On Saturday, Jan. 11, as we entered the final week of the Biden-Harris administration, I got a call about a suspected Marburg outbreak in Tanzania. Marburg virus disease is like its close cousin Ebola, but worse. It can have a mortality rate as high as 80% and, unlike at least one strain of Ebola, we do not have an approved vaccine or treatment for Marburg. Our best hope for protecting Americans when an outbreak like this occurs is to stop it at its source. When the World Health Organization heard about the suspected outbreak, one of their first actions was to alert the Centers for Disease Control and Prevention.
The call was not a complete surprise. These outbreaks are increasing in frequency — this was the 12th Marburg or Ebola outbreak we faced during the Biden-Harris administration. But we had made it to January 2025 without a single case of either disease in the United States. One of the reasons we were successful was that we had a plan in place — a playbook — for responding to biological threats, which we implemented quickly and aggressively every time there was a new outbreak. We had partners in place, from WHO to vaccine manufacturers, who were on standby and ready to act. We had emergency funding available that could quickly be redirected. And we had people — at the National Security Council and across federal departments and agencies — who had responded to countless biological threats, could get on a plane at a moment’s notice if needed, and, most importantly, who knew how to keep Americans safe.
As I’ve watched the Trump administration announce a series of actions that undermine our ability to detect and respond to biological threats, including stopping CDC staff from communicating or traveling and sending National Security Council staff home indefinitely, I wonder: Who is protecting the American people from Marburg right now?
Undermining the emergency preparedness system we have in place
In a slew of executive orders released on Jan. 20, the Trump administration announced its intention to withdraw the United States from the WHO, replace the 2024 U.S. Global Health Security Strategy (which closely mirrors a similar strategy released in 2019), and place a 90-day pause on foreign assistance, among other actions. It also put a pause on public communications from CDC and the Food and Drug Administration, and research funding from the National Institutes of Health. The Trump administration’s plans will sever ties with critical partners, cut our resources to stop outbreaks before they reach our shores, diminish our access to vital early warning data, slash the pipeline of innovative vaccines and treatments that could be used in an emergency, and hamper the ability of federal agencies to act quickly to warn Americans about emerging threats.
Perhaps the new administration plans to replace these with a new preparedness system, but what about the threats facing Americans right now? The highest responsibility for any administration is to protect the American people. When it comes to emerging biothreats, Americans deserve a government that runs like a well-oiled and efficient machine. We spent the last four years strengthening that machine. Sure, it could still be improved. But to get rid of it with nothing in its place is irresponsible and dangerous.
The playbook
When I got that call about Marburg on a Saturday afternoon, we immediately put our playbook into action. By Sunday morning, we had convened federal departments and agencies to assess the risk to the United States. (Our conclusion: This was a significant biological threat). CDC had a response team up and running by Tuesday, three days after learning of the threat, with support from the U.S. Agency for International Development and the State Department. Staff across the U.S. government had worked to issue travel guidance to Americans in Tanzania, determine the volume of travel from airports near the outbreak into the United States, and assess whether and how many experimental vaccines and therapeutics we had available for Americans if needed. We remained in close contact with key partners, from the private sector to multilateral institutions, to ensure they were prepared to respond. This — and more — happened within 72 hours, because early, aggressive action is how you protect the homeland. And we had that extra time to prepare because the World Health Organization alerted us to the threat more than a week before the outbreak was announced publicly.
Marburg and Ebola represent a significant risk, to be sure, but they are known threats. Next time, we could be facing an unknown pathogen that a country may not even acknowledge, in which case the WHO will likely have much more luck than the U.S. in gaining access and information. It could be a deliberate threat from an adversary, which the adversary might deny, and the world would look to the WHO as a neutral trusted voice. Or it could be a lab accident, which could be prevented with better guidance and training, and contained more quickly if we have eyes and ears on the ground.
To stop biological threats from coming to the United States, we need to know about them early, we need partners and resources to help quickly contain them, and we need countermeasures to respond. That was our plan to keep Americans safe. It worked for the last four years, and it’s our best bet to keep Americans safe for the next four.
What needs to happen in the next few days to protect Americans?
The Marburg outbreak has continued to evolve since the transition last week, but we have little visibility into what is happening. Scientific experts across the U.S. government have lost access to many of the tools they would normally use to protect Americans. Those tools, those data, would be needed for CDC to decide whether to elevate their travel health notice warning Americans who are planning travel to the affected region.
If I were still at the White House, I would be asking the Department of Homeland Security and CDC to follow up with travelers who recently arrived from the region to check whether they have symptoms of Marburg. I would ask USAID and CDC whether they have staff, resources, or supplies (diagnostic tests, for example) that they can surge to the response to help contain the outbreak before it spreads. I would ask the State Department to reiterate the U.S. offer of help to contain the outbreak to the government of Tanzania. And I would ask the Department of Health and Human Services whether we have vaccines or therapeutics that we can offer Tanzania to help contain the outbreak quickly.
I would be on the phone with WHO leadership to get the latest information on the outbreak, including from Director-General Tedros Adhanom Ghebreyesus, who traveled to Tanzania last week to help with the outbreak response. And I would be calling our closest outside partners — from industry to multilateral institutions — to ask what resources they can deploy quickly to protect Americans. It is unclear whether anyone is making those calls now. With CDC travel cancelled, the world’s leading experts on containing outbreaks are unable to head to Tanzania to help. And with the WHO relationship severed, it is hard to imagine that anyone is speaking to Dr. Tedros.
These outbreak responses are hard enough to get right when you have the support of political leadership to act quickly. There are plenty of experienced civil servants who know how to contain this outbreak, but if their ability to take quick decisive action is hampered even for a few days the window for quick action might close. Now is not the time to demolish our well-oiled machine. Instead, the United States should do what it does best — drive an effective and efficient response to stop outbreaks at their source. Because that’s the best way to save lives around the world, and to protect our homeland too.
Stephanie Psaki served on the National Security Council of President Biden’s White House, most recently as U.S. coordinator for global health security.