Jeffrey A. Singer
I have recently written that the “healthy rebellion” by national, state, and local professional medical and public health organizations against the Centers for Disease Control and Prevention’s (CDC) health recommendations can be beneficial if it results in Congress ultimately restoring the CDC’s original mission of providing surveillance, data collection, coordination, and logistical support to regional and local public health authorities. This would leave public health recommendations to them and personal health recommendations to health care professionals.
Last September, California, Hawaii, Oregon, and Washington established the West Coast Health Alliance of state public health agencies, which collaborate to issue vaccination recommendations for both adults and children. Around the same time, several northeastern states and New York City announced the Northeast Health Collaborative, with a similar mission. Shortly thereafter, the governors of 14 states plus Guam announced the creation of the Governors Public Health Alliance, which will “serve as a unified, cross-state liaison with the global health community and will facilitate cross-state collaboration by bringing together regional and other groups to share best practices and surface common challenges, elevating national considerations for vaccine policy and regulatory solutions to keep science front and center.”
I viewed President Trump’s January 2025 announcement that he intended to withdraw the US from the World Health Organization (WHO) in a similar light. The decision functioned less as a repudiation of global disease surveillance than as a governance shock to the existing public health order—one that created institutional space for alternative networks and partnerships to emerge. Over the years, the WHO, like the CDC, has experienced mission creep and growing susceptibility to political and economic pressures. The withdrawal, therefore, raised a legitimate question: whether global outbreak surveillance and coordination require a single dominant authority, or whether a more pluralistic architecture might better preserve both scientific independence and institutional accountability.
Although the WHO’s recommendations are not mandates, many public health officials and healthcare practitioners tend to see the opinions of this highly respected global organization as the “one right way”—similar to how, domestically, the CDC’s recommendations hold inordinate influence.
With the world’s population as interconnected as it is today, the world needs a global organization that can surveil, collect data, coordinate, and provide international logistical support to help stop the spread of communicable and infectious diseases. But it need not be the WHO.
In the wake of the US’s formal exit from the WHO last month, some states are now joining the WHO’s Global Outbreak Alert and Response Network (GOARN), a multinational surveillance and rapid-response consortium. Axios reports today that New York Governor Kathy Hochul announced the state plans to join GOARN. California and Illinois have already joined. New York City announced a week ago that it was joining the network separately.
But the GOARN is not the only option. There are several other intergovernmental surveillance and response networks, such as the European Centre for Disease Prevention and Control (ECDC), the African Centres for Disease Control and Prevention (Africa CDC), and the Association of Southeast Asian (ASEAN) Emergency Operations Centre Network.
There are military-run systems, such as the Defense Threat Reduction Agency (DTRA) and the NATO Center of Excellence for Military Medicine.
There are also non-governmental and academic systems, like HealthMap, affiliated with Boston Children’s Hospital, and the Program for Monitoring Emerging Diseases (ProMED), administered by the International Society for Infectious Diseases.
It is ironic that the Trump administration, rightly, objects to the WHO’s mission creep and politicization but fails to see the same problem with the CDC in its own backyard.
It remains to be seen where this all leads. But the current realignment of public health governance might promote pluralism and decentralization and reduce domestic and global groupthink.
As a physician, I value good data, early warnings, and logistical support when outbreaks emerge. Clinical and public health professionals rarely improve their judgment by deferring to distant bureaucratic consensus. They improve it by staying close to patients, communities, and local realities.
If the current reshuffling of public health governance restores that balance—globally and here at home—it may ultimately strengthen, rather than weaken, our collective capacity to respond to the next crisis.