Centers for Disease Control and Prevention (CDC) Funding Overview

Centers for Disease Control and Prevention (CDC) Funding Overview

Centers for Disease Control and Prevention
July 16, 2024
(CDC) Funding Overview
Kavya Sekar
The Centers for Disease Control and Prevention (CDC) works to protect public health by
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. In addition, the Agency for Toxic Substances and Disease Registry
please call 7-5700 or visit
(ATSDR), headed by the CDC Director, is tasked with identifying potential public health effects
www.crs.gov.
from exposure to hazardous substances. This CRS report provides an overview of CDC’s budget
and appropriations, with a focus on FY2024 enacted appropriations and the FY2025 President’s budget request, including
ATSDR. The report also discusses supplemental appropriations for CDC.
This report divides CDC’s program level, or annual funding from all sources of budget authority, into two categories, with a
focus on the first:
• A core public health program level that funds most of the agency’s main public health programs. This is
made up of 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 act.
• Other mandatory programs that include several CDC-administered health services, compensation-related,
and user fee programs. These include the World Trade Center Health Program and user fees for cruise ship
inspection, among others.
CDC’s enacted FY2024 (P.L. 117-328) core public health program level is $9.248 billion, which represents a $21 million
(-0.2%) decrease from the FY2023 final core public health program level. The Biden Administration has proposed an
FY2025 CDC program level of $9.768 billion, a proposed increase of $520 million over the FY2024 enacted program level.
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 remained between approximately $6.5 and $8 billion until the increases provided in FY2022 and FY2023 (not
adjusted for inflation). CDC saw a decrease in its overall program level in FY2024.
CDC also frequently receives one-time 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
Coronavirus Disease 2019 (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.

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Contents
Introduction ..................................................................................................................................... 1
Understanding CDC Funding .......................................................................................................... 3
Core Public Health Program Level ........................................................................................... 4
Other Mandatory Programs ....................................................................................................... 8
Proposed Mandatory Programs ............................................................................................... 10
Funding Table ................................................................................................................................ 10
Trends in Core Public Health Program Level................................................................................ 12
CDC Budget in Context ................................................................................................................ 13
Supplemental Appropriations for Public Health Emergencies and Other Incidents ............... 13
CDC Infectious Diseases Rapid Response Reserve Fund ................................................ 15

Figures
Figure 1. Centers for Disease Control and Prevention Organization Chart ..................................... 2
Figure 2. FY2024 Enacted Centers for Disease Control and Prevention Program Level by
Category and Budget Authority .................................................................................................... 4
Figure 3. Example of CDC Appropriation Language ...................................................................... 5
Figure 4. Example of CDC Appropriations Report Language ........................................................ 6
Figure 5. Example of Prevention and Public Health Fund Allocations ........................................... 7
Figure 6. Trends in Core Public Health Program Level ................................................................ 13

Tables
Table 1. Centers for Disease Control and Prevention (CDC) and Agency for Toxic
Substances and Disease Registry (ATSDR) Appropriations, FY2023-FY2025 Request ........... 10
Table 2. Appropriations History to the IDRRRF ........................................................................... 16

Contacts
Author Information ........................................................................................................................ 17

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Introduction
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,
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
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
ongoing public health activities, the agency has played a major role in disease outbreaks and
public health emergencies, including the federal response to the Coronavirus Disease 2019
(COVID-19) pandemic. 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 effects from exposure to hazardous substances.
CDC focuses on supporting science-based disease prevention and health promotion on a
population-wide basis. CDC 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 in Figure 1. Some 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 services).2
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.
Most of CDC’s programs are authorized in the Public Health Service Act (PHSA). Many CDC
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
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
guiding the agency’s policy priorities.
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 state5 and local health departments.6
CDC also awards funding to a variety of other entities, including international governments and
organizations; tribal governments and organizations; academic and research institutions; and
nonprofit organizations.
This report reviews the CDC’s budget and appropriations from FY2023 to FY2025 and its
funding history for core public health programs from FY2011 to FY2025. 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 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).
6 In FY2023, CDC obligated more than $12.5 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/fy2023/fy-2023-ofr-assistance-snapshot-508.pdf.
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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/
cdc-org-chart.pdf, updated as of February 23, 2023.
Notes: HIV = Human Immunodeficiency Virus; STD = Sexually Transmitted Disease; TB = Tuberculosis; OPDIV
= Operating Division.
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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
Departments of Labor, Health and Human Services, and Education, and Related
Agencies (LHHS) appropriations and the mandatory Prevention and Public
Health Fund (PPHF), and
• other mandatory programs, including CDC-administered health services,
compensation-related, and user fee programs.
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
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
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
level” in this CRS report aligns with the “CDC/ATDSR program level” presented in FY2025
CDC budget documents.8
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
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
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 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 in the
agency’s own budget presentations.9

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/fy2025/FY-2025-CDC-Budget-
Detail.pdf. CDC changes its budget presentations and categories from year to year.
9 See, for example, CDC, “FY2025 Budget Detail Table,” https://www.cdc.gov/budget/documents/fy2025/FY-2025-
CDC-Budget-Detail.pdf.
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Figure 2. FY2024 Enacted Centers for Disease Control and Prevention Program
Level by Category and Budget Authority
Thousands of Dollars

Source: FY2024 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/documents/fy2025/FY-2025-CDC-Budget-Detail.pdf.
Notes: Amounts reflect some post-appropriations adjustments. Acronyms: CDC = Centers for Disease Control
and Prevention.
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 developing expertise and best practices in disease
prevention and control; conducting and supporting public health research; supporting and
conducting public health surveillance and data collection; developing and supporting public
health laboratory capacity; supporting and conducting health education and promotion efforts;
funding, coordinating, and providing technical assistance to public health programs at the state
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and local level; supporting some preventive health services programs (e.g., some vaccination and
cancer screening programs); and supporting public health emergency preparedness and response
efforts. Many of the programs fund and support public health activities at the state and local
level.10
CDC’s core public health program level is made up of (1) discretionary appropriations; (2),
mandatory funding from the Prevention and Public Health Fund (PPHF); and (3) some other
funding sources, such as transfers from other accounts.
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. Within LHHS
appropriations, CDC receives funding in several accounts, many of which align with CDC CIOs.
Some accounts fund activities through multiple CIOs (e.g., the Public Health Scientific Services
account). Some CDC accounts are for agency-wide activities, such as the Buildings and Facilities
account and the CDC-Wide Activities and Program Support account.
As an example, the Birth Defects, Developmental Disabilities, Disabilities and Health account
funds activities at CDC’s National Center on Birth Defects and Developmental Disabilities
(NCBDDD). The appropriations act text provides funding to the account with respect to such
activities as authorized by several PHSA titles as shown in Figure 3.
Figure 3. Example of CDC Appropriation Language
From FY2024 LHHS Appropriations

Source: Consolidated Appropriations Act, 2024, P.L. 118-47, Division D, Title II.
Appropriations report language accompanying CDC appropriations generally specifies amounts
for programs or activities funded by CDC accounts in greater detail than the appropriations act
text. Shown below in Figure 4 is the FY2024 report language and funding table accompanying
the Birth Defects and Developmental Disabilities appropriation.11

10 See CDC, “Grant Funding Profiles,” https://fundingprofiles.cdc.gov/.
11 For a general overview of appropriations report language, see CRS Report R44124, Appropriations Report
Language: Overview of Development and Components.
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Figure 4. Example of CDC Appropriations Report Language

Source: “Explanatory Statement Accompanying Consolidated Appropriations Act, 2024,” Congressional Record,
vol. 170 (March 22, 2024), p. H1889.
This CRS report focuses on account-level funding in Table 1. CDC’s annual Operating Plans
reflect programmatic funding levels within accounts as directed by appropriations report
language.12 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 years, some CDC LHHS accounts have received annual allocations of
the mandatory PPHF as directed in LHHS appropriations laws. In 2010, 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 In recent years, appropriators have directed specific
amounts of annual PPHF funding to specific CDC accounts and programs (in addition to other
HHS agencies) through LHHS laws and accompanying report language.14 See Figure 5 for PPHF
allocations from FY2024 appropriations.

12 See CDC, Operating Plans, https://www.cdc.gov/budget/operating-plans/index.html.
13 42 U.S.C. §300u-11(a).
14 Prior to FY2014, the HHS Secretary determined uses of the PPHF. See CRS report, CRS Report R47895, Prevention
and Public Health Fund: In Brief.
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Figure 5. Example of Prevention and Public Health Fund Allocations
From FY2024 LHHS Appropriations

Source: “Explanatory Statement Accompanying Consolidated Appropriations Act, 2024,” Congressional Record,
vol. 170 (March 22, 2024), p. H1894.
As shown in Figure 5, most of the FY2023 PPHF allocation went to CDC. Additional allocations
went to the Administration for Community Living (ACL) and the Substance Abuse and Mental
Health Services Administration (SAMHSA).
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.
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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 programs have been funded by mandatory budget authorities, such as for the Childhood
Obesity Demonstration Project,18 as authorized in Social Security Act (SSA) Section
1139A(e)(8).19
Supplemental Appropriations
CDC has also received supplemental appropriations during public health emergencies and other specific incidents,
such 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
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
are discussed in a separate section in this CRS report to distinguish regular appropriations for CDC’s annual
operations from these one-time appropriations.
Other Mandatory Programs
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.
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.
The Vaccines for Children (VFC) program (FY2024 estimate: $7.213 billion) provides
vaccines to enrolled health care providers to vaccinate eligible children.20 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 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 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 administration.21 VFC is financed by a Medicaid
appropriation within the HHS Centers for Medicare & Medicaid Services (CMS) and is

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
authorized through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA; P.L. 111-3), and
the program was extended through several laws until FY2023. 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-508.pdf.
20 VFC is funded by Medicaid appropriations that are transferred annually to CDC. See 42 U.S.C. §1396s.
21 See “State Table: Vaccines for Children” in CDC, FY2025 Congressional Budget Justification, pp. 81-82,
https://www.cdc.gov/budget/documents/fy2025/FY-2025-CDC-congressional-justification.pdf.
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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 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 Energy.24 CDC
provides support to the program by conducting radiation dose estimates, evaluating certain
petitions, and providing other administrative support. DOL uses these estimates in making
compensation determinations.25 Annual funding for these CDC activities is 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 pursuant to that section shall be direct spending
(i.e., mandatory funding).26
The World Trade Center Health Program (WTCHP) (FY2024 estimated obligations: $768
million) provides medical monitoring and treatment to eligible individuals directly affected by the
September 11, 2001 attacks for certain incident-related health conditions. This program also funds
medical research into health conditions that may develop due to exposure during the attacks.27
The program is authorized by PHSA Title XXXIII (42 U.S.C. §§300mm et seq.) and funded
through appropriations provided by PHSA Section 3351 (42 U.S.C. §300mm–61).
User fee programs (FY2024 estimate: $2.226 million). CDC also receives relatively small
amounts of user fees from authorized user fee programs such as the vessel sanitation program,28
which collects fees from cruise ship owners for public health 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.
25 CDC, “Energy Employees Occupational Illness Compensation Program Act (EEOICPA) Budget Request” in
FY2025 Congressional Budget Justification, p. 360, https://www.cdc.gov/budget/documents/fy2025/FY-2025-CDC-
congressional-justification.pdf.
26 See, for example, in FY2021 LHHS appropriations, 134 STAT 1571 of Division H, Title II, P.L. 116-260.
27 CDC, “World Trade Center Health Program,” https://www.cdc.gov/wtc/.
28 “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
cruise ships.” Under authority in in PHSA Section 361; 42 U.S.C. §264. See CDC, “Vessel Sanitation Program,”
https://www.cdc.gov/vessel-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
respirators. 42 C.F.R. Part 84. See also CDC, Respirator Certification Fees Schedules,” https://www.cdc.gov/niosh/
npptl/respcertfeescheduletables.html.
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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
legislative proposal for mandatory funding of $1.004 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 Insurance Program
(CHIP). The proposal would also change the fee structure for providers
participating in the program. Both of those changes would affect annual VFC
funding. The FY2025 requested amount 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 Justification, p. 15, https://www.cdc.gov/budget/documents/fy2025/FY-2025-
CDC-congressional-justification.pdf.
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2023
FY2024
FY2024
FY2025
Program or Activity
Final
Request
Enacted
Request
PPHF Transfer (non-add)
(419)
(505)
(682)
(469)
HIV/AIDS, Viral Hepatitis, STI and TB
1,391
1,545
1,391
1,391
Emerging & Zoonotic Infectious Diseases
751
846
760
781
PPHF Transfer (non-add)
(52)
(52)
(52)
(52)
Chronic Disease Prevention and Health Promotion
1,430
1,814
1,434
1,559
PPHF Transfer (non-add)
(255)
(262)
(241)
(255)
Birth Defects, Developmental Disabilities, Disability
206
223
206
206
and Health
Environmental Health
247
421
243
267
PPHF Transfer (non-add)
(17)
(17)
(51)
(17)
PHS Evaluation Transfer (non-add)
—
(7)
—
—
Injury Prevention and Control
761
1,352
761
943
PHS Evaluation Transfer (non-add)
—
—
—
(100)
Public Health Scientific Services
754
962
754
804
PPHF Transfer (non-add)
—
(140)
—
(183)
PHS Evaluation Transfer (non-add)
—
(170)
(43)
—
Occupational Safety and Health
363
363
363
363
Global Health
693
765
693
694
Public Health Preparedness and Responseb
905
943
938
943
Crosscutting Activities and Program Support
724
1,039
664
724
PPHF Transfer (non-add)
(160)
(160)
(160)
(160)
Office of the Director (non-add)
(129)
(144)
(129)
(129)
Infectious Diseases Rapid Response Reserve Fund (non-add)
(35)
(35)
(25)
(35)
Public Health Infrastructure and Capacity (non-add)
(350)
(600)
(350)
(350)
Center for Forecasting and Analytics (CFA; non-add)
(50)
(50)
—
—
CFA- PPHF Transfer (non-add)
—
(50)
—
(50)
Buildings and Facilities
40
55
40
40
Agency for Toxic Substances and Disease Registry
85
86
82
85
(ATSDR)c
Total, Core Public Health Program Level (CPHPL)
9,269
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
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2023
FY2024
FY2024
FY2025
Program or Activity
Final
Request
Enacted
Request
Energy Employees Occupational Il ness Compensation
51
51
51
51
Program Act (EEOICPA)d
World Trade Center Health Program (WTCHP)e
710
782
768
788
User Fees
2
2
2
2
Vaccines for Adults (proposed mandatory)
—
1,004
—
1,004
Community Violence Intervention (proposed mandatory)
—
—
—
150
Total Other Mandatory Programsf
5,980
7,841
8,034
10,035
Total, Core Public Health Program Level + Other
15,249
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 requested amounts from CDC, “FY2025 Budget Detail Table,”
https://www.cdc.gov/budget/documents/fy2025/FY-2025-CDC-Budget-Detail.pdf. FY2024 request and enacted
amounts are from Congressional Record, vol. 170, no. 51 (March 22, 2024), H2020-H2022, and other mandatory
program amounts from CDC, “FY2025 Budget Detail Table,” https://www.cdc.gov/budget/documents/fy2025/FY-
2025-CDC-Budget-Detail.pdf, except where noted below.
Notes: Individual amounts may not add to subtotals or totals due to rounding. FY2023 enacted amounts reflect
some post-appropriations adjustments. Acronyms: HIV = Human Immunodeficiency Virus; AIDS = Acquired
Immunodeficiency Syndrome; STI = Sexually Transmitted Infection; TB = Tuberculosis; 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 account.
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
CDC activities added to the FY2023 appropriated amount ($883 mil ion).
c. Provided separately in the Interior/Environment Appropriations Act.
d. Per the FY2024 budget request table, all amounts for EEOICPA reflect sequestration and therefore differ
from appropriated funding levels.
e. Amounts reflect federal obligations. FY2023 WTHCP amount does not include the $1 bil ion supplemental
appropriation provided in Consolidated Appropriations Act, 2023 (P.L. 117-328), 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.
Trends in Core Public Health Program Level
As shown in Figure 6, in terms of nominal dollars, 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 FY2023 (+11.2%; not adjusted for inflation). From FY2011 to FY2021,
CDC saw annual increases and 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.pdf.
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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.
Notes: 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 =
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
Social 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
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.
117-328), the Coronavirus Disease 2019 (COVID-19) pandemic,33 medical screening and
supports for Afghan refugees (P.L. 117-70), and funding for domestic and global activities related
to the war in Ukraine (e.g., 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.
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this report as they are not intended to fund the agency’s regular operating expenses and programs.
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
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
agencies include
• H1N1 influenza pandemic, 2009. In response to the H1N1 influenza pandemic,
CDC spent $600 million on its public health response and also administered $1.4
billion through its Public Health Emergency Response grant program to state and
local partners.34 These funds were made available to CDC from the Supplemental
Appropriations Act of 2009 (P.L. 111-32), enacted in June 2009.
• Ebola outbreak, 2014-2015. In response to the Ebola outbreak, Consolidated
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
and international Ebola preparedness and response efforts.35 Using these funds,
CDC provided several supplemental grants to state and local agencies, including
$145 million through the Public Health Emergency Preparedness (PHEP)
cooperative agreement and more than $114 million through the Epidemiology
and Laboratory Capacity (ELC) grant program.36
• Zika outbreak, 2016. The Zika Response and Preparedness Appropriations Act,
2016 (P.L. 114-223; Division B) provided $394 million to CDC in supplemental
appropriations for preparedness and response to the Zika outbreak, domestically
and internationally.37 CDC obligated a portion of the funding to state and local
agencies through several grant programs, including more than $184 million
through the ELC grant program.38
• COVID-19 pandemic, 2020-present. As reported by GAO, as of January 2023,
CDC has received $26.4 billion through the COVID-19 relief appropriations
measures to the CDC-Wide Activities and Program Support Account.39 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, 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.
35 P.L. 113-234, 128 Stat. 2520.
36 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 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-18-362.pdf.
37 P.L. 114-223, 130 Stat. 901- 130 Stat. 902.
38 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
provided by CDC to CRS on April 22, 2022.
39 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, 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.
40 CDC, “Budget: Novel Coronavirus (COVID-19),” https://www.cdc.gov/budget/fact-sheets/covid-19/index.html.
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As a result, of the total appropriated to and administered by CDC, $59.525 billion
in CDC COVID-19 grants have been awarded to state, tribal, and local agencies
as of September 2023 (amount includes some regular appropriations).41 For more
information on CDC 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, 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.
43 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.
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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
P.L. 115-245, regular
$50
FY2020
P.L. 116-94, regular
$85
P.L. 116-123, supplemental
$300
P.L. 116-136, supplemental
$300
FY2021
P.L. 116-260 (Division H), regular
$10
FY2022
P.L. 117-103, regular
$20
FY2023
P.L. 117-328, (Division H), regular
$35
FY2024
P.L. 118-47, (Division D), regular
$25
Source: CRS analysis of appropriations laws.
IDRRRF funding has been used for multiple responses, including for recent Ebola outbreaks in
Africa, the mpox outbreak in 2022-2023, and for the COVID-19 pandemic response.45 As of May
2024, the IDRRRF has an unobligated balance of $550.5 million available for infectious disease
emergencies.46
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)]
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
currently has a balance of $56,500 and has not received appropriations for many years.47
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
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
prior to the Coronavirus Disease 2019 (COVID-19) pandemic—the H1N1 influenza pandemic in

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
Human Services,” last updated May 20, 2024, https://www.usaspending.gov/federal_account/075-0945.
47 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.
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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. Former CRS Analyst in Public Health
Emergency Management Taylor Wyatt and CRS Analyst in Health Policy Hassan Sheikh contributed to an
earlier version of this report.

Disclaimer
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
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
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
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
material from a third party, you may need to obtain the permission of the copyright holder if you wish to
copy or otherwise use copyrighted material.

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.
Congressional Research Service
R47207 · VERSION 7 · UPDATED
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