The Trump administration is sending mixed signals about its commitment and prioritization of global-health security as the international community responds to an Ebola outbreak in the Democratic Republic of the Congo.
Given the size of themost recent outbreak—27 people have died as of May 21—Washington’s response to the crisis has been sufficient so far, according to a former government official. The U.S. government has committed $8 million to the effort. For the devastating 2014 outbreak in West Africa, which led to nearly 12,000 deaths, the government ended up spending $2.4 billion.
“This is much more along the pattern of all the other previous Ebola outbreaks where they reached to at most a few hundred cases, unlike the close to 30,000 that we saw in 2014-2015,” said Jeremy Konyndyk, senior policy fellow at the Center for Global Development and a former U.S. Agency for International Development official who led government humanitarian responses during the 2014 outbreak.
The context for this crisis is different from 2014 and several factors, such as the improved response capacities of the World Health Organization and the historical experience of the DRC with Ebola, may mean the U.S. does not have to respond in the same way, Kaiser Family Foundation experts wrote in a recent brief.
But the administration’s efforts to reduce funding to global health security and its elimination of the White House point person on biosecurity and global health has raised troubling questions about the government’s ability to contend with future outbreaks and pandemics.
“The U.S. has been the main funder internationally for global health and has been a very important part of the international discussion and diplomacy around a lot of these issues,” said Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation.
“I think in this current environment where you have a White House talking about America First and sort of a pullback by the U.S., that has created some uncertainty, concern, and other donors in some cases said, ‘Well maybe we need to kind of do stuff on our own,” when they’re not clear if the U.S. is going to play the same role,” she added.
The focus of congressional lawmakers and experts has been on the funding of these efforts, specifically for the Centers for Disease Control and Prevention, and the U.S. Agency for International Development.
As part of a rescission package—which was released the same day that the DRC declared the Ebola outbreak—the Trump administration is seeking to pull back $252 million in excess funds at the USAID from the 2015 Ebola outbreak efforts. But the move may affect the U.S’s response to threats beyond just Ebola.
“When I was still at USAID, we in the administration and the appropriators on the Hill had an informal understanding, that we would just leave that money on USAID’s books as a rainy day fund for some future disease emergency and there was a provision in the appropriation that allowed that to be reprogrammed towards other disease threats if needed,” Konyndyk said.
“That was very very useful because another major lesson of the 2014-2015 outbreak is that epidemics do not respect the congressional budget process,” he added, noting that the 2014 Ebola outbreak really exploded in July and August of that year, which meant it was toward the end of the fiscal year and the USAID and CDC did not have the resources readily available to respond.
The CDC, another key agency in the global health security effort, is facing a funding cliff as resources provided to them to support global health security activities—around $597 million—will expire in 2019. The president’s budget request does include a funding increase of $51 million for CDC’s Global Disease Detection and other programs, but this is the only increase for global-health programs, according to a Kaiser analysis.
Keeping funds going to these programs beyond 2019 is critical to support the progress the agency has made with overseas partners, said Cyrus Shahpar, director of the Prevent Epidemics Team at Vital Strategies’ Resolve to Save Lives initiative and former team lead of the CDC Global Rapid Response Team.
“The work that has gone on since then is really about making countries stronger so they can control health threats within their borders and obviously protect the health of the whole world,” he said. “A lot of that work in the past five years, it takes time. CDC set up offices overseas, they got staff to work in those places to develop relationships with governments, and most of the countries around the world have taken a look at where their weaknesses are.”
The Kaiser analysis also points out that funding for the State Department and USAID, “which represents the bulk of global-health assistance,” would decline by $2 billion.
The push from the White House to cut funding in this area sends a pointed message about the U.S.’s approach to global-health security, said Thomas Bollyky, senior fellow for global health, economics, and development at the Council on Foreign Relations. “I think that’s a very clear signal both domestically and internationally this is an area where the U.S. wants to do less,” he said.
In addition to the funding concerns, there is also a lack of leadership within the White House on biosecurity and global health. The same week that the DRC announced the Ebola crisis, Rear Adm. Timothy Ziemer departed the White House’s National Security Council and his team was disbanded, sparking immediate criticism from Democratic Sens. Elizabeth Warren and Patty Murray.
Konyndyk explained that before Ziemer took the helm, it was harder for the White House to coordinate a response to the West Africa outbreak. “There was no one on the NSC who had full visibility on the whole range of this issue,” he said. “That kind of segmented ownership meant that it was tougher for the White House to get its own house in order and tougher for the White House to get the interagency in order, and it made us slower off our marks.”
Ziemer’s departure suggests “that the White House does not see biothreats as a priority,” according to Konyndyk.
Noting that the White House’s global health security roles have been moved to the division that addresses weapons of mass destruction and biodefense, Bollyky said it may reflect the government’s prioritization of domestic defense.
“What I think is probably a better way to think of it instead of whether [global-health security is] a priority or not, is whether or not our international cooperation is a priority or is the priority more about our defense at home,” he said. “I think moving it into the WMD-focused directorate is a lot about U.S. preparedness for these threats, whereas when this agenda is in this global health security portfolio I think it’s a lot about working with other countries collectively to address these issues.”