CDC tells health programs to deprioritize harm reduction within days

The CDC has ordered state, territorial, tribal, and local health programs to sign on within days to a new list of policy priorities that include a shift away from proven overdose-prevention methods and a focus on “parental authority” — a directive that researchers and public health experts said represents an escalation of political control over federal public health grants.

The U.S. Centers for Disease Control and Prevention informed health programs at the state, territorial, tribal and local level on Wednesday that they must agree to a list of the agency’s priorities within five business days, or by July 1, according to a copy of the memo obtained by The Guardian. The notice applied to programs covering immunizations, HIV, hepatitis, and tobacco. It did not come from the program staff at the CDC, who were unaware of the new requirement, according to a source familiar with the memo. It was not immediately clear whether all affected programs received the notice.

While the requirement was not explicitly tied to funding, the grant note references a previous statement from the CDC that funding may be canceled if programs do not comply with the agency’s terms. The Department of Health and Human Services did not respond to questions about the memo by publication time.

The new priorities include “parental authority” and policies giving parents “greater control over their children’s education,” according to the memo. Researchers said this language could refer to vaccination requirements for school attendance, which are set at the state and sometimes local level. HHS Secretary Robert F. Kennedy Jr., a longtime vaccine critic, has signaled the administration’s focus on ending such requirements. As previously covered by MSI in January, HHS narrowed the recommended childhood vaccine schedule from 18 to 11 diseases. The following month, states sued the Trump administration over the vaccine rollback — a case that remains active.

“The requirements may put pressure on states to reconsider vaccine mandates,” said Dorit Reiss, a vaccines expert and professor at UC Law San Francisco. She said withholding federal funding because a state or locality mandates vaccines would be “essentially begging for a lawsuit” and that states would have “very good arguments” against such a move. “Of course, that doesn’t mean they won’t try,” she added.

The memo also deprioritizes Housing First, harm reduction, and safe consumption programs — strategies that public health researchers said have been proven to reduce drug overdoses and help people with substance use disorder.

“The main thing that harm reduction programs do is bring those people into care and into services that allow them to make those better choices about what they put on their bodies,” said Nabarun Dasgupta, a street drug researcher and senior scientist at UNC Chapel Hill’s Injury Prevention Research Center. “These directives weaken the most critical frontline care of engaging with people who are falling through the cracks.”

The directive comes as new challenges are reshaping the illicit drug supply. On the East Coast, the drug adulterant medetomidine is changing the street drug mix, Dasgupta said. “This new form of adulterant really is a gamechanger in terms of being able to provide care, and in this exact setting is when you actually need harm reduction more than ever,” Dasgupta said. “You need to help them step down their use to the point where they can go into treatment, but if we use an abstinence-first model, if we move away from harm reduction, if we move away from housing first, then you’re going to end up filling ICUs and emergency rooms.”

Dasgupta described the move as a “prelude” to imposing similar restrictions on other kinds of federal funding, such as direct service provision.

The CDC is also prioritizing evidence-based programs to reduce homelessness, drug use, and “public disorder,” which is not defined in the memo. A July 2025 executive order from the White House took aim at unstably housed and mentally ill people, creating a pathway to criminalize greater numbers of people, experts have said.