The impact of USAid cuts on the global Mpox response: A looming public health crisis

As the Trump administration moves forward with dismantling the United States Agency for International Development (USAid) and withdrawing funding from international public health initiatives, experts warn that mpox, formerly known as monkeypox, could escalate into a broader global health emergency. With resources suddenly frozen and aid workers pulled from affected regions, the ability to contain the virus is rapidly diminishing.

A Critical Moment for Mpox Containment

The World Health Organization (WHO) classified mpox as a public health emergency of international concern in August, as cases surged in the Democratic Republic of Congo (DRC) and began spreading to neighboring countries. USAid, in collaboration with the Centers for Disease Control and Prevention (CDC), had been actively engaged in containment efforts through vaccination campaigns, testing, and disease surveillance. In the past year alone, these agencies allocated $55 million in emergency assistance to combat the outbreak.

However, despite these financial commitments, not all allocated funds have been utilized. Under orders from the Trump administration, disbursement has been halted, leaving critical health programs in limbo. Additionally, USAid personnel were instructed to evacuate the DRC at the end of January, effectively ending U.S. leadership in coordinating response efforts.

A USAid worker, speaking anonymously due to concerns over retaliation, expressed the uncertainty gripping the organization: “Everyone is looking at USAid to take the lead, and now, with funding frozen and personnel gone, nobody knows what to do.”

The Consequences of Defunding Public Health Efforts

The abrupt withdrawal of USAid support has already led to severe consequences in provinces that relied entirely on its funding to fight mpox. A second USAid worker highlighted that efforts were underway to build a sustainable response system that could address both the current mpox outbreak and future epidemics. However, with funding cut off, these long-term plans may never materialize.

Experts warn that the inability to contain the virus in the DRC significantly raises the risk of mpox spreading to more countries, including the United States. A U.S.-based researcher specializing in infectious diseases, who requested anonymity due to ongoing collaborations with the National Institutes of Health (NIH) and the CDC, described the USAid shutdown as catastrophic: “This isn’t just about Africa. By cutting off support, we’re increasing the chances of another global outbreak, which could inevitably reach the U.S.”

This warning is not without precedent. In 2022, an mpox outbreak spread beyond its usual endemic regions in Central and West Africa, infecting over 100,000 people across 122 countries. Although containment efforts, including widespread vaccination, have since reduced infection rates, the new outbreak in the DRC involves a distinct variant of the virus. Without intervention, health officials fear a repeat of the 2022 crisis—this time with fewer resources available to combat it.

Trump administration officials have defended their decision to freeze humanitarian aid, citing concerns over wasteful spending and fraud. However, public health experts argue that the manner in which these cuts were implemented was reckless.

Amesh Adalja, a professor at the Johns Hopkins Bloomberg School of Public Health, emphasized the importance of a measured approach: “If you’re going to make budget cuts, they need to be carefully planned. Disease control programs require predictability, and sudden funding disruptions make it impossible to allocate vaccines, strategize testing, or implement expert-driven solutions.”

The U.S. Secretary of State, Marco Rubio, has stated that some life-saving humanitarian assistance, such as funding for food and medicine, could still be approved through waivers. However, USAid workers say their requests for an exemption to continue mpox-related programming have not yet been granted.

Uncertainty for USAid and Its Employees

The legal battle over USAid’s future remains ongoing, with a federal judge recently issuing a temporary halt to the aid freeze. The ruling, which required the government to comply within five days, has added another layer of confusion, as aid workers struggle to determine how, or if, programs can be restarted.

Beyond the operational challenges, USAid employees themselves are facing personal turmoil. In late January, as tensions escalated in Kinshasa, the U.S. embassy ordered an emergency evacuation. Many workers were forced to flee by boat with only minimal belongings, leaving behind pets, homes, and possessions. Without government support, they had to fund their own evacuations.

Back in Washington, their professional futures remain uncertain. One USAid employee, using the pseudonym Nancy Doe in a court filing, described the physical and emotional toll of the situation: “I’ve suffered from extreme stress, sleep deprivation, and anguish, not just for myself, but for the colleagues and partners still on the ground in the DRC, unable to respond as we normally would.”

Public health experts caution that USAid’s shutdown, combined with the Trump administration’s earlier withdrawal from the WHO, has significantly weakened the global response to pandemics. The U.S. was the largest financial contributor to the WHO and benefited from international research collaborations, resources that are now lost.

Stephen Morse, an epidemiology professor at Columbia University, underscored the dangers of this isolationist approach: “By pulling out of the WHO and shutting down USAid, we’re effectively blindfolding ourselves. This won’t make us safer, it will only ensure that we’re less prepared for whatever comes next.”

As the fate of USAid remains tied up in legal battles, the world watches anxiously. The decision to defund public health efforts in the midst of an active outbreak carries consequences not just for the DRC, but for global health security as a whole. If history has taught us anything, it’s that pandemics do not respect borders.