Ebola Containment Efforts May Have Been Hindered by USAID Shutdown and CDC Cuts

The Ebola crisis in East Africa is rapidly escalating, with cases now confirmed in major population centers in the Democratic Republic of Congo and Uganda. Public health experts around the world and health workers on the ground say that the response has been significantly hindered by the near-absence so far of the United States, historically the leader in any major outbreak.

The United States used to fund robust disease surveillance networks across the region and maintained emergency teams to take charge in public health crises like this one. Much of that work ended with the shutdown of the U.S. Agency for International Development early last year. The U.S. Centers for Disease Control and Prevention has also lost hundreds of experts, including some in the Democratic Republic of Congo, who could have helped contain the epidemic.

Epidemiologists and others who worked on previous Ebola outbreaks say that the fact that this one came to international attention weeks, or perhaps months, after it began and had already spread across international borders, is a direct result of the weakened surveillance.

American officials did not learn of the outbreak until Thursday, nine days after the World Health Organization did, and almost a month after the first person died. The delay in confirming the outbreak was in part because samples were taken to the national lab in Kinshasa, Congo, at the wrong temperature. That task previously would have been managed by U.S.A.I.D.

As of Wednesday, the virus was believed to have sickened 600 people and killed 139, according to the W.H.O., a steep increase in just a few days. Those numbers are likely to climb quickly as the process of contact tracing and testing revs up, helping to determine how widely the virus has spread.

Infections have been confirmed in Goma, a Congolese city of at least a million people on the border with Rwanda; in Bunia, a city of about 800,000 people; and in the Ugandan capital of Kampala, population 1.9 million, suggesting a wide footprint for the virus. Goma is about 350 miles from the region where the first cases were identified.

The outbreak is centered in Ituri Province, where multiple armed groups engage in near-constant conflict and where the population is highly mobile, moving both for work and to flee fighting. All of these factors make it difficult to trace infected people and contain the outbreak. And the region has only a rudimentary health system.

“The health system is on its knees here,” said Heather Kerr, the country director for Congo for the humanitarian organization International Rescue Committee.

“Everything to do with the logistics of an Ebola response in its first phase, we would have hoped to see some U.S. funding for that,” she said.

Congo has deep epidemiological expertise on Ebola, but in previous outbreaks, it has counted on help from the United States with logistics and crucial supplies.

For weeks, health workers have likely been treating Ebola patients wearing only gloves and surgical masks, if even that, rather than respirators and face shields, impermeable coveralls and surgical hoods to prevent exposure to bodily fluids.

“My heart is breaking for those workers,” said Megan Fotheringham, who was U.S.A.I.D.’s deputy director of infectious diseases, including during the Ebola outbreak in Ituri between 2018 and 2020. “They are not protected, and they are putting their lives on the line.”

She added that U.S.A.I.D. would have moved stockpiles of personal protective equipment that it maintained within hours.

Congolese physicians are highly experienced in identifying and treating Ebola, said Dr. Salim Abdool Karim, who leads the emergency committee of the Africa Centres for Disease Control and Prevention. But other types of assistance that the United States provided in previous outbreaks were essential.

“Who else can bring 20 trucks in a matter of three days, have drivers, have fuel?” he said.

The W.H.O. has moved nearly 25 tons of gear from storage in Kinshasa; Nairobi, Kenya; and Dakar, Senegal, but the first shipments arrived only on Friday. “We don’t know the extent of that outbreak, so we cannot say we have enough or not,” said Dr. Marie-Roseline Belizaire, who is leading the W.H.O.’s response to the outbreak.

The State Department disputed the characterization that the United States was any less involved in the outbreak response than it would have been in earlier years, or that surveillance was any weaker.

“It is false to claim that the U.S.A.I.D. reform has negatively impacted our ability to respond to Ebola,” said Tommy Pigott, a spokesman for the department.

This week, the State Department said it was sending $23 million to Congo and Uganda. Officials said the money would go toward resources including protective equipment.

Additional funding “in the nine figures” will help build and maintain 50 clinics, which may take a few weeks to months to set up, they said.

Secretary of State Marco Rubio seemed to blame the W.H.O. for the delay in detecting the outbreak. Addressing reporters on Tuesday, he said the W.H.O. “was a little late to identify this thing, unfortunately.”

The first hint of the outbreak surfaced on May 5, when the W.H.O. learned of a cluster of unexplained deaths.

The organization promptly alerted the International Health Regulations, a legal framework for disclosing outbreaks. But the United States withdrew from the W.H.O. earlier this year, cut funding to the organization and rejected the framework, and American officials no longer talk regularly with their international partners. By the time American officials heard the outbreak had been confirmed, on Thursday, the virus had already been thought to have caused about 250 cases and 80 deaths.

“In a time when hours matter, we’re delayed by weeks,” said Nicholas Enrich, the former top global health official for U.S.A.I.D. who became a whistle-blower, releasing internal memos on the agency’s destruction.

The funds being released now will certainly help, public health officials said, but they are coming without the infrastructure to make them most effective. In previous outbreaks, U.S.A.I.D., which coordinated the practical aspects of a response, trained health workers, facilitated contact tracing, boosted testing capacity and provided resources for safe burials. (Traditional funeral practices in the region, which bring groups of loved ones together to bathe the body of the deceased, pose a major risk for transmission.) It would also have pushed partner organizations to move faster.

Historically the United States would likely also have already set up intensified surveillance at border posts with neighboring countries, said Courtney Blake, who helped lead the U.S.A.I.D. response to a multicountry Ebola outbreak in West Africa in 2014 and 2015.

“In case there is spillover, we would want to make sure that we’re able to capture it very quickly,” she said. “But our ability to do that swiftly has been eliminated.”

With the world’s attention now on the outbreak, health officials and workers in the region say there are signs that the United States is stepping up its involvement. Dr. Mamadou Kaba Barry, the head of mission in Congo for the aid organization Alliance for International Medical Action, which is setting up isolation wards in Ebola-affected districts, said that State Department staff had called his team in recent days to ask what was needed and what his organization was in a position to do. “It’s encouraging that they are concerned, they are interested,” he said.

Many experts said the places where the U.S. absence would be felt most sharply were in the supply chain for moving protective medical supplies and, if eventually there is a vaccine or treatment for this species of the virus, for moving those too.

“The supply chain was organized perfectly, arriving on time, and we saved lives in 2019,” said Dr. Manenji Mangundu, the country director for the aid agency Oxfam in Congo and a veteran of multiple Ebola outbreak responses.

Containment efforts in this outbreak have been further complicated by the fact that the infections are caused by a species of the virus, called Bundibugyo, for which there is no vaccine or therapeutics. The standard tests for Ebola do not detect it, which means it had been circulating for some time before analysis at Congo’s national laboratory finally raised the alarm.

Numerous positions in the U.S. government created to help detect and respond to global health threats remain vacant. The coordinator for global health security, a position created by Congress in 2023 to oversee preparedness to biological threats, is unfilled. The White House Office of Pandemic Preparedness and Response Policy, established by Congress in 2022, is also unstaffed.

The C.D.C.’s emerging disease center has lost about 700 staff members and contractors, including the head of the Division of High-Consequence Pathogens, which covers hantavirus and Ebola. The C.D.C.’s Global Health Center has lost hundreds more employees, including many who helped African health ministries manage disease outbreaks.

On Sunday, Dr. Satish Pillai, who is leading the C.D.C.’s Ebola response, told reporters there were more than 30 people in the agency’s country office in Congo. On Monday, he said there were “approximately 25” employees, adding that the number “hasn’t substantially changed.”

In fact, the C.D.C.’s Congo office has seven vacant positions for American staff, including the deputy director of the global health protection program and director of the H.I.V. program. (Staff from all programs would typically help in a large outbreak like this one.)

C.D.C.’s country office in Uganda likewise has at least four vacant spots, including the leaders of the global health protection and H.I.V. programs.

Andrew Nixon, a spokesman for the Department of Health and Human Services, which oversees the C.D.C., did not answer questions about staffing or how many C.D.C. officials have been deployed to Congo. “C.D.C. is fully equipped to protect Americans and mitigate risks through experts in this disease area,” he said in an emailed statement.

The Trump administration has also indefinitely paused research at one of the few institutes worldwide with the high-security facilities needed for studying Ebola.

Ebola has a mortality rate of up to 50 percent and an incubation period of up to 21 days. The first known death in this outbreak was a nurse on April 27 suggesting, even by the most conservative estimate, that the virus has been spreading since early April.

“We’re playing catch-up, and so this is going to be a tough one,” said Ms. Fotheringham, the former U.S.A.I.D. official. “It’s going to be a really long slog.”

Michael Crowley and Edward Wong contributed reporting from Washington.