Gutting Global and Local Outbreak Response Threatens Us All

Author: Sylvia He, PhD & MBA

April 30, 2025

[Image credit: ImageFlow/Shutterstock.com via WorldAtlas]

Introduction

From losing close to 40% (25 million) of the Europeans to the Black Death to helping more than 99%, or 8 billion, of the global population survive the COVID-19 pandemic, we have made great strides in fighting infectious diseases.

Scientific advancements in treatment, such as drugs to fight bacteria, viruses, and parasites, as well as hydration therapy for cholera and dysentery, have saved millions of lives. More importantly, we have learned to protect many millions more by identifying the specific pathogen causing a disease, tracking its spread across communities and countries, and treating it appropriately with vaccines or medication so that a local outbreak does not explode into a regional epidemic or international pandemic.

Such herculean efforts depend on international cooperation and the sharing of knowledge and best practices between institutions, such as the World Health Organization (WHO) and government agencies of different countries. For example, vaccine development during the COVID-19 pandemic succeeded due to close international collaboration and coordinated large-scale government-funded initiatives, such as Operation Warp Speed.

After COVID-19, we should be discussing how we can repair and buttress those already burdened with rising costs and nurse and physician shortages with better strategies and methods for future pandemics. However, we are facing the inexplicable cancellation of the United States Agency for International Development (USAID) programs that are pillars of the global outbreak response. Furthermore, the billions in federal funding for state health services that are essential for regional and local outbreak response have been cut.

Gutting the USAID and local response programs will not only have a significant adverse impact on the world but also affect how Americans can respond to future virus outbreaks, epidemics, and pandemics. In the end, our collective survival and fundamental right to health will be in danger.

Tracking and testing for dealing with emerging viruses

Effective disease tracking and testing is our first-line defense against infectious diseases. Without it, we cannot effectively get to the next steps—providing appropriate patient care or developing the most effective vaccines or drugs.

Disease tracking and testing are especially crucial for emerging viruses, some of which are more fatal than the COVID-19 virus, such as Ebola and Marburg. While vaccines have been effective in saving millions of lives over the past 50 years, we do not have vaccines for many of these viruses. Therefore, they need to be identified and tracked so that health authorities can act to contain their spread and treat the cases early before they become more severe and harder to treat.

Outbreak tracking relies on a vast network of healthcare providers, laboratories, and public health agencies that report and analyze unusual illnesses in various countries and regions. They do this work to identify patterns, confirm the virus using lab tests, and use contact tracing to determine how the virus has spread, to whom, and where to contain the outbreak. In parallel, they share data to coordinate and deploy personnel to the field.

Over the years, the U.S. has built up programs for outbreak tracking in a bipartisan effort, such as the National Health Survey during the Franklin Roosevelt administration, the Centers for Disease Control and Prevention (CDC) during the Truman administration, and the National Strategy for Pandemic Influenza during the Bush Senior administration. In addition, USAID, established by the Kennedy administration, was designed to administer foreign aid and provide staff to help countries respond to outbreaks. The CDC, tasked to initiate human health responses to areas with outbreaks, plays a key role in the U.S.’s global response to health emergencies.

Virus outbreak response programs under attack

Right now, these response programs, set up to respond to emerging viruses that do not have vaccines or effective treatment, such as Ebola and Marburg, are all under attack.

The recent cuts at the CDC have laid off a large number of workers involved in various steps of outbreak tracking. The CDC’s Laboratory Leadership Service (LLS) program, which trains Ph.D. researchers to lead labs that perform virus testing, is essential for monitoring and controlling transmission. LLS fellows were involved in testing for Dengue fever in American Samoa in 2016, COVID-19 in Arizona in 2020, and Oroporche virus in Florida in 2024. Cutting the LLS program will deprive outbreak responses of the first responders who develop and perform tests.

Entry point screening is also affected. Port health stations, which screen human travelers and animals for dangerous pathogens at airports and land border crossings, are the first line of defense. After the cuts, 3 out of the 20 port health stations have no CDC staff, and 10 have no officer in charge. Another CDC program involves overseas traveler screening, which aims to prevent cases from reaching the U.S. Although this program was instrumental in preventing the export of cases, such as in Uganda, it has also been cut.

Meanwhile, at USAID, the outbreak response team of about 60 people has been cut down to 6. Those who were fired included USAID’s leading expert in lab diagnostics and the manager of the Ebola response team. The original Ebola team of 10 is now down to one. In addition, almost all of its funding to other countries has been cut.

Although the Trump administration insisted that the Ebola team was rehired, the members of other response teams were not. More importantly, the cuts to USAID have left the global response programs fundamentally damaged and hollowed.

We already have a before vs. after picture. In late 2024, the CDC promptly responded to a Marburg virus outbreak in Rwanda, helping limit the damage to 66 illnesses and 15 deaths. Now, Ugandan health workers are struggling to get in touch with the CDC in a timely manner, according to Craig Spencer, an American epidemiologist who survived Ebola himself in 2014. He also worries that, without robust US global public health funding and infrastructure, “Outbreaks will be worse on the ground, and get bigger quicker.”

Impact on Emerging Viruses

The USAID cuts coincide with many imminent outbreaks. There is the Ebola virus in Uganda, the Marburg virus in Tanzania, and the Lassa virus in Nigeria and Sierra Leone. In addition, the mpox outbreak in the Democratic Republic of Congo, the deadliest in history, is exploding into a dozen other African countries. Lastly, the H5 bird flu crisis in the U.S. is worsening.

The Ebola virus has an average death rate of 50% and 40% to 60% for the Sudan strain currently exploding in Uganda. The Ebola vaccine is only to be used during an outbreak. It is not in large-scale production and is not ready for immediate deployment in epidemics or pandemics.

The Marburg virus has an average fatality rate of 50%.

The Lassa virus has a general fatality rate of 1% and 15% or higher for hospitalized patients. There is already one recent death in the U.S., likely due to Lassa.

As one of the fired officials of the originally 60-person outbreak response team, now down to 6, put it, “I have no idea how six people are going to run four outbreak responses.”

While mpox is usually less deadly, it still has a death rate of 1% to 10%. Additionally, the bird flu has crossed over to people in the U.S. and caused one death so far. While the current public health risk is low, in 1997, a bird flu outbreak in Hong Kong infected 18 and killed 6.

According to internal USAID memos by Nicholas Enrich, acting assistant administrator for global health at USAID, the cuts to foreign aid will mean, every single year, more than 28,000 new cases of highly infectious diseases, including Ebola and Marburg, will emerge. Given that the average fatality rates of Ebola and Marburg are 50%, the new infections could translate to thousands, if not tens of thousands, of deaths.

Fighting Old Battles Again

In addition, cutting USAID funding will result in 2 to 3 million additional deaths from lack of vaccination. Specifically, cuts to malaria programs, such as the Amazon Malaria Initiative, will increase malaria cases by up to 18 million and deaths by 166,000, or more than 20% of those infected. In 2023, 597,000, 76% of whom are children under 5, died of malaria. Moreover, one million children will not be treated for severe acute malnutrition, and many will die as a result.

Lastly, 200,000 new cases of paralysis will emerge in children due to a lack of polio vaccines. The likely re-emergence of polio is especially poignant. It was due to an international effort across borders and even political ideologies between the USSR and the U.S. that polio was eradicated, preventing close to 30 million cases and saving an estimated 1.5 million children from death.

HIV Re-emerging

USAID cuts are also making HIV an emerging virus again.

HIV patients taking the HIV antiretroviral therapy (ARV, also known as “the HIV cocktail”) are essentially virus-free and will not transmit the virus to their sexual partners. When a patient stops taking the cocktail, HIV will start multiplying again.

South Africa has the highest number of people living with HIV at 7.7 million, of which 5 million receive the HIV ARV. The programs providing the ARV receive significant funding from USAID. There are also millions of HIV patients in Haiti, Kenya, Lesotho, South Sudan, Burkina Faso, Mali, Nigeria, and Ukraine who rely on USAID funding.

With USAID cuts, hundreds of thousands, even millions, of HIV patients will no longer have access to medications. Since HIV does not have a vaccine, these patients will, in effect, become HIV-positive again. In other words, the pool of HIV carriers will suddenly increase by millions, and we will have an instant epidemic.

Discontinuation of the HIV cocktail regimen may cause the onset of symptoms, deterioration of health, and even death for the patients. Furthermore, tuberculosis is the leading cause of death for people who develop AIDS. USAID cuts also affect tuberculosis programs, worsening the situation for HIV patients. The modeling by the Desmond Tutu Foundation suggests that the funding cuts will cause 2 to 3 million HIV-related deaths in South Africa in the next 10 years. This point was echoed by WHO Director-General Tedros Adhanom Ghebreyesus, who said these cuts could lead to over 10 million additional HIV cases across 8 countries, 7 in addition to South Africa.

If we need more clues as to what happens when outbreak response programs are taken away, we can look to the 2012 to 2014 Ebola outbreak, the largest in history, which did not have outbreak response programs.

During the critical early phase of the outbreak, not enough was done by the U.S., the WHO, or any of the other countries involved. They squandered the opportunity to keep it under control when the case numbers were small, according to Jeremy Konyndyk, who oversaw USAID’s response to the outbreak. Consequently, it reached urban areas and began spreading in capital cities in West Africa. The problem became so dire that it required the deployment of the U.S. military, including close to 2,700 soldiers, a disaster assistance response team from the CDC, and billions of dollars in U.S. funding. In the end, more than 28,000 people were infected, and 11,000 people were killed in West Africa, primarily in Guinea, Liberia, and Sierra Leone.

Measles Re-emerging

As in the case of HIV, other normally controllable viruses, such as measles, will cause outbreaks in the absence of appropriate prevention.

Measles, a virus declared “eliminated” in the U.S. back in 2000 and 93% to 97% preventable with vaccination, is highly contagious and can cause death. Right now, there are 3 different measles outbreaks in the U.S. across 17 states. There are close to 400 cases, the majority of which are in Texas. Federal funding cuts for state health services will deprive critical support to state health services and likely exacerbate the situation. So far, there have been two deaths.

Conclusion

If you think Americans will remain unaffected because outbreaks that begin overseas remain overseas, remember that the Black Death started as a Central Asian problem and spread to Europe. The Spanish flu originated in the American Midwest and was transmitted across the Atlantic. HIV and Ebola started in Africa before going global. COVID-19 began as an outbreak in China, an ocean away. They have the perfect platform to spread in the globalized world since billions of passengers fly in tens of millions of flights annually.

Outbreak response is underappreciated because it works in the background or largely overseas so that Americans can go on with their lives without giving much thought to viruses and pandemics. It should be bolstered and strengthened if we have learned anything from the COVID-19 pandemic.

Any damage done to the global outbreak response threatens our livelihood and the right to a healthy life. Randomly destroying it should be the last thing to do.

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Glossary

• Black Death: A pandemic caused by the bacterium Yersinia pestis that killed approximately 30% to 50% of the European population in the mid-1300s.

• CDC: Centers for Disease Control and Prevention, the national public health agency in the United States under the Department of Health and Human Services.

• COVID-19: A pandemic caused by SARS-CoV-2, a coronavirus, with more than 7 million deaths from 2019 to the present.

• Dengue virus: A mosquito-borne virus that causes dengue fever.

• Ebola virus: a virus that causes severe and often fatal hemorrhagic fever in humans and other mammals.

• Epidemic: The rapid spread of disease due to a large number of hosts in a given population within a short period.

• Epidemiology: the study and analysis of the distribution (who, when, and where) patterns and determinants of health and disease conditions in a defined population and the application of this knowledge to disease prevention.

• FDA: The Food and Drug Administration, an agency of the Department of Health and Human Services responsible for protecting and promoting public health.

• HIV cocktail: Also known as antiretroviral therapy (ART), a combination of antiretroviral drugs used to treat HIV infection. 

• Infection: The invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to pathogens and the toxins they produce.

• Lassa virus: The virus that causes Lassa hemorrhagic fever, a type of viral hemorrhagic fever, in humans and other primates.

• Marburg virus: a virus that causes a rare but severe hemorrhagic fever that affects both people and non-human primates.

• mpox: Also known as monkeypox, a viral disease caused by the monkeypox virus that can occur in humans and other animals.

• Oroporche virus: The virus that causes Oropouche fever, a rapid fever illness.

• Outbreak: A sudden increase in the occurrence of a disease when cases are in excess of normal expectancy for a given location or season.

• Pandemic: A virus epidemic that has a sudden increase in cases and spreads across a large region, such as a continent.

• Pathogen: a bacterium, virus, or other microorganism that can cause disease

• Preventive care: The application of healthcare measures to prevent diseases.

• Spanish Flu: Also known as the 1918-1920 flu pandemic, caused by the H1N1 subtype of the influenza A virus.

• Tuberculosis: A contagious disease usually caused by Mycobacterium tuberculosis bacteria.

• Vaccine: A biological preparation that provides active acquired immunity to a particular infectious agent.

• Virology: The study of viruses.

• USAID: The United States Agency for International Development, an independent agency of the U.S. government responsible for providing civilian aid and development assistance to foreign countries.

• WHO: The World Health Organization, a specialized agency of the United Nations responsible for global public health.

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Sources

1. Adedeji, WA. (2016). The treasure called antibiotics. Annals of Ibadan Postgraduate Medicine. 14(2):56-57. https://pmc.ncbi.nlm.nih.gov/articles/PMC5354621/

2. Air Transport Action Group. (n.d.) Facts & Figures. https://atag.org/facts-figures#:~:text=The%20estimate%20for%202024%20is%205%20billion%20passengers.&text=In%202023%2C%2035.3%20million%20scheduled,some%2096%20million%20aircraft%20movements.&text=8.17%20trillion%20Revenue%20Passenger%20Kilometres,flown%20by%20passengers%20in%202023

3. Anyaogu, I. (2025). Nigeria steps up fight against Lassa fever outbreak after 98 deaths this year. Reuters. https://www.reuters.com/business/healthcare-pharmaceuticals/nigeria-steps-up-fight-against-lassa-fever-outbreak-after-98-deaths-this-year-2025-03-11/

4. Badizadegan, K., Kalkowska, D.A. & Thompson, K.M. (2022). Polio by the Numbers—A Global Perspective. Journal of Infectious Diseases. 226(8):1309–1318. doi: 10.1093/infdis/jiac130

5. Balasubramanian, C. (2025). How to track virus outbreaks: An overview of disease surveillance. https://www.gideononline.com/blogs/how-to-track-virus-outbreaks-an-overview-of-disease-surveillance/

6. Barry, J.M. (2004). The site of origin of the 1918 influenza pandemic and its public health implications. Journal of Translational Medicine.2:3. doi: 10.1186/1479-5876-2-3

7. Centers for Disease Control and Prevention. (n.d.) About The Laboratory Leadership Service (LLS). https://www.cdc.gov/lls/php/about/index.html

8. Centers for Disease Control and Prevention. (n.d.) Are you up to date on your preventive care? https://www.cdc.gov/chronic-disease/prevention/preventive-care.html

9. Centers for Disease Control and Prevention. (n.d.) Clade I mpox Outbreak Originating in Central Africa. https://www.cdc.gov/mpox/outbreaks/2023/index.html

10. Centers for Disease Control and Prevention. (n.d.) Ebola Outbreak Caused by Sudan Virus in Uganda. https://www.cdc.gov/han/2025/han00521.html

11. Centers for Disease Control and Prevention. (n.d.) Fast Facts: Global measles. https://www.cdc.gov/global-measles-vaccination/data-research/index.html

12. Centers for Disease Control and Prevention. (n.d.) H5 Bird Flu: Current Situation. https://www.cdc.gov/bird-flu/situation-summary/index.html

13. Centers for Disease Control and Prevention. (2016). Overview, Control Strategies, and Lessons Learned in the CDC Response to the 2014–2016 Ebola Epidemic. Supplements 65(3);4-11. https://www.cdc.gov/mmwr/volumes/65/su/su6503a2.htm

14. Centers for Disease Control and Prevention. (n.d.) Port Health Stations. https://www.cdc.gov/port-health/stations/index.html

15. Centers for Disease Control and Prevention. (n.d.) Prevention & Response. https://www.cdc.gov/global-health/annual-report-2024/prevention-response.html#:~:text=CDC%20aims%20to%20increase%20the,a%20response%20within%207%20days

16. Centers for Disease Control and Prevention. (n.d.) Reconstruction of the 1918 Influenza Pandemic Virus. https://archive.cdc.gov/www_cdc_gov/flu/about/qa/1918flupandemic.htm

17. Center for Strategic & International Studies. (n.d.) The World’s Largest HIV Epidemic in Crisis: HIV in South Africa. https://www.csis.org/analysis/worlds-largest-hiv-epidemic-crisis-hiv-south-africa#:~:text=South%20Africa%20remains%20the%20epicenter,over%20the%20age%20of%2015

18. Chan, P.K.S. (2002) Outbreak of avian influenza A(H5N1) virus infection in Hong Kong in 1997. Clinical Infectious Diseases. 1:34 Suppl 2:S58-64. doi: 10.1086/338820.

19. Cohen, J. (2025) “A bloodbath”: HIV field is reeling after billions in U.S. funding are axed. Science. https://www.science.org/content/article/bloodbath-hiv-field-reeling-after-billions-u-s-funding-axed#:~:text=USAID's%20promises%20to%20support%20lifesaving%20efforts%20are%20broken%2C%20putting%20millions%20in%20peril&text=The%20decision%20by%20President%20Donald,and%20left%20its%20leaders%20seething

20. Davies N., Bisnauth, M. & Rees, K. (2025). Enhancing Antiretroviral Therapy Initiation for Hospitalized and Recently Discharged People Living With HIV in Johannesburg, South Africa. Global Health: Science and Practice. 13(1): 1-12. https://doi.org/10.9745/GHSP-D-24-00017

21. Emanuel, G. (2025). Musk says work to stop Ebola was accidentally cut but restored. Experts raise doubts. National Public Radio. https://www.npr.org/sections/goats-and-soda/2025/02/27/g-s1-50929/elon-musk-ebola-usaid

22. Encyclopedia Britannica. (n.d.) Antimicrobial agent. https://www.britannica.com/science/antimicrobial-agent

23. Encyclopedia Britannica. (n.d.) Black Death: cause and outbreak. https://www.britannica.com/event/Black-Death/Cause-and-outbreak

24. Enrich, Nicholas. (2025). INFO memo. https://static01.nyt.com/newsgraphics/documenttools/2dbddd9a823b8824/168a9032-full.pdf

25. Gandhi, A.R., Bekker, L.G., Paltiel, D. Hyle, E.P., Ciaranello, A.L., Pillay, Y., Freedberg, K. A. & Neilan, A.M. (2025). Potential Clinical and Economic Impacts of Cutbacks in the President’s Emergency Plan for AIDS Relief Program in South Africa: A Modeling Analysis. Annals of Internal Medicine. https://doi.org/10.7326/ANNALS-24-01104

26. Hill, G. (2023). How did the COVID-19 pandemic affect healthcare spending? U.S. Bureau of Labor Statistics. https://www.bls.gov/opub/btn/volume-12/how-did-the-covid-19-pandemic-affect-healthcare-spending.htm

27. Izudi, J. & Bajunirwe, F. (2024). Case fatality rate for Ebola disease, 1976–2022: A meta-analysis of global data. Journal of Infection and Public Health. 17(1); 25-34. https://doi.org/10.1016/j.jiph.2023.10.020

28. Jedwab, R., Johnson, N.D., & Koyama, M. (2019). Pandemics, Places, and Populations: Evidence from the Black Death. CESifo Working Paper No. 7524. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3331972

29. Johns Hopkins Bloomberg School of Public Health. (2024). Mpox outbreak Clade I vs Clade II. https://publichealth.jhu.edu/sites/default/files/2024-06/mpox-clad-i-vs-ii.pdf

30. Kadanali, A. & Karagoz, G. (2015). North Clinics of Istanbul. 2(1):81-86. doi: 10.14744/nci.2015.97269

31. Knibbs, Kate. (2025). USAID was promised emergency waivers for Ebola and AIDS. They’re not working. https://www.wired.com/story/the-usaid-emergency-waivers-arent-working-from-ebola-to-aids/

32. Knickermeyer, E., Lee, M. & Sherman, M. (2025). Trump administration says it’s cutting 90% of USAID foreign aid contracts. AP News. https://apnews.com/article/trump-usaid-foreign-aid-cuts-6292f48f8d4025bed0bf5c3e9d623c16

33. Lightsey, R.F. (2016). Fighting Ebola: An Interagency Collaboration Paradigm. National Defense University Press. https://ndupress.ndu.edu/Media/News/Article/702033/fighting-ebola-an-interagency-collaboration-paradigm/#:~:text=The%20deployment%20of%20the%20101,Agency%20for%20International%20Development's%20(USAID's)

34. Mandavilli, A., Sanger-Katz, M. & Hoffman, J. (2025). Trump Administration Abruptly Cuts Billions From State Health Services. The New York Times. https://www.nytimes.com/2025/03/26/health/trump-state-health-grants-cuts.html?campaign_id=190&emc=edit_ufn_20250326&instance_id=151022&nl=from-the-times&regi_id=77677469&segment_id=194464&user_id=6b90856b8fbbcb39ed3458f96ff6d573

35. Martin, B., Kaminski-Ozturk, N., O’Hara, C. & Smiley, R. (2023). Examining the Impact of the COVID-19 Pandemic on Burnout and Stress Among U.S. Nurses. Journal of Nursing Regulation. 14(1):4–12. doi: 10.1016/S2155-8256(23)00063-7.

36. Mellis, C. (2022). Lives saved by COVID-19 vaccines. Journal of Paediatrics and Child Health. 58(11): 2129. https://doi.org/10.1111/jpc.16213 

37. Morens, D.M., Breman, J.G., Calisher, C.H., Doherty, P.C., Hahn, B.H., Keusch, G.T., Kramer, L.D., LeDuc, J.W., Monath, T.P. & Jeffery K Taubenberger, J.K. (2020). The Origin of COVID-19 and Why It Matters. American Journal of Tropical Medicine and Hygiene. 103(3):955–959. doi: 10.4269/ajtmh.20-0849

38. National Emerging Special Pathogens Training and Education Center. (2024). Situation Report: Lassa Fever Death in Iowa. https://netec.org/2024/10/30/situation-report-lassa-fever-death-in-iowa/

39. National Institute of Allergy and Infectious Diseases. (n.d.). 10 Things to know about HIV suppression. https://www.niaid.nih.gov/diseases-conditions/10-things-know-about-hiv-suppression#:~:text=How%20does%20being%20durably%20undetectable,virus%20to%20people%20without%20HIV

40. Ndebo, G. (2025). Africa received billions in U.S. aid. Here’s what it will lose. The New York Times. https://www.nytimes.com/2025/03/08/world/africa/africa-usaid-funds.html

41. Office of Inspector General. (2025). Global Health: USAID Planned for Emergency Responses in Accordance With Best Practices but Gaps Remain. https://oig.usaid.gov/node/7485#:~:text=USAID%20plays%20a%20key%20role%20in%20the,staff%20and%20providing%20financial%20assistance%20to%20help

42. Office of Inspector General. (2016). Quarterly Progress Report on U.S. Government International Ebola Response and Preparedness. https://oig.usaid.gov/sites/default/files/2018-06/oig_ebola_fy16_q2_0.pdf

43. Rascoe, A. (2025). He led the 2014 U.S. response to Ebola. He says USAID cuts will impact future readiness. National Public Radio. https://www.npr.org/2025/03/02/nx-s1-5313045/he-led-the-2014-us-response-to-ebola-he-says-usaid-cuts-will-impact-future-readiness

44. Robeznieks, A. (2022). What we’ve learned about COVID-19, burnout and the doctor shortage. The American Medical Association. https://www.ama-assn.org/practice-management/sustainability/what-we-ve-learned-about-covid-19-burnout-and-doctor-shortage#:~:text=%E2%80%9CEmployment%20turnover%20among%20nearly%20all,published%20in%20JAMA%20Health%20Forum

45. Sharp, P.M. & Hahn, B.H. (2011). Origins of HIV and the AIDS Pandemic. Cold Spring Harbor Perspective in Medicine. 1(1):a006841. doi: 10.1101/cshperspect.a006841

46. Shin, B. (2023). The East-West Collaboration across the Iron Curtain against Polio Epidemics: Soviet Engagement with Global Health and Poliomyelitis Vaccine Development in 1956-1964. Journal of Eurasian Studies. 14(1). https://doi.org/10.1177/18793665231159685

47. Spyrou, M.A., Musralina, L., Gnecchi Ruscone, G.A. et al. (2022). The source of the Black Death in fourteenth-century central Eurasia. Nature. 606, 718–724. https://doi.org/10.1038/s41586-022-04800-3

48. Stone, W. & Huang, P. (2025). Upheaval and firings at CDC raise fears about disease outbreak response. National Public Radio. https://www.npr.org/sections/shots-health-news/2025/02/25/nx-s1-5307117/cdc-firings-infectious-disease-response

49. Sunny, M.E. & Santhosh, C. (2025). Eight countries could run out of HIV treatments due to USAID cuts, WHO says. https://www.reuters.com/business/healthcare-pharmaceuticals/eight-countries-could-run-out-hiv-treatments-due-usaid-cuts-who-says-2025-03-17/

50. UK Health Security Agency. (2025). Ebola: overview, history, origins and transmission. https://www.gov.uk/government/publications/ebola-origins-reservoirs-transmission-and-guidelines/ebola-overview-history-origins-and-transmission#:~:text=origins%2Dand%2Dtransmission-,Background,virus%20(orthoebolavirus%20zairense%2C%20EBOV%20)

51. United States Agency for International Development. (n.d.). Amazon Malaria Initiative. https://linksglobal.org/AMI/

52. U.S. Government Accountability Office. (n.d.). Operation Warp Speed. https://www.gao.gov/products/gao-21-319

53. World Health Organization. (n.d.). COVID-19 vaccine tracker and landscape. https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines

54. World Health Organization. (n.d.). Diarrhoael disease. https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease#:~:text=ill%20from%20diarrhoea.-,Dehydration,on%20a%20scale%20of%203

55. World Health Organization. (n.d.). Ebola virus disease: vaccines. https://www.who.int/news-room/questions-and-answers/item/ebola-vaccines

56. World Health Organization. (n.d.). Fact sheet: Lassa fever. https://www.who.int/news-room/fact-sheets/detail/lassa-fever#:~:text=The%20overall%20case%20fatality%20rate,treatment%20improves%20chances%20of%20survival

57. World Health Organization. (n.d.). Human rights. https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health

58. World Health Organization. (n.d.). Malaria. https://www.who.int/news-room/fact-sheets/detail/malaria

59. World Health Organization. (n.d.). Marburg virus disease. https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease

60. World Health Organization. (n.d.). Marburg virus disease– United Republic of Tanzania. https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON559#:~:text=On%2013%20March%202025%2C%20after,outbreak%2C%20as%20per%20WHO%20recommendations

61. World Health Organization. (n.d.). Measles – United States of America. https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON561

62. World Health Organization. (2021). Measles and rubella strategic framework: 2021-2023. https://www.who.int/publications/i/item/measles-and-rubella-strategic-framework-2021-2030

63. World Health Organization. (n.d.). mpox – Democratic Republic of Congo. https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON522

64. World Health Organization. (n.d.). Number of COVID-19 deaths reported to WHO. https://data.who.int/dashboards/covid19/death

65. World Health Organization. (n.d.). Poliomyelitis. https://www.who.int/news-room/fact-sheets/detail/poliomyelitis#:~:text=More%20than%2020%20million%20people