Federal health programs that receive US funding have been given just five days to sign up to a new set of Trump administration priorities, including a push for “parental authority” in education and the deprioritisation of proven overdose-prevention methods such as harm reduction. The directive, issued by the US Centers for Disease Control and Prevention (CDC) on Wednesday, requires state, territorial, tribal and local programs to agree to the new terms by 1 July or risk having their funding cancelled.
The notice did not come from the CDC’s own program staff, who were unaware of the requirement, according to a source familiar with the memo. It remains unclear whether all relevant bodies received it, though programs focused on immunisations, HIV, hepatitis and tobacco did. While the requirement was not explicitly tied to funding, the grant note references a previous CDC statement that funding may be terminated if programs fail to comply with the agency’s terms.
Emily Hilliard, a spokesperson for the US Department of Health and Human Services (HHS), later said that “grantees were directed to review their work plans and ensure their activities align with the Department’s priorities and produce meaningful public health outcomes”. The department oversees the CDC.
New priorities: parental authority and the future of vaccine mandates
According to a copy of the memo obtained by the Guardian, the new priorities include a focus on “parental authority” and policies giving parents “greater control over their children’s education”. This is widely seen as a signal of potential moves against school vaccination requirements, which are currently set at the state and local level. The Trump administration has already made clear its opposition to such mandates. HHS Secretary Robert F. Kennedy Jr., a longtime vaccine critic, has sent letters on school vaccine mandates, and President Trump previously signed an executive order prohibiting federal funding for Covid-19 vaccine mandates in schools.
Dorit Reiss, a vaccine expert and professor at UC Law San Francisco, said the requirement could be “a next step in the fight against vaccines and vaccine mandates”. She warned that it “may be related to state immunisation grants – a way to tell states that if they require vaccines they will lose grants”. But vaccine mandates are a state and local matter, not part of the CDC’s remit. Withholding federal funding because a state or locality mandates certain vaccines would be “essentially begging for a lawsuit”, Reiss said, adding that states would have “very good arguments” against such a move. “Of course, that doesn’t mean they won’t try,” she added.
Harm reduction deprioritised: a blow to overdose prevention
The new CDC memo also deprioritises “housing first”, harm reduction and safe consumption programmes for substance use. These are proven strategies for reducing drug overdoses and helping people with substance use disorder — and the decision to downgrade them has alarmed public health experts.
“The main thing that harm reduction programmes do is bring those people into care and into services that allow them to make those better choices about what they put in their bodies, and the thing these directives do is weaken the most critical frontline care of engaging with people who are falling through the cracks,” said Nabarun Dasgupta, a street drug researcher and senior scientist at the University of North Carolina at Chapel Hill’s Injury Prevention Research Center.
The timing is particularly concerning because of the rapid evolution of the illicit drug supply. On the east coast, fentanyl is being replaced with the drug adulterant medetomidine, which does not produce a high but can cause heart attacks among people who attempt to quit cold turkey. Dasgupta described medetomidine as a “gamechanger” — a sea change in street drugs not seen in decades, with consequences even greater than the introduction of fentanyl, which helped drive overdoses to a record 107,941 known deaths in 2022.
“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 with people in this severe form of withdrawal that they weren’t expecting.”
Medetomidine, often mixed with fentanyl and xylazine, can cause profound sedation and severe withdrawal symptoms. Naloxone, while effective for opioid overdoses, is not fully effective against medetomidine, underscoring the urgent need for harm reduction strategies such as test strips and supervised consumption sites. Yet the Trump administration has already moved away from funding such programmes. Guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA) has stated that funds cannot be used for certain harm reduction services such as syringes or smoking kits.
‘Public disorder’ and the criminalisation of homelessness
The CDC is also prioritising evidence-based programmes to reduce homelessness, drug use and “public disorder” — a term the memo does not define. The move appears to align with a July 2025 executive order from the White House that took aim at unstably housed and mentally ill people, creating a pathway to criminalise greater numbers of individuals, experts have said. Critics argue that approach conflates homelessness with behavioural health problems and shifts away from the “Housing First” model, which prioritises stable accommodation before treatment, towards a more punitive framework that emphasises involuntary treatment and criminalisation.
Dasgupta described the entire directive as “a warm-up” and “a warning shot”, adding that it appeared to be a “prelude” to imposing similar restrictions on other forms of federal funding, such as direct service provision. “This absolutely appears to signal greater political interference into public health,” he said.
Reiss echoed that concern, noting that some of the new policies “are in tension with public health” and would undermine work in the field, including “prioritising parental control over, potentially, children’s health and community health”. She pointed out that “housing programmes and harm reduction programmes save lives and promote health.”
The research briefing also notes broader controversies surrounding the Trump administration’s approach to public health: HHS Secretary Robert F. Kennedy Jr. has been accused of undermining vaccine science and public trust by altering the charter of the Advisory Committee on Immunization Practices (ACIP) and firing its members, replacing them with individuals who have expressed doubts about vaccine safety. A judge previously ruled against some of those changes, citing violations of federal law. President Trump also issued an executive order to reduce the number of recommended childhood vaccines, aligning with assessments that the US recommends more than other developed nations. Meanwhile, billions in federal grant funding have been delayed due to a new political review process within HHS, which includes AI screening for certain keywords and approval by senior political officials, raising concerns about the politicisation of grantmaking.