Health programs receiving federal funding must agree within days to new priorities from the Trump administration, including a focus on “parental authority” in education and a move away from proven overdose-prevention methods like harm reduction, suggesting greater political control over public health.

The new priorities will likely affect progress against the opioid crisis, and they could signal an attack on vaccination requirements at schools, which are set at the state and local level. The priorities may also weaponize public health to quash “public disorder.”

The move “absolutely” appears to signal greater political interference into public health, said Nabarun Dasgupta, a street drug researcher and senior scientist at the University of North Carolina at Chapel Hill’s Injury Prevention Research Center.

“This is a warm-up. This is a warning shot,” he said. The move appears to be a “prelude” to imposing similar restrictions of other kinds of federal funding, such as direct service provision, he added.

Some of the new policies “are in tension with public health” and would undermine that work, including “prioritizing parental control over, potentially, children’s health and community health”, said Dorit Reiss, a vaccines expert and professor at UC Law San Francisco.

“Similarly, housing programs and harm reduction programs save lives and promote health,” she said.

The US Centers for Disease Control and Prevention (CDC) informed health programs at the state, territorial, tribal and local level on Wednesday that they must agree to a list of the CDC’s priorities within five business days, or by 1 July.

The notice did not come from the program staff at the CDC, who were unaware of the new requirement, according to a source familiar with the memo. It’s not clear whether all state, territorial, tribal and local programs received the notice. Programs focused on immunizations, HIV, hepatitis and tobacco did.

While this requirement was not explicitly tied to funding, the grant note makes reference to a previous statement from the CDC that funding may be canceled if programs do not comply with the agency’s terms.

After this story was published, Emily Hilliard, a spokesperson for the US Department of Health and Human Services (HHS), 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 new priorities include “parental authority” and policies giving parents “greater control over their children’s education”, according to a copy of the memo obtained by the Guardian. This could be a reference to vaccination requirements for school attendance.

The Trump administration has signaled a focus on ending these requirements, including letters on school vaccine mandates from Robert F Kennedy Jr, the HHS secretary and a longtime vaccine critic.

But vaccine mandates are set at the state and sometimes local level. Requiring states, territories, tribes and localities to agree to the CDC priorities may signal pressure to reduce these mandates, Reiss said.

“It might be a next step in the fight against vaccines and vaccine mandates,” she said.

The requirements may put pressure on states to reconsider vaccine mandates and “may be related to state immunization grants – a way to tell states that if they require vaccines they will lose grants”, she said.

Parental control of child education is not in the CDC’s purview. And federal vaccine grants are usually focused on access; they’re not related to mandates.

Withholding federal funding for state health programs because a state or locality mandates some vaccines would be “essentially begging for a lawsuit”, and states would have “very good arguments” against such a move, Reiss said. “Of course, that doesn’t mean they won’t try.”

Housing first, harm reduction and safe consumption programs for substance use are also deprioritized, the new CDC memo said. These are all strategies proven to help reduce drug overdoses and help with substance use disorder.

“The main thing that harm reduction programs 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,” Dasgupta said.

On the east coast, fentanyl is being replaced with the drug adulterant medetomidine, which doesn’t give a high – but it does cause heart attacks among people who try to quit cold turkey, Dasgupta said. Medetomidine represents a sea change in street drugs, the likes of which have not been seen in decades – with even greater consequences than the introduction of fentanyl, which was partly responsible for driving the overdose crisis to a record 107,941 known drug overdose deaths in 2022, he said.

“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.”

The CDC is also prioritizing evidence-based programs to reduce homelessness, drug use and “public disorder”, which is not defined in the memo. A July 2025 executive order from the White House took aim at unstably housed and mentally ill people, creating a pathway to criminalize greater numbers of people, experts have said.