual budget is awarded as external financial assistance (typically in A large portion of CDC’s annual budget is awarded as external financial assistance (typically in
the form of grants or cooperative agreements)—especially to the form of grants or cooperative agreements)—especially to state10state5 and local health and local health
departments.departments.11 6 CDC also awards funding to a variety of other entities, including international CDC also awards funding to a variety of other entities, including international
governments and organizations; tribal governments and organizations; academic and research governments and organizations; tribal governments and organizations; academic and research
institutions; and nonprofit organizations. institutions; and nonprofit organizations.
This report reviews the CDC’s budget and appropriations from This report reviews the CDC’s budget and appropriations from FY2022 to FY2024FY2023 to FY2025 and its and its
funding history for core public health programs from FY2011 to funding history for core public health programs from FY2011 to FY2024FY2025. It also discusses CDC 1 Centers for Disease Control and Prevention (CDC), “Mission, Role, and Pledge,” https://www.cdc.gov/about/organization/mission.htm. 2 CDC, “Official Mission Statement & Organizational Chart,” https://www.cdc.gov/about/cdc/?CDC_AAref_Val=https://www.cdc.gov/about/organization/mission.htm. 3 CDC, “Our History-Our Story,” https://www.cdc.gov/museum/history/our-story.html. 4 CRS Report R47981, Centers for Disease Control and Prevention (CDC): History, Overview of Domestic Programs, and Selected Issues. 5. It also discusses
selected policy issues related to CDC appropriations, including the roles of emergency
supplemental funding and state and local funding in public health.12 ATDSR appropriations are
included within the overall discussion of CDC funding.

6 For example, PHSA Section 301 (42 U.S.C. §241) authorizes the HHS Secretary to conduct and support health-
related research and investigations. PHSA Section 317 (42 U.S.C. §247b) authorizes the Secretary to award grants to
states for preventive health programs, and PHSA Section 319 (42 U.S.C. §247d) authorizes the Secretary to respond to
public health emergencies.
7 Explicitly authorized CDC components include the National Institute for Occupational Safety and Health (NIOSH),
authorized by the Occupational Safety and Health Act of 1970 (29 U.S.C. §§651 et seq.); the National Center on Birth
Defects and Developmental Disabilities (NCBDDD) established in PHSA Section 317C (42 U.S.C. §247b-4); the
National Center for Health Statistics (NCHS) established in PHSA Section 306 (42 U.S.C. §242k); and the Agency for
Toxic Substances and Disease Registry (ATSDR) established by the Comprehensive Environmental Response,
Compensation and Liability Act of 1980 (CERCLA, the “Superfund” law; 42 U.S.C. §§9601 et seq.).
8 Among numerous others, PHSA Sections 317A et seq. authorize lead poisoning prevention activities, and PHSA Title
XXXIII authorizes the World Trade Center Health Program.
9 See CDC, “CDC Regulations,” https://www.cdc.gov/regulations/index.html.
10 For the purposes of this report, U.S. territories are included in the term, “state,” consistent with the definition of For the purposes of this report, U.S. territories are included in the term, “state,” consistent with the definition of
“state” in the PHSA (Section 2, 42 U.S.C. §201). “state” in the PHSA (Section 2, 42 U.S.C. §201).
11 In FY2020, CDC provided6 In FY2023, CDC obligated more than $ more than $6 billion in non-COVID-19-related grant funding into public health programs
and research around the world. CDC, “Office of Financial Assistance: FY2020 Assistance Snapshot12.5 billion in grants for public health programs and research, including more than $6.7 billion for non-COVID-19 related awards and over $5.8 billion for COVID-19 related awards. See CDC, “Office of Financial Resources: FY2023 Assistance Snapshot at CDC,” ,”
https://www.cdc.gov/funding/documents/https://www.cdc.gov/funding/documents/fy2020/fy-2020-ofr-fy2023/fy-2023-ofr-assistance-snapshot-508.pdf. Congressional Research Service 1 snapshot-508.pdf.
12 This report draws from prior year Congressional Budget Justifications and relevant appropriations laws and
accompanying reports. See CDC, “Congressional Justifications,” https://www.cdc.gov/budget/congressional-
justifications/index.html.
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supplemental and emergency reserve funding. ATDSR appropriations are included within the overall discussion of CDC funding. Figure 1. Centers for Disease Control and Prevention Organization Chart

Source: Adapted by CRS from CDC, “CDC Organization Chart,” https://www.cdc.gov/about/pdf/organization/ Adapted by CRS from CDC, “CDC Organization Chart,” https://www.cdc.gov/about/pdf/organization/
cdc-org-chart.pdf, updated as of February 23, 2023. cdc-org-chart.pdf, updated as of February 23, 2023.
Notes: HIV = Human Immunodeficiency Virus; STD = Sexually Transmitted Disease; TB = Tuberculosis HIV = Human Immunodeficiency Virus; STD = Sexually Transmitted Disease; TB = Tuberculosis.
Understanding CDC Appropriations
This CRS report divides CDC’s annual program level13 into two categories, as shown in Figure 2.

13 For the purposes of this report, CDC’s program level is the sum of the agency’s funding for a fiscal year reflecting all
sources of budget authority.
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; OPDIV = Operating Division. Congressional Research Service 2 link to page 7 Centers for Disease Control and Prevention (CDC) Funding Overview Understanding CDC Funding This CRS report divides CDC’s annual program level7 into two categories, as shown in Figure 2: • core public health program level, funded mostly by annual discretionary core public health program level, funded mostly by annual discretionary
Departments of Labor, Health and Human Services, and Education, and Related Departments of Labor, Health and Human Services, and Education, and Related
Agencies (LHHS) appropriations and Agencies (LHHS) appropriations and the mandatory Prevention and Public Health mandatory Prevention and Public Health
Fund (PPHF)Fund (PPHF) appropriations, and , and
• other mandatory programs, including other mandatory programs, including health services or compensation-related
programs funded by program-specific mandatory budget authorities. In addition,
CDC receives funding from mandatoryCDC-administered health services, compensation-related, and user fee programs. user fee programs.
CRS has divided CDC’s program level into the two categories to allow for valid year-to-year CRS has divided CDC’s program level into the two categories to allow for valid year-to-year
comparisons of programmatic funding levels for the agency. The core public health program level comparisons of programmatic funding levels for the agency. The core public health program level
reflects both (1) funding for the main public health program activities conducted by CDC CIOs reflects both (1) funding for the main public health program activities conducted by CDC CIOs
and ATDSR in support of the agencies’ core missions, and (2) funding that is largely subject to and ATDSR in support of the agencies’ core missions, and (2) funding that is largely subject to
the annual appropriations process, and therefore reflects the legislative decisions made by the annual appropriations process, and therefore reflects the legislative decisions made by
Congress each year to fund CDC and ATDSR programs. The CDC “core public health program Congress each year to fund CDC and ATDSR programs. The CDC “core public health program
level” level” for FY2023 in this CRS report aligns with the “CDC/ATDSR program level” presented in in this CRS report aligns with the “CDC/ATDSR program level” presented in
FY2024 FY2025 CDC budget documents.CDC budget documents.148
The other mandatory programs excluded from the core public health program level have funding The other mandatory programs excluded from the core public health program level have funding
levels that are mostly controlled by their program authorizations. The two largest programs—the levels that are mostly controlled by their program authorizations. The two largest programs—the
Vaccines for Children (VFC) program and the World Trade Center Health Program (WTCHP)—Vaccines for Children (VFC) program and the World Trade Center Health Program (WTCHP)—
primarily finance specific health services for eligible populations. Changes in annual spending primarily finance specific health services for eligible populations. Changes in annual spending
reflect usage and demand for the program services. These programs’ funding levels are therefore reflect usage and demand for the program services. These programs’ funding levels are therefore
presented separately from CDC’s core public health program level and are excluded from presented separately from CDC’s core public health program level and are excluded from
analysis of funding trends for the agency’s main programmatic and operating expenses. These analysis of funding trends for the agency’s main programmatic and operating expenses. These
other mandatory programs are also generally presented separately from the rest of CDC’s budget other mandatory programs are also generally presented separately from the rest of CDC’s budget
in the agency’s own budget presentations.in the agency’s own budget presentations.15

14 See CDC, “FY20249 7 For the purposes of this report, CDC’s program level is the sum of the agency’s funding for a fiscal year reflecting all sources of budget authority. 8 See CDC, “FY2025 Budget Detail Table,” https://www.cdc.gov/budget/documents/ Budget Detail Table,” https://www.cdc.gov/budget/documents/fy2024/FY-2024fy2025/FY-2025-CDC-Budget--CDC-Budget-
Detail.pdf. CDC changes its budget presentations and categories from year to year. Detail.pdf. CDC changes its budget presentations and categories from year to year.
159 See, for example, CDC, “ See, for example, CDC, “FY2024FY2025 Budget Detail Table,” https://www.cdc.gov/budget/documents/ Budget Detail Table,” https://www.cdc.gov/budget/documents/fy2024/FY-2024fy2025/FY-2025--
CDC-Budget-Detail.pdf.CDC-Budget-Detail.pdf.
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Centers for Disease Control and Prevention (CDC) Funding Overview

Figure 2. FY2023FY2024 Enacted Centers for Disease Control and Prevention Program
Level by Category and Budget Authority
Thousands of Dollars Thousands of Dollars

Source: FY2023 Enacted numbers from CDC, “FY2024FY2024 discretionary amounts are from P.L. 118-47 and Congressional Record, vol. 170, no. 51 (March 22, 2024), H2020-H2022, and other mandatory program amount estimates from CDC, “FY2025 Budget Detail Table,” https://www.cdc.gov/budget/ Budget Detail Table,” https://www.cdc.gov/budget/
documents/documents/fy2024/FY-2024fy2025/FY-2025-CDC-Budget-Detail.pdf. -CDC-Budget-Detail.pdf.
Notes: Amounts reflect some post-appropriations adjustments. Acronyms: CDC = Centers for Disease Control Amounts reflect some post-appropriations adjustments. Acronyms: CDC = Centers for Disease Control
and Preventionand Prevention; WTCHP = World Trade Center Health Program; EEOICPA = Energy Employees Occupational
Il ness Compensation; VFC = Vaccines for Children; LHHS = Labor, Health and Human Services, Education, and
Related Agencies appropriations bil ; ATSDR = Agency for Toxic Substances and Disease Registry; PPHF =
Prevention and Public Health Fund.
Core Public Health Program Level
CDC’s core public health program level funds the main public health programs implemented by
CDCs CIOs. Core Public Health Program Level CDC’s core public health program level funds the main programs that CDC CIOs implement in their efforts to prevent and control disease and to improve public health. Types of funded activities include but are not limited to. Types of funded activities include but are not limited to: developing expertise and developing expertise and
best practices in disease prevention and control; conducting and supporting public health best practices in disease prevention and control; conducting and supporting public health
research; supporting and conducting public health surveillance and data collection; developing research; supporting and conducting public health surveillance and data collection; developing
and supporting public health laboratory capacity; supporting public health laboratory capacity; supporting and conducting health education and promotion efforts; health education and promotion efforts;
coordinatingfunding, coordinating, and providing technical assistance to public health programs at the state and providing technical assistance to public health programs at the state Congressional Research Service 4 link to page 8 link to page 9 Centers for Disease Control and Prevention (CDC) Funding Overview and local and local
level; supporting some preventive health services programs (e.g., some vaccination and cancer level; supporting some preventive health services programs (e.g., some vaccination and cancer
screening programs); and supporting public health emergency preparedness and response efforts. screening programs); and supporting public health emergency preparedness and response efforts.
Many of the programs Many of the programs fund and support public health activities at the state and local level.support public health activities at the state and local level.1610
CDC’s core public health program level is made up of (1) discretionary appropriations; (2), CDC’s core public health program level is made up of (1) discretionary appropriations; (2),
mandatory mandatory appropriationsfunding from the Prevention and Public Health Fund (PPHF); and (3) some from the Prevention and Public Health Fund (PPHF); and (3) some
other funding sources, such as transfers from other accounts. other funding sources, such as transfers from other accounts.

16 See CDC, “Grant Funding Profiles,” https://fundingprofiles.cdc.gov/.
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Centers for Disease Control and Prevention (CDC) Funding Overview

Discretionary Appropriations. CDC receives funding through annual discretionary LHHS
Discretionary Funding (FY2024: $7.938 billion in LHHS budget authority; $82 million for ATSDR). CDC receives discretionary funding through annual LHHS appropriations, while ATSDR is separately funded by Interior/Environment appropriations. appropriations, while ATSDR is separately funded by Interior/Environment appropriations.
Within LHHS appropriations, CDC receives funding in several accounts, many of which Within LHHS appropriations, CDC receives funding in several accounts, many of which have
titles that align with the names ofalign with CDC CIOs. Some accounts fund activities through multiple CDC CIOs. Some accounts fund activities through multiple
CIOs (e.g., CIOs (e.g., the Public Health Scientific ServicesPublic Health Scientific Services account). Some CDC accounts are for agency-wide ). Some CDC accounts are for agency-wide
activities, such as the Buildings and Facilities account and the CDC-Wide Activities and Program activities, such as the Buildings and Facilities account and the CDC-Wide Activities and Program
Support account. Support account.
As an example, the As an example, the Injury Prevention and ControlBirth Defects, Developmental Disabilities, Disabilities and Health account funds activities at CDC’s National account funds activities at CDC’s National
Center for Injury Prevention and Control (NCIPCCenter on Birth Defects and Developmental Disabilities (NCBDDD). The appropriations act text provides funding ). The appropriations act text provides funding
to the Injury Prevention and Control to the account with respect to such activities as authorized by account with respect to such activities as authorized by
several PHSA titles as shown iseveral PHSA titles as shown in Figure 3.
Figure 3. Example of CDC Appropriation Language
From From FY2023FY2024 LHHS Appropriations LHHS Appropriations

Source: Consolidated Appropriations Act, Consolidated Appropriations Act, 20232024, P.L. , P.L. 117-328;118-47, Division Division HD, Title II. , Title II.
Appropriations report language accompanying CDC appropriations generally specifies amounts Appropriations report language accompanying CDC appropriations generally specifies amounts
for programs or activities funded by CDC accounts in greater detail than the appropriations act for programs or activities funded by CDC accounts in greater detail than the appropriations act
text. Shown below itext. Shown below in Figure 4 is the is the FY2023FY2024 report language and funding table accompanying report language and funding table accompanying
the the Injury Prevention and ControlBirth Defects and Developmental Disabilities appropriation. appropriation.17

1711 10 See CDC, “Grant Funding Profiles,” https://fundingprofiles.cdc.gov/. 11 For a general overview of appropriations report language, see CRS Report R44124, For a general overview of appropriations report language, see CRS Report R44124, Appropriations Report
Language: Overview of Development and Components. .
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Centers for Disease Control and Prevention (CDC) Funding Overview

Figure 4. Example of CDC Appropriations Report Language

Source: “Explanatory Statement Accompanying Consolidated Appropriations Act, “Explanatory Statement Accompanying Consolidated Appropriations Act, 20232024,” ,” Congressional Record, ,
vol. vol. 168 (December 20, 2022), p. S8880170 (March 22, 2024), p. H1889. .
This CRS report focuses on account-level funding in This CRS report focuses on account-level funding in Table 1. CDC’s annual DC’s annual Operating Plans
reflect programmatic funding levels within accounts as directed by appropriations report reflect programmatic funding levels within accounts as directed by appropriations report
language.language.18
Mandatory Appropriations12 In addition, the appropriations reports include many directives or recommendations from Congress to CDC regarding funded programs. Mandatory Funding from the Prevention and Public Health Fund (PPHF). (FY2024 funding: $1.186 billion). In recent In recent
years, some CDC LHHS accounts have received annual allocations of the mandatory PPHF years, some CDC LHHS accounts have received annual allocations of the mandatory PPHF
appropriations as directed in LHHS appropriations laws. as directed in LHHS appropriations laws. The PPHF was established in 2010 in
Section 4002 ofIn 2010, the Affordable Care Act the Affordable Care Act (ACA; P.L. 111-148, as amended) established the PPHF, which is a permanent, annual appropriation that was intended to provide support prevention, wellness, and related public health programs funded through HHS accounts.13(ACA; P.L. 111-148, as amended) “to provide for
expanded and sustained national investment in prevention and public health programs to improve
health and help restrain the rate of growth in private and public sector health care costs.”19 The
PPHF has its own appropriation (provided by its authorizing law) and its own account within the
HHS Office of the Secretary. In recent years, appropriators have directed specific amounts of In recent years, appropriators have directed specific amounts of
annual PPHF funding to specific CDC accounts and programs (in addition to other HHS annual PPHF funding to specific CDC accounts and programs (in addition to other HHS
agencies) through LHHS agencies) through LHHS Appropriations Actslaws and accompanying report language. and accompanying report language.2014 See Figure 5
for PPHF allocations from for PPHF allocations from FY2023FY2024 appropriations. appropriations.

18 12 See CDC, See CDC, Operating Plans, https://www.cdc.gov/budget/operating-plans/index.html. https://www.cdc.gov/budget/operating-plans/index.html.
1913 42 U.S.C. § 42 U.S.C. § 300u-11(a). 300u-11(a).
2014 Prior to FY2014, the HHS Secretary determined uses of the PPHF Prior to FY2014, the HHS Secretary determined uses of the PPHF funding. See. See CRS report, CRS Report CRS Report R44796, The ACA
R47895, Prevention and Public Health Fund: In Brief, by Sarah A. Lister. .
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Figure 5. Example of Prevention and Public Health Fund Allocations
From From FY2023FY2024 LHHS Appropriations LHHS Appropriations

Source: “Explanatory Statement Accompanying Consolidated Appropriations Act, “Explanatory Statement Accompanying Consolidated Appropriations Act, 20232024,” ,” Congressional Record, ,
vol. vol. 168 (December 20, 2022), p. S8895170 (March 22, 2024), p. H1894. .
As shown i As shown in Figure 5, mostmost of the FY2023 PPHF allocation went to CDC. Additional allocations of the FY2023 PPHF allocation went to CDC. Additional allocations
went to the Administration for Community Living (ACL) and the Substance Abuse and Mental went to the Administration for Community Living (ACL) and the Substance Abuse and Mental
Health Services Administration (SAMHSA). Health Services Administration (SAMHSA).
Other funding. CDC sometimes receives funding for its core public health program level
through transfers from other sources, including both discretionary and mandatory appropriations,
some subject to specific transfer rules.
Transfers. In some years, CDC has received transfers from other HHS accounts or appropriations
subject to specific transfer authorities. For example, as shown in Figure 6, CDC has received
occasional transfers from the Public Health and Social Services Emergency Fund (PHSSEF)21
and the Nonrecurring Expenses Fund (NEF) accounts.22 In some years, CDC also received
transfers under the Public Health Service (PHS) Program Evaluation Set-Aside, or the “PHS
evaluation tap” transfer authority. Authorized by PHSA Section 241, the PHS evaluation tap
allows the HHS Secretary, with the approval of appropriators, to redistribute a portion of eligible
PHS agency appropriations across HHS for program evaluation purposes. Recent LHHS
Appropriations Acts have established the higher maximum percentage for the set-aside and have
distributed specific amounts of “Tap” funding to selected HHS programs. As shown in Figure 6,
CDC has not received PHS evaluation tap funding since FY2014. The PHS evaluation tap

21 The Public Health and Social Services Emergency Fund is an account of the HHS Secretary that funds several offices
and programs including the Administration for Strategic Preparedness and Response (ASPR), the HHS Cybersecurity
program, and the Office of National Security. It is also frequently used to provide emergency supplemental
appropriations for transfer by the HHS Secretary to agencies in HHS and elsewhere, according to legislative direction.
22 The NEF permits HHS to transfer unobligated balances of expired discretionary funds from FY2008 and subsequent
years into the NEF account. Statute authorizes use of the funds for capital acquisitions, including information
technology (IT) and facilities infrastructure (42 U.S.C. §3514a). Congress and the President can direct the funds to
certain accounts through appropriations acts.
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amounts shown in this CRS report reflect the transfer of those funds as directed in appropriations
acts, but do not reflect final amounts of transfers out of CDC accounts under the same authority.
Smaller mandatory appropriations for Public Health Service Evaluation Tap (FY2024: $43 million). The PHS Evaluation Set-Aside, also known as the PHS Evaluation Tap, has the effect of redistributing a certain percentage of eligible appropriations among HHS accounts funded by the LHHS Act (up to 2.5% of eligible appropriations in FY2024).15 Eligible appropriations potentially subject to the transfer include any provided for programs authorized in the Public Health Service Act, with some exemptions.16 In recent years, appropriations laws have directed specific amounts of PHS tap funds to specific agencies. Until FY2024, CDC had not received directed PHS tap transfers since FY2014 (see Figure 6). By convention, appropriations acts direct where specified PHS tap transfers are to be allocated, but do not specify the accounts that are to be the sources of those transfers. Thus, tables in this report show only the amount of PHS tap funds received in any CDC account, and not the amount transferred out of source accounts. Other funding. CDC sometimes receives funding for its core public health program level through transfers from other sources, including both discretionary and mandatory appropriations, some subject to specific transfer rules. 15 Authorized by Section 241 of the Public Health Service Act (PHSA). The authorizing law allows the HHS Secretary to redistribute a portion of eligible PHS agency appropriations across HHS for program evaluation purposes. The PHSA limits the set-aside to not less than 0.2% and not more than 1.0% of eligible program appropriations. In recent years, annual appropriations laws have established requirements in addition to those in statute. These include a higher maximum percentage for the set-aside and directing specific amounts of tap funding to selected HHS programs. Since FY2010, and including in FY2024, this higher maximum set-aside level has been 2.5% of eligible appropriations. 16 Annual appropriations laws have exempted certain appropriations from transfer that would be otherwise eligible. For example, see in the Substance Abuse and Mental Health Services Administration (SAMHSA) appropriation for mental health, “none of the funds provided for section 1911 of the PHS Act shall be subject to section 241 of such Act” in P.L. 118-47. Congressional Research Service 7 link to page 16 link to page 16 link to page 16 Centers for Disease Control and Prevention (CDC) Funding Overview Transfers. In some years, CDC has received transfers from other HHS accounts. For example, as shown in Figure 6, CDC has received occasional transfers from the Public Health and Social Services Emergency Fund (PHSSEF).17 Smaller mandatory appropriations for core public health programs. Some smaller CDC public health Some smaller CDC public health
programs have been funded by mandatory budget authorities, such as for the Childhood Obesity programs have been funded by mandatory budget authorities, such as for the Childhood Obesity
Demonstration Project,Demonstration Project,2318 as authorized in Social Security Act (SSA) Section 1139A(e)(8). as authorized in Social Security Act (SSA) Section 1139A(e)(8).2419
Supplemental Appropriations
CDC has also received supplemental appropriations during public health emergencies and other specific incidents, CDC has also received supplemental appropriations during public health emergencies and other specific incidents,
such as during the COVID-19 pandemic, as discussed further insuch as during the COVID-19 pandemic, as discussed further in “Supplemental Appropriations for Public Health
Emergencies.” Of note, the recently enacted COVID-19 supplemental appropriations and the American Rescue f note, the recently enacted COVID-19 supplemental appropriations and the American Rescue
Plan Act (P.L. 117-2) budget reconciliation measure included several major funding streams for general public Plan Act (P.L. 117-2) budget reconciliation measure included several major funding streams for general public
health capabilities not specific to the pandemic, such as for data modernization. These additional appropriations health capabilities not specific to the pandemic, such as for data modernization. These additional appropriations
are discussed in a separate section in this CRS report to distinguish regular appropriations for CDC’s annual are discussed in a separate section in this CRS report to distinguish regular appropriations for CDC’s annual
operations from these one-time appropriations. operations from these one-time appropriations.
Other Mandatory Programs
CDC also administers several health services and compensation-related programs that are funded CDC also administers several health services and compensation-related programs that are funded
by mandatory budget authorities and are distinct from the agency’s core public health programs. by mandatory budget authorities and are distinct from the agency’s core public health programs.
In several cases, the program’s authorizing law determines annual funding levels for these In several cases, the program’s authorizing law determines annual funding levels for these
programs. In addition, CDC receives a small amount of user fees through authorized user fee programs. In addition, CDC receives a small amount of user fees through authorized user fee
programs. programs.
The Vaccines for Children (VFC) program (FY2024 estimate: $7.213 billion) provides vaccines to enrolled health care providers provides vaccines to enrolled health care providers
to vaccinate eligible children.to vaccinate eligible children.2520 As authorized in SSA Section 1928 (42 U.S.C. §1396s), the HHS As authorized in SSA Section 1928 (42 U.S.C. §1396s), the HHS
Secretary can purchase vaccines as necessary for eligible children at a federally negotiated Secretary can purchase vaccines as necessary for eligible children at a federally negotiated
discounted price and then distribute vaccines to participating state and local health departments. discounted price and then distribute vaccines to participating state and local health departments.
State and local health departments then distribute a portion of the supply to participating health State and local health departments then distribute a portion of the supply to participating health
care providers and also administer vaccines through their own programs. In addition, some of the care providers and also administer vaccines through their own programs. In addition, some of the
annual VFC funding is awarded to states and other jurisdictions for program operations and annual VFC funding is awarded to states and other jurisdictions for program operations and
administration.administration.2621 VFC is financed by a Medicaid appropriation within the HHS Centers for VFC is financed by a Medicaid appropriation within the HHS Centers for
Medicare & Medicaid Services (CMS) and is Medicare & Medicaid Services (CMS) and is administered by CDC.27 Like other Medicaid
programs, VFC is an appropriated entitlement, meaning that VFC funding is provided through
LHHS appropriations acts, but the funding level is determined based on budget projections for
meeting the funding needs of the program.28

23 Social Security Act (SSA) Section 1139(e)(8).
24 17 The Public Health and Social Services Emergency Fund is an account of the HHS Secretary that has historically funded several offices and programs, including the Administration for Strategic Preparedness and Response (ASPR), the HHS Cybersecurity program, and the Office of National Security. It is also frequently used to provide emergency supplemental appropriations for transfer by the HHS Secretary to agencies in HHS and elsewhere, according to legislative direction. 18 Social Security Act (SSA) Section 1139(e)(8). 19 See, for example, funding for the CDC’s Childhood Obesity Research Demonstration (CORD) Project was initially See, for example, funding for the CDC’s Childhood Obesity Research Demonstration (CORD) Project was initially
authorized through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA; P.L. 111-3), and authorized through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA; P.L. 111-3), and
$25 million was appropriated for FY2010 through FY2014 through the Affordable Care Act (ACA; P.L. 111-148, as
amended) in 2010the program was extended through several laws until FY2023. CDC, “Report to Congress on the Centers for Disease Control and Prevention’s Childhood Obesity . CDC, “Report to Congress on the Centers for Disease Control and Prevention’s Childhood Obesity
Research Demonstration Project,” https://www.cdc.gov/obesity/downloads/strategies/report-to-congress-CORD-Research Demonstration Project,” https://www.cdc.gov/obesity/downloads/strategies/report-to-congress-CORD-
508.pdf. 508.pdf.
2520 VFC is funded by VFC is funded by mandatory Medicaid appropriations that are transferred annually to CDC. See 42 U.S.C. §Medicaid appropriations that are transferred annually to CDC. See 42 U.S.C. § 1396s. 1396s.
2621 See “State Table: Vaccines for Children” in CDC, See “State Table: Vaccines for Children” in CDC, FY2022FY2025 Congressional Budget Justification, pp. pp. 74-7581-82, ,
https://www.cdc.gov/budget/documents/https://www.cdc.gov/budget/documents/fy2022/FY-2022fy2025/FY-2025-CDC-congressional-justification.pdf. Congressional Research Service 8 Centers for Disease Control and Prevention (CDC) Funding Overview administered by CDC.22 Like other Medicaid programs, VFC is an appropriated entitlement, meaning that VFC funding is provided through LHHS appropriations acts, but the funding level is determined based on budget projections for meeting the funding needs of the program as required by the program’s authorization law.23 The Energy Employees Occupational Illness Compensation Program (EEOICP) (FY2024 estimate: $51 million), administered by the Department of Labor (DOL), provides -CDC-congressional-justification.pdf.
27 Centers for Medicare & Medicaid Services (CMS), FY2023 Congressional Budget Justification, p. 107,
https://www.cms.gov/files/document/fy2023-cms-congressional-justification-estimates-appropriations-committees.pdf.
28 See CRS Report R42640, Medicaid Financing and Expenditures.
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The Energy Employees Occupational Illness Compensation Program (EEOICP) provides
compensation and medical benefits to eligible civilians (or their survivors) who have performed compensation and medical benefits to eligible civilians (or their survivors) who have performed
duties related to the nuclear weapons production and testing programs of the Department of duties related to the nuclear weapons production and testing programs of the Department of
Energy.Energy.2924 CDC provides support to the program by conducting radiation dose estimates, CDC provides support to the program by conducting radiation dose estimates,
evaluating certain petitions, and providing other administrative support.evaluating certain petitions, and providing other administrative support.30 DOL uses these estimates in making compensation determinations.25 Annual funding for Annual funding for
these CDC activities these CDC activities areis generally provided pursuant to Section 151(b) of Division B, Title I of generally provided pursuant to Section 151(b) of Division B, Title I of
Consolidated Appropriations Act, 2001 (P.L. 106-554), which specifies that annual funding Consolidated Appropriations Act, 2001 (P.L. 106-554), which specifies that annual funding
pursuant to that section shall be direct spending (i.e., mandatory pursuant to that section shall be direct spending (i.e., mandatory appropriations).31funding).26
The World Trade Center Health Program (WTCHP) (FY2024 estimated obligations: $768 million) provides medical monitoring and provides medical monitoring and
treatment to eligible individuals directly affected by the September 11, 2001 attacks for certain treatment to eligible individuals directly affected by the September 11, 2001 attacks for certain
incident-related health conditions. incident-related health conditions. Furthermore, this programThis program also funds medical research into health funds medical research into health
conditions that may develop due to exposure during the attacks.conditions that may develop due to exposure during the attacks.32 27 The program is authorized by The program is authorized by
PHSA Title XXXIII (42 U.S.C. §PHSA Title XXXIII (42 U.S.C. § §300mm et seq.) and funded 300mm et seq.) and funded through appropriations provided bythrough mandatory appropriations
in PHSA Section 3351 (42 PHSA Section 3351 (42 USCU.S.C. §300mm–61). §300mm–61).
User fee programs. (FY2024 estimate: $2.226 million). CDC also receives relatively small amounts of user fees from authorized CDC also receives relatively small amounts of user fees from authorized
user fee programs such as the vessel sanitation user fee programs such as the vessel sanitation program33 and the respirator certification
program.34
FY2022-FY2024 Budget and Appropriations
The following provides an overview of the budget and appropriations for CDC’s coreprogram,28 which collects fees from cruise ship owners for public public
health program level in fiscal years 2022 through 2024. Other CDC mandatory appropriations are
not addressed in the discussion as most are not subject to the annual appropriations process
(except for EEOICP). Estimates and amounts for those programs are summarized in Table 1.
However, some notable new mandatory programs proposed by the Biden Administration in
FY2023 and FY2024 requests are explained.
FY2022
In March 2022, Congress and the President enacted the Consolidated Appropriations Act, 2022
(P.L. 117-103), which provided FY2022 LHHS appropriations in Division H and
Interior/Environment appropriations in Division G. The law provided CDC a total core public
health program level of $8.482 billion, comprising the following:
 $7.499 billion in LHHS discretionary appropriations for CDC,

29health inspections. In addition, the respirator certification program charges fees to respirator manufacturers for certain regulatory activities.29 22 Centers for Medicare & Medicaid Services (CMS), FY2025 Congressional Budget Justification, p. 97, https://www.cms.gov/files/document/fy2025-cms-congressional-justification-estimates-appropriations-committees.pdf. 23 See CRS Report R42640, Medicaid Financing and Expenditures. 24 CDC, “NIOSH Radiation Dose Reconstruction Program,” https://www.cdc.gov/niosh/ocas/faqsact.html. CDC, “NIOSH Radiation Dose Reconstruction Program,” https://www.cdc.gov/niosh/ocas/faqsact.html.
3025 CDC, “Energy Employees Occupational Illness Compensation Program Act (EEOICPA) Budget Request” in CDC, “Energy Employees Occupational Illness Compensation Program Act (EEOICPA) Budget Request” in
FY2022FY2025 Congressional Budget Justification, p. Congressional Budget Justification, p. 302360, https://www.cdc.gov/budget/documents/, https://www.cdc.gov/budget/documents/fy2022/FY-2022fy2025/FY-2025-CDC--CDC-
congressional-justification.pdf. congressional-justification.pdf.
3126 See, for example, in FY2021 LHHS appropriations, 134 STAT 1571 of Division H, Title II, P.L. 116-260. See, for example, in FY2021 LHHS appropriations, 134 STAT 1571 of Division H, Title II, P.L. 116-260.
3227 CDC, “World Trade Center Health Program,” https://www.cdc.gov/wtc/. CDC, “World Trade Center Health Program,” https://www.cdc.gov/wtc/.
3328 “The Vessel Sanitation Program (VSP) at the Centers for Disease Control and Prevention (CDC) assists the cruise “The Vessel Sanitation Program (VSP) at the Centers for Disease Control and Prevention (CDC) assists the cruise
ship industry to prevent and control the introduction, transmission, and spread of gastrointestinal (GI) illnesses on ship industry to prevent and control the introduction, transmission, and spread of gastrointestinal (GI) illnesses on
cruise ships.” Under authority in in PHSA Section 361; 42 U.S.C. §264. See CDC, “Vessel Sanitation Program,” cruise ships.” Under authority in in PHSA Section 361; 42 U.S.C. §264. See CDC, “Vessel Sanitation Program,”
https://www.cdc.gov/https://www.cdc.gov/nceh/vsp/default.htm.
34vessel-sanitation/about/index.html. CDC collects fees from ship owners for operational inspections, see CDC, “Public Health Operational Inspections,” https://www.cdc.gov/vessel-sanitation/php/age-on-cruise-ships/public-health-inspections.html. 29 The respirator certification program conducts assessments and NIOSH approval of particulate filtering facepiece The respirator certification program conducts assessments and NIOSH approval of particulate filtering facepiece
respirators. 42 C.F.R. Part 84. See also CDC, Respirator Certification Fees Schedules,” https://www.cdc.gov/niosh/respirators. 42 C.F.R. Part 84. See also CDC, Respirator Certification Fees Schedules,” https://www.cdc.gov/niosh/
npptl/respcertfeescheduletables.html. npptl/respcertfeescheduletables.html.
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 $81 million in Interior/Environment discretionary appropriations for ATSDR, and
 $903 million in mandatory PPHF appropriations.
FY2023 Budget Request
President Biden’s FY2023 budget request for CDC would have provided a core public health
program level of $38.76 billion made up of the following:35
 $9.621 billion in LHHS discretionary appropriations for CDC,
 $85 million in Interior/Environment discretionary appropriations for ATSDR,
 $903 million in mandatory PPHF appropriations,
 $151 million in PHS evaluation tap transfers, and
 $28 billion in proposed new mandatory public health preparedness funding,
available over five years.
This requested FY2023 core public health program level, including the new mandatory public
health preparedness funding, would have represented a $30.277 billion (+356.9%) increase over
the FY2022 enacted program level. Of the total increase, 92.5% of the amount would have been
from the new proposed mandatory pandemic preparedness appropriation of $28 billion to be
made available for five years.36 Excluding the pandemic preparedness funding, the proposed core
public health program level would have been $10.675 billion, which would have represented a
$2.273 billion (+27.1%) increase over the FY2022 enacted program level.
In addition to the pandemic preparedness funding the request also proposed the following:
 Consolidating 13 CDC LHHS accounts under a single appropriations heading,
CDC-Wide Activities and Program Support.37
 Proposed Mandatory Programs The Biden Administration proposed new mandatory programs in the FY2025 budget request, summarized below.30 Estimated amounts for those programs are summarized in Table 1 where applicable. • Pandemic Preparedness. For FY2025, President Biden’s budget proposes $6.100 billion in public health preparedness funding as a transfer to CDC from $20.000 billion appropriated to the Public Health and Social Services Emergency Fund, to be made available for five years. The FY2025 proposed public health preparedness funding is presented as a non-add in the President’s budget and is therefore not included within the FY2025 total program level for CDC. • Vaccines for Adults Program. According to the request, CDC submitted a According to the request, CDC submitted a
legislative proposal for mandatory funding of $ legislative proposal for mandatory funding of $25 billion provided over 10 years
to establish a new Vaccines for Adults program.
 VFC program modifications. CDC proposed expanding eligibility for the VFC
program1.004 billion in FY2025 for a capped mandatory program to provide vaccines to adults. As requested, $12 billion would be provided for the program over 10 years. • VFC program modifications. Similar to the FY2024 request, the CDC proposes some legislative changes to VFC, including expanding eligibility to all children under 19 years of age enrolled in the Children’s Health to all children under 19 years of age enrolled in the Children’s Health
Insurance Program (CHIP). The proposal would Insurance Program (CHIP). The proposal would have also changedalso change the fee the fee
structure for providers participating in the program. structure for providers participating in the program. The FY2023-Both of those changes would affect annual VFC funding. The FY2025 requested requested
amount for VFC in Table 1 reflects the proposed program modifications.
According to the FY2023 budget request, the FY2023 VFC funding estimate
based on current law was $5.609 billion.38

35 CDC, Congressional Budget Justification: FY2023, https://www.cdc.gov/budget/documents/fy2023/FY-2023-CDC-
congressional-justification.pdf.
36 This sections cites FY2023 enacted numbers from CDC, “FY2024 Budget Detail Table,” https://www.cdc.gov/
budget/documents/fy2024/FY-2024-CDC-Budget-Detail.pdf. Numbers in the table account for some post-
appropriations adjustments, specifically to account for some funding initially appropriated to the Public Health and
Social Services Emergency Fund account for activities implemented by CDC (see footnote 8 of budget detail table).
37 Accounts consolidated would include: Immunization and Respiratory Diseases, HIV/AIDS, Viral Hepatitis, STI and
TB Prevention, Emerging and Zoonotic Infectious Diseases, Chronic Disease Prevention and Health Promotion, Birth
Defects, Developmental Disabilities, Disability and Health, Environmental Health, Injury Prevention and Control,
Public Health Scientific Services, Global Health, Public Health Preparedness and Response, and Cross-Cutting
Activities and Program Support.
38 CDC, FY2023 Budget Detail Table, https://www.cdc.gov/budget/documents/fy2023/FY-2023-CDC-Budget-
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FY2023 Enacted
In December 2022, Congress and the President enacted the Consolidated Appropriations Act,
2023 (P.L. 117-328), which provided FY2023 LHHS appropriations in Division H and
Interior/Environment appropriations in Division G. CDC’s FY2023 total core public health
program level is $9.269 billion, comprising the following:39
 $8.281 billion in LHHS discretionary appropriations for CDC,
 $85 million in Interior/Environment discretionary appropriations for ATSDR, and
 $903 million in mandatory PPHF appropriations.
The FY2023 CDC core public health program level represents a $787 million increase (+9.3%)
over the FY2022 CDC core public health program level. Relative to the FY2023amount for VFC in Table 1 does not reflect all the proposed program modifications. • Community Violence Intervention: The request proposes $150 million in mandatory funding for a Community Violence Intervention Initiative, in addition to $100 million in discretionary funding. According to CDC, “This investment will support scaling up existing community violence prevention efforts and implementing and evaluating programs, policies, and practices based on the best available evidence for preventing community violence.”31 Funding Table Table 1 provides an overview of CDC/ATSDR budget and appropriations for FY2023 enacted through the FY2025 budget request, reflecting all sources of regular budget authority (excludes supplemental appropriations). Table 1. Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry (ATSDR) Appropriations, FY2023-FY2025 Request (Millions of Dollars) 2023 FY2024 FY2024 FY2025 Program or Activity Final Request Enacted Request Immunization and Respiratory Diseases 919 1,256 919 969 30 CDC, FY2025 Congressional Budget Justification, pp. 15 and 28, https://www.cdc.gov/budget/documents/fy2025/FY-2025-CDC-congressional-justification.pdf. 31 CDC, FY2025 Congressional budget request,
the enacted core public health program level is $29.491 billion less (-76.1%). However, of this
difference, $28 billion is due to the proposed but not adopted mandatory pandemic preparedness
proposal. Excluding the proposed pandemic preparedness appropriations, the enacted core CDC
public health program level was $1.49 billion (-13.9%) less than the proposed level.
All CDC discretionary appropriations accounts received nominal appropriations increases relative
to FY2022 enacted levels. The accounts with the greatest relative increases were (1) CDC-Wide
Activities (+46.6%), (2) Birth Defects, Developmental Disabilities, Disability and Health
(+16.1%), and (3) Public Health Scientific Services (+15.7%). In addition to the proposed
pandemic preparedness funding, the Administration’s other proposals were not adopted, including
changes to the appropriations account structure, the mandatory Vaccines for Adults program, and
VFC program modifications.
FY2024 Request
President Biden’s FY2024 budget request for CDC proposes a core public health program level of
$11.667 billion, made up of the following:40
 $10.217 billion in LHHS discretionary appropriations for CDC,
 $86 million in Interior/Environment discretionary appropriations for ATSDR,
 $1.186 billion in mandatory PPHF appropriations, and
 $177 million in PHS evaluation tap transfers.
Similar to President Biden’s FY2023 budget request, the CDC budget request proposes a new
mandatory public health preparedness fund. For FY2024, President Biden’s budget proposes $6.1
billion in public health preparedness funding as a transfer to CDC from $20 billion total
appropriated to the Public Health and Social Services Emergency Fund, to be available for five
years. Unlike in the FY2023 proposal, the FY2024 proposed public health preparedness funding
is presented as a non-add, and therefore not included within the FY2024 total program level for

Detail.pdf.
39 This sections cites FY2023 enacted numbers from CDC, “FY2024 Budget Detail Table,” https://www.cdc.gov/
budget/documents/fy2024/FY-2024-CDC-Budget-Detail.pdf. Numbers in the table account for some post-
appropriations adjustments, specifically to account for $21.9 million initially appropriated to the Public Health and
Social Services Emergency Fund account for activities implemented by CDC (see footnote 8 of budget detail table).
40 CDC, Congressional Budget Justification: FY2023, https://www.cdc.gov/budget/documents/fy2023/FY-2023-CDC-
congressional-justification.pdf.
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CDC. The CDC core public health program level in addition to proposed new mandatory public
health preparedness funding totals to $17.767 billion.
Analysis of Proposed Pandemic Preparedness Mandatory Funding
In both the FY2023 and FY2024 budget requests for CDC, the Biden Administration has proposed new five-year
funding for pandemic preparedness:

FY2023 Request: $81.7 bil ion total for HHS, with $28 bil ion for CDC.

FY2024 Request: $20 bil ion total for HHS, with $6.1 bil ion for CDC.
CRS fol ows the convention used in budget documents to analyze funding. In the FY2023 request budget
documents, the proposed mandatory pandemic preparedness funds were shown as an “add,” or in other words,
were included within CDC’s proposed FY2023 budget. The FY2024 budget displays the FY2024 pandemic
preparedness funding as a non-add. CRS therefore fol ows that convention in Table 1, with some additional
analysis to allow for comparisons between years.
This requested FY2024 core public health program level would represent a $2.398 billion
(+25.9%) increase over the FY2023 enacted program level. Including the proposed mandatory
pandemic preparedness funding in the FY2024 requested total would represent a $8.498 billion
(+91.7%) increase over the FY2023 enacted program level.
Of the total increase to the core public health program level, 63.3% of the amount is composed of
increases to five of the 17 program accounts. These accounts include Immunization and
Respiratory Diseases; Chronic Disease Prevention and Health Promotion; Injury Prevention and
Control; and Public Health Scientific Services.
In addition to the pandemic preparedness funding the request also proposed the following:
 Consolidating 13 CDC LHHS accounts under a single appropriations heading,
CDC-Wide Activities and Program Support.41
 Vaccines for Adults Program. According to the request, CDC submitted a
legislative proposal for mandatory funding of $1.004 billion for a capped
mandatory program to provide vaccines to adults.
 VFC program modifications. Similar to the FY2023 request, the CDC proposes
expanding eligibility for the VFC program to all children under 19 years of age
enrolled in the Children’s Health Insurance Program (CHIP). The proposal would
also change the fee structure for providers participating in the program. The
FY2024 requested amount for VFC in Table 1 reflects the proposed program
modifications.
Funding Table
Table 1 provides an overview of CDC/ATSDR budget and appropriations for FY2022 enacted
through the FY2024 budget request, reflecting all sources of regular budget authority (excludes
supplemental appropriations).

41 Accounts consolidated would include Immunization and Respiratory Diseases; HIV/AIDS, Viral Hepatitis, STI and
TB Prevention; Emerging and Zoonotic Infectious Diseases; Chronic Disease Prevention and Health Promotion; Birth
Defects, Developmental Disabilities, Disability and Health; Environmental Health; Injury Prevention and Control;
Public Health Scientific Services; Occupational Safety and Health; Global Health; Public Health Preparedness and
Response; and Cross-Cutting Activities and Program Support. CDC, FY2024 Budget Justification, Budget Justification, p. 15, p. 35,
https://www.cdc.gov/budget/documents/https://www.cdc.gov/budget/documents/fy2024/FY-2024-fy2025/FY-2025-CDC-congressional-justification.pdf. CDC-congressional-justification.pdf.
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Table 1. Centers for Disease Control and Prevention (CDC) and
Agency for Toxic Substances and Disease Registry (ATSDR) Appropriations, FY2022-
2023 FY2024 Request
(Millions of Dollars)
2022
2023
2023
FY2024 FY2024 FY2025
Program or Activity
Final
RequestaRequest
Enacted
Request
Immunization and Respiratory Diseases
868
1,251
919
1,256
PPHF Transfer (non-add)
(419)
(419505) (682) (469))
(419)
(505)
HIV/AIDS, Viral Hepatitis, STI and TB
1,345391
1,471545
1,391
1,545
391 Emerging & Zoonotic Infectious Diseases
693
703
751
846
751 846 760 781 PPHF Transfer (non-add)
(52)
(52)
(52)
(52)
Chronic Disease Prevention and Health Promotion
1,339430
1,612814
1,430
1,814
434 1,559 PPHF Transfer (non-add)
(255)
(255262) (241) (255))
(255)
(262)
Birth Defects, Developmental Disabilities, Disability
177
195206 223
206
223
206 and Health
Environmental Health
228
402
247
421
247 421 243 267 PPHF Transfer (non-add)
(17)
(17)
(17)(51)
(17)
PHS Evaluation Transfer (non-add)
— —
(7)
— —
(7)
Vessel Sanitation (as appropriated in P.L. 117-43, Sec. 138b)
(2)
—
—
—
Injury Prevention and Control
715
1,283
761
1,352— Injury Prevention and Control 761 1,352 761 943 PHS Evaluation Transfer (non-add) — — — (100)
Public Health Scientific Services
652
799754 962
754
962 804
PPHF Transfer (non-add)
— —
—(140)
— —
( (140183) )
PHS Evaluation Transfer (non-add)
— —
(144(170) (43) —)
—
(170)
Occupational Safety and Health
352
345363 363
363
363
Global Health
647
748693 765
693
765
694 Public Health Preparedness and Responsecb
862
842
905
943
905 943 938 943 Crosscutting Activities and Program Support
494
969
724
1,039
724 1,039 664 724 PPHF Transfer (non-add)
(160)
(160)
(160)
(210160)
Office of the Director
(non-add) (129 (114)
(124144)
(129)
(144129)
Infectious Diseases Rapid Response Reserve Fund
(non-add) (35 (20)
(35)
(3525)
(35)
Public Health Infrastructure and Capacity (non-add) (350
(200)
(600)
(350)
(600350)
Center for Forecasting and Analytics
—(CFA; non-add)
(50)
(50)
(100)
Buildings and Facilities
30
55
40
55
Pandemic Preparedness (proposed mandatory)
—
28,000
—
(6,100)
— — CFA- PPHF Transfer (non-add) — (50) — (50) Buildings and Facilities 40 55 40 40 Agency for Toxic Substances and Disease Registry
8185
8586
85
8682 85
(ATSDR)dc
Total, Core Public Health Program Level (CPHPL)
8,482
38,760
9,269
11,667
Total, CPHPL with FY2023 Proposed Mandatory
8,482
38,760
9,269
17,767
Pandemic Preparedness
Less Pandemic Preparedness (proposed mandatory)
—
-28,000
—
-6,100
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2022
2023
2023
FY2024
Program or Activity
Final
Requesta
Enacted
Request
Total, CPHPL without Pandemic Preparedness
8,482
10,760
9,269
11,667
Less PPHF (mandatory)
-903
-903
-903
-1,186
Less PHS Evaluation Transfer
—
-151
—
-177
Total, CDC/ATSDR Discretionary BA
7,578
9,706
8,366
10,303
Less ATSDR
-81
-85
-85
-86
Total, CDC LHHS Discretionary BA
7,499
9,621
8,281
10,217
Vaccines for Children (VFC)e
5,540
5,859
5,609
6,0029,269 11,667 9,248 9,769 Less PPHF (mandatory) -903 -1,186 -1,186 -1,186 Less PHS Evaluation Transfer — -177 -43 -100 Total, CDC/ATSDR Discretionary BA 8,366 10,303 8,019 8,482 Less ATSDR -85 -86 -82 -85 Total, CDC LHHS Discretionary BA 8,281 10,217 7,938 8,397 Vaccines for Children (VFC) 5,217 6,002 7,213 8,040 Congressional Research Service 11 link to page 15 link to page 15 link to page 15 link to page 16 Centers for Disease Control and Prevention (CDC) Funding Overview 2023 FY2024 FY2024 FY2025 Program or Activity Final Request Enacted Request
Energy Employees Occupational Il ness Compensation Energy Employees Occupational Il ness Compensation
51
51
51
51
51 51 51 Program Act ( Program Act (EEOICPA)fEEOICPA)d
World Trade Center Health Program (WTCHP World Trade Center Health Program (WTCHP)ge
641710 782
710
710
782
768 788 User Fees User Fees
2
2
2
2
2 2 2 Vaccines for Adults (proposed mandatory) Vaccines for Adults (proposed mandatory)
— —
2,088
—
1,0041,004 — 1,004 Community Violence Intervention (proposed mandatory) — — — 150
Total Other Mandatory Programshf
6,234
8,459
5,197
7,8415,980 7,841 8,034 10,035
Total, Core Public Health Program Level + Other
14,717
47,219
14,466
19,50815,249 19,508 17,282 19,803 Mandatory Pandemic Preparedness (proposed mandatory) — 6,100 — 6,100 Total w/ Pandemic Preparedness 15,249 25,608 17,282 25,753 Source: FY2023 final and FY2025
Mandatory
Source: FY2022 final, FY2023 enacted, and FY2024 requested amounts from CDC, “ requested amounts from CDC, “FY2024FY2025 Budget Detail Budget Detail
Table,” https://www.cdc.gov/budget/documents/Table,” https://www.cdc.gov/budget/documents/fy2024/FY-2024-CDC-congressional-justification.pdf. FY2023
requested discretionary appropriationsfy2025/FY-2025-CDC-Budget-Detail.pdf. FY2024 request and enacted amounts are from are from Congressional Record, vol. vol. 168170, no. , no. 198 (December 20, 2022),
S9142-S914451 (March 22, 2024), H2020-H2022, and other mandatory program amounts from CDC, “, and other mandatory program amounts from CDC, “FY2023FY2025 Budget Detail Table,” Budget Detail Table,”
https://www.cdc.gov/budget/documents/https://www.cdc.gov/budget/documents/fy2023/FY-2023fy2025/FY-2025-CDC-Budget-Detail.pdf, except where noted below. -CDC-Budget-Detail.pdf, except where noted below.
Notes: Individual amounts may not add to subtotals or totals due to rounding. Individual amounts may not add to subtotals or totals due to rounding. FY2022 final and FY2023 enacted FY2023 enacted
amounts reflect some post-appropriations adjustments. Acronyms: HIV = Human Immunodeficiency Virus; AIDS amounts reflect some post-appropriations adjustments. Acronyms: HIV = Human Immunodeficiency Virus; AIDS
= Acquired Immunodeficiency Syndrome; STI = Sexually Transmitted Infection; TB = Tuberculosis= Acquired Immunodeficiency Syndrome; STI = Sexually Transmitted Infection; TB = Tuberculosis.
a. The FY2023 and FY2024 requests propose; PPHF = Prevention and Public Health Fund; ATSDR= Agency for Toxic Substances and Disease Registry. a. The FY2024 request proposed consolidating 13 CDC LHHS discretionary accounts into a single consolidating 13 CDC LHHS discretionary accounts into a single
account.account.
b. The Extending Government Funding and Delivering Emergency Assistance Act (P.L. 117-43), one of the
FY2022 continuing resolutions, provided an additional $1.5 mil ion for CDC’s vessel sanitation program.
c For the sake of comparability, this request is displayed with amounts in the current account structure. b. This reflects $21 mil ion in appropriations from the Public Health and Social Services Emergency Fund for . This reflects $21 mil ion in appropriations from the Public Health and Social Services Emergency Fund for
CDC activities added to the FY2023 CDC activities added to the FY2023- appropriated amount ($883 mil ion). appropriated amount ($883 mil ion).
dc. Provided separately in the Interior/Environment Appropriations Act.. Provided separately in the Interior/Environment Appropriations Act. FY2023-requested amount from
Congressional Record, vol. 198, no. 11 (December 20, 2022), S8853.
e. The FY2024 amount for VFC reflects proposed legislative changes.
f.
d. Per the FY2024 budget request table, all amounts for EEOICPA reflect sequestration and therefore differ Per the FY2024 budget request table, all amounts for EEOICPA reflect sequestration and therefore differ
from appropriated funding levels. from appropriated funding levels.
g. e. Amounts reflect federal obligations. FY2023 WTHCP amount does not include the $1 bil ion supplemental WTHCP amount does not include the $1 bil ion supplemental appropriation provided in Consolidated appropriation provided in Consolidated
Appropriations Act, 2023 (P.L. 117-328)Appropriations Act, 2023 (P.L. 117-328).
h. FY2023 and FY2024, or from the special fund enacted in P.L. 118-31. f. FY2024 and FY2025 amounts are estimates for VFC, WTCHP, User Fees, and Vaccines for Adults. amounts are estimates for VFC, WTCHP, User Fees, and Vaccines for Adults.
Trends in Core Public Health Program Level
As shown iAs shown in Figure 6, in terms of nominal dollars, from FY2011 to FY2021, CDC’s core public health program level from FY2011 to FY2021, CDC’s core public health program level
remained mostly between $6.5 and $8 billion until the increases provided in FY2022 (+9.0%) and remained mostly between $6.5 and $8 billion until the increases provided in FY2022 (+9.0%) and
FY2023 (+FY2023 (+9.111.2%; not adjusted for inflation). From FY2011 to FY2021, CDC saw annual increases %; not adjusted for inflation). From FY2011 to FY2021, CDC saw annual increases
and decreases in its core public health funding level ranging from 1and decreases in its core public health funding level ranging from 1 % to 6% (except for FY2013). For FY2013—the lowest funding level in the period covered—budget sequestration of nonexempt discretionary spending occurred.32 CDC saw an overall decrease in its program level in FY2024 (-1.8%). The FY2025 request would provide an increase of 5.6%. 32 CDC, “Fact Sheet: Impact of Sequestration and other Budget Changes on the Centers for Disease Control and Prevention,” https://www.cdc.gov/budget/documents/fy2013/fy-2013-sequester-impacts.pdfto 6% (except for FY2013). .
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For FY2013—the lowest funding level in the period covered—budget sequestration of
nonexempt discretionary spending occurred.42
Figure 6. Trends in Core Public Health Program Level
FY2011-FY2024 Request Figure 6. Trends in Core Public Health Program Level FY2011-FY2024 final, FY2025 request ($ in billions, nominal) (Figure is interactive in the HTML version of this report.)

Source: CDC Congressional Budget Justifications, and sources in Table 1. CDC Congressional Budget Justifications, and sources in Table 1.
Notes: Amounts are not adjusted for inflation. *President’s budget request; does not reflect proposed Amounts are not adjusted for inflation. *President’s budget request; does not reflect proposed
mandatory preparedness funding. Acronyms: CDC = Centers for Disease Control and Prevention; LHHS = mandatory preparedness funding. Acronyms: CDC = Centers for Disease Control and Prevention; LHHS =
Labor, Health and Human Services, Education, and Related Agencies appropriations bil ; ATSDR = Agency for Labor, Health and Human Services, Education, and Related Agencies appropriations bil ; ATSDR = Agency for
Toxic Substances and Disease Registry; PPHF = Prevention and Public Health Fund; PHSSEF = Public Health and Toxic Substances and Disease Registry; PPHF = Prevention and Public Health Fund; PHSSEF = Public Health and
Social Services Emergency Fund; PHS = Public Health ServiceSocial Services Emergency Fund; PHS = Public Health Service; ACA = Affordable Care Act. .
CDC Budget in Context
Supplemental Appropriations for Public Health Emergencies and
Other Incidents
CDC regularly receives supplemental or one-time appropriations in response to public health CDC regularly receives supplemental or one-time appropriations in response to public health
emergencies and other incidents. For example, since 2019, CDC has received supplemental emergencies and other incidents. For example, since 2019, CDC has received supplemental
appropriations for hurricane and natural disaster response (for example, in P.L. 116-20 and P.L. appropriations for hurricane and natural disaster response (for example, in P.L. 116-20 and P.L.

42 CDC, “Fact Sheet: Impact of Sequestration and other Budget Changes on the Centers for Disease Control and
Prevention,” https://www.cdc.gov/budget/documents/fy2013/fy-2013-sequester-impacts.pdf.
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117-328), the Coronavirus Disease 2019 (COVID-19) pandemic,117-328), the Coronavirus Disease 2019 (COVID-19) pandemic,4333 medical screening and medical screening and
supports for Afghan refugees (P.L. 117-70), and supports for Afghan refugees (P.L. 117-70), and funding for domestic and global activities related to the for domestic and global activities related to the
2022 war in Ukraine (war in Ukraine (e.g., P.L. 117-128). These amounts are not reflected in the other sections of P.L. 117-128). These amounts are not reflected in the other sections of 33 See CRS Report R46711, U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress and CRS Report R46834, American Rescue Plan Act of 2021 (P.L. 117-2): Public Health, Medical Supply Chain, Health Services, and Related Provisions. Congressional Research Service 13 Centers for Disease Control and Prevention (CDC) Funding Overview this this
report as they are not intended to fund the report as they are not intended to fund the agency’s regular operating expenses and programsregular operating expenses and programs of the agency. .
While these supplemental funds are, in most cases, primarily intended for the specific incident for While these supplemental funds are, in most cases, primarily intended for the specific incident for
which they are appropriated, they are sometimes correlated with cycles of funding increases and which they are appropriated, they are sometimes correlated with cycles of funding increases and
decreases for overall public health capacity at the federal, state, and local levels. Large historical decreases for overall public health capacity at the federal, state, and local levels. Large historical
supplemental appropriations to the agency and subsequent funding awards to state and local supplemental appropriations to the agency and subsequent funding awards to state and local
agencies include agencies include
• H1N1 influenza pandemic, 2009. In response to the H1N1 influenza pandemic, In response to the H1N1 influenza pandemic,
CDC CDC received overspent $600 million $600 million and awardedon its public health response and also administered $1.4 billion through its Public $1.4 billion through its Public
Health Emergency Response grant program to state and local partners.Health Emergency Response grant program to state and local partners.4434 These These
funds were made available to CDC from the Supplemental Appropriations Act of funds were made available to CDC from the Supplemental Appropriations Act of
2009 (P.L. 111-32), enacted in June 2009. 2009 (P.L. 111-32), enacted in June 2009.
• Ebola outbreak, 2014-2015. In response to the Ebola outbreak, Consolidated In response to the Ebola outbreak, Consolidated
and Further Continuing Appropriations Act, 2015 (P.L. 113-235; Division G), and Further Continuing Appropriations Act, 2015 (P.L. 113-235; Division G),
enacted in December 2014, provided CDC with $1.771 billion for both domestic enacted in December 2014, provided CDC with $1.771 billion for both domestic
and international Ebola preparedness and response efforts.and international Ebola preparedness and response efforts.4535 Using these funds, Using these funds,
CDC provided several supplemental grants to state and local agencies, including CDC provided several supplemental grants to state and local agencies, including
$145 million through the Public Health Emergency Preparedness (PHEP) $145 million through the Public Health Emergency Preparedness (PHEP)
cooperative agreement and cooperative agreement and overmore than $114 million through the Epidemiology and $114 million through the Epidemiology and
Laboratory Capacity (ELC) grant program.Laboratory Capacity (ELC) grant program.4636
• Zika outbreak, 2016. The Zika Response and Preparedness Appropriations Act, The Zika Response and Preparedness Appropriations Act,
2016 (P.L. 114-223; Division B) provided $394 million to CDC in supplemental 2016 (P.L. 114-223; Division B) provided $394 million to CDC in supplemental
appropriations for preparedness and response to the Zika outbreak, domestically appropriations for preparedness and response to the Zika outbreak, domestically
and internationally.and internationally.4737 CDC obligated a portion of the funding to state and local CDC obligated a portion of the funding to state and local
agencies through several grant programs, including agencies through several grant programs, including overmore than $184 million through $184 million through
the ELC grant program.the ELC grant program.48
38 • COVID-19 pandemic, 2020-present. As reported by GAO, as of January 2023, As reported by GAO, as of January 2023,
CDC has received $26.4 billion through the COVID-19 relief appropriations CDC has received $26.4 billion through the COVID-19 relief appropriations
measures to the CDC-Wide Activities and Program Support Account.measures to the CDC-Wide Activities and Program Support Account.49 Some of

43 See CRS Report R46711, U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th
Congress and CRS Report R46834, American Rescue Plan Act of 2021 (P.L. 117-2): Public Health, Medical Supply
Chain, Health Services, and Related Provisions.
4439 Some of the one-time public health funding for CDC in the American Rescue Plan Act (ARPA; P.L. 117-2) was not tied to the pandemic, but instead was made available for general public health capabilities, see example of the Public Health Infrastructure grant program in the textbox below. In addition, CDC has received at least $1 billion in transfers and has administered more than $40 billion through its grant programs funded by HHS appropriations from the PHSSEF account.40 34 U.S. Government Accountability Office, U.S. Government Accountability Office, Influenza Pandemic: Lessons from the H1N1 Pandemic Should be
Incorporated into Future Planning, GAO-11-632, June 2011, pp. 7, 16, https://www.gao.gov/assets/gao-11-632.pdf. , GAO-11-632, June 2011, pp. 7, 16, https://www.gao.gov/assets/gao-11-632.pdf.
4535 P.L. 113-234, 128 Stat. 2520. P.L. 113-234, 128 Stat. 2520.
4636 CDC, “Ebola Funding,” https:// CDC, “Ebola Funding,” https://web.archive.org/web/20220306103011/https://www.cdc.gov/cpr/readiness/funding-ebola.htm, and data provided by CDC to CRS on www.cdc.gov/cpr/readiness/funding-ebola.htm, and data provided by CDC to CRS on
April 22, 2022. See also U.S. Government Accountability Office, April 22, 2022. See also U.S. Government Accountability Office, Infectious Disease Threats: Funding and
Performance of Key Preparedness and Capacity-Building Programs, May 2018, https://www.gao.gov/assets/gao-18-, May 2018, https://www.gao.gov/assets/gao-18-
362.pdf. 362.pdf.
4737 P.L. 114-223, 130 Stat. 901- 130 Stat. 902. P.L. 114-223, 130 Stat. 901- 130 Stat. 902.
4838 U.S. Government Accountability Office, U.S. Government Accountability Office, Zika Supplement: Status of HHS Agencies’ Obligations, Disbursements, and
the Activities Funded, GAO-18-389, May 2018, pp. 33-54, https://www.gao.gov/assets/gao-18-389.pdf, and data , GAO-18-389, May 2018, pp. 33-54, https://www.gao.gov/assets/gao-18-389.pdf, and data
provided by CDC to CRS on April 22, 2022. provided by CDC to CRS on April 22, 2022.
4939 CDC received funding from five different COVID-19 relief laws: P.L. 116-123, P.L. 116-136, P.L. 116-139, P.L. CDC received funding from five different COVID-19 relief laws: P.L. 116-123, P.L. 116-136, P.L. 116-139, P.L.
116-260, and P.L. 117-2. U.S. Government Accountability Office, 116-260, and P.L. 117-2. U.S. Government Accountability Office, COVID-19 Relief: Funding and Spending as of Jan.
31, 2023, GAO- 23-106647, February 2023, https://www.gao.gov/assets/gao-23-106647.pdf, GAO- 23-106647, February 2023, https://www.gao.gov/assets/gao-23-106647.pdf. 40 CDC, “Budget: Novel Coronavirus (COVID-19),” https://www.cdc.gov/budget/fact-sheets/covid-19/index.html. .
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the one-time public health funding for CDC in the American Rescue Plan Act
(ARPA; P.L. 117-2) was not tied to the pandemic, but instead was made available
for general public health capabilities, such as for data modernization (Section
2404; $500 million). In addition, CDC has received at least $1 billion in transfers
and has administered over $40 billion in appropriations on behalf of HHS
through its grant programs from the PHSSEF account.50 As a result, of the total As a result, of the total
appropriated to and administered by CDC, $59.appropriated to and administered by CDC, $59.481525 billion in CDC COVID-19 billion in CDC COVID-19
grants have been awarded to state, tribal, and local agencies grants have been awarded to state, tribal, and local agencies as of September 2023 as of December 2022
(amount includes some regular appropriations).(amount includes some regular appropriations).5141 For more information on CDC For more information on CDC
funding in the COVID-19 relief laws, see, CRS Report R46711, funding in the COVID-19 relief laws, see, CRS Report R46711, U.S. Public
Health Service: COVID-19 Supplemental Appropriations in the 116th Congress
and CRS Report R46834, and CRS Report R46834, American Rescue Plan Act of 2021 (P.L. 117-2): Public
Health, Medical Supply Chain, Health Services, and Related Provisions. Some of the COVID relief dollars have since been rescinded. The Congressional Budget Office estimated that the Fiscal Responsibility Act (P.L. 118-5) rescinded $1.5 billion in CDC budget authority. In addition, FY2024 appropriations rescinded certain American Rescue Plan Act appropriations for public health; the full impact on CDC is unclear from publicly available sources.42 Congress often appropriates emergency supplemental funding to HHS for purposes that are somewhat general, or with the authority for HHS to transfer those funds, and therefore HHS decides the final allocation of funds among HHS operating divisions (such as CDC). Final data on HHS supplemental appropriations allocations are not available for all public health emergencies listed above. Spotlight: Public Health Infrastructure Grant Program CDC began to fund a new Public Health Infrastructure Grant program beginning in FY2023, drawing from roughly $3.5 bil ion provided in the American Rescue Plan Act for public health workforce and data modernization programs combined with funding from regular appropriations (GAO-24-105891). Through this program, CDC expects to award $5 bil ion over five years to 107 health departments in all 50 states; Washington, DC; eight territories and freely associated states; and 48 large localities. Recipients are to use this award to hire and retain public health staff, strengthen organization systems and processes, and modernize public health data systems. State health department recipients are expected to distribute a portion of grant funds for public health workforce among local health departments that did not receive direct grant funding from CDC. Given that this five-year grant is funded in large part by a one-time appropriation from the ARPA, funds may no longer be available to support hired staff at the end of the five-year period. For further information, see CDC, “Public Health Infrastructure Grant,” https://www.cdc.gov/infrastructure-phig/about/. CDC Infectious Diseases Rapid Response Reserve Fund FY2019 appropriations (P.L. 115-245) established an Infectious Diseases Rapid Response Reserve Fund (IDRRRF) at CDC.43 The IDRRRF is an emergency reserve fund available specifically for infectious disease emergencies. Funds may be drawn from IDRRRF for an infectious disease emergency if the HHS Secretary • declares a public health emergency pursuant to PHSA Section 319, or • determines that the infectious disease emergency “has significant potential to imminently occur and potential, on occurrence, to affect national security or the health, and security of United States citizens, domestically or internationally.” 41 CDC, “CDC COVID-19 State, Tribal, Local, and Territorial Funding,” data last updated September 5, 2023, https://www.cdc.gov/budget/fact-sheets/covid-19/funding/index.html. 42 See Section 529 of Division D of P.L. 118-47. 43Provisions.
Congress often appropriates emergency supplemental funding to HHS for purposes that are
somewhat general, or with the authority for HHS to transfer those funds, and therefore HHS
decides the final allocation of funds among HHS operating divisions (such as CDC). Final data on
HHS supplemental appropriations allocations are not available for all public health emergencies
listed above.
CDC Infectious Diseases Rapid Response Reserve Fund
Through FY2019 appropriations (P.L. 115-245), Congress established an Infectious Diseases
Rapid Response Reserve Fund (IDRRRF) at CDC.52 The IDRRRF is an emergency reserve fund
available specifically for infectious disease emergencies. Funds may be drawn from IDRRRF for
an infectious disease emergency if the HHS Secretary
 declares a public health emergency pursuant to PHSA Section 319, or
 determines that the infectious disease emergency “has significant potential to
imminently occur and potential, on occurrence, to affect national security or the
health, and security of United States citizens, domestically or internationally.”
The CDC Director may transfer IDRRRF funds to other CDC accounts as well as to National
Institutes of Health (NIH) accounts or the PHSSEF account.53
Since FY2019, the IDRRRF has received the following regular and supplemental appropriations
shown in Table 2.

50 CDC, “Budget: Novel Coronavirus (COVID-19),” https://www.cdc.gov/budget/fact-sheets/covid-19/index.html,
CDC, “CDC in Action: Working 24/7 to Stop the Threat of COVID-19,” February 4, 2021, https://www.cdc.gov/
budget/documents/covid-19/CDC-247-Response-to-COVID-19-fact-sheet.pdf, and HHS, “Biden Administration to
Invest More Than $12 Billion to Expand COVID-19 Testing,” press release, March 17, 2021, https://www.hhs.gov/
about/news/2021/03/17/biden-administration-invest-more-than-12-billion-expand-covid-19-testing.html.
51 CDC, “CDC COVID-19 State, Tribal, Local, and Territorial Funding,” data last updated December 19, 2022,
https://www.cdc.gov/budget/fact-sheets/covid-19/funding/index.html.
52 Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and
Continuing Appropriations Act, 2019, P.L. 115-245, Division B, Title II, Section 231. Codified at 42 U.S.C. §247d-4a. Continuing Appropriations Act, 2019, P.L. 115-245, Division B, Title II, Section 231. Codified at 42 U.S.C. §247d-4a.
53 Per footnote 23, the PHSSEF account funds ASPR, the HHS lead operating division for medical and public health
preparedness for, response to, and recovery from disaster and public health emergencies. ASPR oversees several
programs, including the Biomedical Advanced Research and Development Authority and the Strategic National
Stockpile.
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Congressional Research Service 15 link to page 19 link to page 11 Centers for Disease Control and Prevention (CDC) Funding Overview The CDC Director may transfer IDRRRF funds to other CDC accounts as well as to National Institutes of Health (NIH) accounts or the PHSSEF account.44 Since FY2019, the IDRRRF has received the following regular and supplemental appropriations shown in Table 2.
Table 2. Appropriations History to the IDRRRF
Amount
Fiscal Year
Law and Type of Appropriation
(dollars in millions)
FY2019 FY2019
P.L. 115-245, regular P.L. 115-245, regular
$50 $50
FY2020 FY2020
P.L. 116-94, regular P.L. 116-94, regular
$85 $85
P.L. 116-123, supplemental P.L. 116-123, supplemental
$300 $300
P.L. 116-136, supplemental P.L. 116-136, supplemental
$300 $300
FY2021 FY2021
P.L. 116-260 (Division H), regular P.L. 116-260 (Division H), regular
$10 $10
FY2022 FY2022
P.L. 117-103, regular P.L. 117-103, regular
$20 $20
FY2023 FY2023
P.L. 117-328, (Division H), regular P.L. 117-328, (Division H), regular
$35 $35
FY2024 P.L. 118-47, (Division D), regular $25 Source: CRS analysis of appropriations laws. CRS analysis of appropriations laws.
IDRRRF funding has been used for multiple responses, including for recent Ebola outbreaks in IDRRRF funding has been used for multiple responses, including for recent Ebola outbreaks in
AfricaAfrica, the mpox outbreak in 2022-2023, and for the COVID-19 pandemic response. and for the COVID-19 pandemic response.54 As of March 2, 202345 As of May 2024, the IDRRRF has an , the IDRRRF has an
unobligated balance of $unobligated balance of $600.6 million.55550.5 million available for infectious disease emergencies.46
Other reserve fund accounts outside of CDC can also support public health emergency response. Other reserve fund accounts outside of CDC can also support public health emergency response.
These include the (1) Public Health Emergency Fund [PHSA Section 319(b), 42 U.S.C. §247d(b)] These include the (1) Public Health Emergency Fund [PHSA Section 319(b), 42 U.S.C. §247d(b)]
and (2) the Disaster Relief Fund at the Department of Homeland Security. (A detailed discussion and (2) the Disaster Relief Fund at the Department of Homeland Security. (A detailed discussion
of these funding sources is outside the scope of this report.) The Public Health Emergency Fund of these funding sources is outside the scope of this report.) The Public Health Emergency Fund
currently has a balance of $56,500 and has not received appropriations for many years.currently has a balance of $56,500 and has not received appropriations for many years.5647
Transfers from the Disaster Relief Fund have funded HHS’s response to non-infectious disease Transfers from the Disaster Relief Fund have funded HHS’s response to non-infectious disease
emergencies, such as for natural disasters, pursuant to authorities in the Robert T. Stafford emergencies, such as for natural disasters, pursuant to authorities in the Robert T. Stafford
Disaster Relief and Emergency Assistance Act (Stafford Act; 42 U.S.C. §§5721 et seq.). Stafford Disaster Relief and Emergency Assistance Act (Stafford Act; 42 U.S.C. §§5721 et seq.). Stafford
Act assistance was not available for HHS’s response to three recent infectious disease epidemics Act assistance was not available for HHS’s response to three recent infectious disease epidemics
prior to the Coronavirus Disease 2019 (COVID-19) pandemic—the H1N1 influenza pandemic in prior to the Coronavirus Disease 2019 (COVID-19) pandemic—the H1N1 influenza pandemic in
2009, the Ebola virus outbreak in 2014, and the Zika virus outbreak in 2016.57 Congress
subsequently established the IDRRRF in 2018.
State and Local Funding for Public Health
In the U.S. federal system, most public health activities are carried out by state and local
governments. A large portion of CDC’s annual budget is awarded as external financial assistance
(typically in the form of grants or cooperative agreements)—especially to state and local health
departments. For example, in FY2019, 58% of CDC’s $5.652 billion in grants were awarded to
government entities, the majority of which were state and local government recipients.58 As a

54 See “Response Funding” section of CRS Report R46219, Overview of U.S. Domestic Response to Coronavirus
Disease 2019 (COVID-19).
55 44 Per footnote 18, the PHSSEF account historically funded ASPR, the HHS lead operating division for medical and public health preparedness for, response to, and recovery from disaster and public health emergencies. ASPR oversees several programs, including the Biomedical Advanced Research and Development Authority and the Strategic National Stockpile. Beginning in FY2024, ASPR has received its appropriations in separate accounts from the PHSSEF. 45 U.S. Government Accountability Office, Public Health Preparedness: HHS Reserve Funding for Emergencies, GAO-23-106102, August 2023, https://www.gao.gov/assets/gao-23-106102.pdf. 46 USASpending.gov, “Infectious Diseases Rapid Response Reserve Fund, Centers for Disease Control, Health and USASpending.gov, “Infectious Diseases Rapid Response Reserve Fund, Centers for Disease Control, Health and
Human Services,” last updated Human Services,” last updated March 2, 2023May 20, 2024, https://www.usaspending.gov/federal_account/075-0945, https://www.usaspending.gov/federal_account/075-0945.
56. 47 USASpending.gov, “Public Health Emergency Fund, Public Health Services, Office of Assistant Secretary for USASpending.gov, “Public Health Emergency Fund, Public Health Services, Office of Assistant Secretary for
Health, Health and Human Services,” https://www.usaspending.gov/federal_account/075-1104. Health, Health and Human Services,” https://www.usaspending.gov/federal_account/075-1104.
57 See CRS Insight IN11229, Stafford Act Assistance for Public Health Incidents.
58 CDC, “Office of Financial Resources: FY2019 Assistance Snapshot,” https://www.cdc.gov/funding/documents/
fy2019/fy-2019-ofr-assistance-snapshot-508.pdf. FY2019 data are cited here instead of FY2020 and FY2021 data, as
those years reflect significant amounts of COVID-19-specific grant funding that are not reflective of CDC’s usual grant
practices.
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link to page 24 Congressional Research Service 16 Centers for Disease Control and Prevention (CDC) Funding Overview 2009, the Ebola virus outbreak in 2014, and the Zika virus outbreak in 2016.48 Congress subsequently established the IDRRRF in 2018. Author Information Kavya Sekar Analyst in Health Policy Acknowledgments CRS Research Assistants Joe Angert and John Gorman assisted with this report update. CRS Visual Information Specialist Jamie Bush provided graphics assistance. Centers for Disease Control and Prevention (CDC) Funding Overview

major source of funding, CDC budget trends influence state and local budgets for public health
initiatives. State and local health departments also receive federal funding from other agencies
(e.g., Heath Services and Resources Administration), but CDC is a main source of funding for
core public health activities such as infectious disease control or chronic disease prevention.
CDC’s funding awards complement state and local governments’ own funding for public health.
CDC’s funding and its overall impact on U.S. public health capacity are perhaps best viewed in
the context of state and local funding trends.
Trends
There is no single source of standardized and generally accepted data on public health funding at
the federal, state, and local level, which hinders analysis of public health funding trends.59
Analyses have found differing trends in state and local public health funding in recent years.
Federal data in the National Health Expenditure (NHE) Accounts show that state and local
investments for public health grew from $73.5 billion in 2014 to $91.7 billion (+24.8%) by
2019.60
However, academic researchers (Leider, Resnick, and McCullough, 2020) have argued that the
NHE data overestimates actual spending on public health.61 An analysis by Alfonso, Leider, and
Resnick (2021) used different methodology from NHE, and found that state government spending
on public health had remained mostly flat or declined between 2008 and 2018 with some
variability across states.62 (State public health spending amounts in this analysis include federal
grant funding to states, whereas the NHE state and local data do not.) Figure 7 shows per capita
inflation-adjusted trends in state spending by public health category from the 2021 analysis.

59 Arthur L. Sensenig et al., “The Who, What, How, and Why of Estimating Public Health Activity Spending,” Public
Health Management and Practice, vol. 23, no. 6 (November/December 2017), pp. 556-559.
60 Micah Hartman et al., “National Health Care Spending In 2020: Growth Driven By Federal Spending In Response
To The COVID-19 Pandemic,” Health Affairs, vol. 1 (2022), pp. 13-25. 2020 data excluded because of the large one-
time funding increases for public health during the COVID-19 pandemic. The National Health Expenditures Accounts
classify multiple federal public health agency appropriations into the overall “public health activity” category,
including CDC and the U.S. Food and Drug Administration. The state and local funding is based on census data on
state and local government budgets. Federal grant awards to state and local governments are deducted to avoid double
counting the federal funding in the state and local funding category. See Centers for Medicare & Medicaid Services,
National Health Expenditure Accounts: Methodology Paper, 2020, pp. 27-28, https://www.cms.gov/files/document/
definitions-sources-and-methods.pdf.
61 Jonathan P. Leider et al., “Inaccuracy of Official Estimates of Public Health Spending in the United States, 2000–
2018,” American Journal of Public Health, vol. 110 (April 4, 2020), pp. S194-S196.
62 Y. Natalia Alfonso et al., “US Public Health Neglected: Flat Or Declining Spending Left States Ill Equipped To
Respond To COVID-19,” Health Affairs, vol. 40, no. 4 (March 25, 2021).
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Figure 7. Inflation-adjusted Trends in State Spending on Public Health by Category
Per Capita from Alfonso et al. (2021).

Source: Y. Natalia Alfonso et al., “U.S. Public Health Neglected: Flat or Declining Spending Left States Il
Equipped To Respond to COVID-19,” Health Affairs, vol. 40, no. 4 (April 2021), p. 667.
Notes: Analysis used data from Census Bureau’s State Finance Division files as reported by state budget offices
to the Census Bureau. The study authors re-coded the data to classify spending as public health spending.
Analysis does not include public health spending by local (county) governments or federal spending on in-kind
assistance to state governments (e.g., federal employee details). However, amounts do include federal grants
made to states as well as state funding that is ultimately transferred to local governments.
Another source of data—the Association of State and Territorial Health Officials’ (ASTHO)
survey of state health departments—shows the following funding trends for specific categories
relevant to pandemic preparedness:63
 For public health all-hazards preparedness and response activities, state
funding for preparedness and response programs remained relatively constant
from 2010 to 2018 ($101 million to $112 million). However, federal funding to
states for preparedness and response declined approximately 48.5% from $1.440
billion in 2010 to $742 million in 2018.
 For infectious disease prevention and control programs, state funding
declined approximately 37.2% from $709 million in 2010 to $445 million in
2018. On the other hand, federal funding to states for infectious disease
prevention and control activities declined approximately 10% from $1.095 billion
in 2010 to $985 million in 2018.
Local health departments receive funding from federal, state, and local sources. Local health
departments have also reported flat or declining spending in recent years. According to a survey
of local health departments by the National Association of County and City Health Officials
(NACCHO), inflation-adjusted median per capita expenditures by local health departments

63 Association of State and Territorial Health Officials (ASTHO), “State Health Agency Expenditures: 2010-2018,”
https://www.astho.org/globalassets/pdf/state-health-agency-expenditures-2010-2018.pdf.
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increased from $44 in 2008 to $50 in 2010, and then fell back to $41 by 2019.64 Both ASTHO’s
and NACCHO’s surveys rely on reported data from health departments, and therefore are subject
to some limitations.
Other Funding-Related Challenges
Aside from overall trends, observers have cited other challenges in CDC public health funding
faced at the state and local level, including the following:
 Variability. As noted earlier, supplemental appropriations for public health
emergencies can lead to periodic increases and decreases in overall public health
funding at the federal, state, and local levels. Some analysts have characterized
emergency funding as contributing to “boom and bust” cycles where public
health capacity developed during an emergency is later lost due to subsequent
funding decreases.65 Some have also argued that reliance on the annual
appropriations process results in year-to-year funding variability that adversely
affects continuity of programs at the state and local level.66
 Siloed and categorical funding. As shown in this report, CDC has received
annual appropriations in recent years for disease or activity-specific categories.
These appropriations are then further designated for specific programs through
appropriations report language. States and other jurisdictions then receive
categorical public health grants from these appropriations. Some analysts have
argued that siloed and categorical grants have hindered state and local public
health agencies’ ability to spend according to their priorities or emerging needs.
Analysts have also argued that state and local health agencies have not had
sufficient flexibility to spend categorical grants on general capabilities, such as
workforce and technology.67
 Competitive grant programs. In many cases, CDC does not receive enough
funding for a specific program to award a grant to every state or local
jurisdiction. In these cases, CDC awards the funding through a competitive

64 National Association of County and City Health Officials (NACCHO), “2019 National Profile of Local Health
Departments,” p.69, https://www.naccho.org/uploads/downloadable-resources/Programs/Public-Health-Infrastructure/
NACCHO_2019_Profile_final.pdf.
65 Karen DeSalvo et al., Public Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs,
National Academy of Medicine, April 7, 2021, https://nam.edu/public-health-covid-19-impact-assessment-lessons-
learned-and-compelling-needs/, and Bipartisan Policy Center, Positioning America’s Public Health System for the Next
Pandemic, June 2021, p. 40, https://bipartisanpolicy.org/download/?file=/wp-content/uploads/2021/06/Public-Health-
Report_RV2.pdf, and Michelle R. Smith, Lauren Weber, and Hannah Recht, “Public Health Experts Worry About
Boom-Bust Cycle of Support,” Kaiser Health News, April 19, 2021, https://khn.org/news/article/public-health-experts-
worry-about-boom-bust-cycle-of-support.
66 Institute of Medicine (now National Academy of Medicine), For the Public’s Health: Investing in a Healthier
Future, April 10, 2012, https://www.ncbi.nlm.nih.gov/books/NBK201023/.
67 Karen DeSalvo et al., Public Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs,
National Academy of Medicine, April 7, 2021, https://nam.edu/public-health-covid-19-impact-assessment-lessons-
learned-and-compelling-needs/, and Bipartisan Policy Center, Positioning America’s Public Health System for the Next
Pandemic, June 2021, pp. 38-39, https://bipartisanpolicy.org/download/?file=/wp-content/uploads/2021/06/Public-
Health-Report_RV2.pdf, and Trust for America’s Health, The Impact of Chronic Underfunding on America’s Public
Health System, 2021, p. 11 https://www.tfah.org/wp-content/uploads/2021/05/2021_PHFunding_Fnl.pdf.
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application process (consistent with federal requirements), unless the process for
awarding the funds is otherwise specified in law.68 Some observers have argued

68 See HHS, Grants Policy Statement, https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/
hhsgps107.pdf. See also 45 C.F.R. Part 75.
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 that competitive funding disproportionately rewards agencies or organizations
with the resources and skills to submit successful competitive grant applications.
The result is that agencies and organizations in poor or underserved communities
may be less likely to successfully obtain competitive grant funding.69





Author Information

Kavya Sekar

Analyst in Health Policy


Acknowledgments
Former CRS Analyst in Public Health Emergency Management Taylor Wyatt and CRS Analyst in Health Former CRS Analyst in Public Health Emergency Management Taylor Wyatt and CRS Analyst in Health
Policy Hassan Sheikh contributed to Policy Hassan Sheikh contributed to a previousan earlier version of this report version of this report. CRS Research Assistant John
Gorman provided assistance for the update. .

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
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69 Institute of Medicine (now National Academy of Medicine), For the Public’s Health: Investing in a Healthier
Future, April 10, 2012, https://www.ncbi.nlm.nih.gov/books/NBK201015/, and Trust for America’s Health, The Impact
of Chronic Underfunding on America’s Public Health System, 2021, p. 11. https://www.tfah.org/wp-content/uploads/
2021/05/2021_PHFunding_Fnl 48 U.S. Government Accountability Office, Public Health Preparedness: HHS Reserve Funding for Emergencies, GAO-23-106102, August 2023, https://www.gao.gov/assets/gao-23-106102.pdf. .pdf.
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