After Elon Musk “spent the weekend feeding USAID into the wood chipper,” as he put it last year, he and President Donald Trump scoffed that American humanitarian aid was, in effect, woke nonsense.
Yet in reality American humanitarian aid not only saved one life every 10 seconds but was also safeguarding the world from epidemics. So now we face a rapidly increasing outbreak of Ebola, and the Trump administration is finding that some of the things that went into the wood chipper were the very tools needed to tackle the virus.
Global health is unpredictable, and it’s not certain that the U.S. Agency for International Development would have stopped Ebola this time. But in three ways, Trump’s assault on global health has left us in a worse position to combat Ebola (although, in fairness, the administration has done one thing right).
The first failing was the destruction of USAID. Jeremy Konyndyk, who oversaw the response to the 2014 Ebola epidemic for the agency, noted that it used to have a major presence in Ituri, Congo, where the Ebola outbreak appears to have begun. But most of the aid to Congo was cut, and Ebola spread widely by the time anyone realized that it was present.
“I don’t think there is any way that this outbreak would have been missed for so long if all those programs were still at full strength and the USAID mission team was still there,” Konyndyk told me. “And I can tell you that in my former job as head of disaster response, if my team was hearing reports of unexplained viral hemorrhagic fever clusters in Congo, that would be a four-alarm-fire-type moment. I would have immediately notified the White House.”
The United States had been the largest donor to Congo, financing some 70% of humanitarian work there, according to Physicians for Human Rights — and most of that aid was shut off with no time for adjustment. Dr. Celine Gounder, an infectious disease specialist, posted a searing video interview in which a Congolese doctor spoke of another doctor forced by aid cuts to become a farmer, growing cassava.
The lack of a significant aid presence was compounded by the fact that this outbreak involved the unusual Bundibugyo strain of Ebola and by the remote location. But I’ve traveled through this area, and I’m confident that aid workers would have reported news of the outbreak — if the system hadn’t been mostly dismantled. And delay was disastrous.
“With Ebola, time is lives,” Dr. Tom Frieden, who was the director of the Centers for Disease Control and Prevention during the 2014 Ebola epidemic, told me. “Get to an outbreak in days, and you can stop it in weeks. Get there in weeks, and it goes on for months. Get there in months, and it can go on for years.”
“This outbreak had a running head start,” he added. “By the time we began responding in 2014, there were 40 to 50 cases. By the time the world began responding this time, there were 400 to 500.”
The upshot is that this Ebola outbreak is already the third worst on record.
My New York Times colleague Declan Walsh has written extraordinary dispatches from the front lines that health workers trying to defeat the virus have lacked even basic protective equipment to stop it from spreading.
The second failing on the part of the Trump administration was its hostility to the World Health Organization. Trump not only withdrew the United States from the WHO, but his administration also reportedly barred some U.S. health officials even from communicating with counterparts there.
“For all its weaknesses, WHO is essential,” Frieden said. “The stronger WHO is, the safer we are.” Traditionally, the U.S. and WHO worked together in a constructive partnership, pooling knowledge and capabilities. But today, while WHO officials are on the ground in Ituri, the United States didn’t even learn about the outbreak until nine days after WHO did.
The third failing is simply the administration’s disregard for public health and lack of preparation. The Biden administration had several hundred pages of planning documents for handling an infectious disease outbreak, and it left these for incoming Trump aides, according to Stat News — but the Trump administration reportedly ignored the materials.
That’s not a surprise. The Trump administration also left positions for disease preparedness vacant. It cut funding for Gavi, the Vaccine Alliance, which is helping develop a vaccine for this strain of Ebola. Secretary of State Marco Rubio promised that the State Department is “going to reengage on the issue of Gavi,” but it’s unclear what this means or what the timetable is.
The administration is reportedly seeking to cut funding further for HIV/AIDS worldwide, targeting the PEPFAR program that has saved more than 26 million lives so far. Eight former heads of the CDC recently wrote a joint essay warning that these cuts would weaken surveillance for diseases like Ebola and “will destroy PEPFAR and undermine health security.”
I said that Trump did one thing right, and that was to push to end the war in eastern Congo, for that war has made it harder to detect and respond to disease outbreaks in the region; most notably, the administration imposed sanctions on Rwanda’s military for its role in the conflict. But Trump’s aid cuts work in the other direction by fomenting conflict. One recent study found that in areas of Africa that had received significant assistance, the abrupt shutdown of USAID caused roughly a 10% increase in violence, including riots and combat deaths.
Ebola is a terrifying disease, initially producing a fever, muscle ache and headaches and then leading to vomiting, diarrhea, and often bleeding and death. It is transmitted by body fluids, but in a broader sense it is transmitted by love: When people tend to an ailing loved one or prepare a body for burial, it is easy to be infected by blood, vomit or diarrhea.
The fecklessness of Washington, D.C., officials, recklessly cutting programs they didn’t understand, contrasts with the raw courage of doctors, nurses, aid workers and burial teams in places like Congo who are risking their lives and making do without adequate supplies to stop this outbreak.
The USAID cuts were lethal: I’ve documented how we let children die from malaria for want of $2 mosquito bed nets or from starvation because we couldn’t be bothered to provide 50-cent packets of peanut paste. A Boston University researcher estimates that the aid cuts have already cost more than 750,000 lives worldwide.
Yet USAID was intended to protect our interests as well as project our values — and a significant element of that self-interest was fighting diseases like tuberculosis and Ebola.
Now Musk and Trump — and Rubio, who let all this happen on his watch — are learning that USAID wasn’t just a pet project of woke bleeding hearts. The actions of these three men have led to an immense number of unnecessary deaths worldwide and may have empowered Ebola. They have made the world — and America — less safe.
