The Centers for Disease Control and Prevention was modernizing a public health surveillance system used by 25 health jurisdictions nationwide to track diseases like hepatitis and tuberculosis when the Trump administration began its push to shed government employees, leaving the future murky for this project and other government technology efforts like it.
This system — called the National Electronic Disease Surveillance System Base System, or NBS — helps public health departments track and investigate reportable disease data and share that information with the CDC for a nationwide view to prevent and monitor diseases.
The CDC launched the system in 2003. More recently, the need for an overhaul became clear during the coronavirus pandemic, when this and other public health systems collapsed under the strain of the crisis.
Now, the modernization of this particular 20-year-old system is likely stalled if not over, said Itir Cole, a former employee at what used to be the U.S. Digital Service. Until recently, Cole was a portfolio lead for that team’s work with the CDC.
President Trump remade USDS into the government-slashing Department of Government Efficiency effort on day one of his second term. Cole resigned last month because she didn’t want to work for billionaire Elon Musk or DOGE.
The team of USDS and CDC employees working on the surveillance system has shrunk from around 20 people to a handful, according to Cole, as the CDC fired probationary employees, and people in the seven-person USDS contingent at the CDC were dismissed or resigned, she said. The group had finished developing the modernized system and was going to pilot it with jurisdictions.
Although two from the CDC may have been rehired, the future of this public health surveillance program is still in doubt, as Cole said that there likely are not enough employees to maintain and modernize the system. The CDC did not respond to requests for comment.
“Folks at the CDC are most likely looking for alternatives and new guidance they can give the jurisdictions who are on the system,” said Cole. Those states and other jurisdictions using it may have to find other solutions to support the workflow of public health investigations, as well as process and share disease information.
USDS started working with the CDC during the pandemic. The digital service was founded in the wake of the Healthcare.gov crash as a sort of government tech SWAT team to help other agencies avert similar tech meltdowns.
When it worked with agencies, it brought not only tech expertise, but also a holistic approach focused on the end impact on Americans — not simply on optimizing whatever problem was most evident — said Kate Green, a former U.S. Digital Service engineer.
USDS “brought a powerful shift in perspective that enabled services like disease reporting, tax filing, and healthcare to veterans to be meaningfully improved, as measured in satisfaction, time spent, and money saved. Losing this approach will hurt all of us in ways we are just beginning to envision,” she said.
At the CDC, the USDS team was a “huge boost of technical capabilities with a focus on doing things in a more efficient (but safe and secure) way,” said another former USDS employee who previously worked at the CDC. They spoke to Nextgov/FCW on the condition of anonymity. Although the CDC is a highly technical agency, its staff is mostly focused on medical professionals.
After struggling with not having enough employees “for a long time,” the team working on this CDC system had finally gotten to a size where there were enough people to “attend to fires” but also “plan ahead,” said Cole.
And the base system did have real problems. It was hard to maintain and host, the former team member said. It collapsed during the pandemic, said Cole.
In Texas, the system couldn’t process pandemic lab results as they came in, leading to a backlog of about 350,000 tests. The state hadn’t kept up with updating the system over time, meaning that it “looked like something out of the 1990s,” as The Texas Tribune detailed.
The CDC gives public health departments the NBS for free, it said, although those jurisdictions have to pay for software licenses and maintain hardware and personnel to keep it running.
Texas paid over $1 million to create a new tracking program for coronavirus, although by the time it rolled out, many local health departments had already forked over money for pricey private sector solutions or developed workarounds via programs like Excel, according to The Texas Tribune.
While jurisdictions housed the legacy system on-premise, the modern one was going to be hosted in the cloud and maintained by the CDC in an agile way over time, Cole said.
Some jurisdictions use other systems to do the same work — NBS is only used by just over 20 jurisdictions — but the CDC was aiming to provide tech standards and best practices for the entire ecosystem, offering jurisdictions an “off-the-shelf solution that doesn’t require building a new system from scratch.”
The CDC described its modernization efforts as a plan to turn the NBS into a “flagship, state-of-the-art integrated disease surveillance system” with better performance, improved data quality and more flexibility.
This isn’t the only work the USDS has done with the CDC.
The tech service also helped stand up software to report test results from nontraditional testing locations — like parking lots or schools — that sprung up during the pandemic. Another tool helped route that data correctly, as a 2024 USDS report outlined. The USDS contingent at the CDC was also working on open-source, cloud-based data tools, said Cole.
“Our ability to respond in an effective and so-called efficient way to threats to our health is going to slow down if we don’t have the right systems and tools in place,” she said. “And the last thing you want when there is a contaminated food item on the shelves of grocery stores or in freezers at restaurants is people not being able to move as quickly as they want to.”
Whatever happens next to the disease surveillance system, it is likely just one example of the impact that the shrinking of tech teams is having on government programs.
People within DOGE reportedly intend to build public-facing apps and websites, according to the Washington Post. Among the potential targets is an expansion of a free, IRS online tax filing system piloted by the Biden administration.
But some of the staff working on that project, called Direct File, were among those pushed out of their jobs when the government tech consultancy 18F was eliminated. Former staff at that office said that projects to help military service members vote overseas and track unaccompanied children in the government’s care were interrupted when the office was shuttered.
“There are thousands of invisible systems and programs that run in the background of our lives,” said Cole. “The reason that your life is as easy and healthy and simple as it is is because those work, and you never have to think about them. Now as they start to collapse — now it’s going to be in the forefront of your life.”
