The Trump administration’s “America First” approach to Ebola has shifted the US response in the Democratic Republic of Congo away from one of its traditional priorities: getting American medical personnel and resources to the heart of an outbreak.
When US doctors Patrick LaRochelle and Peter Stafford were exposed to Ebola in Congo in May, they expected to be evacuated to the United States for treatment or monitoring. During a previous outbreak in 2018, that is what happened.
Instead, the Trump administration decided that exposed US citizens would not be brought home. LaRochelle was eventually transported to the Czech Republic, while Stafford was treated in Germany. Neither contracted the virus.
The decision was part of a broader strategy that has emphasized preventing Ebola from entering the United States, including a 21-day “do-not-board” policy for Americans who had been in Congo and the creation of a US quarantine facility in Kenya.
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Public health experts and people involved in the response say the approach has also made it harder to send American medical workers to Congo, adding pressure to an already overstretched health system.
From Fighting Ebola Abroad to Keeping It Out of America
The United States has historically treated Ebola outbreaks as a global health security problem.
During the 2014 West African outbreak, the Obama administration deployed about 3,000 US troops and committed substantial resources to help contain the virus at its source. Eleven people were treated for Ebola in the United States during that outbreak, two of whom died.
The US subsequently invested hundreds of millions of dollars in specialized biocontainment facilities designed in part to treat Americans exposed to dangerous infectious diseases overseas.
The current approach is markedly different.
Rather than routinely bringing exposed Americans home, the Trump administration established a 50-bed Ebola quarantine facility at a US air force base in Kenya. The facility cost an estimated $70 million but has housed only seven people and is currently empty, according to a US official cited by Reuters.
The administration also introduced a policy preventing Americans from boarding US-bound flights if they had been in Congo during the previous 21 days.
The objective is straightforward: reduce the possibility of Ebola reaching the United States.
But public health officials argue that the policy creates another problem if it discourages medical professionals from travelling to the outbreak zone in the first place.
Why Medical Volunteers Matter
Ebola outbreaks depend heavily on trained personnel who can identify cases, trace contacts, operate treatment centres and protect other health workers from infection.
Franklin Graham, president and CEO of Samaritan’s Purse, said Americans previously accounted for around 80% of the organization’s staff at Ebola treatment centres in Congo. That figure has fallen to roughly 20%.
He also said the cost of deploying medical professionals had more than doubled because of the quarantine requirements.
At one hospital in Bunia, the staffing impact was similarly visible. Six US doctors had previously worked in Bunia and nearby Nyankunde, two areas badly affected by the outbreak. After the quarantine policy was introduced, only one remained in Bunia, according to the hospital’s director.
The issue is therefore not simply whether American volunteers are willing to work in Congo. It is whether the conditions imposed on their return make repeated deployments practical.
For an outbreak that requires sustained international staffing, that distinction matters.
A Fast-Spreading Outbreak
The policy changes have coincided with an Ebola outbreak that has spread at an unprecedented pace.
The current outbreak involves the Bundibugyo virus, a different Ebola species from the Zaire species that caused the major West African epidemic in 2014.
According to the US Centers for Disease Control and Prevention, 139 days after Ebola was detected in May, Congo had recorded 8,224 confirmed cases. At the same point during the 2014 West African outbreak, there had been 1,766 cases. During Congo’s 2018 outbreak, there had been 543.
The CDC has identified several factors complicating the response, including violence against health workers, shortages of protective equipment and misinformation.
It has warned that without a stronger response, deaths could eventually exceed the 11,308 recorded during the 2014 epidemic.
Although transmission has slowed in parts of Ituri province, the virus has been spreading rapidly in other regions, including North Kivu.
That has increased the importance of maintaining enough personnel and supplies in affected communities.
The USAID and WHO Factor
The reduction in American engagement extends beyond medical volunteers.
The Trump administration’s shutdown of USAID and withdrawal from the World Health Organization disrupted established systems for supplying medicines and equipment, according to people involved in the response.
South African epidemiologist Salim Abdool Karim said USAID had traditionally played an important logistical role, helping arrange trucks, drivers and warehouses to move supplies to where they were needed.
The organizations still operating in Congo have continued the response, but funding shortages have made their work more difficult.
The US State Department says it has allocated $780 million to the Ebola response, largely through NGOs operating health facilities and procuring supplies. The department describes this as the largest contribution by an outside country.
The administration has also requested $1.4 billion for Ebola prevention and detection, including funding for the Kenyan treatment facility and medical evacuation costs. Separately, the CDC says it has $113 million in emergency funds available for domestic and international outbreak response.
The problem, therefore, is not simply the amount of money being committed. It is also how quickly and effectively resources, personnel and supplies reach the areas where transmission is occurring.
Washington Defends Its Approach
The administration disputes the characterization that it has withdrawn from the Ebola response.
A Health Department spokesperson said the US response includes both protecting Americans from Ebola being imported into the United States and combating the outbreak at its source.
The CDC continues to have more than 120 personnel in Congo and Uganda working on disease surveillance, contact tracing, laboratory testing and training.
The State Department also says its Ebola funding has supported health facilities and supplies on the ground.
That means the US has not abandoned the response altogether. Instead, the dispute is over priorities and the consequences of the new approach.
Public health officials acknowledge that preventing Ebola from entering the United States is a legitimate objective. But the World Health Organization has warned that policies making it harder to deploy or retain responders could slow the overall response.
The Bigger Question for America First
The Ebola response illustrates a broader tension within the “America First” approach to global health.
A strategy focused primarily on preventing diseases from reaching the United States can reduce direct risks to Americans. But infectious diseases do not respect borders, and containing an outbreak often requires intervention where transmission is occurring rather than relying primarily on measures at the border.
That was the logic behind previous US Ebola responses: deploy personnel, strengthen local health systems and attempt to stop transmission before the virus spreads further.
The current policy places greater emphasis on controlling the movement of Americans and preparing facilities outside the United States to quarantine them.
For medical workers on the ground, that change has had a practical consequence. Some are now less willing to deploy because of what happens when they try to return home.
The Kenyan quarantine facility and the US biocontainment centres may therefore represent two different approaches to the same problem. One focuses on keeping exposed Americans away from the United States, while the other reflects years of investment in safely treating them when they return.
Whether the Trump administration’s approach can contain the outbreak without weakening the international response remains an open question.
For now, the experience in Congo suggests that a policy designed to protect Americans from Ebola can also affect the willingness and ability of Americans to help fight it where it is spreading.
With information from Reuters.
