Viruses do not respect national borders. They thrive when global cooperation on prevention efforts is interrupted. The White House, though, seems determined to learn these lessons the hard way. The chaos caused by recent executive orders affecting American science, public health and assistance is increasing the probability of another devastating infectious disease pandemic.
Since the president’s inauguration, the new administration has announced the U.S.’ withdrawal from the World Health Organization, the dismantling of the U.S. Agency for International Development, stop work orders and staffing reductions at the Centers for Disease Control and Prevention, and cuts to research awards from the National Institutes of Health. In the last month, CDC staff have been recalled from WHO headquarters in Geneva and forbidden to communicate with WHO colleagues.
Frighteningly, the fallout could have been even worse.
These actions are incomprehensible. The U.S. is an essential partner with WHO and should play a leadership role in the global response to emerging epidemics. The administration’s decisions don’t just threaten America’s leadership role in global health and science. They are exactly the wrong moves to make in order to prepare for and prevent the next pandemic.
Frighteningly, the fallout could have been even worse. The CDC’s iconic Epidemic Intelligence Service, which for 70 years has trained highly regarded “disease detectives,” was reportedly facing cuts before being spared at the 11th hour due to widespread outrage. But starting this week, CDC will be less prepared to respond to new disease outbreaks. Staff cuts across the agency will lead to weakened leadership and decision-making capacity. The leadership and systems that support EIS officers to respond to emerging health threats and infectious disease outbreaks, including the Laboratory Leadership Service, suffered severe cuts. Medical epidemiologists and laboratory scientists work hand-in-hand to counter disease outbreaks. Cuts to well-established training programs will have a chilling effect on CDC’s ability to attract and retain the world-class scientific workforce required to keep America and the world safe from disease.
We must heed the lessons learned during the past five years since the beginning of the Covid-19 pandemic, with its estimated 18 million excess deaths and unprecedented disruption. The world remains at high risk for another respiratory virus pandemic, especially from highly pathogenic avian influenza A (H5N1) that is circulating widely in the United States among poultry and cattle and is spreading to other species, including house cats and humans.
To date in the U.S., there have been limited H5N1 infections and disease in humans and only one human death. However, the longer H5N1 viruses circulate in mammals, the greater the probability that the virus will adapt to humans and develop the ability for efficient human-to-human transmission, putting the US and the world at risk of a new pandemic.
Two decades ago, H5N1 outbreaks decimated poultry flocks in multiple Asian countries and resulted in hundreds of human infections, mainly due to bird exposure. Mortality rates among infected humans exceeded 50%, compared to less than 1% for Covid-19. Fortunately, human-to-human H5N1 transmission did not take off; we may not be so fortunate the next time.
The U.S. will be seen as a pariah in the global community if it does not play a collaborative role in preventing the next major disease outbreak. Domestically, the U.S. Department of Agriculture (USDA), the Food and Drug Administration (FDA), CDC and state officials should cooperate to protect people, farms and livestock from H5N1. Therefore, it is essential that the White House rescind those executive orders that limit the activities of CDC or other agencies and prevent a coordinated response to the ongoing H5N1 threat. Any disruption to that cooperation will increase the likelihood of a pandemic. Globally, it is imperative that U.S. health agencies, including the CDC, NIH and USAID, remain fully engaged with WHO and global disease surveillance networks. These groups need to be able to share data that serve as a warning system and allow for early disease intervention measures. Viral surveillance and data sharing are essential to the design and formulation of diagnostic tests, preventive vaccines and drug treatments targeting the relevant viral strains. If the U.S. does not share data and cooperate, we cannot expect other countries to share their data and specimens from new infectious diseases with U.S. scientists, laboratories and pharmaceutical companies. In the worst case scenario, cuts to U.S.-based science and public health hamstring measures against H5N1 to such a degree that it yields a virus that is efficiently transmitted human-to-human and unleashed on the world. Such a strain would likely be called “the American virus.” The U.S. will be seen as a pariah in the global community if it does not play a collaborative role in preventing the next major disease outbreak. The American public must speak up to elected officials and policymakers, reminding them to do everything in their power to promote public health and science in the U.S. and globally and prevent another pandemic.
Timothy Mastro
Timothy Mastro is adjunct professor of epidemiology at the University of North Carolina at Chapel Hill. He has worked in public health for more than 40 years, including 20 years at the Centers for Disease Control and Prevention, and has served on committees for the World Health Organization, UNAIDS, PEPFAR and the National Institutes of Health. 
