The dangerous pathogen left unsecured in African labs. Testing for MPOs, Ebola and other infectious diseases at airports and other checkpoints has been suspended. Millions of unexcluded animals have been shipped across the border.
The Trump administration's suspension of foreign aid has embraced programs that prevent outbreaks and vanishes around the world, scientists say it makes people more vulnerable to dangerous pathogens everywhere.
That includes Americans. Outbreaks that begin overseas may move quickly. For example, the coronavirus could have first appeared in China, but soon appeared everywhere, including the US. When polio or dengue appears in this country, cases are usually linked to international travel.
“In fact, it's Americans' interest to control the illness,” said Dr. Githinji Gitahi, who heads Amref Health Africa, a large nonprofit organization that relies on the United States for about 25% of its funds.
“Even when we have the best people, the illness is heading towards the US, and now we don't have the best people on it,” he added.
In the interview, more than 30 current and former staff members of the U.S. International Development Agency, health organization members and infectious disease experts described a world at risk more than they were weeks ago.
Many spoke on the condition of anonymity, fearing federal retaliation.
The timing is miserable. The Democratic Republic of the Congo has experienced the most deadly MPOX outbreak in history, and will explode in dozens of other African countries.
The United States is facing an exacerbating bird flu crisis. Multiple hemorrhagic fever viruses are smoldering: Ebola in Uganda, Marburg in Tanzania, Lassa in Nigeria and Sierra Leone.
In 2023, USAID invested around $900 million to fund labs and emergency response preparations in more than 30 countries. A suspension of foreign aid has frozen these programs. Even payments to grantees for work already completed are being organized in court.
The exemption issued by the State Department was intended to allow continued preparations for Ebola, Marburg, MPOX and avian flu.
But Trump administration appointees choked their payment systems and caused obstacles to enforce the exemption, according to a USAID memo from Nicholas Enrich, who was the agent manager for Global Health's agency until Sunday.
Then last month, the Trump administration cancelled around 5,800 contracts and effectively shut down most of its USAID-funded initiatives.
“It was finally clear that we weren't going to implement,” Enrich recalled in an interview, even the exemption program.
The decision could result in over 28,000 new cases of infectious diseases such as Ebola and Marburg, and 200,000 cases of paralytic polio each year.
Secretary of State Marco Rubio said “we've been working diligently ever since we were sworn to review every dollar we spent,” the State Department said in an emailed statement.
“We can say that all the programs we operate are useful in our national interests because we are safer, stronger, or more prosperous,” Rubio quotes.
Most USAID staff were placed on exit or on administrative leave without warning. The agency had over 50 people dedicated to answering outbreaks. This is the result of Congress pushing to strengthen pandemic preparations.
Now there are six. Those fired included key experts in the LAB diagnosis organization and managers of the Ebola response. “I don't know how six people will carry out the answers of four outbreaks,” said one official who was let go.
Hundreds of thousands of community health workers, who were sick sentinels in Africa, also returned home.
In early January, the Tanzanian government denied that there was a new incident in Marburg, a hemorrhagic fever. This was a community healthcare worker trained through a US-funded Ebola program that reported the disease a week later.
The outbreak eventually included 10 cases. The government said it is now under control.
Even in quiet times, foreign aid can help prevent, detect and treat diseases that could put Americans at risk, such as drug-resistant HIV, tuberculosis, malaria, and bacteria that do not respond to available antibiotics.
Much of that work will halt and other organizations and countries will not be able to fill the gap. It is the withdrawal of the US World Health Organization that exacerbates the losses, which has its own cost-cutting measures.
“This is a loss scenario,” said Dr. Fukuda, who led the pandemic prevention efforts at the WHO and CDC.
The novelty of foreign aid is taking away the world of American leadership and expertise, but it also shuts down the United States from global debate.
I'm trying to adapt
USAID's global health security focus is almost ten years ago, but it has mainly received bipartisan support. The first Trump administration expanded the program to 50 countries.
Much of the aid was intended to help them eventually tackle the problem on their own. And to some extent it was happening.
But in the face of new viruses and outbreaks, “There's so much to do and many countries can't do it on their own,” said Dr. Lucille Blumberg, an infectious disease physician and an emerging disease expert.
USAID and its partners helped the country identify the expertise, training and machinery they needed, bringing together farmers, businesses and family officials who worked with various ministries.
“It doesn't actually cost much to the US government,” said an official with a large development organization. “But that trust building, communication and shared evidence is the real strength that the United States brings to health safety. It's gone.”
In Africa, some countries have responded to the disappearance of aid due to warnings, while others have resigned. “We are doing our best to adapt to this development,” said Dr. Muhammad Ali Patee, Nigerian Minister of Health.
“Ultimately, the US government is not responsible for the health and safety of the people of Nigeria,” he said. “At the end of the day, responsibility is ours.”
A successful outbreak response requires adjustments to countless factors. Investigators confirming the initial report. Workers trained to do tests. Access to the test kit. Transporting samples; lab with sufficient workers, running water, electricity and diagnostic chemicals. Experts who interpret and act on results.
In the broad strokes, the CDC provided disease, USAID-funded logistics, and expertise in which WHO convened stakeholders, including the Ministry of Health.
Before the aid freezes, employees from each organization spoke, shared information and discussion strategies every day. Together, they reduced response times to outbreaks from two weeks in 2014 to five days in 2022 to the most recent 48 hours.
But now, CDC experts who have hone their expertise for decades are not even allowed to talk to colleagues on Who
The phone plans for USAID funds for sample transport, lab supplies, generator fuel, and contact tracer have been completed. Many of our investments in simple solutions to seemingly unruly problems have also ceased.
In West Africa, for example, rodents spreading Lassa fever invade homes in search of food. One program in USAID's Stop Spilover Project introduced rodent resistant food containers to limit the problem, but is now shutting down.
In the Congo, corruption, conflict and infinite outbreaks mean that surveillance “looks like Swiss cheese at its best.” The MPOX response slowed because there were no medical workers transporting the samples, and USAID officials are familiar with the response.
More than 400 MPOX patients were stuck after fleeing the clinic they had escaped. Before the exemption resumed some work, the US identified two new cases of MPOX in both those who traveled to East Africa.
In Kenya, USAID supported eight lab and community-based surveillance in 12 high-risk counties. The labs in Marsavit, Mandala and Garissa counties, crossing the Ethiopian-Somalia border, have run out of test kits and reagents for diseases such as Rift Valley Fever, Yellow Fever and Polio, losing almost half of their staff.
Kenya is also adjacent to Uganda and Tanzania, close to Congo – all fighting dangerous outbreaks, losing more than 35,000 workers.
“Orders for these outage operations mean increasing the risk of index cases passing through unnoticed cases,” Dr. Gitahi said, referring to the first known case of an outbreak. His organization has finished nearly 400 of its 2,400 staff.
Many laboratories in Africa store samples of pathogens that occur naturally in their environment. If the surveillance program is stopped, pathogens can be stolen, and bioterrorist attacks may not be detected until it is too late.
Some experts were worried about bad actors who could release threats like cholera into the water, or weaponize the charcoal thr bacteria and brucellosis that are common in African animals. Others said they are concerned that even the unskilled handling of these disease threats may be sufficient to cause disasters.
Funding from the US government helped hire and train lab workers, maintaining and disposing of dangerous viruses and bacteria safely.
But now pathogens can enter and exit the lab, and no one is wise. “We have lost the ability to understand where pathogens are,” said Kaitlin Sandhaus, founder and CEO of Global Exploration Solutions.
Her company helped 17 African labs to be certified with biosafety procedures and helped five countries in drafting laws to ensure compliance. The company is now closed.
In the future, other countries, including China, will learn more about where dangerous pathogens are housed, Sunhouse said: “It feels very dangerous to me.”
China is already investing in building labs in Africa. There, it's cheaper and easier to tackle what you want without anyone else paying attention,” said a USAID official.
Russia is also offering mobile labs to Ugandans in Mbale on the border with Kenya, another source said.
Some African countries like Somalia have vulnerable health systems and persistent security threats, but have minimal ability to track infections that have made animals and people sick, said Abdynasir Yusuf Osman, Somali epidemiologist and chair of the working group.
Every year, Somalia exports millions of camels, cattle and other livestock, mainly to the Middle East. The country relies heavily on foreign aid to screen for diseased animals, he said.
“In my view, the consequences of this lack of funding are devastating and increase the likelihood of an uncontrolled outbreak,” Dr. Osman said.
In countries with large economies, foreign aid helps build relationships. Thailand was a pioneer in infectious diseases, and USAID was funding a modest project on malaria elimination that would increase surveillance capabilities.
The sudden end of that commitment, Jui Shah, who helped run the program, said the sudden end of that commitment risks losing goodwill.
“In Asia, relationships are important for all kinds of tasks, but relationships are important, especially when it comes to the roles they work on surveillance and patient data,” she said. “Americans will suffer if other countries hesitate to engage with us about the outbreak.”
