Our phones buzz with the same question every time an unusual outbreak makes the news: “What’s happening?” As doctors and frequent responders to infectious threats around the world, people assume we have immediate answers. But in the chaotic early days of an outbreak, even seasoned experts face more questions than certainties. This was recently the case with reports of a “mysterious illness» in the Democratic Republic of Congo (DRC).
Recently, the World Health Organization reported 406 cases and 31 deaths due to an unknown disease in the Panzi health zone, a remote area more than 600 kilometers from the capital Kinshasa. While investigations initially explored multiple possibilities, the DRC Ministry of Health blames the outbreak severe malaria — a devastating disease, particularly among children under 5 years old, whose vulnerability is increased by food insecurity and malnutrition in the region. The World Health Organization is conducting additional testing.
This time, the culprit could be a known illness. But the initial uncertainty underscores a crucial truth: In a world where pathogens are constantly emerging and evolving, we must have systems in place to detect, investigate and respond quickly, especially when it is not a familiar enemy .
It is a global health cliché to say that what is circulating in Congo today could be in Colorado tomorrow. But it’s also true. And in these situations, the time to detection and intervention is important because it can translate into lives saved. As political changes fuel calls to withdraw our global presence, the United States must strengthen its partnerships and commitments to surveillance, response, and research in the face of outbreaks around the world. Failure to do so amplifies health threats abroad and increases risks here at home. When a disease can cross distant shores in a single plane flight, maintaining and strengthening these investments and relationships is not only an act of global leadership, but also a critical investment in America’s own security.
The United States has long played a central role in establishing surveillance systems to detect emerging infectious threats. In 1951, just five years after its founding, the Centers for Disease Control and Prevention launched the Epidemic Intelligence Service (EIS), training “disease detectives” to identify and contain epidemics both domestically and globally. U.S. funding and expertise have since driven key initiatives such as the Global Polio Eradication Initiative (GPEI) and the Integrated Disease Surveillance and Response (IDSR) systems. Most recently, in 2016, the United States supported the creation of the Africa CDC to strengthen public health capacity and response across the continent.
The President’s Emergency Plan for AIDS Relief (PEPFAR), although designed to combat the HIV pandemic, has arguably been the most effective initiative to strengthen global detection capabilities. Launched 21 years ago, PEPFAR remains the largest global health investment any country has ever made, saving more than 26 million lives. From the beginning, it funded laboratories, purchased diagnostic equipment, trained local laboratory technicians, and built robust health information systems to monitor and report reliable health data around the world.
These investments have been critical not only for HIV surveillance, but also for detecting and responding to other health threats like tuberculosis, malaria and emerging pathogens. During the Covid-19 pandemic, those investments has helped increase diagnostic and surveillance capacity for SARS-CoV-2 globally. Despite its undeniable impact and long-standing bipartisan support, recent partisan gridlock threatens PEPFAR’s future. Without it, vital disease detection systems could collapse and millions of HIV patients could lose access to life-saving medicines, putting their health at risk and risking a resurgence of the global HIV pandemic.
Programs to detect outbreaks are essential, as is a rapid and effective response once a threat is detected. This is why the United States has also established an extensive network of public health partnerships and field offices abroad. The CDC operates in more than 60 countries, including the Democratic Republic of Congo, where the current “mystery illness” has emerged. The CDC’s presence on site since 2002 has provided essential access and trust, allowing U.S. experts to work side-by-side to respond to outbreaks with local health authorities from the start.
These relationships do not happen overnight and require trust. Without deep, pre-existing ties, built on years of cooperation, training and shared oversight, the United States would be just another outsider scrambling to negotiate entry and information at the start of a crisis. Consider the global effort to monitor and contain emerging strains of influenza: U.S. support supports a network of international laboratories that track new flu variants, giving health officials a head start on vaccine development and public health measures. Or consider it 2016 Zika outbreakwhen close collaboration with Latin American partners, supported by U.S. funding and expertise, quickly identified transmission hotspots and targeted mosquito control interventions.
The United States is heavily involved in the development and deployment of medical countermeasures that stop disease outbreaks. During a recent Marburg virus outbreak In Rwanda, U.S. funding enabled the rapid deployment of tests, vaccines and treatments, protecting health workers, saving lives and likely preventing the outbreak from spreading beyond the region, including to states -United.
This reflects a long-standing U.S. commitment to the research and development of medical countermeasures. During the Ebola outbreak in West Africa from 2014 to 2016, there were no vaccines or treatments to protect health workers or treat patients. As providers working in Ebola treatment units in West Africa – and one of us later as a patient after contracting the disease – we saw first-hand the consequences devastating effects of this absence. Since then, U.S.-funded research has led to the development of effective Ebola vaccines and treatments, tools that have proven essential in subsequent outbreaks and may one day prove essential in a national crisis.
Each year, many U.S. agencies – including the National Institutes of Health, the Biomedical Advanced Research and Development Authority, the Department of Defense, and the Administration for Strategic Preparedness and Response, among others – invest hundreds of millions of dollars in research and development of medical countermeasures. Without this funding, the global capacity to respond to emerging health threats would erode, making it more difficult to protect frontline health workers, provide lifesaving care to patients, and contain outbreaks before they spread. spread – potentially to US shores.
This is not to say that these agencies are perfect. The CDC’s National Outbreak Responses, particularly during the Covid-19 pandemic, have highlighted areas needing improvement. The NIH has also been criticized for bureaucratic inefficiency and layoffs. But these institutions have built immense scientific and operational capabilities over decades.
Reforms that streamline processes, improve responsiveness and increase transparency are essential. But punish these agencies are not seen as being excessive during Covid-19. To ignore the expertise and infrastructure they have cultivated would be dangerously short-sighted. Instead, we must refine — not discard — the global health apparatus that has protected Americans and millions of others around the world.
Equally concerning are misguided proposals like the “eight-year pause in infectious disease research” initiated by Robert F. Kennedy Jr., whom President-elect Trump intends to nominate for Secretary of Health and to Social Services. Infectious threats are unlikely to understand that they are supposed to take such a break. And by forgoing investment in critical areas – such as tools to combat antimicrobial resistance and vector-borne diseases caused by climate change, or harnessing synthetic biology and artificial intelligence to help us to combat infectious disease threats – the United States will fall behind the rest of the world. the world at our disposal. Microbes remain impervious to electoral cycles; parasites and pathogens are not swayed by partisan slogans.
The United States is the the largest funder and implementer of global health programsand it must remain so – regardless of who or which parties are in positions of political power. There is no wall high enough to protect us from the world’s array of pathogens.
Craig Spencer is a professor of public health and emergency physician at Brown University. Nahid Bhadelia is an associate professor of infectious diseases and founding director of the Center on Emerging Infectious Diseases at Boston University. She previously served as Senior Policy Advisor for the Global Covid-19 Response on the White House COVID-19 Response Team.