The US Government agency charged with combating disease outbreaks abroad is shrinking as Donald Trump’s “America First” approach to foreign policy takes hold, with concerned experts warning of the consequences of a reduction in personnel and resources, reports POLITICO.
The crucial Centres for Disease Control and Prevention (CDC) offices in Angola and South Sudan were both closed last Thursday, with the office in Zimbabwe due to shut its doors at the end of the year. Current and former CDC officials told POLITICO they expect more than a dozen other foreign offices will follow in the next few years.
It’s the latest blow to an agency that took a dual hit last year when Trump shut down the US Agency for International Development, its partner in providing foreign assistance, and Elon Musk’s Department of Government Efficiency slashed staffing. The CDC now has 30% fewer employees than when Trump took office.
“The office closures will result in preventable infections and death overseas,” said Asia Russell, the executive director of Health GAP, a non-profit advocating for access to HIV treatment.
“Who’s going to pick up the phone if there’s a Marburg outbreak and the Zimbabwe office has closed?” she said, referring to the severe haemorrhagic fever virus that has sparked outbreaks in several African countries recently.
The CDC has long been the lead agency tasked with responding to health threats abroad. Before the cutbacks, this included not only funding the distribution of tests and medicine but also encouraging people to seek treatment, training local healthcare providers and providing guidance to help foreign governments strengthen their health systems.
Now the CDC’s work abroad is dependent on deals the State Department is negotiating, in which recipient countries promise to pay an increasing share of their own health costs and show progress on key health and development metrics, with the goal of weaning off US assistance.
The administration insists that the CDC will get a boost. “Countries have now selected CDC services that will result in CDC overseas funding levels that are at or higher than prior years,” it said. “This new model will help save lives and prevent the spread of infectious diseases globally, delivering better results for people in countries and for the American taxpayer.”
The deals the State Department has already reached with 35 countries took effect in October. Foreign governments receiving US global health funding have to choose what services they want the CDC to provide, and the State Department pays the agency for them.
Angola and South Sudan, where CDC offices are closing, have signed. Angola is due to receive $71m by 2030, while South Sudan will get $146m over the next three years. But a combination of decreasing funding, operational restrictions from the State Department, and security challenges have made it hard to maintain the CDC offices there, said a current CDC official.
Meanwhile, the Zimbabwean Government earlier this year rejected a deal with the US, saying it was concerned about sharing sensitive health data in exchange for American funding.
The State Department has not publicly released the details of how much CDC services will cost countries that have signed deals, and how much the CDC will receive. Leaked documents published by journalist Emily Bass show that countries receiving more than $125m from the US over five years are required to purchase a minimum package of CDC services.
The State Department said only deals with Kenya and Rwanda would result in “slightly lower” CDC funding because their governments have agreed to pick up a greater share of health costs.
Last week, Zambia, which was due to sign a revised five-year agreement, said this pact would not include contentious clauses committing it to share patient health data and specimens with the US, and that the deal was worth $3.6bn in total combined funding from both countries.
AP reports that previous government statements indicate the US would provide $1.5bn over the five years.
The data-sharing clauses have been controversial.
Already, signed data and specimen-sharing agreements with at least nine of the African nations will commit them to sending data and specimens within five days of a request.
The US says it can then give the data and specimens to up to 10 American “non-government entities” to develop diagnostics and medical treatments. The entities are not specified.
The agreements say the information will help it track and prepare for new and emerging infectious diseases with “epidemic or pandemic potential”, but they do not guarantee that the African nation that provided the data would benefit from any medical treatments developed.
They would only receive treatments developed “subject to the availability of funds” and “behind the US Government’s domestic need”, according to the agreements. The African nation would also have to pay for them.
After Zimbabwe rejected the US health – partially over the data and specimen-sharing requirements, while Namibia also rejected some of these clauses – last month the US announced it had ended all health assistance to Zimbabwe, and has since announced it will also phase out funding for Namibia’s HIV treatment and prevention programme as well.
Ghana had also issued a similar rejection, saying after its cabinet had inspected the proposal, it was “thrown out in record time”.
‘Protect Americans’
HHS said in an emailed statement that the US “will maintain a robust overseas presence to protect Americans from emerging health threats”.
“The CDC will continue working with local health officials and sustain critical global health security capabilities through regional offices, headquarters staff, other US government personnel and implementing partners,” it added.
Current and former CDC staffers interviewed by POLITICO said they expected the CDC cuts would prove broader and bigger. “I don’t see the numbers adding up to a place where you can actually have a robust CDC presence in the same way,” said John Blandford, who retired last year after leading the CDC’s South Africa office.
For countries that eschew deals, the effects could be devastating, say people who work in global health. Much of the CDC’s work abroad has been funded by the President’s Emergency Plan for Aids Relief (Pepfar), created in 2003 and widely credited with saving millions of lives.
Pepfar’s goal, shared with the United Nations, is to end the Aids epidemic by 2030. Despite progress, that goal is slipping out of reach, the UN says, due in part to declining funding from the US and other rich countries.
An assessment by Aids activists and academics published in the Journal of Acquired Immune Deficiency Syndromes this month projects 75 000 new HIV infections in Zimbabwe resulting from the end of US aid there.
Pamela Tremont, the US ambassador to Zimbabwe, had praised America’s co-operation with the African country, which she said had led to a vast majority of Zimbabweans with HIV receiving treatment.
The priority now is to sustain that gain, she said, according to a Zimbabwe media report.
CDC cutbacks could also have repercussions for Americans. Agency staff abroad have served as an early-warning system for disease outbreaks that could reach the US. The CDC and its offices abroad are helping respond to the ongoing Ebola outbreak in central Africa.
When Trump withdrew from the WHO, Department of Health and Human Services officials said the US would rely on the CDC instead.
“This was the shining hope of the CDC for a little while, that HHS was going to offer an alternative to the WHO, and that CDC would be in the driver’s seat,” said a former Trump administration official.
Some in Congress have sought to protect the CDC’s funding stream for global health work by pressuring the State Department and by writing it into law, taking away the administration’s discretion.
Congressional Democrats have called on Secretary of State Marco Rubio to continue to earmark $2bn for the CDC’s Pepfar work, while earlier in the year, several senators and a Republican who chairs the Senate Health Committee, asked their colleagues in the Appropriations Committee to include the $2bn transfer from the State Department to the CDC in the upcoming appropriations Bill for the 2027 fiscal year or to directly increase funding for the CDC’s global work.
The Bill has not yet been released.
Politico article – Trump is conditioning foreign aid on deals
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