The U.S. Ebola Response Is a Harbinger of Worse Things to Come

Last summer, the Kiel Institute, a non-profit think tank in Germany, asked me to lead an analysis of the global benefits of international health aid programs, such as the Global Fund, the President’s Emergency Plan for AIDS Relief (PEPFAR), and Gavi. My team got to work reviewing the research literature and interviewing experts.

It quickly became clear that the positive impacts of these programs in controlling diseases like HIV/AIDS and malaria in low- and middle-income countries (LMICs) are well proven by research and widely communicated in news reporting. So, when some wealthy nations, including the U.S., France, Germany, and the U.K., slashed their health aid last year, the resulting surge in deaths in LMICs from infections and maternal and health conditions received substantial worldwide media coverage.

What surprised us was how little attention there has been to the enormous benefits that donor countries themselves receive from giving health aid. In other words, health aid brings “mutual benefits” to both recipients and donors.

The most obvious benefit to donor nations comes when they invest aid in preventing epidemics and pandemics, thus averting sickness, deaths, and social, political, and economic harms in both recipient and donor countries. As we say in our analysis, “A relatively small amount of investment can go a long way to preventing future loss of life and money.” Every dollar invested in pandemic prevention and response is estimated to yield health and economic returns of $14.

The benefits to donors go far beyond averting the devastation of regional or global outbreaks. Donor investments in controlling antimicrobial resistance benefit recipient and donor countries by slowing down the global spread of drug-resistant infections and through development of new antimicrobials. When donors invest in global health, they reap reputational “soft power” benefits. For example, a study of the impact of PEPFAR and the U.S. President’s Malaria Initiative on public opinion of the U.S. in 45 LMICs found that the public had a much more favorable opinion after the introduction of these programs. And investing aid into global health R&D — developing new medicines, vaccines, and diagnostics — both improves health in LMICs and benefits donor nations by supporting their industrial sectors and domestic job creation.

Given that the U.S. cuts in global health aid were by far the largest of any donor nation, it’s no surprise that these cuts had the biggest impact on the “mutual benefits” of such aid. I’d go so far as to say that the U.S. retreat from global health assistance has caused the greatest “mutual harms.”

These harms came not just from cutting aid but also from the Trump administration dismantling the federal apparatus for supporting international health assistance.

Elon Musk, working for President Trump as a member of the Department of Government Efficiency (DOGE), a truly Orwellian name, shuttered the United States Agency for International Development (USAID). He famously posted on X that he spent his weekend “feeding USAID into the wood chipper” when he could have gone to parties instead. Meanwhile, HHS Secretary Robert F. Kennedy Jr. fired hundreds of experts at the CDC who had decades of experience in outbreak control and froze $600 million in aid to Gavi that was appropriated by Congress. Kennedy also ended federal support to develop mRNA vaccines, the most promising health technology in a generation; Jay Bhattacharya, the NIH Director and CDC Interim Director, wrote an opinion piece — labeled “anti-scientific” by public health experts — defending Kennedy’s awful decision.

But wait, there’s more. Bhattacharya co-authored a bizarre editorial with the NIH deputy director saying the U.S. government should shift away from investing in pandemic preparedness and response and just urge individuals to get healthy to improve their odds of surviving the next pandemic. This sounds a lot like eugenics to me. President Trump withdrew the U.S. from, and defunded, the World Health Organization (WHO). The White House Office for Pandemic Response Policy has been gutted.

And that’s just a partial list.

We are now witnessing the direct impacts of this unprecedented, wholesale retreat: the U.S. is largely missing in action from the Ebola response in the Democratic Republic of Congo and Uganda. Its most visible efforts have been targeted at protecting Americans and preventing the virus from arriving on our shores.

In earlier times, the U.S. would have played a leading role in any Ebola outbreak, deploying expert CDC “disease detectives” on the ground. But Kennedy fired many of them.

Previously, thanks in large part to USAID support, an established infectious disease infrastructure was in place in the Congo that would have been central in ending Ebola transmission. This infrastructure, which included surveillance, laboratories, stockpiles of personal protective equipment, and trained health workers, collapsed when Musk shut down USAID.

Trump’s withdrawal from the WHO also hurt the Ebola response and put America itself at risk in two key ways.

First, the WHO is responsible for alerting its member states about outbreaks and for coordinating the global response to epidemics and pandemics. When the U.S. withdrew, still owing the WHO $260 million, the organization was forced to shrink its workforce by about a quarter, leaving it with fewer human resources to deploy.

Second, the U.S. has shot itself in the foot. Since it’s no longer a WHO member, American officials found out about the Ebola outbreak 9 days after the WHO did.

The U.S. government’s shameful dereliction of duty in the Ebola response is a harbinger of things to come. The COVID pandemic killed an estimated 25 million people worldwide, and while Ebola’s pandemic potential is low, experts predict a greater than 50% chance of a COVID-like pandemic within the next 25 years. The Trump administration’s retreat from global health makes the world less ready to respond. And its destruction of the federal public health apparatus makes it much more likely that in the next pandemic we’ll see mass sickness, suffering, and death here on our shores.

It’s a lose-lose situation for America and the world.