On Tuesday, officials confirmed a new outbreak of the deadly Ebola virus in the Democratic Republic of the Congo.
Just hours earlier, the Trump Administration asked for Ebola-related funding cuts of $252 million, part of a new rescission request aimed at reining in government spending.
That timing couldn’t be worse.
“The entire global health community would agree that cutting funding is a bad idea,” Rebecca Katz, an associate professor and co-director of Georgetown University’s Center for Global Health Science and Security, told The Daily Beast. “An outbreak anywhere can be everywhere within a matter of days. Viruses do not respect political boundaries, which means we have a collective risk and a collective responsibility to prevent, detect, and respond.”
So far, the new outbreak remains small. The World Health Organization reports that two patient samples have tested positive for the Ebola virus, and 17 possibly related deaths have been recorded. The outbreak began in Bikoro, in the far west of the DRC, near the border with the Republic of the Congo in Equateur Province. The WHO says it is working closely with the DRC government in order to quickly scale up a response operation, in an attempt to contain the outbreak.
Meanwhile, the Trump Administration has other plans. The full rescission request—which would reverse previous budgeting set by Congress—totals $15.4 billion across 38 different areas, a move deemed to be a response to the president’s reluctant signing of the $1.3 trillion spending package in March, with representatives largely voting along party lines.
Part of that includes $252 million “in prior year balances of emergency funding appropriated in FY 2015 for the Ebola response.”
Cutting the Ebola funding would fly in the face of the progress made after the Ebola pandemic of 2014, which lasted into 2016. May Chu, an infectious diseases expert who helped lead the Obama White House Office of Science and Technology (OSTP) response to that crisis, criticized the move to pull funding.
“In my opinion, [the funds] have been put to good use to build up infrastructure in the most vulnerable countries,” she told The Daily Beast. “I say that because DRC is one of those success stories, a country where international assistance has been put to building a system that can effectively respond, map, and control an Ebola outbreak.”
In an email, a White House official familiar with the rescission deal told The Daily Beast that “The Administration understands the risks posed by infectious disease threats such as Ebola, and that quick action is necessary to stop an outbreak at its source.”
Still, the official added that “we do not believe the funds proposed for rescission are necessary to respond to the DRC outbreak, due to the increased capabilities of the Congolese government and quick mobilization by partners in country.”
The DRC has had at least nine outbreaks of the virus over several decades, but none blew up into the epidemic crisis seen in Liberia, Sierra Leone, and Guinea in 2014 and 2015. That outbreak in West Africa eventually killed more than 11,000 people, though the response by groups like Médecins Sans Frontières, and by the U.S. and other countries likely prevented a far worse catastrophe. The WHO itself was sharply criticized for its slow response; though the outbreak was the first to ever cross into three separate countries as early as May 2014, the organization did not declare an emergency until August. The death toll reached 1,000 only days later. .
The largest outbreak was also the first, in 1976 when the country was known as Zaire. That outbreak killed nearly 300 people, and was among the world’s first, and it brought the virus into the global spotlight. There was an outbreak in the DRC in 2014 that killed 49 people, but in spite of the similar timing, sequencing of the virus showed it was not actually related to the larger outbreak in West Africa.
The DRC suffered fewer casualties in the last outbreak, in 2017. A total of eight cases and four deaths were confirmed, all in the northern part of the country near the Central African Republic.
Though only the two cases have so far been confirmed in the present outbreak, the WHO has released $1 million from its Contingency Fund for Emergencies, and plans to send experts to the region immediately to help contain the virus.
Chu, who is now a professor at the Colorado School of Public Health’s Anschutz Medical Campus, said deploying new vaccines in the area is the critical first step. And there’s been promise in this area: In 2015, researchers from Liberia and the U.S. National Institutes of Health tested two potential vaccines during the West Africa outbreak in 2015, with positive results. One year after receiving the vaccine, as many as 80 percent of volunteers showed an immune response, compared to only seven percent of those who received a placebo.
There is no indication yet of any plans to deploy the vaccine in the DRC.
It isn’t entirely clear how the funds included in the rescission request might be used otherwise. In a detailed document from the Office of Management and Budget, the request said that the funds are no longer needed because the outbreak related to the actual appropriation has ended — a blinkered approach not shared by the global health community, which clearly sees more of an ongoing threat that needs careful management.
The White House official also told The Daily Beast that USAID “has substantial resources available to respond to the DRC outbreak if necessary,” including nearly $70 million in its Emergency Reserve Fund along with $35 million more available for designation by the President.
Still, public health experts see it as a mistake to pull back any of the funding in this arena, both for humanitarian reasons and for the security of the U.S. “When it comes to global health security, which is one part of [national] security, we’re not entirely safe right now,” said Ronald Waldman, a professor at George Washington University with extensive experience at the CDC, WHO, and elsewhere in responding to global pandemic threats. “We could be doing a better job by reinforcing our defenses. And that will require additional investment, in fact, over and above what we currently have.”
Much of the money in the original 2014 Ebola appropriation was designated to be available indefinitely. According to an analysis by the Kaiser Family Foundation of the bill appropriating the funds, $3.74 billion of the total $5.4 billion was set aside for international response (the rest was for research and development, and domestic response); of that, $1.75 billion, given to USAID for various purposes, was designated “to remain available until expended.” Another $1.2 billion granted to the Centers for Disease Control and Prevention was “to remain available until September 30, 2019.” Smaller amounts were set to expire by September of 2016 or 2017.
Chu said that though the DRC has responded relatively well to these outbreaks in the past, with help from the international community, there is always a danger that people in the affected area “flee to find better care in crowded city hospitals.” This would increase the chances of transmission in those cities, potentially sparking a much larger outbreak.
It was this sort of movement that helped expand the epidemic in West Africa, Chu said; at the time, she helped the Obama administration weather calls for a total travel ban on the area, explaining that attempting to close borders doesn’t necessarily stop the movement of people in the affected areas and would only shut off the region from receiving the outside help it needed to contain the virus.
The Trump administration has insisted that it is prepared to confront disease outbreaks or related crises, in spite of a dramatically diminished roster of scientific and health expertise on hand. As The Daily Beast reported in February, the OSTP has fewer than half the staff it had under President Obama, with no indication that experts like Chu are consulted at all. Moreover, in 2014 Trump was among the loudest voices calling for a full travel ban to the afflicted countries and lambasting Obama for failing to institute one.
In September 2014, a few months after the West African outbreak began and amidst a rising crescendo of voices calling for that travel ban, President Obama deployed approximately 3,000 military personnel to the region to help coordinate the response, set up medical facilities, and reach rural areas where the disease was spreading. Waldman pointed out that the U.S. is traditionally involved with responding to outbreaks large and small from the start, though “we may not send in the teams in the space suits.” This includes funding to WHO and other groups.
Though there are no plans from the White House to change the rescission request given this latest outbreak, it is not ruling out getting further involved in the response. According to the White House official, “the U.S. government, including the CDC and USAID, is working with the government of the DRC … and other international partners such as Doctors Without Borders to identify priority areas for support, which could include deployment of staff to the field.”