February 6, 2025



Trump administration moves to overhaul federal health agencies, global health influence, with potential harms to health security

The Trump administration’s recent moves to withdraw from WHO, restrict federal health agencies’ communication, and freeze all foreign aid, including that for health and humanitarian programs, represent a seismic shift in US policy with far-reaching health and security consequences. There are many facets and factors to all these developments, but here we try to summarize some main points.

WHO withdrawal

On his first day in office, President Trump signed an executive order to initiate a process to withdraw the US from WHO and halted funding. This week, Argentina announced its intention to exit WHO, mirroring Trump’s move. WHO leadership and member states, as well as members of Congress, have urged the US to reconsider its position.

Impact:

• A US withdrawal would create a leadership vacuum in global health governance, potentially opening the door for China to expand its influence in the arena.
• As the largest donor in both assessed and voluntary contributions, the US withdrawal could reduce WHO's budget, particularly beginning in 2026. The US was set to provide US$900 million in total funding for 2024-2025, but it has yet to pay its full fees for that period.
• The US withdrawal will weaken international cooperation on pandemic preparedness and response, threaten the availability of technical guidance and data on emerging health threats, and exacerbate health inequities worldwide.
• Notably, the withdrawal will weaken the US’s potential to respond to infectious disease threats, such as Ebola and mpox, both domestically and abroad at a time when ongoing outbreaks necessitate protective measures.

What to watch:

• Other countries could potentially follow suit in leaving WHO. Officials in Hungary and Russia already have signaled favor of their nations’ withdrawal.
• Without US support and funding, and the potential for other nations’ withdrawal, WHO could become destabilized and lose its ability to function effectively. Already, the International Pandemic Preparedness Secretariat (IPPS) says the world is unprepared for the next global pandemic.
• China or another country could take on greater influence in global health governance.

Foreign aid freeze and dismantling of USAID

Also on his first day in office, President Trump signed a different executive order that calls for a 90-day pause in new foreign assistance obligations and disbursements pending review of all foreign aid programs. A notice sent on January 24 went further, calling for a freeze on all existing foreign assistance and stop-work orders for nearly all existing programs supported by these funds, including global health efforts such as PEPFAR.

Impact:

• Though a limited waiver was issued a week later, allowing “life-saving” services to restart, many remain paralyzed due to confusion over which programs fall under the waiver and subsequent staff cuts.
• Over the weekend, Elon Musk, a “special government employee” of President Trump’s, indicated on his social media platform that USAID—the world’s largest provider of humanitarian assistance—would be dismantled. The independent agency’s website went dark, social media accounts disappeared, and its more than 10,000 employees were locked out of their email accounts. The USAID website now displays a message stating that most employees will be placed on administrative leave on February 7 and all overseas staff will be repatriated within 30 days, with few exceptions.

What to watch:

• Secretary of State Marco Rubio is now in charge of whatever is left of USAID. A group of 37 US senators sent a letter to him this week asking about the legality of the stop-work orders, furloughs, and overall efforts to seemingly eliminate the agency, which they said disregard laws and harm US national security.
• The Congressional Research Service published an explainer of whether the Trump administration has the authority to abolish or restructure the agency, and what happens to USAID’s resources if such actions are undertaken. The document leaves open the possibility for Congress to initiate oversight activities.
• Many observers—even those who feel USAID needs reform—said that dismantling the organization will severely wound US soft power, opening the door to China, Russia, or others to fill that void. In fact, authoritarian governments worldwide appeared to delight in President Trump’s dismantlement of the foreign aid agency, which many hardline leaders view as a threat.
• With the shutdown of programs that deliver medicines, treatment, food, and other humanitarian assistance, analysts predict many thousands, even millions, of lives will be harmed or lost. One report estimated that more than 8,000 women and girls will die from complications during pregnancy and childbirth over the course of a 90-day freeze.
• The cessation of PEPFAR services alone threatens the lives of more than 20 million people worldwide, including 500,000 children; risks reversing decades of progress made against HIV; and could spur the emergence of drug-resistant HIV strains.

CDC data disappearance and communication ban

Two other executive orders signed on January 20 set in motion the removal of thousands of web pages and datasets from government websites, particularly affecting health agencies such as CDC and NIH and topics including gender, vaccines, and climate change. The information is being reviewed and either altered or removed permanently to comply with the executive orders by deleting any mention of gender, DEI, and accessibility. Additionally, CDC staff were ordered to halt all communication with WHO and to withdraw any research papers submitted to journals. These moves have significant implications for public health, including the loss of technical guidance for clinicians and parents and diminished ability to respond to health threats, such as bird flu. Some communications from federal health agencies are now allowed, but many remained blocked.

The bottom line

While it is normal for new presidential administrations to make changes and shifts to operations, Trump's recent actions risk creating rifts in global health leadership and disease surveillance, potentially leaving the US vulnerable to health threats. In addition to possibly weakening health security in the US, the long-term consequences could extend beyond public health, affecting diplomatic relationships, economic stability, and national security.

Uganda confirms 7 Ebola cases, including 1 death; first-ever trial of Sudan virus vaccine begins

Uganda has confirmed 7 cases of Ebola Sudan virus, including the wife of the index case, a 32-year-old male nurse who died on January 29, and several healthcare workers. The woman tested positive on February 2 after experiencing symptoms indicative of the disease. Nearly 300 contacts have been identified.

The source of the man’s infection is under investigation. Phylogenetic analysis of samples collected from the man suggest the viral strain is not related to Uganda’s last Ebola Sudan outbreak in 2022 but is strongly correlated with sequences from a lineage identified in 2012. The results suggest a shared source, such as an animal reservoir, instead of sustained human-to-human transmission.

With support from WHO and its partners, Uganda’s health ministry launched the first-ever vaccine trial against Ebola Sudan virus, only 3 days after the outbreak was first declared. Both US and WHO officials have warned that the Trump administration’s shutdown of USAID and freeze on aid has created gaps in response and funding shortfalls, forcing delays in the early US response to Uganda’s growing Ebola outbreak. The CDC this week issued a health advisory for clinicians and a travel advisory.

Second H5N1 genotype detected in dairy cattle in Nevada, indicating at least 2 spillover events from wild birds

The USDA has confirmed that a second genotype of H5N1 avian influenza has been detected for the first time in at least 6 dairy cattle herds in Nevada. The cows are showing respiratory symptoms. The detection was first made through the National Milk Testing Strategy that was implemented last year. Highly pathogenic avian influenza (HPAI) H5N1 clade 2.3.4.4b, genotype D1.1 is currently circulating in wild birds and has been found in human infections, including the fatal case in a Louisiana resident and the severe case in a Canadian teenager. This strain is different than the genotype that has been circulating in dairy cows for the past year (HPAI H5N1 clade 2.3.4.4b, genotype B3.13) and indicates the virus has spilled from birds into cows at least twice, and that it likely will continue to do so. The USDA currently classifies H5N1 as a foreign animal disease, meaning it is not currently present in the US, but many experts say the virus should now be considered endemic to the states.

The detection raises new questions about bird flu’s wider spread and the difficulty of controlling infections in animals—including livestock, poultry, pets, and wild animals—and the people who interact closely with them, such as farm workers, backyard flock owners, and hunters. Bird flu viruses, including H5N1 and H5N9, are increasingly being found in wild bird and sea mammal populations, sometimes causing mass die offs or necessitating large culls. While the risk to the general population remains low, researchers are working hard to learn more about avian flu viruses, including what conditions could enable the virus to be spread from person to person or become airborne. Notably, the new development comes during a pause in routine communication from federal health agencies, making it difficult to fully understand the situation and oftentimes leaving surveillance, testing, and response up to state governments.

Conflict in DRC hampers mpox response; UK reports 9 clade Ib cases, opens more vaccination sites

The ongoing M23 rebel offensive in Goma, Democratic Republic of the Congo (DRC) has displaced more than 1 million people and destroyed health infrastructure, creating a humanitarian crisis and exacerbating the spread of diseases, including measles, cholera, and mpox. In the week leading up to January 30, DRC—the epicenter of the mpox outbreak in Africa—recorded more than 2,700 cases, including 516 confirmed cases, and 38 deaths. Africa CDC and WHO warned that the ongoing war could further spread mpox throughout DRC and neighboring countries, complicating efforts to contain the outbreak.

UK response

The UK Health Security Agency (UKHSA) has confirmed 9 cases of clade Ib mpox in the UK as of February 4. Since January 20, 4 cases have been reported, all with travel history to Uganda. UKHSA also noted that as of February 5, it will no longer provide updates on new clade Ib mpox cases on a case-by-case basis, instead updating the case numbers weekly on Thursdays. The National Health Service opened 12 new mpox vaccination sites across England this week to allow each region to have vaccination services. 

RFK Jr. likely to win confirmation as HHS secretary following endorsement by key GOP senator

STAT: RFK Jr. likely to win confirmation to top Trump health role as key GOP senator says he’ll vote yes

STAT: Senate Republicans draw a red line on vaccines even as they advance RFK Jr.

The Hill: Cassidy says he secured key vaccine commitments from RFK Jr.

The Atlantic: The Doctor Who Let RFK Jr. Through

AP: RFK Jr. misled the US Senate on measles deaths, Samoa's health chief says

See also: STAT: Trump’s pick for science adviser is a rarity among his nominees — he’s not controversial

Nobel laureates, journal editors, other experts push back on Trump administration’s ban on certain terms in research papers

STAT: Nobel laureates call on National Academies and biotech CEOs to speak out against Trump attacks on science

MedPage Today: Physician Group Sues Trump Health Agencies Over Scrubbed Sites, Data

MedPage Today: Public Health Journal Won't Be Complicit in Trump Admin's Censorship

The BMJ: Medical journal editors must resist CDC order and anti-gender ideology (opinion)

STAT: How to protect HHS, FDA, NIH, and other health agencies from political interference (opinion)

Trump administration considers invoking public health border restrictions to label migrants, asylum seekers as disease threats

New York Times: Inside Trump’s Search for a Health Threat to Justify His Immigration Crackdown

Wall Street Journal: Trump Considers Labeling Migrants a Measles, Tuberculosis Risk

As Trump administration reshapes US public health, GAO warns of workforce shortage, experts present vision for modernizing systems

AFP/Business Times: Silencing science: How Trump is reshaping US public health

NBC News: Some communication from federal health agencies is now allowed; most still blocked

PoliticoPro: Is Trump 2.0 ready for another public health threat?

CIDRAP: GAO: Public-health workforce shortage undermines ability to respond to outbreaks, other emergencies

Health Affairs: Updating US Public Health For Healthier Communities

Bird flu outbreaks continue to cause egg shortages, drive up prices across US

Washington Post: Egg problems driving up prices at Waffle House and others could persist

ABC News: Here's why eggs might not be on store shelves right now

The Guardian: US egg prices expected to climb further as farmers strained by bird flu outbreak

NPR: On the frontline against bird flu, egg farmers fear they're losing the battle

New York Times: Are Eggs Safe to Eat as Bird Flu Spreads?

See also: USA Today: These influencers, RFK Jr. can't get enough of raw milk. But what about bird flu?

Recent journal articles examine epidemiology of global mpox outbreaks

BMJ Global Health: Decoding mpox: a systematic review and meta-analysis of the transmission and severity parameters of the 2022–2023 global outbreak

BMJ Global Health: Risk factors associated with human Mpox infection: a systematic review and meta-analysis

New England Journal of Medicine: Evolving Epidemiology of Mpox in Africa in 2024

Influenza activity at high, very high levels across US, while COVID levels lower than previous winters; COVID still kills thousands

Force of Infection: Flu spikes

New York Times: The U.S. Is Having Its Mildest Covid Winter Yet

ABC News: 5 years since COVID declared public health emergency in US, still killing thousands

CIDRAP: COVID led to more hospital stays, deaths than flu from 2022 to 2024, study suggests

See also: USA Today: Is a 'quademic' swirling? What you should know about flu, RSV, COVID and norovirus

“This flu season is not out of the ordinary for a pre-pandemic (year). People have kind of gotten lulled into having light flu seasons, so I think that’s part of what’s driving people to be kind of surprised by this. We haven’t had ordinary flu seasons for a while, so it seems extraordinary.” Amesh Adalja, MD, FIDSA, senior scholar at the Center for Health Security, speaking to Nexstar/The Hill

Patients with history of COVID-19 developed more severe cardiovascular event risk factors than those who were never infected, study shows

Gavi/VaccinesWork: COVID-19 may accelerate dangerous hardening of the arteries

HealthDay News: COVID Might Clog Arteries, Increase Heart Risk

Long COVID prevalence among children held steady from 2022–2023; 80% reported activity limitations

ABC News: Long COVID impacting more than 1 million children: CDC study suggests

CIDRAP: Pediatric long-COVID levels hold steady in US, result in activity limitations

Opinion pieces discuss importance of learning from lived experiences of people with post-viral illnesses, integrating research on similar conditions

STAT: NIH must address the twin crises of long Covid and ME/CFS — together

The BMJ: We must recognise the collective wisdom of those with lived experience of long covid

Measles outbreak in Texas; state health officials there, in neighboring New Mexico urge residents to stay alert, get vaccinated

Texas Tribune: Measles cases reported in Texas as vaccine rate against the disease has fallen

Texas Health and Human Services: State health officials urge vigilance as additional measles cases are identified

Source NM: Texas measles outbreak puts New Mexico health officials on alert

With active TB outbreaks in Kansas, Michigan, health officials in several states warn of disease’s comeback

CNN: Two dead, dozens sickened in Kansas tuberculosis outbreak

The Guardian: Kansas reckons with large tuberculosis outbreak as health officials hamstrung

CIDRAP: TB cases linked to high schools in Michigan, California

Sacramento Bee: ‘Unprecedented’ tuberculosis outbreak is underway in Kansas. Are Californians at risk?

NJ.com: Tuberculosis is making a comeback, experts warn. Why N.J. is at a higher risk.

WRAL News: Tuberculosis cases on the rise in NC after more than 30 years of decline

See also: Kansas Reflector: Kansas tuberculosis outbreak reminds us of long battle for public health — and importance of trust (opinion)

Researchers identify novel henipavirus in Alabama shrews, first of Paramyxoviridae viral family discovered in US

AL.com: Alabama town’s name attached to highly lethal new virus

Fox News: Potentially deadly zoonotic virus found in US, sparking concerns of spread to humans

University of Queensland: UQ team finds relative of deadly Hendra virus in the US

ICYMI: Check out the Center’s four-part series, Dissecting Pandemic-Prone Viral Families, including a report on the Paramyxoviridae family.

Guillain-Barre syndrome outbreak in Maharashtra, India, linked to water contaminated with C. jejuni; nation’s total GBS death toll reaches 7 for 2025

Times of India: Tests confirm water caused Pune GBS outbreak; toll hits 7 after 10-year-old’s death

BBC: Guillain-Barre syndrome: India faces outbreak of creeping paralysis

The Independent: Guillain-Barre Syndrome: Five dead as India faces outbreak of nerve disease

PAHO alert warns of increase in yellow fever cases, change in geographic distribution of disease

PAHO: Epidemiological Alert: Increase in Yellow Fever Cases in Latin America

CIDRAP: PAHO warns of rise of yellow fever in the Americas

FROM THE CENTER

Center for Health Security and other staff with Sen. Richard Burr / Photo credit: Kaveh Sardari

Capitol Hill Steering Committee on Health Security presents Sen. Richard Burr with lifetime achievement award

Johns Hopkins Center for Health Security Director Tom Inglesby, MD, and Deputy Director Anita Cicero, JD, and other staff celebrated former US Senator Richard Burr’s career and legacy by presenting him with the Health Security Lifetime Achievement Award today in Washington, DC.

This award, presented by the Center’s Capitol Hill Steering Committee on Health Security to a Member of Congress, recognizes Sen. Burr’s extraordinary contributions to strengthening health security policies, laws, and funding. His leadership in health security created a legacy and inspired future generations to continue the work of protecting domestic and global health security.

The Center thanks Sen. Burr for his dedication over the years. For more on the Capitol Hill Steering Committee, visit: https://centerforhealthsecurity.org/our-work/the-capitol-hill-steering-committee. 

Editor: Alyson Browett, MPH