Imagine if your town had been especially fire prone with fires that threatened to spread to the rest of the city. City officials created a fire prevention fund for nearly 40 parts of town prone  to fire.  While work remained to be done, the funds ran out. Elected political leaders decided that since the town had not experienced a significant fire for two years, there was no need to spend any more money.

That strategy make little sense, but it appears to be the one the Trump administration is adopting by failing to renew funding for CDC and USAID disease prevention efforts in about 40 countries around the world. Those funds will run out in 2019.

Unlike climate change, global health made it into the Trump Administration’s new National Security Strategy:

We will work with other countries to detect and mitigate outbreaks early to prevent the spread of disease.

It appears that the Trump Administration is not taking the threat seriously. This underscores what Tom Wright recently observed in The Atlantic that the Trump Administration is undermining its own national security strategy by failing to act to address threats such as the rise of revisionist powers. The same goes for pandemic preparedness.

How did we get here?

Remember that it was not that long ago–2014–when the Ebola virus emerged in West Africa and over two years claimed the lives of 11,000 people and infect more than 28,000, with real fear that it might not be contained to Liberia, Sierra Leone, and Guinea. In December 2014, Congress appropriated $5.4 billion for Ebola response, including $1 billion to help developing countries prevent disease outbreaks to support Global Health Security Agenda or GHSA.

The Washington Post’s Lena Sun reported that the CDC began notifying partner countries that the money would not be renewed:

Two weeks ago, the CDC began notifying staffers and officials abroad about its plan to downsize these activities, because officials assume there will be “no new resources,” said a senior government official speaking on the condition of anonymity to discuss budget matters.

The Wall Street Journal’s Betsy McKay reported that the lack of funds would force the CDC to reduce work from 39 to 10 core countries:

The 10 countries where global health security activities will remain are India, Thailand, Vietnam, Kenya, Uganda, Liberia, Nigeria, Senegal, Jordan and Guatemala, according to the email—countries of strategic or regional importance for the CDC.

Some of the countries likely affected by the lack of new funding include the Democratic Republic of Congo (which recently had a new Ebola outbreak) and China, which recently experienced another bird flu outbreak. The countries on the expanded priority list should CDC get some more money include, China, the DRC, Ethiopia, Indonesia and Sierra Leone.

What did the money pay for?

Roughly 2/3 of the $1 billion supported the CDC with the remaining $300 million allocated to USAID. The Atlantic’s Ed Yong reported that funds supported a number of activities:

Thanks to the GHSA, Uganda now has a secure lab for studying dangerous germs. Tanzania has a digital communications network so people can phone in information on potential outbreaks from remote locations. Liberia has more than 115 frontline disease detectives trained by the CDC. Cameroon shortened its response time to recent outbreaks of cholera and bird flu shortened from 8 weeks to just 24 hours. The DRC controlled an outbreak of yellow fever and built an emergency operations center (EOC)—a kind of war room for responding to outbreaks.

Here are some other activities The Wall Street Journal  reported that the program supported:

Professionals trained in the initiative have helped quickly contain an anthrax outbreak in Kenya and yellow fever in Uganda and identify over 4,000 cases of measles in Sierra Leone.

The Atlantic reports that this money has been spent well:

That money has been used well, to train epidemiologists, buy equipment, upgrade labs, and stockpile drugs. If it disappears, progress will halt, and potentially reverse. The CDC, for example, would have to pull back 80 percent of its staff in 35 countries, breaking ties with local ministries of health.

What are the consequences?

We are more likely to end up fighting disease outbreaks over here if we do not contain them at the source in other countries. It will cost more and like lead to needless loss of life. Former CDC director Tom Frieden warns of the consequences in The Atlantic:

“We’ll leave the field open to microbes,” says Tom Frieden, a former CDC director who now heads an initiative called Resolve to Save Lives. “The surveillance systems will die, so we won’t know if something happens. The lab networks won’t be built, so if something happens, we won’t know what it is. We can’t be safe if the world isn’t safe. You can’t pull up the drawbridge and expect viruses not to travel.”

Echoing my fire defense metaphor, Carolyn Reynolds of the NGO PATH was quoted in the Post about the unfinished work in the DRC on the operational center that was built there last year but where officials still need to be trained:

This next phase of work may be at risk if CDC cuts back its support, she said. “It would be akin to building the firehouse without providing the trained firemen and information and tools to fight the fire,” Reynolds said in an email.

Concluding Thoughts

As Jeremy Youde wrote here on the Duck ,the Trump administration has not put its best foot forward of late with the CDC. The new CDC director, Brenda Fitzgerald, resigned all of a sudden last week, when it was revealed that she had bought stock in tobacco companies after she took the CDC job. Good grief.

The Trump administration, under OMB budget cutter in chief Mick Mulvaney has proposed vast cuts to foreign aid. The CDC has about $150 million left for the GHSA. Let’s hope that their next budget proposal includes more money for preparedness efforts. If the Trump Administration budget won’t fund this core threat properly, let’s hope Congress does.

Postscript: I wanted to come back to Tom Wright’s piece on the liberal order. Wright warned that the America-first approach of the Trump Administration has a major downside:

But if the United States follows the examples of Russia and China and elects to define its interests so narrowly, it reduces the appeal of the American model of international order. Little would differentiate America from the other great powers that aspired to leadership, either now or in the past.

Both the Obama administration and the previous George W. Bush administration backed ambitious global health policies that were not only good for the United States, they were good for the world. There were tangible benefits for people in partner countries that created a reservoir of goodwill towards the United States. By lowering its sights to “what’s in it for us?,” the Trump Administration will not only hurt its only interests in stopping pandemic diseases but make it harder for other countries to cooperate on issues it cares about.