The Centers for Disease Control and Prevention (CDC) is the leading national public health institute of the United States. The CDC is a United States federal agency under the Department of Health and Human Services and is headquartered in Atlanta, Georgia.^[2]

Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability in the US and internationally.^[3] The CDC focuses national attention on developing and applying disease control and prevention. It especially focuses its attention on infectious disease, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention and educational activities designed to improve the health of United States citizens. In addition, the CDC researches and provides information on non-infectious diseases such as obesity and diabetes and is a founding member of the International Association of National Public Health Institutes.^[4]

The Communicable Disease Center was founded July 1, 1946, as the successor to the World War II Malaria Control in War Areas program^[5] of the Office of National Defense Malaria Control Activities.^[6]

Preceding its founding, organizations with global influence in malaria control were the Malaria Commission of the League of Nations and the Rockefeller Foundation.^[7] The Rockefeller Foundation greatly supported malaria control,^[7] sought to have the governments take over some of its efforts, and collaborated with the agency.^[8]

The new agency was a branch of the U.S. Public Health Service and Atlanta was chosen as the location because malaria was endemic in the Southern United States.^[9] The agency changed names (see infobox on top) before adopting the name Communicable Disease Center in 1946. Offices were located on the sixth floor of the Volunteer Building on Peachtree Street.

With a budget at the time of about $1 million, 59 percent of its personnel were engaged in mosquito abatement and habitat control with the objective of control and eradication of malaria in the United States^[10] (see National Malaria Eradication Program).

Among its 369 employees, the main jobs at CDC were originally entomology and engineering. In CDC's initial years, more than six and a half million homes were sprayed, mostly with DDT. In 1946, there were only seven medical officers on duty and an early organization chart was drawn, somewhat fancifully, in the shape of a mosquito. Under Joseph Walter Mountin, the CDC continued to advocate for public health issues and pushed to extend its responsibilities to many other communicable diseases.^[11]

In 1947, the CDC made a token payment of $10 to Emory University for 15 acres (61,000 m2) of land on Clifton Road in DeKalb County, still the home of CDC headquarters as of 2019. CDC employees collected the money to make the purchase. The benefactor behind the "gift" was Robert W. Woodruff, chairman of the board of The Coca-Cola Company. Woodruff had a long-time interest in malaria control, which had been a problem in areas where he went hunting. The same year, the PHS transferred its San Francisco based plague laboratory into the CDC as the Epidemiology Division, and a new Veterinary Diseases Division was established.^[5] An Epidemic Intelligence Service (EIS) was established in 1951, originally due to biological warfare concerns arising from the Korean War; it evolved into two-year postgraduate training program in epidemiology, and a prototype for Field Epidemiology Training Programs (FETP), now found in numerous countries, reflecting CDC's influence in promoting this model internationally.^[12]

The mission of CDC expanded beyond its original focus on malaria to include sexually transmitted diseases when the Venereal Disease Division of the U.S. Public Health Service (PHS) was transferred to the CDC in 1957. Shortly thereafter, Tuberculosis Control was transferred (in 1960) to the CDC from PHS, and then in 1963 the Immunization program was established.^[13]

It became the National Communicable Disease Center (NCDC) effective July 1, 1967.^[6] The organization was renamed the Center for Disease Control (CDC) on June 24, 1970, and Centers for Disease Control effective October 14, 1980.^[6] An act of the United States Congress appended the words "and Prevention" to the name effective October 27, 1992. However, Congress directed that the initialism CDC be retained because of its name recognition.^[14]

Currently, the CDC focus has broadened to include chronic diseases, disabilities, injury control, workplace hazards, environmental health threats, and terrorism preparedness. CDC combats emerging diseases and other health risks, including birth defects, West Nile virus, obesity, avian, swine, and pandemic flu, E. coli, and bioterrorism, to name a few. The organization would also prove to be an important factor in preventing the abuse of penicillin. In May 1994 the CDC admitted having sent several biological warfare agents to the Iraqi government from 1984 through 1989, including Botulinum toxin, West Nile virus, Yersinia pestis and Dengue fever virus.^[15]

On April 21, 2005, then–CDC Director Julie Gerberding formally announced the reorganization of CDC to "confront the challenges of 21st-century health threats".^[16] The four Coordinating Centers—established under the G. W. Bush Administration and Gerberding—"diminished the influence of national centers under [their] umbrella", and were ordered cut under the Obama Administration in 2009.^[17]

Today, the CDC's Biosafety Level 4 laboratories are among the few that exist in the world,^[18] and serve as one of only two official repositories of smallpox in the world. The second smallpox store resides at the State Research Center of Virology and Biotechnology VECTOR in the Russian Federation. The CDC revealed in 2014 that it had discovered several misplaced smallpox samples and also that lab workers had potentially been infected with anthrax.^[19]

The CDC is organized into "Centers, Institutes, and Offices" (CIOs), with each organizational unit implementing the agency's activities in a particular area of expertise while also providing intra-agency support and resource-sharing for cross-cutting issues and specific health threats. Generally, CDC "Offices" are subdivided into Centers, which in turn are composed of Divisions and Branches.^[5] However, the Center for Global Health and the National Institute for Occupational Safety and Health are freestanding organizational units and do not belong to a parent Office.

As of August 2019, the CIOs are:

The Office of Public Health Preparedness was created during the 2001 anthrax attacks shortly after the terrorist attacks of September 11, 2001. Its purpose was to coordinate among the government the response to a range of biological terrorism threats.^[20]

CDC's budget for fiscal year 2018 is $11.9 billion.^[21]

In addition to its Atlanta headquarters, CDC's other domestic locations are Anchorage, Fort Collins, Hyattsville, Research Triangle Park, San Juan (Puerto Rico), and Washington, D.C., while NIOSH operates its own facilities in Cincinnati, Morgantown, Pittsburgh, Spokane, Denver, and Anchorage.^[22] In addition, CDC operates quarantine facilities in 20 cities in the U.S.^[23]

The CDC offers grants that help many organizations each year advance health, safety and awareness at the community level throughout the United States. The CDC awards over 85 percent of its annual budget through these grants.^[24]

As of 2008, CDC staff numbered approximately 15,000 (including 6,000 contractors and 840 Commissioned Corps officers) in 170 occupations. Eighty percent held bachelor's degrees or higher; almost half had advanced degrees (a master's degree or a doctorate such as a PhD, D.O., or M.D.).^[25]

Common CDC job titles include engineer, entomologist, epidemiologist, biologist, physician, veterinarian, behavioral scientist, nurse, medical technologist, economist, public health advisor, health communicator, toxicologist, chemist, computer scientist, and statistician.^[26]

The CDC also operates a number of notable training and fellowship programs, including those indicated below.

The Epidemic Intelligence Service (EIS) is composed of "boots-on-the-ground disease detectives" who investigate public health problems domestically and globally.^[27] When called upon by a governmental body, EIS officers may embark on short-term epidemiological assistance assignments, or "Epi-Aids", to provide technical expertise in containing and investigating disease outbreaks.^[28][29][30] The EIS program is a model for the international Field Epidemiology Training Program.

The CDC also operates the Public Health Associate Program (PHAP), a two-year paid fellowship for recent college graduates to work in public health agencies all over the United States. PHAP was founded in 2007 and currently has 159 associates in 34 states.^[31]

The Director of CDC is a Senior Executive Service position^[32] that may be filled either by a career employee, or as a political appointment that does not require Senate confirmation, with the latter method typically being used. The director serves at the pleasure of the President and may be fired at any time.^[33][34][35] The CDC director concurrently serves as the Administrator of the Agency for Toxic Substances and Disease Registry.^[36]

Sixteen directors have served the CDC or its predecessor agencies.^[37][38]

The CDC's programs address more than 400 diseases, health threats, and conditions that are major causes of death, disease, and disability. The CDC's website has information on various infectious (and noninfectious) diseases, including smallpox, measles, and others.

The CDC has launched campaigns targeting the transmission of influenza, including the H1N1 swine flu, and launched websites to educate people in proper hygiene.^[47]

Within the division are two programs: the Federal Select Agent Program (FSAP) and the Import Permit Program. The FSAP is run jointly with an office within the U.S. Department of Agriculture, regulating agents that can cause disease in humans, animals, and plants. The Import Permit Program regulates the importation of "infectious biological materials."^[48]

The CDC runs a program that protects the public from rare and dangerous substances such as anthrax and the Ebola virus. The program, called the Federal Select Agent Program, calls for inspections of labs in the U.S. that work with dangerous pathogens.^[49]

During the 2014 Ebola outbreak in West Africa, the CDC helped coordinate the return of two infected American aid workers for treatment at Emory University Hospital, the home of a special unit to handle highly infectious diseases.^[50]

As a response to the 2014 Ebola outbreak, Congress passed a Continuing Appropriations Resolution allocating $30,000,000 towards CDC's efforts to fight the virus.^[51]

The CDC also works on non-communicable diseases, including chronic diseases caused by obesity, physical inactivity and tobacco-use.^[52]

The CDC implemented their National Action Plan for Combating Antibiotic Resistant Bacteria as a measure against the spread of antibiotic resistance in the United States. This initiative has a budget of $161 million and includes the development of the Antibiotic Resistance Lab Network.^[53]

The CDC works with other organizations around the world to address global health challenges and contain disease threats at their source. It works closely with many international organizations such as the World Health Organization (WHO) as well as ministries of health and other groups on the front lines of outbreaks. The agency maintains staff in more than 60 countries, including some from the U.S. but even more from the countries in which it operates.^[54] The agency's global divisions include the Division of Global HIV and TB (DGHT), the Division of Parasitic Diseases and Malaria (DPDM), the Division of Global Health Protection (DGHP), and the Global Immunization Division (GID).^[55]

The CDC is integral in working with the WHO to implement the International Health Regulations (IHR), a legally binding agreement between 196 countries to prevent, control, and report on the international spread of disease, through initiatives including the Global Disease Detection Program (GDD).^[56]

The CDC is also a lead implementer of key U.S. global health initiatives such as the President's Emergency Plan for AIDS Relief (PEPFAR) and the President's Malaria Initiative.^[57]

The CDC collects and publishes health information for travelers in a comprehensive book, CDC Health Information for International Travel, which is commonly known as the "yellow book."^[58] The book is available online and in print as a new edition every other year and includes current travel health guidelines, vaccine recommendations, and information on specific travel destinations. The CDC also issues travel health notices on its website, consisting of three levels:

"Watch": Level 1 (practice usual precautions)

"Alert": Level 2 (practice enhanced precautions)

"Warning": Level 3 (avoid nonessential travel)^[59]

The CDC Foundation operates independently from CDC as a private, nonprofit 501(c)(3) organization incorporated in the State of Georgia. The creation of the Foundation was authorized by section 399F of the Public Health Service Act to support the mission of CDC in partnership with the private sector, including organizations, foundations, businesses, educational groups, and individuals.^[60][61]

Because of the Lead contamination in Washington, D.C. drinking water the United States House of Representatives conducted an investigation, that uncovered that the CDC had made claims in a report that had indicated there was no risk from high lead levels - although it is the opposite.

For 15 years, the CDC had direct oversight over the Tuskegee syphilis experiment.^[62] In the study, which lasted from 1932 to 1972, a group of African American men (nearly 400 of whom had syphilis) were studied to learn more about the disease. Notably, the disease was left untreated in the research subjects and they never gave their informed consent to serve as research subjects. The Tuskegee Study was initiated in 1932 by the Public Health Service. The CDC took over the study in 1957.^[63]

The CDC's response to the AIDS crisis in the 1980s has been criticized for promoting some public health policies that harmed HIV+ people and for providing ineffective public education. The agency's response to the 2001 anthrax attacks was also criticized for ineffective communication with other public health agencies and with the public.^[64]

On May 16, 2011, the Centers for Disease Control and Prevention's blog published an article instructing the public on what to do to prepare for a zombie invasion. While the article did not claim that such a scenario was possible, it did use the popular culture appeal as a means of urging citizens to prepare for all potential hazards, such as earthquakes, tornadoes, and floods.^[65]

According to David Daigle, the Associate Director for Communications, Public Health Preparedness and Response, the idea arose when his team was discussing their upcoming hurricane-information campaign and Daigle mused that "we say pretty much the same things every year, in the same way, and I just wonder how many people are paying attention." A social-media employee mentioned that the subject of zombies had come up a lot on Twitter when she had been tweeting about the Fukushima Daiichi nuclear disaster and radiation. The team realized that a campaign like this would most likely reach a different audience from the one that normally pays attention to hurricane-preparedness warnings and went to work on the zombie campaign, launching it right before hurricane season began. "The whole idea was, if you're prepared for a zombie apocalypse, you're prepared for pretty much anything," said Daigle.^[66]

Once the blog article became popular, the CDC announced an open contest for YouTube submissions of the most creative and effective videos covering preparedness for a zombie apocalypse (or apocalypse of any kind), to be judged by the "CDC Zombie Task Force". Submissions were open until October 11, 2011.^[67] They also released a zombie-themed graphic novella available on their website.^[68] Zombie-themed educational materials for teachers are available on the site.^[69]

One area of current partisan dispute related to CDC funding is studying gun violence. The 1996 Dickey Amendment states "none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control".^[70] Advocates for gun control oppose the amendment and have tried to overturn it.^[71]

In 1992, Mark L. Rosenberg and five CDC colleagues founded the CDC's National Center for Injury Prevention and Control, with an annual budget of c. $260,000 that focused on "identifying the root causes of firearm deaths and the best methods to prevent them".^[72] Their first report which was published in the New England Journal of Medicine in 1993, entitled "Gun Ownership as a Risk Factor for Homicide in the Home" reported that the "mere presence of a gun in a home increased the risk of a firearm-related death by 2.7 percent, and suicide fivefold—a "huge" increase."^[72] In response, the NRA launched a "campaign to shut down the Injury Center." Doctors for Responsible Gun Ownership and Doctors for Integrity and Policy Research joined the pro-gun effort and by 1995, politicians also supported the pro-gun initiative. In 1996, Jay Dickey (R) Arkansas introduced the Dickey Amendment statement "which stated "none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control" as a rider^[70] in the 1996 appropriations bill."^[72] In 1997, "Congress redirected all of the money previously earmarked for gun violence research to the study of traumatic brain injury."^[72] David Satcher, who was the CDC head from 1993 to 1998^[73] advocated for gun violence research until he left in 1998. In 1999 Rosenberg was fired.^[72] Over a dozen "public health insiders, including current and former CDC senior leaders" told The Trace interviewers that CDC senior leaders took an overly cautious stance in their interpretation of the Dickey amendment. They could have done much more.^[72] Rosenberg told The Trace in 2016, "Right now, there is nothing stopping them from addressing this life-and-death national problem."^[72]

The American Medical Association, the American Psychological Association and the American Academy of Pediatrics sent a letter to the leaders of the Senate Appropriations Committee in 2013 asking them "to support at least $10 million within the Centers for Disease Control and Prevention (CDC) in FY 2014 along with sufficient new funding at the National Institutes of Health to support research into the causes and prevention of gun violence. Furthermore, we urge Members to oppose any efforts to reduce, eliminate, or condition CDC funding related to gun violence prevention research."^[74] Congress maintained the ban in subsequent budgets.^[71]

In December 2017, The Washington Post reported that the Trump administration had issued a list of seven words that were forbidden in official CDC documentation.^[75][76] Yuval Levin, after contacting HHS officials, wrote in National Review that the Post story was not accurate.^[77][78][79]