CDC’s Response to Ebola and Hantavirus Prompts Senator Letter

The World Health Organization (WHO) has declared the Ebola outbreak in the Democratic Republic of the Congo (DRC) and Uganda a public health emergency of international concern (PHEIC). As of May 18, there are more than 336 suspected cases including 88 deaths in the DRC, along with two confirmed cases and 1 confirmed death in Uganda. On Monday, after an American tested positive for Ebola in the DRC, the U.S. Centers for Disease Control and Prevention (CDC) moved to enhance travel screening and restrict entry for some people traveling from the region, invoking public health authorities that allow the government to limit movement to prevent the spread of communicable disease.

The Ebola outbreak comes on the heels of another global outbreak involving a high-consequence pathogen: hantavirus.

In April, the MV Hondius, a Dutch-owned cruise ship in the Atlantic, became the site of a hantavirus outbreak. Eleven confirmed or suspected cases are linked to the ship, including three fatalities. Eighteen Americans onboard the ship are now quarantined and being monitored at specialized medical facilities—16 at Nebraska Quarantine Unit at the University of Nebraska Medical Center, and two at Emory University in Atlanta, Georgia.

Although the CDC has deemed risk to the American public low for both Ebola and hantavirus, public health, disease, and disaster experts have publicly expressed growing alarm at the pace of the federal response. That concern prompted U.S. Senator Reverend Raphael Warnock to issue a letter to U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr., urging him to allow CDC experts to do their job “without political interference.”

The following is a brief look at the dual outbreaks, where risks lie given shifts to the nation’s preparedness posture, and steps healthcare facilities, private sector and non-governmental organizations can take to mitigate impacts for these and future crises.

Current Federal Capacity for Public Health Surveillance and Response

What are the components of an effective, systemic response to a disease outbreak? It involves disease surveillance, public health and clinical diagnostic capabilities, quarantine and isolation, emergency operations coordination, timely information sharing, clear and effective risk communication, trusted messaging with affected communities, healthcare surge capacity, medical countermeasure development and dispensing, and supply chain management—cross-sector capabilities that are built over time, years, and sometimes decades.

In this context, it’s worth noting what has worked in response to the current outbreak. The facilities used to transport and quarantine American passengers from the MV Hondius were made possible through funding from the U.S. Administration for Strategic Preparedness and Response (ASPR) Health Care Readiness Programs, a federal preparedness funding source that exists to improve the ability of healthcare systems to plan for and respond to disasters and emergencies. The Health Alert Network (HAN) notice to clinicians about the hantavirus outbreak is another example of public health preparedness infrastructure built through sustained federal investment. (HAN notices are the federal government’s primary method of sharing urgent public health information with clinicians.) Operation Warp Speed, an example from the COVID-19 era, was a high-profile public-private partnership established by the White House in the first Trump administration which brought to market COVID-19 vaccines in record time.

These examples illustrate how sustained federal funding not only builds public-sector disaster preparedness capacity, but also response capacity across the private sector, which owns 92% of the U.S. healthcare system.

In the past year, the U.S. has shifted its approach to public health preparedness, weakening our capacity to respond rapidly and effectively to future crises.

Changes include:

• Formal withdrawal from the WHO, which is leading the response to both hantavirus and Ebola outbreaks, after previously contributing roughly 20 percent of the organization’s operating budget;
• A $10 billion decline in global health funding across federal agencies and programs, including CDC and USAID which have played critical roles in previous Ebola outbreaks;
• Workforce losses including the departure of more than 20,000 staff within the CDC alone;
• Significant turmoil surrounding budget certainty, precluding strategic planning and hiring, along with a proposed 5 percent reduction for FY2027;
• Federal funding cuts exceeding $8.9 billion reducing support for the Epidemiology and Laboratory Capacity program, which states rely on for laboratory staffing, testing operations, and surveillance infrastructure;
• The administration’s push to move primary responsibility for disaster preparedness to state and local governments, which amounts to significant cuts at the local level, as state and local public health budgets rely heavily on federal funding.

The effects of these changes are already observable with the hantavirus outbreak, including: inconsistencies in the guidance being issued to providers between states; a CDC HAN alert the global outbreak; and divergence from the full 42-day WHO-recommended quarantine period for the seven asymptomatic Americans returning home from the MV Hondius, with federal officials emphasizing a preference for responding “in the least restrictive way possible.” What is interesting is that in a relatively short period, federal guidance has already shifted to be more restrictive. While public health guidance commonly evolves to address new information during responses to novel events, neither hantavirus nor Ebola are new to the U.S. This signals that current shifts in the federal response are more likely a failure to apply lessons learned from the past, rather than changes prompted by new scientific evidence.

As the federal role in disaster response continues to evolve, the one thing we know for certain and can prepare for is that as the federal government’s role in disaster preparedness shrinks, responsibility will fall to states, healthcare systems, private industry, and NGOs.

Novel Threats, Familiar Mistakes

The CDC’s decision to restrictrare but certainly not new. CEO Jeanne Marrazzo, MD, MPH, FIDSA of the Infectious Diseases Society of America (IDSA)—the nation’s leading professional organization for infectious disease physicians and scientists—released a statement on the policy cautioning that careful coordination is necessary to ensure effective intervention, pointing out that, “Diseases don’t recognize passports.”

A look back at infectious disease outbreaks in the recent past reveals a common thread, that regardless of the regions and communities impacted, lack of coordination and failure to sufficiently prioritize timely public communications with the public can do more harm than good.

Hantavirus was first discovered in the U.S. following the deaths of two healthy, young individuals in 1993. The two fatalities—a young woman and her fiancé—occurred on Navajo lands in the southwest of the U.S., a region known as the Four Corners. Prior to its naming in 1995, the media described hantavirus as an unexplained illness affecting tribal members, which led to discrimination against tribal community members within and around the Four Corners region.

The 2014 and 2016 outbreaks of Ebola are other examples where delayed communication drove misinformation and stigma.

In October of 2014, an Ebola outbreak reached the U.S. when a Liberian citizen died from the disease in Dallas. Despite the CDC’s initial assertion that hospitals across the U.S. were well prepared to contain Ebola cases, two nurses who treated the Ebola patient in Dallas also became infected. Absent clear, consistent communications from the federal level, and coupled with rising hysteria driven in part by media coverage, by December of 2014, nearly half of states announced quarantine and policies to restrict movement, many going above and beyond the CDC’s guidelines. The elevated response from numerous states led to discrimination against West African immigrant communities and healthcare workers who treated Ebola patients.

Yet another example from the summer of 2022: mpox. Previously known as monkeypox and renamed by the public health community as mpox in 2023, the disease was known for causing painful, rash-based illness that was spread through close contact with individuals. A comprehensive, coordinated response was established involving the White House, HHS, and other federal, state, and local agencies to stand up surveillance systems, monitoring, testing, and to administer a limited supply of the JYNNEOS vaccine treatment. Mpox disproportionately affected members of the LGBTQ+ community, particularly men who have sex with men. Early messaging around the highest-risk groups sometimes fueled stigma and led exposed individuals to avoid testing or treatment.

Where We Go From Here

Public health recommendations often evolve as situations develop. However, neither hantavirus nor Ebola is a completely novel threat—we’ve faced outbreaks of the same before albeit with different strains of the virus. The threats facing public health and the patient characteristics involved are not new. In many ways, shifts in our federal response raises broader questions about whether the hard-earned lessons from prior outbreaks are being consistently operationalized, and whether we have the resources, leadership, and institutional knowledge necessary to do so effectively. This is especially concerning given that the current outbreaks of hantavirus and Ebola pose relatively low risk of transmission among the American public. Future events may not be as forgiving.

So what does this mean for organizations now that we can no longer assume there will be a prompt, clear direction from the federal government?

• For healthcare facilities: These dual outbreaks are a fresh reminder that hospitals and health systems are often the first point of contact and that guidance may be delayed or inconsistent. Now is the time to revisit and test emergency operations plans, including protocols for identification and isolation. Review your infection prevention and control procedures and confirm that staff know when and how to apply them. Confirm your current stock and access to PPE (gloves, gowns, masks) and work with your supply chain department before any shortages occur. Identify your regional healthcare coalition and any biocontainment pathways (is that right word?) – know who to contact for potential cases. Designate a clinical lead and ensure a direct relationship with your state health department.
• For private sector companies: Start with the basics: ready your continuity plans. If staff, families, or your supply chain are disrupted, what’s your fallback? The U.S. Chamber of Commerce’s Resilience in a Box toolkit is worth exploring. On supply chain specifically: the IV fluid shortage following Hurricane Helene was a reminder that healthcare supply chains are more fragile than they appear. Alternative sourcing strategies are worth the investment before the next event. The same applies to PPE, pharmaceuticals, diagnostics, and other critical medical supplies that remain vulnerable to manufacturing concentration, transportation disruptions, and sudden spikes in demand during emergencies.
• For companies looking to support communities in a crisis: Become familiar now with organizations that can help you reach your communities of interest during a disaster—there won’t be much time during an emergency to determine how to get help in the hands of your customers/staff/etc. The Center for Disaster Philanthropy maintains vetted networks of community-facing partners. In the healthcare supply chain space, Healthcare Ready can also support supply vendor vetting and identifying community organizations equipped to receive donations in disaster-affected areas.
• For NGOs: Your role in the next response may be larger than in prior ones. Stay current on developing situations—Healthcare Ready publishes situation reports on active events—and be ready to help communities navigate response resources and recovery pathways (Sign up to receive alerts, here). Just as importantly, build relationships and coalitions before a crisis occurs. Cross-sector partnerships between NGOs, healthcare systems, faith-based organizations, community groups, and private industry can dramatically improve coordination during emergencies.

Organizations preparing now—before the next emergency—will be the ones best positioned to protect operations, support communities, and sustain continuity when federal coordination alone is no longer enough.