The Widening Gap in Pandemic Prevention Measures
From avian flu to cholera to the Marburg virus to Mpox, the threats to public health are legion. Public health workers are attempting to stop the spread, care for patients, and limit ripple effects that could cause the next global outbreak five years after the World Health Organization (WHO) declared COVID-19 a pandemic.
The WHO plays a critical role in this process, providing a “neutral forum” to discuss health issues in every country in the world, regardless of diplomatic status, said Stefano M. Bertozzi, former dean and current professor of health policy and management at UC Berkely School of Public Health.
“We can work together to stop threats from becoming global pandemics or otherwise threatening the world,” Bertozzi explained in a recent Q&A with Berkeley’s Public Health Department. “That’s everything from recognizing a new spillover from an animal to a person that is starting an epidemic of a brand-new disease; to working together on laboratory safety to prevent leaks from laboratories; to working together to track the emergency of antimicrobial resistance for existing diseases for which we have effective antibodies, but for which we may lose that effectiveness as antimicrobial resistance spreads.
“Fires cross borders and so does smoke—thinking of a very recent example,” Bertozzi continued. “There are just so many issues that cross borders.”
There are also significant security ramifications if outbreaks are not addressed quickly and instead allowed to spread. Researchers Rebecca Cordell, Reed M. Wood, and Thorin M. Wright studied how large-scale disease outbreaks are linked to civil unrest and published their findings, “Disease and Dissent: Epidemics as a Catalyst for Social Unrest,” in the journal Global Studies Quarterly in April 2023.
“As with climate change and natural disasters, epidemics are not the proximate cause of unrest,” the researchers wrote. “Instead, large-scale outbreaks of infectious disease often create conditions that are conducive to collective dissent, unrest, and popular resistance to authority.
“Epidemics induce fear and heighten uncertainty, diminish state capacity, generate acute economic losses, create resource shortages and competition, undermine leaders’ legitimacy, and intensify existing inequities in societies,” they continued. “These factors in turn create opportunities and incentives for members of the public to mobilize—sometimes violently—against the government or against other social groups that participants hold responsible for collective grievances.”
Despite the need for cooperation and collaboration at the international level to address outbreaks, however, public health is facing a mounting crisis: inaction and lack of resources from governments that are now more focused on domestic issues than global health security.
The most glaring case of this is the United States. Since 2000, the country has contributed $278 billion towards global health assistance, according to an article published by the medical journal The Lancet in December 2024.
Looking at one year of that aid, the 2023 contribution made up 29.1 percent of total development assistance for health from all donor nations, but only 0.3 percent of the U.S. federal government’s overall spending.
“Investing in global health is good for U.S. diplomacy and international strategic interests,” according to The Lancet. “Additionally, businesses in the USA benefit from direct investment from development assistant programs and, in the long run, the U.S. economy indirectly benefits through global trade spurred by a healthy, prospering global economy. Finally, investments in pandemic preparedness and health security benefit all U.S. citizens by ensuring a healthier world that is more equipped to tackle global health threats.”
The authors cautioned that despite rising nationalism in the United States and rhetoric by the then-incoming Trump Administration to engage in an America First policy, investments in public health should continue.
“Major cuts in support from the USA could snowball and result in a loss of $13.7 billion to global development assistance programs by 2030, with even more drastic consequences related to lives lost and regression in health outcomes as proven health strategies are interrupted due to the shortage of funds,” according to The Lancet article.
Those cautions were not heeded, though, when U.S. President Donald Trump took office in January 2025. He immediately directed his administration to withdraw the United States from the World Health Organization—a process that will take one year—and pause future funding or resources to the global public health agency. The United States was one of the original founders of the WHO in 1948 and has played a critical role in promoting global health security.
“For over seven decades, WHO and the USA have saved countless lives and protected Americans and all people from health threats,” the WHO said in a statement about the U.S. decision to withdraw. “Together, we ended smallpox, and together we have brought polio to the brink of eradication.”
One of the recent pandemic prevention efforts that the United States partnered with the WHO on was the Global Health Security Agenda—a partnership of governmental, non-governmental, and private sector representatives that was renewed in 2023 to last through 2028, known as GSHA 2028. The partnership was designed to accelerate implementation of the International Health Regulations (IHR), a legally binding mandate that requires 196 countries to monitor and promptly report potential global health risks to the WHO.
“These regulations require countries to be well-prepared to prevent, detect, report, and respond to disease outbreaks and health emergencies swiftly to minimize disruptions to trade and travel,” according to a fact sheet.
As of 2023, 58 countries had achieved a level of demonstrated capacity (a score of four or higher on a joint external evaluation), and the partnership’s goal was to see another 100 meet that threshold in the next year.
“The COVID-19 pandemic response revealed significant disparities among countries in their abilities to prevent, detect, respond to, and recover from outbreaks,” according to the GHSA 2028 Framework. “The GHSA 2028 framework acknowledges the transformative impact of COVID-19 and other recent outbreaks and emphasizes the need for enhanced and sustained multisectoral attention and cooperation for disease prevention and preparedness.”
While it’s not yet clear what the United States’ withdrawal from the WHO means for this partnership, overall, the decision has potentially significant ramifications for global health security and national security.
“Since World War II, the U.S. has developed a reputation around the world as a country that supports others, and that has important consequences for global diplomacy,” said Judd Walson, MD, MPH, the Robert E. Black Chair in International Health at Johns Hopkins University, in an episode of the Public Health on Call podcast. “We are known in the health space as a country that provides assistance to many countries. In fact, many countries with whom we have very poor diplomatic relations, and that we don’t see eye-to-eye with politically, still reach out to us for support around health.
“Health provides an entryway for us to engage with countries, many of whom we may not agree with, and to have diplomatic conversations and other conversations,” Walson continued. “If that is lost, it will have tremendous consequences for the U.S.’s security and long-term economic and political outlook.”
One of the most successful examples of this approach is the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). U.S. President George W. Bush’s administration created the program in 2003 to increase funding for, and bring attention to, the AIDS epidemic. The Kaiser Family Foundation assessed that the United States had contributed $120 billion to the program as of August 2024, saving millions of lives around the world and changing the trajectory of the global spread of HIV.
The success of the PEPFAR program also helped build health infrastructure that was leveraged to address other disease outbreaks, including Ebola, avian flu, and cholera, according to a blog post by Deborah L. Birx, who served as the U.S. global aids coordinator and U.S. special representative for global health diplomacy during Trump’s first administration.
“Healthy populations are a prerequisite for prosperous and stable societies,” Birx wrote. “Investing in the well-being of our partner countries not only saves lives, but also enhances global public health and security. In our interconnected world, there is no better investment.”
Health provides an entryway for us to engage with countries, many of whom we may not agree with.
The United States has also played a key role in responding to emergencies, including the Mpox outbreak in the DRC by supporting vaccine delivery, the Marburg virus disease outbreak in Rwanda by enhanced surveillance and contact tracing, and helping respond to natural disasters.
“Leadership from the United States has been instrumental in protecting vulnerable populations—such as in Africa during the fight against deadly diseases like Ebola—and in ensuring health systems remain strong and responsive during crises,” according to a fact sheet from the WHO. “By supporting WHO’s emergency health efforts, the United States drives global health security, from preventing and preparing for future threats to delivering rapid response and recovery when it matters most.”
A key component of the U.S. global health security apparatus is the U.S. Agency for International Development (USAID). The U.S. Congress created the agency in 1961, and since then, it has played a critical role in responding to public health emergencies, such as the PEPFAR in 2004, Ebola outbreaks in 2015 and 2016, and emergency assistance to combat COVID-19 in 2020.
For instance, USAID funds efforts or sends personnel to conduct border screenings at airports and other points of entry around the world, including those into the United States. USAID personnel would ask travelers if they had come into contact with someone who was sick or if they were exhibiting symptoms, as well as conduct temperature checks. USAID personnel also provided supplies to health officials to aid individuals directly impacted by disease outbreaks.
These efforts, however, are no longer being carried out after Trump issued an executive order to freeze foreign aid and took action to effectively shut down USAID. In February, Trump’s administration issued a stop work order and fired most of USAID’s personnel—leaving just 300 staffers to run the agency. These measures, as of Security Management’s press time, were being contested in the court system. But security experts are already sounding the alarm about the potential ramifications of the loss of USAID.
U.S. Global Leadership Coalition (USGLC) President and CEO Liz Schrayer released a statement about the dismantling of USAID, saying that it poses national security risks for the United States and gives its rivals—China, Russia, Iran, and North Korea—room to play a larger role on the international stage.
“For less than 1 percent of the overall federal budget, America’s international development programs remain one of our nation’s greatest returns on investment for protecting our economic interests and stopping threats before they reach our shores,” Schrayer said. “From working alongside our military to fight ISIS in Syria, to preventing the spread of new outbreaks like Ebola, to saving tens of millions of lives from polio and HIV/AIDS, to competing with China for new markets and influence, we cannot cede ground to our rivals.”
Dale Buckner, CEO of Global Guardian who retired as a colonel from the U.S. Army, worked with USAID personnel in Afghanistan, Colombia, Honduras, and Iraq during his military service. He says he respects efforts to address government waste, but stopping all funding for USAID abruptly is the equivalent of “cutting with a sword, not a scalpel” and could pose ramifications for both diplomatic and corporate efforts outside of the United States.
For instance, USAID funding provided a foot in the door for the U.S. State Department to negotiate with governments where the United States or the West overall might be viewed unfavorably. It also helped ease the way for private companies to operate in these jurisdictions, Buckner says.
“When you pull that much aid all at the same time, one, it’s a vacuum and somebody else might fill it—think China, think Russia in Africa specifically and parts of Asia,” he explains. “…if we turn people off that used to be our friends and allies, who now become enemies, it’s going to limit our access—it’s going to limit U.S. corporate access potentially.
“Now, when Americans or Westerners get in trouble, they get arrested for a car accident, they get arrested for theft, they get arrested for having prescription drugs without the appropriate paperwork…when those things happen, if we pulled all that aid, our pliability of our ability to work with these countries and governments now becomes limited,” he continues. “They’re not incentivized to work with us.”
When you pull that much aid all at the same time, one, it’s a vacuum and somebody else might fill it.
While the justice system evaluates the future of the funding and USAID, however, there is a gap in global health security initiatives. The WHO is attempting to compensate, but it remains to be seen who—if anyone—will step up to fill the void that the United States could leave in the world’s public health infrastructure.
“The likelihood is that without the United States indelibly involved in preparing for, and responding to, these outbreaks all around the world, this withdrawal will come back and haunt us,” says Craig Spencer, MD, MPH, associate professor of the practice of health services, policy, and practice, at Brown University School of Public Health. “I don’t know if it’s going to be this outbreak, an outbreak a year from now, an outbreak a couple of years from now, but we will regret it. We will absolutely regret it.”
Prior to his role at Brown, Spencer worked in frontline humanitarian and public health—including in Guinea during the Ebola outbreak to coordinate the Doctors Without Borders/Médecins Sans Frontières’ (MSF) national epidemiological response. Spencer adds that while some of the existing public health agencies are imperfect, they are necessary for responding to infectious threats around the world and limiting their spread to the United States.
“We have seen time and time again how the attempts to just build walls around the country don’t work for people, and they are certainly not going to work for pathogens,” Spencer explains. “The idea that we can just prevent them from coming into this country is pure fallacy. Our inability to measure them or manage them at their source just increases the likelihood that those pathogens will come and visit us here.”
Megan Gates is senior editor at Security Management. Connect with her at [email protected] or on LinkedIn.
