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By the time African health officials confirmed the world’s latest Ebola outbreak, the epidemic had already spilled from the Democratic Republic of the Congo into neighboring Uganda. Within two days, the World Health Organization declared the outbreak a public-health emergency of international concern. Less than two weeks later, the potential case count has risen past 1,000, including more than 230 deaths, and 10 other African countries have been designated at risk of being swept into the crisis.
Countries and health coalitions from around the globe have quickly mobilized funds, medical resources, and personnel to the region. But one nation has been conspicuously absent from the core of the international response. Prior to January, when the United States officially withdrew from the World Health Organization, it was one of the coalition’s largest, richest, and most prominent partners, and its biggest funder. Now it has sidelined itself—limiting the potential effect any of its actions will have.
Were the U.S. still a member of the WHO, its federal health officials likely would have been able to start responding to the crisis sooner and better positioned to direct resources where they were most needed; were USAID still intact, its officials would have been in Congo, managing the outbreak before it ballooned. As things stand, American health officials did not learn of the epidemic until nine days after the WHO did. (When reached for comment, a State Department spokesperson wrote over email that the U.S. began its response within 24 hours of hearing about the outbreak and argued that “the WHO’s delay in informing the world of concerns until May 15 had a grave impact.”) Even as the U.S. has leaped into action, it has remained on the outskirts of the primary effort to control this outbreak.
American leaders “are not doing nothing,” Lawrence Gostin, a global-health-law expert at Georgetown University, told me. The U.S. government has announced that it is dispatching more than $160 million in emergency and humanitarian funds to contend with Ebola on the ground, deploying CDC personnel and a disaster-assistance-response team to the region, and bankrolling “up to 50” Ebola-treatment units in affected areas. Yet to public-health experts around the world, the U.S. response looks siloed, uncoordinated, and ultimately less effective than it would otherwise be. When one country holds itself at arm’s length from other global-health actors during an international crisis, “at best it wastes resources,” Jennifer Nuzzo, the director of the Pandemic Center at Brown University School of Public Health, told me. “At worst it winds up conflicting with or impeding the work of others.”
For this particular Ebola outbreak, the margin for error is even slimmer than usual. The viral strain causing the epidemic, Bundibugyo, is frequently missed by standard field tests and lacks both treatments and licensed vaccines. Local and international health officials were weeks late responding to it, which allowed the virus to spread more widely. Many regions of Congo, including ones at the center of the outbreak, have been fragmented by intensifying armed conflict, which has weakened health infrastructure. And the Trump administration’s gutting of domestic and international public-health infrastructure increased the region’s fragility, cut down on available health personnel, and likely delayed the initial detection of Bundibugyo, researchers told me.
Situations this dire, Nuzzo said, call for an incident-command system, in which roles are carefully delegated “so we aren’t showing up and stepping on the toes of others who are already in the area.” American leaders are still communicating with relevant countries to some degree—setting up bilateral financial agreements, for instance, with Congo and Uganda. The government also has contributed to an emergency-response fund through the United Nations Office for the Coordination of Humanitarian Affairs and is working with “implementing partners, Africa CDC, and technical channels on the ground,” according to the State Department spokesperson; Andrew G. Nixon, the deputy assistant secretary for media relations at the Department of Health and Human Services, wrote in an email that the U.S. has “activated an aggressive, coordinated response.”
Meanwhile, the WHO, a UN agency that marshals responses across its nearly 200 member nations, is spearheading collaborative efforts on a much larger scale and leveraging its own technical expertise—capabilities that the U.S. does not have on its own. The Trump administration has also reportedly placed restrictions on the number of federal health officials who can attend virtual WHO meetings.
As a result, the U.S. is now a side channel to the main event, risking redundancies through its bespoke response. “You’re going to get massive confusion and duplication,” Salim Abdool Karim, who chairs Africa CDC’s Emergency Consultative Group, told me. (The WHO did not respond to requests for comment.)
The WHO has never been the sole or perfect arbiter of public-health response. In recent years, experts have criticized aspects of the WHO’s delayed responses both to the Ebola outbreak that began in 2014 and to COVID-19. (When justifying the U.S.’s withdrawal from the WHO, the White House specifically cited the organization’s “mishandling of the COVID-19 pandemic.” President Trump has also said that the WHO asked the U.S. to contribute too much money, insisting that “World Health ripped us off.”) But few agree with U.S. leaders that improving global health involves withdrawing from the organization. As Ebola rips through Congo and threatens to overflow into neighboring regions, coordination is the only viable path—and the WHO is the main channel through which coordination occurs. “Trying to imagine how you would do this response without WHO? It boggles my mind,” Abdool Karim said. Yet that’s exactly what the U.S. is now attempting to do.
As things stand, Gostin, who has been in constant contact with colleagues in Congo and at the WHO, said that he and many of his fellow public-health experts have little knowledge of what actions that U.S. officials have actually taken. Some of the government’s choices so far also seem incongruous with the region’s needs. For instance, funneling so many early-response resources into Ebola-treatment units—which are extremely expensive—makes “absolutely no sense,” Courtney Blake, who helped lead the USAID response to the Ebola outbreak that began in 2014, told me. Treatment units, although important, represent a late line of defense, Blake said, because they do little to halt the virus’s spread. Top officials in Uganda’s Ministry of Health have also expressed confusion about the American contribution to the outbreak response, at one point last week saying that the ministry hadn’t communicated with the U.S. about treatment centers at all.
Those resources, Blake and others told me, could be better focused on efforts that would directly slow viral transmission—including PPE dispersal, testing, quarantining, and community engagement. And this morning, the State Department did announce that some of its allocated funds would help its “implementing partners” with “PPE procurement and delivery, border screening and surveillance, contact tracing, and diagnostics supplies.” Several experts also emphasized the importance of local communication: In the past week, two Ebola-treatment centers have been set on fire by protesters, in at least one case because family members of a man suspected to have died from the virus had been prohibited from retrieving his body. (The Ugandan Ministry of Health and Congo Ministry of Public Health did not respond to requests for comment.)
But what the U.S. actions add up to hasn’t been apparent to the experts I spoke with. “Is there a big-picture strategy?” Mohammad Karamouzian, an infectious-disease epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, told me. “Or are they just trying to show they are doing something?” Any attempt to limit the virus’s spread is now more difficult, too, because “arguably the biggest implementation force on the ground in the region is gone,” Karamouzian said—namely, USAID.
The State Department has started to reconstitute some of the humanitarian resources that the Trump administration previously rendered defunct, Paul Spiegel, the director of the Johns Hopkins Center for Humanitarian Health, told me, by setting up a Bureau of Disaster and Humanitarian Response in the State Department and reassembling disaster-assistance-response teams. The department’s spokesperson argued that USAID reform has not undermined the country’s Ebola response and said that the U.S. responded faster to this outbreak than USAID did to similar outbreaks in 2014 and 2018. (Blake pointed out that although international emergencies were declared later for those epidemics—which grew more slowly than this one—USAID officials were already in the region, available to mount a local response, when those outbreaks began.)
Ultimately, though, the U.S. has been very clear about where its priorities lie—with its own interests. At a recent press conference, Secretary of State Marco Rubio said, “We don’t want anyone dying or being affected by Ebola, but our No. 1 priority will always be making sure it doesn’t come to the United States.” The Trump administration has put in place multiple travel restrictions aimed at keeping Ebola out of the U.S. And although in the past, Americans caught up in dangerous outbreaks have been flown home to be monitored and treated, during this Ebola epidemic, the U.S. has instead evacuated ill and exposed Americans to Germany and the Czech Republic and is standing up a makeshift quarantine center—for Americans specifically—in Kenya.
This “America First” stance has stoked anger among some communities in Congo, Leslie Roberts, an epidemiologist at Columbia University, told me, and where Americans were once welcomed as public-health allies, they are now seen as enemies. If a main part of the U.S. strategy is to coordinate directly with national health ministries, this depends on those ministries wanting to coordinate—which is not always possible in countries that have poor diplomatic relations with the U.S.
In the past, such as during a 2023 outbreak of Marburg virus in Equatorial Guinea, the U.S. depended on WHO relationships with other countries’ ministry of health, Beth Cameron, a former global-health-security adviser for USAID, told me. Coordinating through the WHO means that individual nations don’t need to scramble to remake such connections, or forge them anew, to confront each challenge. Inevitably, in some future outbreak, the U.S. will find that its isolation has left it unprepared to protect even itself.
About the Author
Katherine J. WuFollowKatherine J. Wu is a staff writer at The Atlantic.Explore More TopicsEpidemics and Pandemics, World Health Organization
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