WASHINGTON — For years, the United States has poured hundreds of millions of dollars into programs to prevent and control infectious diseases in the Democratic Republic of the Congo.
But in the months leading up to a fast-moving Ebola outbreak, the Trump administration slashed aid to the country, leading to a cascade of consequences that probably hampered the detection of the outbreak and the response to it, six people involved in or familiar with the efforts in the region said.
Now, the DRC is experiencing the third-largest Ebola outbreak on record. Experts estimate 130 people have died and at least 600 are sick, including an American. The U.S. government has closed its border to people who are from or who have traveled recently in the area, fearing the spread of the disease. (U.S. passport holders are exempt.)
This account of the impact of U.S. funding cuts is drawn from disclosures the Trump administration submitted to Congress last year, a review of government funding databases, and interviews with six people who currently or previously did public health work in the region. Some of the people spoke on condition of anonymity, fearful of retaliation from the Trump administration.
Some of the aid that the Trump administration cut off had been explicitly intended to safeguard against epidemics, build up health systems, create supply chains for infectious disease control supplies, and improve sanitation.
Officials at the Department of Health and Human Services and the State Department defended the government’s efforts in statements highlighting U.S. work in the country. “We are doing everything we can to support Americans in the region,” Heidi Overton, deputy director at the White House Domestic Policy Council, said at a news conference Monday.
Amid the cuts, the work of Ebola response teams was frozen, according to a person who worked on the ground in the region. Programs designed to detect Ebola cases, alert communities to infection, and dispatch response kits had their funding reduced or eliminated.
Related efforts that would have been likely to aid the outbreak response — including building medical stockpiles and supporting local health systems — have been weakened by the cuts, according to four people who work on infectious disease control in the DRC. Aid groups that carried out that work laid off staff in response to funding reductions and are still working with reduced headcounts, they said.
The International Rescue Committee, for instance, said it reduced programming from five to two areas at the heart of the current outbreak after U.S. cuts.
“Preparedness in high-risk areas is critical to disrupting transmission before the outbreak spreads further,” Heather Reoch Kerr, IRC’s country director for the DRC, said in a statement. “Years of underinvestment and recent funding cuts have left many health facilities without adequate protective equipment, surveillance capacity, or front-line support needed to respond quickly and safely.”
Still, non-U.S. entities have continued their work in the region, including the World Health Organization, which has been leading the response (the U.S. cut funding to the WHO and withdrew from the group).
A difficult response to a deadly outbreak
The response to the outbreak, the people directly working on it said, has been complicated for a host of reasons beyond U.S. cuts. Growing violence in the region has hampered the response and played a role in the undoing of the public health infrastructure in the area.
But one of the people who lost their job amid the U.S. funding cuts said in a message to STAT that they have witnessed “a silent but dangerous drift” in the region.
“The actors who once ensured epidemic preparedness … are now absent or paralyzed,” the person said. “Politicians control budgets; budgets control lives. That is the painful reality.”
HHS sent nearly $33 million to the DRC in foreign aid in the 2024 federal fiscal year. That number fell to less than $10 million in 2025. The 2026 fiscal year data remains incomplete.
The U.S. Agency for International Development sent some $67 million in foreign aid to the country in the final three months of 2025, down from $715 million in fiscal 2025 and nearly $1.2 billion in fiscal 2024.
Some of the numbers may change, as there can be significant lags in the reporting of foreign aid spending.
Some public health funding has been transferred to the State Department under a new “America First” agreement with DRC, in which the U.S. pledged $900 million over five years. The changing programs — as well as the pauses and cuts through established USAID work — added new confusion to the system, three of the people working on efforts in the region said.
State Department funding for public health efforts has begun flowing, two of the people said, but headcount and resources in the region remain substantially below what they were before the Trump administration. State Department employees, despite moving to address the outbreak, don’t have the staff or resources to take on the responsibility previously held by USAID, one of the people working on programs in the region said.
“By bringing USAID global health functions under the new Bureau of Global Health Security and Diplomacy at the State Department, our efforts are more aligned and effective. Funding and support to combat Ebola continue, working with allies and partners,” a State Department spokesperson said in a statement.
An HHS spokesperson said the Centers for Disease Control and Prevention “is fully equipped to protect Americans and mitigate risks through experts in this disease area,” noting capacity for virus testing, tracking, and prevention of the virus. They declined to comment on the impact of foreign aid cuts to Ebola and other infectious disease response teams.
In past Ebola outbreaks, foreign aid teams were critical partners, said Daniel Jernigan, who played a key role in the CDC’s response to the 2014-2016 Ebola outbreak in West Africa. Jernigan, who worked at the CDC for about 30 years, was among the leaders who left the agency last year amid political pressure and the firing of then-director Susan Monarez.
“We were sitting next to the USAID people the whole time,” he said. “Those cuts are going to have an effect no matter what the situation is.”
A collapsed system
The cuts to U.S. foreign aid already have had a huge effect on the health systems in the area, according to forthcoming research that found mortality in the area doubled since the funding loss, which coincided with the takeover of the area by the M23 rebel group. Though it’s difficult to untangle the factors that damaged the health system, people working alongside it said, the impacts are clear.
“The central pharmacies collapsed, the rural clinics collapsed, and the mortality doubled,” said Les Roberts, a professor emeritus at Columbia University who was part of the research, conducted by the Congolese nongovernmental organization RHA.
In his previous times in DRC, he said the system worked effectively: Rural clinics might note an unusual rise in certain diseases or symptoms, and aid-backed central pharmacies would quickly dispatch responses. Responses to a host of diseases, including malaria, cholera, and Ebola, would benefit from the system being in place, said the global health workers who spoke to STAT.
A response “almost always was triggered because the clinics told us it was happening,” he said, suggesting a functional system could have sped the response to the current outbreak.
Before the collapse, there had been some improvement over the years in the response speed and reduction of corruption, with the help of USAID and other governmental and nongovernmental organizations steering resources through the local health system, Roberts said, noting his many trips to the region.
One grant, which would have provided funding to the region’s local health systems to build up infection control, was among those cut by the Trump administration. The contract was originally set to expire in 2028.
Tens of millions of dollars in other U.S. grants going to building up public health, sanitation, and infectious disease control in the DRC were paused or canceled, according to a list shared with congressional leaders last year and reviewed by STAT. President Trump previously characterized the broad foreign aid reductions as “waste, fraud, and abuse.”
A Zaire Ebolavirus outbreak that started in 2018 in the same region dragged on for two years, with control efforts also hindered by conflict. That outbreak was the second largest on record.
“But we are now facing a perfect storm,” Megan Coffee, a senior infectious disease specialist at the International Rescue Committee, said in an email. “Last year, in an area where mines draw migrant workers, conflict minerals led rebel groups to displace government control, and at the same time aid cuts weakened the health system.”
The end result of the changes to U.S. policy leaves global health workers with a sense that they are in a new era of American response: taking on problems as they arise instead of investing in trying to stop them in the first place.
“There is this kind of paradigm shift of targeted responses to targeted problems,” said one of the people working on public health in the region. “It’s not on a scale where it needs to be.”
U.S. Secretary of State Marco Rubio criticized the WHO for its response to the outbreak, saying Tuesday it was “a little late” in identifying the outbreak.
The bigger threat to human life, Roberts said, is not Ebola but the cuts to foreign aid broadly. USAID’s cuts have already caused, in his research-based estimate, some 300,000 additional deaths in the DRC. Other research has supported that notion, with one study suggesting some 14 million more people may die around the world if the cuts persist through 2030.
The upending of the foreign aid system has stoked anger toward Americans, Roberts said, at a time when trust in outside medical authorities is critical.
Through his dozens of months spent in the DRC over the years, Roberts has often been asked to sit in the front seat of a car when traveling: having a white American was thought to help their efforts.
In his last trip, since the cuts, that has changed dramatically in some areas.
“The staff told me: ‘Les, you cannot come with us,’” he recalled. “‘You will put our lives in danger.’”