Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.
In 2025, the federal government pursued a deliberate strategy to reduce its role in protecting public health. As a result of changes to the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, and other operating divisions, public health experts agree that the country is now less well protected against infectious diseases, environmental hazards, unsafe food, and chronic conditions.
In 2026, the question facing governors, mayors, and local health officials is glaring: What can be done now to protect public health if the federal government will not? The answer is that state and local governments need to act to support the supplies, staff, systems, and statutes needed to enable and enforce public health.
Supplies: Build stockpiles for public health emergencies and reproductive health
Every public health emergency requires supplies, such as diagnostics, vaccines, therapeutics, and personal protective equipment. For most routine events, states and local governments can rely on their own reserves and commercial supply chains for these so-called “countermeasures.”
For larger or unusual events, they have historically relied on the federal government, such as test kits produced and shipped by the CDC or through supplies released from the Strategic National Stockpile (initially established in 1999). That assumption is no longer safe.
In 2025, staffing to maintain and support this stockpile was cut, along with funding for vaccine research, procurement, and delivery. Similarly, the White House blocked the release of federal emergency funding for response and recovery from environmental disasters in North Carolina and Illinois because they have Democratic governors.
Outside of acute events, there is an additional risk that the federal government could restrict medications for reproductive health given the administration’s strong position opposing abortion.
In 2026, state and local governments could start planning for supply instability by building or expanding countermeasure stockpiles to infectious diseases, reproductive health, and other health emergencies. At a minimum, these stockpiles would need to cover the first weeks of an emergency and ensure continuity of routine services if federal systems falter.
To prepare for the possibility that the federal government’s role could be permanently reduced, states could also consider investing, potentially through a multi-state consortium, in capacity to manufacture or complete the final preparation and distribution of countermeasures. Consider, for example, how California is working to produce and distribute insulin to improve costs and access for its residents. A multi-state network could stabilize supply, support research and development, and reduce dependency on the federal systems.
Staffing: Mitigate the loss of public health workforce
The United States entered the pandemic with a public health workforce that had already been thinned out. In 2025, that situation worsened considerably. Federal grants support a large percentage of staffing at state and large municipal health departments. The administration has cut this funding by canceling grants, rescinding funds already awarded, impounding funds appropriated by Congress, and passing cuts through legislation. Many health agencies have had to eliminate staff and have no funding to replace those functions.
Rebuilding the workforce requires money. In 2026, states will need to find additional funding to restore personnel working on surveillance, community outreach, environmental health, laboratory testing, maternal and child health, and emergency preparedness. It will also fall to them to recruit and retain the next generation of workers with programs that used to be supported by the federal government, such as loan repayment and training programs for public health advisers, field epidemiologists, microbiologists, and related fields.
Even with more funding, no jurisdiction will be able to replace all of the staff lost through federal cuts. This is where artificial intelligence could play an important role. A large percentage of public health practice is cognitive labor: People gather data, clean it, interpret it, and translate it into protocols, policy, and public communications. AI systems purpose-built for public health can automate much of this work, freeing time for humans to conduct field investigations, engage with the community, and work with stakeholders on policy.
Systems: Ensure continuity of disease surveillance systems
Public health relies on systems to monitor health conditions that are largely invisible to the public. These surveillance systems link together data collection in the community, at health care facilities, and from the environment with laboratories and information management systems. These systems require long-term investment to ensure public health agencies can monitor the trends in important health conditions and the impact of interventions.
Some systems have been dismantled, and others are being starved of resources. If this continues, states will lose the ability to detect emerging threats, monitor ongoing ones, and issue credible guidance both within their borders and to understand what is happening in neighboring localities.
In 2026, states will need to begin constructing their own analytic infrastructure and supporting existing academic initiatives, such as Beacon. This can take several forms. It could be in the form of multi-state coalitions that synthesize data across multiple jurisdictions, share resources for laboratory testing, information management, and data analysis.
Statutes: Bolster public health legal authority before it is challenged
According to the U.S. Constitution, public health authority is vested in states and localities. During the pandemic, those laws became targets. In many states, new statutes have been passed to weaken isolation and quarantine powers, vaccine requirements, and emergency authority. The federal government is also asserting greater control over immigration, law enforcement, and regulatory powers in ways that may undermine local action during health emergencies.
In 2026, states and cities will need to publicly clarify and codify their health authorities. This begins with rapid legal reviews of existing statutes governing disease reporting, isolation and quarantine, environmental enforcement, reproductive health, and emergency powers. Those authorities could then be updated and enacted into law.
Even in situations in which existing authorities have not changed, there may be value in conducting these reviews publicly and issuing public statements or passing new laws that signal to courts, the media, and the public that these powers are legitimate, expected, and necessary.
In 2026, states may also need to prepare for conflict with the current administration if there are infectious disease emergencies where they need to restrict people’s movement or mandate vaccines. Multi-state legal defense coalitions may need to be formed now to coordinate litigation, share expertise, and act quickly to defend state authority for public health emergency powers.
The need for states to act now to protect public health
The dismantling of federal public health is likely to proceed further in 2026 as the safety net for health insurance (Medicaid) becomes weaker and the impact of declining vaccination rates grows. While states cannot replace the enormous role that the federal government has played and needs to play, communities will be more reliant than ever on their local health agencies than at any point in recent memory. While each of the actions described above requires a different tactic, they all share the same principle: Do not underestimate the risk. The time to act is now.
Dr. Jay K. Varma is a physician and epidemiologist. An expert in the prevention and control of infectious diseases, he has led epidemic responses, developed global and national policies, and implemented large-scale programs that saved hundreds of thousands of lives in Asia, Africa, and the United States.
