Hey readers,
Sara here.
Shortly after brandishing his infamous chainsaw on a conservative conference stage last February, Elon Musk attended a Cabinet meeting where, giggling slyly, he admitted to having “accidentally canceled” Ebola prevention in his haste to obliterate the US Agency for International Development (USAID).
“We restored the Ebola prevention immediately,” he added coolly at the time, “and there was no interruption." That claim has since proven to be disastrously, profoundly untrue.
On May 17, the World Health Organization declared a rapidly spreading Ebola outbreak in the Democratic Republic of the Congo and Uganda a “public health emergency of international concern,” only the ninth-ever time the agency has made that designation. In the weeks since, at least 220 people have died of the highly fatal virus, and more than 900 suspected cases have been identified so far. It is already the third-largest Ebola outbreak on record.
And yet, that toll is likely a tremendous undercount because, as the New York Times reported from the ground this week, “only a trickle of tests are being processed every day” in the cities most affected by the outbreak. “The virus is far ahead of us,” Ahmed Mahat, a manager with International Medical Corps, told the Times. “And it’s spreading fast.”
In fact, publicly known cases are rising exponentially faster than in any prior outbreak, including the largest ever, West Africa’s catastrophic outbreak in 2014, and the second-largest in 2018. By the time this outbreak was declared, hundreds of people had already been infected.
When you stop looking, you can’t see
Why did this outbreak spread so quickly? Part of it was the virus itself, a rare Bundibugyo strain of Ebola, which is harder to diagnose and for which there are no vaccines or treatments. (At least, not yet.) Another reason is that this outbreak began in a remote province of eastern Congo, an active war zone, where what health systems exist have been ravaged by decades of armed conflict.
As if the odds weren’t already stacked enough, however, this outbreak broke out under the heavy shadow of US foreign aid cuts that, among other calamities, gutted the world’s Ebola detection and response apparatus last year. Despite Musk’s earlier assurances, US-funded programs to detect new Ebola cases and dispatch a response were indeed frozen under the Trump administration, according to Stat. US cuts also indirectly contributed to the outbreak by weakening local health systems and stockpiles.
Altogether, the US Department of Health and Human Services disbursed about $10 million to Congo last year, down from $33 million the year prior, Stat noted. USAID sent $693 million in aid to Congo last year, down from nearly $1.2 billion in 2024.
Cuts to disease surveillance meant that this virus took longer to identify than it should have. And with cuts to local health systems, it’s now much harder to come by the tests, nurses, doctors, and protective equipment needed to stop the spread.
“It’s so bad. It’s so bad,” Jean Kaseya, director-general of the Africa Centre for Disease Control and Prevention, told Devex. The Africa CDC’s role in quelling outbreaks has become even more important as wealthy countries have retreated from the global health stage, but it is impossible to fill all of the medical surveillance gaps left by the US withdrawal of support, he said. “No one can give you the magnitude of this outbreak.”
Bleeding out
The US has done some course correction since the outbreak began. Last week, the State Department pledged $23 million in emergency funding for Congo and Uganda, plus the deployment of a disaster response team and enhanced involvement from the CDC, which says it’s been actively coordinating with local health agencies. At least some lost funding should have also begun flowing back to both countries through their bilateral aid deals with the US.
But when you lose a limb to a chainsaw — even a “chainsaw of bureaucracy” like the one Musk dragged across a stage — you can’t expect a bandaid to make up for the damage. Beyond the money, the US withdrawal from the WHO and other policy decisions have had a deeply destabilizing effect on global health systems, which no doubt helped bungle this outbreak response. In many cases, the disease experts and researchers who were once in charge are simply not there anymore.
Given the outbreak’s virulence so far, things will probably get significantly worse before they get better. While the majority of cases have occurred in Congo so far, Robert Redfield, former head of the CDC, predicted last week that the virus could soon spread to neighboring countries like Tanzania and South Sudan. Researchers have rapidly begun development on a new vaccine for the deadly virus, but even in a very best-case scenario, it will take months to roll out. In the meantime, health workers will continue to play catch-up to a virus that now has a massive head start.
As Nicholas Enrich, the former top global health official for USAID, told the New York Times last week: “In a time when hours matter, we’re delayed by weeks.”
