Dangerous pathogens left unsecured in laboratories across Africa. Checks for MPOX, Ebola and other infections at airports and other checkpoints have been stopped. Millions of unscreened animals are transported on the border.
Scientists say the Trump administration’s suspension of foreign aid has developed plans to prevent and get caught in global outbreaks, leaving people everywhere more vulnerable to threatening viruses and bacteria.
These include Americans. The outbreak that begins overseas may travel very quickly: for example, the coronavirus may appear in China first, but it will soon appear anywhere, including the United States. When polio or dengue is present in this country, cases are often associated with international travel.
“It’s actually in the interests of the American people and can reduce the disease,” said Dr. Githinji Gitahi, head of Amref Health Africa, a large nonprofit that relies on 25% of the U.S. funding.
He added: “Even if we have the best people, disease comes into the United States and now we are not putting the best people in it.”
In the interview, more than 30 current and former officials of the U.S. International Development Agency, WHO and infectious disease experts described a world that became more dangerous than it was a few weeks ago.
Many talked on anonymously because of fear of federal retaliation.
The timing is terrible: The Democratic Republic of Congo is experiencing the deadliest MPOX outbreak in history, with cases exploding in more than a dozen other African countries.
The United States is home to the worsening bird flu crisis. Various hemorrhagic fever viruses are smoldering: Ebola in Uganda, Marburg in Tanzania, and Lhasa and Sierra Leone in Nigeria.
In 2023, the United States Agency for International Development invested approximately US$900 million Funding laboratories and emergency response preparations in more than 30 countries. The pause of foreign aid freezes these plans. Even the work that has been completed to pay the recipient is sorted out in the court.
The State Department's exemption is intended to allow some work to continue to contain Ebola, Marburg and MPOX and prepare for bird flu.
But, according to Nicholas Enrich's USAID memorandum, Trump administration appointees stifled the payment system and created obstacles to the implementation of exemptions.
Then, last month, the Trump administration canceled about 5,800 contracts, effectively closing most of the U.S.A.-IDP-funded initiatives, including many that have been granted continued permission.
“It's finally clear that we won't implement a program of exemption, either,” Mr. Enrich recalled in an interview.
According to an estimate, the decision could lead to more than 28,000 new cases of infectious diseases, such as Ebola and Marlborough, with 200,000 cases of paralytic polio every year.
Secretary of State Marco Rubio “has been working hard since he was sworn in to review every dollar spent,” the State Department said in an emailed statement.
“We can say that every program we operate there provides national interest because it makes us safer, stronger or more prosperous,” the statement said.
Most U.S.A.I.D. staff were terminated or taken administrative leave without warning. The agency has more than 50 people working to respond to the outbreak, the result of Congress’ efforts to strengthen its pandemic preparations.
There are now six. Those fired include the organization’s leading experts in laboratory diagnosis and managers of Ebola response. “I don't know how six people will respond four outbreaks,” said an official who let go.
Also sent home, there were thousands of African community health workers who were sentinels of disease.
In early January, the Tanzanian government denied new cases of Marburg, which was bleeding fever. This is a community health worker trained through the U.S.-funded Ebola program and reported the disease a week later.
The outbreak eventually increased by 10 cases; the government said it is now under control.
Even in quiet times, foreign aid helps prevent, detect and treat diseases that can harm Americans, including drug-resistant HIV, tuberculosis and malaria, as well as bacteria that respond to available antibiotics.
Most of the work has been stopped and other organizations or countries cannot fill the gap. What exacerbated the losses was the U.S. withdrawal from the World Health Organization, which has taken measures to cut costs.
“It’s a failure,” Dr. Keiji Fukuda led pandemic prevention efforts at the WHO and CDC
“The reduction in foreign aid deprives U.S. leadership and expertise, but it also disengages the U.S. from global discussions,” said Dr. Forkuda. “For my life, I don't see this very reasonable, systematic approach to revoking public health reasons or justifications.” ”
Trying to adapt
The United States Agency for International Development (USAID) has been strongly focused on global health security for only a decade, but it has received primarily bipartisan support. The first Trump administration has expanded the program to 50 countries.
Most of the aid is designed to help them eventually solve the problem on their own. To some extent, this is happening.
But in the face of a new virus or epidemic, “there are a lot to do and learn, and many countries cannot do it on their own,” said Dr. Lucille Blumberg, an infectious disease physician and emerging disease expert.
USAID and its partners help countries identify the expertise, training and machinery needed to bring together officials from ministries and engaged farmers, businesses and families.
“In fact, this is not a loss of the U.S. government costs,” said an official from a large development organization. “But this trust building, communication, sharing evidence is the real advantage of the U.S. bringing health security – it has disappeared.”
In Africa, some countries responded to the disappearance of aid, while others resigned. “We are trying our best to adapt to this development,” said Nigeria's Health Minister Dr Muhammad Ali Pate.
“The U.S. government is ultimately not responsible for the health and safety of the Nigerian people,” he said. “At the end of the day, responsibility is our responsibility.”
A successful outbreak response requires coordination of numerous elements: investigators confirm preliminary reports; trained workers conduct testing; access to test kits; transport of samples; a laboratory with adequate workers, tap water, electricity and chemical supplies; and experts explain and take action.
In a broad strokes, the CDC provides expertise in disease, USAID-funded logistics and WHO convenes stakeholders (including the Ministry of Health).
Before the aid freeze, employees at each organization often talked daily, shared information and debated strategies. Together, they lowered their response time from the two weeks in 2014 to five days in 2022, rather than the last 48 hours.
But now, CDC experts who have honed their expertise for decades are not even allowed to talk to WHO colleagues.
Funding for U.S. International Development’s telephone program for sample transport, laboratory supplies, generator fuel, and contact tracer has ended. Much of its investment in simple solutions to seemingly tricky problems has also stopped.
In West Africa, for example, rodents scattering lassa hot invade homes in search of food. A procedure in the U.S.A.D. stops spilling program introduced rodent-proof food containers to limit the problem, but is now closed.
In Congo, corruption, conflict and endless outbreaks mean surveillance “even at the best time it looks like Swiss cheese” because no health workers can transport samples because no health workers come to slow down.
More than 400 MPOX patients will remain after escaping from the overwhelmed clinic. Before the exemption to restart some work, the United States identified two new MPOX cases among those heading to East Africa.
In Kenya, USAID supports eight laboratory and community surveillance in 12 high-risk counties. Laboratories in Masabi, Mandela and Garissa counties, bordering Ethiopia and Somalia, have used up test kits and reagents for diseases including Rift Valley Fever, yellow fever and polio, and have lost nearly half of their staff.
Kenya also borders Uganda and Tanzania, close to the Congo – all fighting dangerous outbreaks) and lost more than 35,000 workers.
“These stop orders will mean it increases the risk of index cases,” said Dr. Gitahi, whose organization has terminated 2,400 employees of nearly 400 employees.
Many laboratories in Africa store samples of pathogens that occur naturally in the environment, including several that can be weaponized. With the shutdown of surveillance programs, pathogens may be stolen and bioterrorist attacks may not be found until it is too late.
Some experts worry that bad actors may release threats such as cholera in African animals, or weaponize anthrax or brucellosis. Others said they were worried that even unskilled handling of these disease threats would be enough to cause disaster.
U.S. government funds help hire and train lab workers to safely maintain and deal with dangerous viruses and bacteria.
But now, no one is more wiser to move pathogens into the lab. “We have lost our ability to understand pathogens,” said Kaitlin Sandhaus, founder and CEO of Global Implementation Solutions.
Her company helped 17 African laboratories gain recognition in biosafety procedures and supported five countries in creating laws to ensure compliance. Now, the company is closing.
In the future, other countries, including China, will learn more about where the dangerous pathogens are located, Ms. Sandhouse said: “It’s very dangerous for me.”
A U.S. Agency for International Development official said China has invested in building labs in Africa, where it is cheaper and easier to “do whatever you want without any other person's attention.”
Russia is also providing mobile laboratories for Ugandans in Mambar, which borders Kenya, another official said.
Veterinary epidemiologist Abdinasir Yusuf Osman said some African countries like Somalia have fragile health systems and ongoing security threats, but have little ability to track infections between animals and people.
Somalia exports millions of camels, cattle and other livestock every year, mainly to the Middle East. He said the country relies heavily on foreign aid to screen animals for diseases.
“In my opinion, the consequences of this shortage of funds will be disastrous and increase the possibility of an uncontrolled outbreak,” Dr. Ottoman said.
In countries with larger economies, foreign aid helps build relationships. Thailand is a pioneer in infectious diseases, and the United States Agency for International Development (USAID) is funding a modest project to eliminate malaria, thereby improving its surveillance capabilities.
Jui Shah, who assisted the program, said the possibility of this commitment could lead to a loss of goodwill.
“In Asia, relationships are crucial for any type of work, especially the role of working with surveillance and patient data,” she said. “If other countries hesitate to interact with us and break out, Americans will suffer.”
