Medical Examiner

Trump Is Putting Us on Course for a Global Health Disaster

By refusing to invest in proven programs and focusing on divisive rhetoric, the president is undermining our nascent global health partnerships.

Illustration: A foot crushes a globe representing global health.
Photo illustration by Natalie Matthews-Ramo/Slate. Photos by Thinkstock.

Forty-two years ago, health officials in the Democratic Republic of the Congo (then called Zaire) reported an explosive outbreak caused by a pathogen that local clinicians could not identify. Within two months, 318 people living around the rural town of Yambuku had fallen ill. Eighty-eight percent of them died, alarming officials at the World Health Organization and U.S. Centers for Disease Control and Prevention, which mobilized a research team to investigate. After analyzing hundreds of blood samples drawn from sick patients and their household contacts, the scientists identified a new virus as the culprit. After a nearby river, they named it Ebola.

“No better example comes to mind to illustrate the need for national disease surveillance and the prompt solicitation of international assistance,” they wrote in their final report in 1978. “Nor of the need for development of international resources that can be made available in a very few days to cope with such emergencies.”

But these recommendations went unheeded. Visions of a standing epidemic response group never materialized, and the Congolese health system was left as weak as it had been before the outbreak (yearly health spending remained below $5 per capita for the next two decades). Instead of being used to help develop new vaccines or treatments, the CDC’s collection of biologic samples would sit neglected in the back of a freezer in Atlanta, a symbol of a system that often springs into action only when a pathogen is deemed a threat to Americans.

In September 2017, President Donald Trump pledged support for our nation’s burgeoning if belated efforts to strengthen health systems in Africa during the United Nations General Assembly. “We cannot have prosperity if we’re not healthy,” he proclaimed. “We will continue our partnership on critical health initiatives.” Yet like much of what the president says, this seems to have been empty rhetoric. With its guidance to federal agencies for the next fiscal year, the Trump administration now appears poised to repeat history.

As first reported by the Wall Street Journal in January, CDC staff have been instructed to begin winding down support to most of the countries that have benefitted from the agency’s Global Health Security Agenda. Launched in response to the largest ever outbreak of Ebola, which infected more than 28,000 people across West Africa between 2013 and 2016, it has helped to bolster the capacity of local health authorities to prevent, detect, and respond to outbreaks before they become pandemics. On top of this, the White House has proposed more than $2 billion in cuts to programs that provide essential health services from immunizations for infants to AIDS treatment worldwide.

Presidential budget requests may be little more than political messaging, but funding for the CDC efforts in question is, in fact, very much in peril. Currently, the money is coming from a one-time appropriation of $582 million intended to last through 2019. The Global Health Security Agenda has registered important early achievements during its first four years, and CDC leaders had planned to build on those gains with renewed funding for the program in 2020. But Trump’s budget requests a mere $59 million, down from the $180 million the GHSA currently spends annually—a 67.2 percent cut.

While Congress could certainly appropriate additional funding on its own, CDC officials’ private discussions with House and Senate Republicans have evidently given them little reason to believe that this will occur; well before Trump’s budget request was made public, they sent out internal guidance to begin the closure of 39 of the 49 GHSA programs started since 2014, including those in Congo, Sierra Leone, Guinea, and Haiti.

What could explain the Trump administration’s willingness to put hundreds of thousands of lives on the line in some of the world’s poorest countries? And to instead direct those funds toward an $18 billion wall incapable of keeping out infectious diseases?

Increasingly, this administration’s “America First” ideology seems to mean that concern for the rights and health of the world’s poorest is a burden we can do without. And given his many racist remarks, it’s hard to see Trump’s global health policy as anything but a reflection of his worldview—one that values white lives over black lives, casts Muslims as inherently threatening, and regards immigrants from Haiti and African nations as unworthy.

Ironically, some of the very countries Trump has disparaged have shouldered far more than their share of the response to recent global crises. Three years ago, one of us worked in Liberia and Sierra Leone with the medical nonprofit Partners In Health during the organization’s response to Ebola. Many of our team’s senior doctors hailed from Haiti. Volunteers on the front lines of the fight, they arrived with not only the skills to treat the sick but also invaluable experience rebuilding fractured health systems, having led clinical relief efforts after the 2010 earthquake that rocked their home country and throughout the cholera epidemic that followed. They chose to risk their lives, they told us in October 2014, not only to save those of the patients before them but also to help defend all of us, including Americans watching fearfully from across the Atlantic, against a global threat.

That same month, at the darkest hour of the Ebola crisis, the African Union announced without fanfare that it was dispatching a team of clinicians to Liberia to treat patients and train local health workers in infection control. The group’s doctors, who would remain on the front lines for over five months, came from countries across Africa.

Seven volunteered from the small East African nation of Rwanda, whose people know better than most what can happen when the international community stands idly by in the face of human suffering. Rwanda had just 625 doctors in 2014, meaning it sent over 1 percent of its entire physician workforce, and that outside of the most-affected nations, Rwanda was the world’s largest proportional contributor to the Ebola response. (Had the United States made a commensurate clinical commitment, we would have sent over 9,000 physicians to provide care in West Africa.)

These courageous Haitian and Rwandan health care workers showed the world that, in the face of a terrifying epidemic, compassion and solidarity are far more powerful tools for shared security than walls or travel bans. It’s a lesson wealthy countries seem always to neglect soon after the panic subsides, and at a profound cost to global health.

Consider that first recorded Ebola epidemic in Congo. In 1987, a CDC scientist involved in the response a decade earlier would frantically track down those frozen blood samples in hopes of answering an urgent question about a different plague. From the thawed serum of one 36-year-old woman, code-named HZ-321, the CDC isolated an actively replicating sample of the human immunodeficiency virus. Today, the HZ-321 virus remains the oldest viable sample of HIV ever found.

The world’s first documented Ebola outbreak, then, had exploded amidst a smoldering yet undetected AIDS epidemic on the banks of the Ebola River. As they peered through their microscopes at the blood of patients exposed to Ebola in 1976, the researchers who had been dispatched to Yambuku quite literally had HIV under their noses.

But that virus would not be “discovered” for another seven years, until after Americans began dying in Los Angeles, and after it had already killed close to 100,000 people in Africa (none of whom were diagnosed while living). And because early research efforts on Ebola were not linked to sustained investments in strengthening the Congolese health system, this cycle of panic and neglect would repeat, again and again.

Unless enough members of Congress can be convinced to reverse the course President Trump has charted, that cycle will surely continue, with consequences for us all.

Patrick Adams is a freelance journalist who reports on public health.
Cameron Nutt is a student at Harvard Medical School.