At Donald Trump’s first Cabinet meeting, late last month, Elon Musk sheepishly admitted that DOGE had “accidentally canceled very briefly” Ebola-prevention programs. After a nervous chuckle, he claimed that the oversight had been swiftly corrected. But it wasn’t. The truth is far more disturbing—this administration didn’t just pause a line item; it has actively dismantled the infrastructure the country relies on to detect and confront deadly pathogens.
For more than a decade, I have worked as a physician and public-health expert responding to infectious diseases around the world. In 2014, while treating Ebola patients in Guinea, I contracted and survived Ebola myself. I know how lethal Donald Trump’s assault on America’s outbreak preparedness could be. We are sure to regret it.
DOGE’s slash-and-burn campaign has hit everything from the NIH to the National Weather Service. The cuts to global health, however, are especially alarming. It’s unclear what Musk thought would happen when he fed the U.S. Agency for International Development “into the wood chipper,” as he proclaimed with gleeful indifference on X, the social-media megaphone he owns. Ditto what Trump thought when he withdrew the United States from the World Health Organization and effectively muzzled the CDC. But the result has been that, in little more than a month, America has transformed itself from a preeminent global-health leader into an untrustworthy has-been. Undermining even one of these institutions would have posed a serious threat; gutting them all at once is an invitation for future outbreaks.
The fallout from these sweeping cuts is particularly evident when examining USAID, or what’s left of it. The agency’s tagline was “From the American people,” and perhaps the American people didn’t understand that it was also for them. Musk disparaged the agency outright—declaring it a “criminal organization.” The White House pointed to alleged wasteful spending, including funding for a “DEI musical” in Ireland (which wasn’t even funded by USAID, it turned out). In decrying the agency’s downfall, many Democrats focused more on the importance of “soft power” foreign policy than on-the-ground impact. Yet much of USAID’s budget was devoted to addressing humanitarian and health crises abroad with the implicit goal of preventing these emergencies from reaching our own shores. (Explicitly, the goal was to “advance American security and prosperity.”) Americans are safer when instability and infectious threats are effectively managed on foreign lands.
USAID was also the primary funder of the President’s Emergency Plan for AIDS Relief, established in 2003 under George W. Bush. PEPFAR has saved more than 25 million lives and helped smother the global HIV pandemic. More than 20 million people—500,000 of them children—were receiving HIV treatment through the program when Trump signed an executive order on his first day back in office pausing all foreign aid for 90 days. Secretary of State Marco Rubio promised that waivers would allow the life-saving work to continue, but few have materialized. Meanwhile, USAID staff who were placed on administrative leave can’t distribute medicines or cover costs for transport and personnel. After this dismantling, PEPFAR’s activities in hundreds of places around the world remain restricted at best, and fully paused at worst. Without the support long provided by the program, thousands of people will likely die far younger than they would have with proper medical care. PEPFAR’s current authorization ends later this month; its future after that is unclear.
Similarly, USAID’s efforts to stop Ebola at its source are also now gone. USAID’s role in Ebola containment has long been essential. During the 2014 West Africa outbreak—during which more than 11,000 people died—USAID oversaw training of local health-care workers, the building of Ebola treatment centers, and passenger screening at the borders and airports. A decade later and just days into Trump’s second term, Uganda reported another Ebola outbreak. This time, though, the foreign-aid freeze Trump had put in place meant that USAID was unable to supply the usual resources for transporting lab specimens or implementing airport screening. The day after Musk reassured the Cabinet that Ebola prevention had been swiftly restored, the State Department canceled crucial contact tracing and surveillance efforts for Uganda’s outbreak. With USAID nowhere to be found, the WHO scaled up its own response. That’s something, for now, but America’s absence is shameful.
Moreover, the WHO may not have the capacity to do so for much longer. On his first day in office, Trump signed an executive order moving to withdraw from the WHO, accusing it of demanding “onerous payments from the United States.” In 2023, the U.S. contributed $481 million—an eighth of what Americans spend on professional dog-training services every year—to WHO’s operating budget. Admittedly, many Americans—fueled by Trump’s denigration of the organization—developed a deep distrust of the WHO following perceived missteps during the coronavirus pandemic. Even its supporters can see the organization’s flaws—it’s bureaucratic, sclerotic, and overdue for reform. Despite these shortcomings, it is an organization we desperately need, and no real alternative exists.
WHO is the only international organization that can identify and respond to emerging threats early on, such as flare-ups of unidentified outbreaks like the one currently circulating in northwestern Democratic Republic of the Congo. Its global network of laboratories to detect infectious threats—known as the Gremlin—relies heavily on U.S. support and is now at risk of closure. And even as its partnerships alongside U.S. colleagues have strengthened surveillance, containment, and readiness abroad, the WHO also helps us here at home. On the same day as Musk’s Ebola comments, the FDA canceled the meeting where experts decide next season’s flu-vaccine composition. Going forward, the U.S. will have to wait on WHO guidance for that crucial decision and download the recipe for next year’s flu shot. If America keeps abdicating its leadership, it will be forced to rely on an organization whose funding it is slashing and whose collaboration it is severing. Although the WHO might still scrape together funds and staff, that’s not guaranteed—especially if other nations follow Trump’s example and cut ties or funding.
With USAID and WHO under siege, more responsibility for global disease detection and response would fall on the CDC. But the future of the world’s preeminent “disease detectives” is at risk as well. The plan to slash the next cohort of CDC Epidemic Intelligence Service officers—think Kate Winslet’s character in Contagion—was thankfully stopped at the 11th hour, but about 750 CDC staff were still let go in recent cuts, including many stationed on outbreak front lines across the country and around the globe (about 180 of those terminated were later reinstated). Certain pages on the CDC website were deleted, and when a judge ordered them restored, many had been dramatically altered. CDC communications such as the Morbidity and Mortality Weekly Report—which providers rely on to track health threats—were abruptly paused for the first time in more than 60 years. CDC staff were also ordered to stop communicating with, and to take their names off any scientific papers written with, anyone from the WHO, further weakening the CDC’s reach and insight into what’s happening around the world. Whether the issue is cuts to USAID, defunding the WHO, or hobbling the CDC, the end result is the same: America is walking away from global health leadership, making the entire world less safe—including us.
Understand how this will work at a practical level: Until recently, countries had compelling reasons to report outbreaks, even if such transparency sometimes came with travel bans or other stigmatizing restrictions. Those sticks were often worth the carrots, namely USAID funding and CDC expertise that would appear and help quickly end outbreaks. Now, with no carrots on offer, why would any country submit to the stick? Future outbreaks may be reported too late or not at all—leaving America oblivious to emerging health crises. Since 2014, seven public-health emergencies of international concern (PHEICs) have been declared by the WHO. The number of Ebola outbreaks is escalating, and climate change will intensify the emergence and spread of known and potentially unknown microbes.
It is in America’s interest to reverse course immediately and rebuild the crucial infrastructure needed to detect and respond to outbreaks. Not only is this the right thing to do, but it also makes economic sense. In 1980, at the height of the Cold War, the WHO declared smallpox eradicated—a milestone achieved through joint U.S. and Soviet support. Americans invested about $30 million to stamp out smallpox, a fraction of what the country now saves every year by no longer needing to vaccinate against or treat smallpox—to say nothing of the lives saved.
Americans believe that about 25 percent of the country’s budget is spent on foreign aid. In reality, the figure is 1 percent, or at least it was. USAID’s entire 2023 spending was $43 billion—a 20th of the U.S. defense budget and about what Musk’s enterprises have received in government funding. The CDC’s was even less, just $9 billion.
Despite his actions, Musk clearly understands that these systems are essential for America’s security. After admitting his Ebola error, he quickly clarified: “I think we all want Ebola prevention.” That would require pulling USAID’s most essential remnants out of the dustbin. The U.S. must also reengage with the WHO and negotiate the terms of its renewed support and engagement with the organization before it’s too late. And for all the distrust many Americans harbor toward the CDC post-pandemic, they must rally around it—an agency whose role will become only more indispensable as measles, bird flu, and other pathogens spread across the country.
Now, and with startling speed, the country is turning its back on global health. In doing so, it is endangering other nations, and also itself. USAID’s account on X, once a digital chronicle of its achievements, is gone. When I search for it on my phone, I get an error message: “Something went wrong. Try again.” We must heed that warning. Musk and Trump have destroyed the shield that once protected America from the next global contagion. Deadly diseases don’t bother with borders; no wall will keep them out. If America stays the course, “Something went wrong” will become the epitaph of a great country, one that once led the world in global health preparedness. It will be deeply missed.
The post The Diseases Are Coming appeared first on The Atlantic.
