When Ebola occurred in Liberia, Sierra Leone and Guinea between 2014 and 2016, it spread widely because those countries did not have the public health systems they needed to stop the virus. The U.S. Centers for Disease Control and Prevention, with other international and national institutions, helped to supply material and expertise essential to end that outbreak. To prevent this kind of disease disaster from happening again, the U.S. government then ramped up its global infectious disease preparedness as part of a new international initiative called the Global Health Security Agenda (GHSA). Many international health efforts aim to improve the response to one disease, but the GHSA builds infrastructure that can control a broad range of biological threats. Though focused on developing countries, the initiative directly helps the U.S. because, unchecked, diseases such as Ebola will reach America's shores. This work, done mostly through the CDC and the U.S. Agency for International Development, has produced hundreds of valuable interventions directed at enhancing countries' capacities to detect, prevent and respond to dangerous infections.
Despite the successes, the budget outlined by President Donald Trump this winter cut funding for the GHSA to $59 million for the coming fiscal year. This is a sharp reduction from the $1 billion that Congress gave for the years 2014–2019. The CDC will need to start closing down many of its overseas health security programs if Congress—which ultimately sets spending levels—does not increase the allocation.
What would we lose? The CDC has been training laboratories in other countries to identify novel strains of influenza, where flu appears before it hits the U.S. In Uganda, programs have strengthened lab capacity and helped to build an emergency operations center and train field epidemiologists. As a result, Uganda recently detected an outbreak of yellow fever in three days; in 2010 it took 40 days to recognize a similar epidemic. In India, CDC-supported efforts helped remote hospitals start diagnosing the causes of mystery fevers and illness. In Sierra Leone, the initiative enabled the identification of 4,000 previously undetected cases of measles, which led to the vaccination and protection of more than 2.8 million children. And in parts of the world where naturally occurring anthrax still kills people and animals, the CDC has been helping provide technical aid to contain those events and diminish their impact. These are exactly the capabilities that the world needs to detect and respond to the next emerging infectious disease threat, which could be a known disease or a novel one attacking humans for the first time. The appearance of diseases such as SARS, 2009 H1N1, MERS, bird flu, Zika and others underscores the urgency.
Other attempts to meet this need have not succeeded. In 2005 many countries signed a commitment called the International Health Regulations, a legally binding agreement to develop core national capacity to contain public health threats. But by 2014 less than a third of the signing countries had fulfilled their responsibilities under the agreement to develop expertise and infrastructure. That is why the GHSA was launched.
In contrast to the earlier effort, more than 60 countries now have joined this initiative. After the U.S. signed on as an early and very strong proponent, additional countries and major international organizations followed by delivering substantial funding and material assistance. The more that countries collaborate to support the initiative, the less they need to spend on their own.
If the U.S. curtails its part in this collaboration, countries at highest risk for new epidemics will have a harder time building up diagnostic and testing labs that provide early warnings of spreading infections, and efforts to train and equip local scientists and public health officials will be hurt. These cuts will diminish the enormous international goodwill that comes from these and other programs that use U.S. science for global good—and protect Americans at the same time. The GHSA is this county's first line of defense in a world where the next deadly disease is just a short airplane flight away.