Last week, standing in front of President Donald Trump’s first Cabinet meeting, Elon Musk, the unelected billionaire running a blitzkrieg against the US government, acknowledged that he had made a mistake—that in going after the US Agency for International Development, the foreign assistance program that he has all but destroyed, he accidentally ended the Ebola prevention project it ran overseas. Musk claimed the error was quickly fixed and there was no interruption in service. But former and current USAID staff quickly told the Washington Post that Musk was wrong—the Ebola response remained sharply curtailed. And, as the Bulwark reported, Nicholas Enrich, the acting assistant administrator for global health at USAID, who was placed on administrative leave Sunday, had drafted an unfinished memo that predicted the demolition of USAID would lead to more than 28,000 cases of Ebola and related diseases, as well as a 28 to 32 percent increase in tuberculosis globally, up to 18 million cases of malaria (with up to 166,000 deaths annually), and an additional 200,000 cases of paralytic polio a year.
Musk’s assertion that his slash-and-burn assault on USAID had no negative impact on combating Ebola was disinformation. He was hiding the truth on a critical global health issue. I spoke about Musk’s claim with Jeremy Konyndyk, president of Refugees International. He ran the Office of Foreign Disaster Assistance at USAID during the Obama years and returned to the agency to work on Covid during the Biden administration. I asked him to describe how dangerous the cuts are. Have Trump and Musk seriously undermined the nation’s ability to prevent a major pandemic from hitting the United States?
Watch the interview and read the lightly edited and condensed Q&A below.
What does USAID do to prevent the spread of Ebola and other highly infectious and dangerous diseases overseas?
So you’ve got two big chunks to that. One is preparedness. You want to have the systems in place at a country level that can respond when an outbreak emerges and also reduce the likelihood that it emerges. That includes things like laboratory capacity for diagnostics and surveillance, so you can detect things rapidly when they emerge. And then you have to implement treatment, isolation, and infection prevention, so that when people begin showing up sick, they don’t infect health workers or other people.
USAID makes those kinds of investments, along with the Centers for Disease Control [and Prevention], in a lot of countries overseas that are prone to novel outbreaks. When something is detected—like the Ebola outbreak now underway in Uganda—USAID would normally swing into action with an active response team, deploying technical experts to support the Ugandan government, ramping up supplies, and providing personal protective equipment.
Another important element is traveler screening. You might remember the big hullabaloo in 2014 about travelers reaching the United States with Ebola. There’s a lot of investment in traveler screening to prevent people who are sick from traveling and potentially spreading the disease to other countries.
We should underscore here that this obviously helps people in the countries where this is happening. But we also have a bit of self-interest in preventing the spread, right? We’re doing good for others and for ourselves. Does this entail using USAID workers or working with contractors?
Typically, that would mean deploying some USAID personnel, but a lot of the frontline work is done through partner organizations—providing grants and contracts to aid organizations to support the Ugandan government and to run some of their own activities.
When Elon Musk came in with his minions and shut down USAID and froze federal foreign assistance, how did that affect this?
Almost none of the things that would routinely happen in a major outbreak actually took place. USAID did not deploy anyone to Uganda to support the response. They did not get money out to partners quickly. It took them weeks, when it would normally take hours or days. And even the funds that did go out were very, very small. Some contracts were canceled. One of the awards that had been made was to a partner supporting traveler screening at Uganda’s major airport in Entebbe—that was just canceled last week.
That means people can get on a plane in Entebbe and fly to London, Frankfurt, New York—wherever—and no one’s asking them about Ebola?
It means that the support to the Ugandan government to make sure that screening is as robust and airtight as possible is gone. So it’s a huge risk.
Elon Musk “has no idea what he’s talking about. He’s making it up as he goes. He doesn’t understand the things he’s canceling.”
Elon Musk says everything’s been fixed. No?
He has no idea what he’s talking about. He’s making it up as he goes. He doesn’t understand the things he’s canceling. He and his team of teenagers and twentysomethings are using AI—or keyword searches, as far as we can tell—to decide what to cut. They’re not bothering to stop and understand what they’re actually losing when they shut these programs down.
We’re focused here on Ebola, but what does this mean in terms of other diseases and other possible pandemic threats?
One of the things you realize really quickly when you start getting involved in outbreak response is that there are outbreaks all over the world all the time. It’s really hard to know at the front end of one which has the potential to truly explode at a global level. That’s why it’s important to get on top of all of them very, very quickly, before they have a chance to spread. When you lose these capabilities, you increase the chances that one of those outbreaks will spread and get out of control globally.
I read in the newspaper that there’s something going on in the Democratic Republic of Congo, 50 people dead from a mysterious illness. What does it mean now that the US aid capacity has been severely cut, if not abolished?
This is a good and interesting example. This was a mystery for the first few weeks. Over the weekend, the World Health Organization (WHO) announced they now believe it’s due to water contamination—a waterborne illness. If that’s confirmed, then hopefully that one won’t pose a risk of spreading. But we only know that because WHO was on top of it.
Why is WHO on top of it? Because the section at WHO that handles emergencies and outbreaks was largely created at the behest of—and under pressure from—the US government after Ebola in 2014. And we are the principal funder of it.
“We’re actively weakening the entire global infrastructure we built to keep us safe from these threats.”
Now, the United States is withdrawing from WHO, and the CDC has been barred from talking to WHO. All of our funding is being pulled. So we’re not just taking ourselves out of the game—we’re actively weakening the entire global infrastructure we built to keep us safe from these threats.
That doesn’t sound very encouraging. Let’s see if we can end on a somewhat optimistic note. Would it be possible to restore these capacities if, for some reason, a wave of rationality and sanity struck the Trump-Musk team?
It absolutely would. One of the ironic things here is that clearly, Musk feels pressure over this. He wants to reassure the public and the administration that they’re not cutting things that put Americans at risk. But, of course, they are. He has no idea what to cut and what not to cut—he’s just cutting everything by default.
“It’s going to take decades to rebuild what we’re about to lose.”
There could be a different approach. Congress could intervene and put parameters around this, asserting itself in the process. They haven’t really done that yet. But when you look at what’s actually been done to USAID—yes, they are canceling contracts; yes, they’re trying to push out staff—none of that is unsalvageable. It could still be pulled back, as you say, in a fit of rationality. The risk is that if we persist on this path—if we lose all this capability, all this expertise—it’s going to take decades to rebuild what we’re about to lose. Right now, they’ve done more talking than actual damage. They’re close to locking it in, but it’s not locked in yet. They have no idea how to read the things they’re looking at, and they’re not bothering to stop and listen to the people who could explain it to them. They’re just making fools of themselves.
