Our phones buzz with the same question every time an unusual outbreak makes the news: “What’s happening?” As physicians 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 are navigating through more questions than certainties. This was recently the case with reports of a “mystery illness” in the Democratic Republic of Congo (DRC).
Recently, the World Health Organization reported 406 cases and 31 deaths from an unknown disease in the Panzi health zone, a remote area more than 400 miles from the capital Kinshasa. While investigations initially explored multiple possibilities, the DRC’s health ministry is attributing the outbreak to severe malaria — a devastating disease, especially for children under 5, whose vulnerability is heightened by food insecurity and malnutrition in the region. The World Health Organization is running further testing.
This time, the culprit may be a known disease. But the initial uncertainty underscores a critical truth: In a world where pathogens are constantly emerging and evolving, we must have systems in place to rapidly detect, investigate, and respond — especially when it’s not a familiar foe.
It’s a global health cliché to say that what circulates in Congo today could be in Colorado tomorrow. But it’s also true. And in these situations, time to detection and response matters because it can translate to lives saved. As political shifts fuel calls to pull back our global presence, the United States must strengthen its partnerships and its commitments to outbreak surveillance, response, and research worldwide. Failure to do so amplifies health threats abroad and increases risks here at home. When a disease can traverse distant shores in a single airplane flight, maintaining and strengthening these investments and relationships is not only an act of global leadership, but also an essential investment in America’s own security.
The U.S. has long played a central role in building 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 outbreaks both domestically and globally. U.S. funding and expertise have since driven key initiatives like the Global Polio Eradication Initiative (GPEI) and the Integrated Disease Surveillance and Response (IDSR) systems. More recently, in 2016, the U.S. supported the creation of the Africa CDC to bolster public health capacity and response across the continent.
The President’s Emergency Plan for AIDS Relief (PEPFAR), while designed to combat the HIV pandemic, has arguably been the most impactful initiative for building global detection capacity. Launched 21 years ago, PEPFAR remains the largest single-disease global health investment ever made by any country, saving more than 26 million lives. From the start, it has funded laboratories, procured diagnostic equipment, trained local lab technicians, and built robust health information systems for monitoring and reporting reliable health data worldwide.
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 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 systems for disease detection could collapse, and millions of HIV patients may lose access to lifesaving medication — jeopardizing their health and risking a resurgence of the global HIV pandemic.
Programs to detect when outbreaks emerge are vital, but so is responding swiftly and effectively the moment a threat is detected. This is why the U.S. has also established an extensive overseas network of public health partnerships and field offices. The CDC operates in more than 60 countries, including in the Democratic Republic of the Congo, where the current “mystery illness” emerged. The CDC’s presence there since 2002 has provided essential access and trust, empowering American experts to work side-by-side on responding to outbreaks with local health authorities from the start.
These relationships are not forged overnight and require trust. Without deep, pre-existing ties built on years of cooperation, training, and shared surveillance, the U.S. would be just another outsider scrambling to negotiate entry and information at the outset of a crisis. Take the global effort to monitor and contain emerging influenza strains: U.S. support underpins a network of international labs that track new flu variants, giving health officials a head start on vaccine development and public health measures. Or consider the 2016 Zika outbreak, when close collaboration with Latin American partners, supported by U.S. funding and expertise, helped rapidly identify transmission hotspots and target mosquito control interventions.
The U.S. is heavily involved in developing and deploying medical countermeasures that stop outbreaks in their tracks. During a recent Marburg virus outbreak in Rwanda, U.S. funding enabled the rapid deployment of tests, vaccines, and treatments — protecting health care workers, saving lives, and likely preventing the outbreak from spreading beyond the region, including to the U.S.
This reflects a long-standing U.S. commitment to medical countermeasure research and development. During the 2014-2016 West African Ebola outbreak, there were no vaccines or treatments to protect health care workers or care for 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 firsthand the devastating consequences of this absence. Since then, U.S.-funded research has led to the development of effective Ebola vaccines and treatments, tools that have been critical in subsequent outbreaks and could one day be essential in a domestic crisis.
Each year, numerous U.S. agencies — including the National Institutes of Health, Biomedical Advanced Research and Development Authority, Department of Defense, and Administration for Strategic Preparedness and Response, and others — invest hundreds of millions of dollars into research and development of medical countermeasures. Without this funding, the global ability to respond to emerging health threats would erode, making it harder to protect frontline health care workers, provide lifesaving care to patients, and contain outbreaks before they spread — potentially to U.S. shores.
This is not to say these agencies are perfect. The CDC’s domestic outbreak responses, particularly during the Covid-19 pandemic, exposed areas in need of improvement. The NIH, too, has faced criticism for bureaucratic inefficiencies and redundancies. But these institutions have built immense scientific and operational capacities over decades.
Reforms that streamline processes, improve responsiveness, and enhance transparency are essential. But punishing these agencies for perceived overreach during Covid-19 is not. Discarding the expertise and infrastructure they have cultivated would be dangerously shortsighted. Instead, we must refine — not reject — the global health apparatus that has protected Americans and millions of others worldwide.
Equally concerning are misguided proposals like the “eight-year pause on infectious disease research” floated by Robert F. Kennedy Jr., whom President-elect Trump intends to nominate for Health and Human Services secretary. Infectious threats are unlikely to get the message that they are supposed to take such a pause. And stepping back from investing in critical areas — such as tools to combat antimicrobial resistance and climate change-driven vector-borne diseases, or harnessing synthetic biology and artificial intelligence to help us combat infectious diseases threats — will make the U.S. fall behind the rest of the world in our readiness. Microbes remain impervious to electoral cycles; parasites and pathogens are not swayed by partisan slogans.
The United States is the largest funder and implementer of global health programs, and it must remain so — regardless of which people or party are in positions of political power. There is no wall tall enough to shield us from the panoply of global pathogens.
Craig Spencer is a public-health professor and emergency-medicine physician at Brown University. Nahid Bhadelia is an associate professor of infectious diseases and the founding director of Boston University’s Center on Emerging Infectious Diseases. She was previously the senior policy adviser for global Covid-19 response on the White House COVID-19 Response Team.