We’re Not Ready for the Next Pandemic

The US dismantled public health infrastructure at the exact wrong time

When it comes to infectious disease outbreaks, it’s often a question of when, not if they’ll occur. That was certainly the case before the COVID-19 pandemic. Many of us in public health had been sounding the alarms about the dangers and vulnerabilities of defunding disease surveillance and control systems. It’s been six years since the last pandemic declaration — an outbreak that was often referred to as a “once in a century” event. The problem is, I don’t think it’ll be another 100 years before we see another one.

The Democratic Republic of the Congo is currently experiencing its 17th outbreak of Ebola since 1976. Health officials believe it began in Mongwalu, a gold-mining town plagued by armed conflict, in Ituri Province, where workers travel in and out from across the region. Nearly three weeks would pass before the first signals were noticed by officials.

Public awareness campaign about ebola in the Democratic Republic of Congo

By the time the first cases were officially reported, on May 15, the virus had already moved across hundreds of miles to the capital city of Kinshasa (population 18.5 million) and across the border to Kampala, Uganda (population of nearly 2 million). As of May 26, the World Health Organization (WHO) had reported 906 suspected cases, 223 suspected deaths, and 10 confirmed deaths in the DRC, and 7 confirmed cases and one confirmed death in Uganda. This is most certainly an undercount.

This outbreak involves the Bundibugyo strain — a rare form of Ebola for which there is no licensed vaccine and no approved treatment. Mortality runs as high as 50%. The missed signals, the delayed response, the high (and yet incomplete) number of cases and deaths are all warning signs.

The outbreak is already the seventh-largest Ebola event in recorded history, and on May 17, the WHO declared it a public health emergency of international concern (PHEIC) — a signal to member states that an extraordinary event has occurred that will require a coordinated and unified response. It’s also the first major Ebola outbreak in modern history in which the United States is not leading the response.

Before January 2025, the playbook for an outbreak like this one was well established and would’ve involved the United States Agency for International Development (USAID) — an agency directly involved in the early detection, prevention, and control of diseases like Ebola, and America’s most reliable guardian of global health security. From the start of the outbreak, USAID would have been tasked with measures like door-to-door contact tracing, ensuring that hospitals and clinics were properly supplied with personal protective equipment (PPE), and making sure that safe and dignified burials were conducted with proper infection prevention measures while respecting cultural and religious practices.

USAID also would have been involved in coordinating isolation and quarantine protocols, training health care workers, supporting the continuation of other essential health services, and providing risk communication and community education services. Now, those same tasks have been left to local groups with fewer resources.

USAID was the connective tissue between agencies like the Centers for Disease Control and Prevention (CDC), the State Department, and even the Department of Defense. It bolstered supplies. It moved people. It maintained long-running country partnerships that allowed responders to operate in some of the most challenging places around the world.

But in early 2025, under the auspices of the Department of Government Efficiency, the Trump administration orchestrated the dismantling of USAID and the defunding of critical infectious disease research. Global public health is now paying the price.

We learned a lot from the 2014 Ebola outbreak in West Africa and the 2018 outbreak in eastern Congo, most notably that public health systems need to exist before public health emergencies. We don’t build fire stations and fire hydrants when communities are burning. We build a robust fire prevention and response infrastructure to prepare for fires. So why do we treat public health like it’s a reactive response?

We also learned that public health can be expensive but that the benefits — even economic benefits — far outweigh the costs. During the 2014 outbreak, the US government deployed 3,000 military personnel and hundreds of CDC scientists in one of the largest public health deployments to date. These Americans built emergency treatment centers, trained hundreds of local health care workers, and helped curb one of the most catastrophic Ebola outbreaks in history.

Health workers at an ebola treatment center in Congo

It cost us hundreds of millions of dollars, but it saved lives and stabilized governments and economies. For context, USAID’s full annual budget cost the average American $24 per year. Since then, shutting it down has cost us an enormous amount of money — reportedly $2 billion to cover closeout costs. Experts estimated that the diversion of funds away from USAID would translate into almost 200,000 preventable deaths — and that’s before factoring in the current outbreaks.

In addition to the dismantling of USAID, the US also withdrew from the WHO, a multilateral United Nations agency tasked with coordinating responses to international public health issues and emergencies. Historically, the US was the largest funder of the WHO and provided diplomatic muscle and technical expertise. Experts flagged that our withdrawal would result in massive consequences for global and domestic health.

The current outbreak is the second recent test of what happens when these relationships and systems are gone. For the last few weeks, before Ebola started to grab the headlines, all eyes were on the hantavirus outbreak linked to the MV Hondius cruise ship. Infectious disease epidemiologists like me tried hard to make sense of the science and the risk for a panicked world still traumatized by the COVID-19 pandemic.

It was clear that the wounds were still open, and the public was not ready for another public health emergency. I made it pretty clear then that I wasn’t worried about a hantavirus pandemic. What I am worried about is the next big one — the disease that does have pandemic potential. Based on the US’s abdication of our role as leaders in global health and the public’s distrust in anything remotely related to public health, we are poised for a terrible experience.

MV Hondius cruise ship

The most useful lesson of the past two months may be that the United States built something more valuable than it realized, paid less than $30 per taxpayer per year for it, and is in the process of finding out what its absence costs. The local responders in Central Africa — many of them trained, equipped, and supported through years of American investment — are doing extraordinary work with the tools they have. They may succeed in slowing this outbreak. They may even contain it. But the system that surrounded them, and that made their work possible, no longer exists in the form it once did. Rebuilding it will take years. Replacing the institutional memory, the regional relationships, and the surge capacity will take even longer.

In the meantime, the policy question now facing the United States is not whether USAID should have been dismantled. It happened, and we are still reeling. The question is whether the country is prepared to live with the consequences when — not if — the next “once in a century” disease crosses a border, perhaps ours.

There’s a frustrating saying about public health: ”When it works, it’s invisible.” Well, the invisible work has functioned like an invisible shield — protecting you, your loved ones, and even our democracy from events that could have been public health emergencies or pandemics. If there’s one thing I want you to consider, it’s that global health security is national security. A healthier world, free from epidemics, means a healthier America.