On Thursdays, the CDC releases their Morbidity and Mortality Weekly Report. It summarizes essential information about current or recent disease outbreaks, environmental health issues, or changes in public health policy. It’s all open access, so anyone in the public can read or subscribe if they’re interested. Almost 150,000 public health professionals are regular subscribers to the MMWR.
You might not be surprised to learn that this week, the entire issue was about Ebola. The Notes from the Field about the current outbreak in the Democratic Republic of the Congo (DRC) and Uganda pointed out that as of June 2, a total of 378 confirmed cases and 63 confirmed deaths have been reported. It also gives more background on this particular strain of Ebola—Bundibugyo virus disease, or BVD—which is rare, and has no vaccine or licensed treatments (unlike the Zaire strain, which is much more common).
But perhaps the most interesting part is the language listed at the top under the heading “What are the implications for public health practice?” That’s where it (rightly) says, “To help reduce the risk for continued spread of Bundibugyo virus, including potential spread beyond DRC and Uganda or importation to the United States, ongoing collaboration between CDC and international partners and coordination among U.S. government agencies are essential.” Remember that – we’ll come back to it.
The MMWR also lays out the assessment of risk to the US population from this outbreak, reminds U.S. clinicians of the CDC guidance about viral hemorrhagic fevers in case they suspect a patient might have it, and provides a series of projections about how big this outbreak might get, modeling a few different scenarios for how well cases are being identified and isolated to prevent spread. The abstract highlights results from one of the best case scenarios (70% of cases entering isolation centers), though the full article notes that if only 20% of patients with BVD are identified and isolated, the likelihood of an outbreak that exceeds 20,000 cases within the next 3 months is 65%, and ≥4000 deaths within 3 months is 69%.
For comparison, the largest Ebola outbreak in history was the 2014–2016 West African epidemic, which resulted in 28,610 reported cases and 11,308 deaths from the Zaire strain, primarily across Guinea, Liberia, and Sierra Leone. This outbreak started in March 2014 and lasted until June 2016 – more than two years. You might recall that during that outbreak, there were 4 confirmed cases in the United States, two of whom were nurses who actually contracted it in Dallas after caring for a man who came from Liberia and fell sick after returning to Texas. (He died; the two nurses recovered.) After that happened, more than a billion (with a B!) taxpayer dollars were spent to establish and sustain a world-class network of biocontainment treatment centers specifically designed for situations like this, so we can prevent nurses from getting sick in the future, and make sure a person with Ebola on U.S. soil has the best possible chance of survival.
Ebola is a disease of movies and nightmares. But the same thing that makes it so scary (that it kills people very quickly)—plus the extremely important fact that it’s not airborne—make Ebola a very poor candidate for a global pandemic like COVID-19. The problem is that it spreads when people show compassion to a loved one who is sick or has just died, and thus come into contact with their highly infectious bodily fluids (which are, tragically, part of the disease’s classic symptoms—the advanced stage of disease is known as the “wet” stage, and only takes 4-5 days to appear). If your child suddenly started showing signs of Ebola, would you stay away and call someone to cart them off to an isolation center, maybe never to be seen alive again? Or would you do your best to care for them, even if it meant risking your own life? That’s exactly why these outbreaks are so hard to contain.
So why am I writing about Ebola in this Substack?
You may have guessed that I’m not just writing this to teach you the basics of Ebola. I’m writing because what’s happening now is exactly what public health professionals have been fearing since January 2025.
It might not surprise you to know that despite the CDC’s assertion that “ongoing collaboration between CDC and international partners and coordination among U.S. government agencies are essential,” our general approach to this outbreak is better characterized as “America First.”
Now, I don’t want to overstate it. There are brave and brilliant people working at CDC and as part of the Public Health Commissioned Corps who are doing their damnedest to help control this outbreak, and protect people in the DRC, Uganda, and elsewhere, not just the US. But the Trump administration is sending these folks there with a new policy: The Wall Street Journal reported last week that the U.S. was planning to construct a makeshift field hospital in Kenya for Americans exposed to or infected with Ebola. Until now, Americans who were infected with Ebola (or any other similar terrible disease) would be brought back to the U.S., so they could receive the best possible medical care. And actually, U.S. citizens have an unqualified constitutional right to enter the United States, per a landmark Supreme Court decision made way back in 1898.
A group from the prestigious O’Neill Institute at Georgetown (many of them members of Defend Public Health, the group I’ve been working with for the last 15 months or so) wrote a letter with profound concern about the plan to relocate Americans to Kenya:
US taxpayers have invested more than a billion dollars to build a network of biocontainment units in major hospitals across the country. These are intensive care units that are engineered to provide maximum biocontainment coupled with the highest standard of care. They require years to design and build and extensively trained staff to safely execute complex clinical interventions without risking self-exposure. The safety record is clear: zero onward transmission to healthcare workers has occurred in these units. Every Ebola patient treated in a US unit survived due to the heroic efforts of the highly trained clinical care teams treating them. In the proposed Kenyan facility, US citizens would be in a makeshift facility that almost certainly cannot provide a level of biocontainment or security comparable to that of a US unit. It would be staffed by personnel with only minimal training, which is insufficient for ensuring robust infection control, adequate biosafety and biosecurity, and high-quality care.
Remember those brave members of the US Public Health Commissioned Corps? They get deployed places, whether they like it or not, similar to the military – they are active duty non-combatant personnel. So some of them are getting sent to Kenya to take care of Americans sent to this new make-shift facility. WaPo reported that in some cases, just three days of training are being offered to them before deployment. Sure, they have public health training. But most of them are not Ebola experts. How would you feel about three days of training before being sent into an Ebola hot zone to provide medical care, if you weren’t already an expert in Ebola??
As the Director of the WHO Center on National and Global Health Law wrote in an editorial on MedPage Today, “Replacing specialized domestic hospitals with a hastily erected facility at a Kenyan air base risks American lives. The Bundibugyo is a rare virus strain for which there are currently no approved vaccines or targeted therapeutic treatments. Managing it relies on high-level supportive care….expecting PHS personnel — many of whom are being deployed rapidly into a fluid environment — to maintain rigid Level 4 biocontainment protocols in a temporary field hospital is unrealistic. The risk of occupational exposure for frontline staff is unacceptably high. If an infection control breach occurs, PHS staff could be exposed to a highly pathogenic virus. The administration is compromising patient outcomes and workforce safety to keep the virus physically off U.S. soil.”
Not to mention, remember that MMWR article that said the outbreak will likely remain pretty small, as long as ≥70% of people with Ebola are identified and properly isolated? What do you think happens when you tell people they’ll be forced to go to a hospital in Kenya that was built in a week, if they are exposed to Ebola? Do you think they’re going to speak up the minute they know something’s wrong? If they knew they’d be able to receive the best possible care at one of the biocontainment centers in the U.S. built and maintained specifically for this purpose, they’d speak up right away so they could benefit from that stellar care. In this situation? They’re much more likely to wait and cross their fingers, until they can’t avoid it anymore…or try to get themselves back to the U.S. before anyone realizes what’s happened. This is life or death. Any of us would be inclined to do the same.
I believe that career scientists at the CDC really believe that “ongoing collaboration between CDC and international partners” is “essential,” and are doing their best to act in a collaborative manner. But they’re being undercut by an executive branch that is sending a message that Americans are too important to take on any risk from Ebola—despite our state-of-the-art facilities that have already been proven to be able to treat people with Ebola in them safely—and so we’d prefer to send them to your country instead. Implied (barely): Because you’re less important than we are.
Kenya isn’t taking this lying down. Last week, U.S. officials went on record saying that the facility would only be open to Americans, and any Kenyans (or others) who fell sick with Ebola would be out of luck. The facility was supposed to actually open this week. But a Kenyan court temporary blocked it from opening, pending another hearing that isn’t even going to be scheduled until June 23rd. The court ordered Kenya’s government to provide details of the agreement it struck with the U.S. over the facility, including financial agreements and whether it would be open to all nationalities, or kept exclusive to Americans.
So at least for now, we’ll have to fly Americans home if they become exposed or sick—or send them to another country willing to take them in, and pretend it’s because of the shorter flight time. Meanwhile, we’re pulling that old “travel ban” out of Trump’s toolkit of favorite harmful and ineffective policies: rolling out new entry restrictions that say that if you’re not a U.S. citizen and have been in the DRC, Uganda, or South Sudan, then you can forget coming to the US. If you’re a U.S. citizen, the new rules say you can only re-enter through Dulles (Washington D.C.), Atlanta, JFK (New York City), or Houston. That sounds reasonable, since presumably people at those 4 airports would be specially trained, and on high alert to make sure Americans stay safe. That’s what all this is about, right? Except this policy was announced on May 21, and on May 24 Laura Kelly arrived to Dulles after having been in Uganda, and no one gave her a second glance. (Spoiler alert: Laura Kelly is white.) So this strategy is going great so far.
The real tragedy?
Here’s the bottom line: We live on an interconnected planet. There are about 50 million airplane seats that fly internationally every single week, and if you’ve flown internationally in the last decade or so, you know that a huge percentage of those have a human sitting in them. Viruses don’t care about international borders, and they don’t care what passport a human body holds when they have the chance to invade. The best way to keep Americans safe from deadly infectious diseases is to invest in international public health infrastructure that keeps people safer everywhere. But despite a long history of the U.S. government doing exactly this, Trump and his cronies have spent the last 18 months doing exactly the opposite.
Let’s start with USAID. Before being dismantled in 2025, USAID used to run the U.S.’s Disaster Assistance Response Team (DART) program, which served to integrate and coordinate the response of USAID, CDC, the State Department, the Department of Defense, WHO, and any other countries’ Ministries of Health during a disaster. In the 2018-2020 Ebola outbreak, USAID managed funding for disease surveillance, lab testing, and investigation of cases and their contacts who may have been exposed, plus oversaw awards to partners in the DRC to help strengthen their systems and bring the outbreak to a close as quickly as possible. Now that there’s no USAID, it’s unclear whether a DART could or would be established and sent to deal with Ebola this time.
Plus, starting in 2009, USAID’s Emerging Pandemic Threats program had been running a project called PREDICT, which strengthened global capacity for early detection of viruses with pandemic potential. The real irony here is that Trump ended PREDICT in…wait for it…March 2020, during his first time in office. MARCH 2020! (On April 1, when half the country was sheltering in place, they got a $2.3 million dollar extension for 6 months as an emergency measure, and then that was it.)
PREDICT actually helped discover an emerging strain of Ebola—Bomboli ebolavirus—in 2018. Might it have been helpful in detecting this current outbreak before it had already gotten so far out of hand? I’ll let you draw your own conclusions.
USAID fell victim to Elon Musk’s chainsaw. Public health professionals were screaming as loudly as possible that the dismantling of USAID and other public health infrastructure at the hands of DOGE was going to spell disaster in the future. And here we are. Defend Public Health’s Tara Smith recently put it very well in an op-ed on MS Now:
In February 2025, Elon Musk admitted the Department of Government Efficiency had accidentally canceled Ebola prevention. He said it was restored “immediately,” but government documents show otherwise…[and] funding from the U.S. Agency for Intentional Development was cut from $1.2 billion to $715 million. In the first three months of fiscal 2026, USAID sent just $67 million. And the Trump administration’s withdrawal from WHO in 2025 reduced the organization’s funding, further hobbling efforts in the area and leaving the U.S. on the sidelines.
It’s not just USAID that’s gone, or the WHO that’s been partially hobbled by our selfish federal policies. In 2024, the U.S. provided $33 million in aid directly to the DRC, to help prop up their health and social sector systems. In 2025, that number fell to less than $10 million. Some people say that the DRC needs to take care of their own country, and shouldn’t be relying on the United States. But here we are back to the point about being an interconnected planet. Withdrawing that much aid that quickly caused a cascade of problems that severely weakened the DRC’s infrastructure.
And now the Ebola outbreak in the DRC in 2026 is everybody’s problem.