Health
Who Should Be Allowed a Medically Assisted Death?
Ron Curtis, an English professor in Montreal, lived for 40 years with a degenerative spinal disease, in what he called the “black hole” of chronic pain.
On a July day in 2022, Mr. Curtis, 64, ate a last bowl of vegetable soup made by his wife, Lori, and, with the help of a palliative care doctor, died in his bedroom overlooking a lake.
Aron Wade, a successful 54-year-old stage and television actor in Belgium, decided he could no longer tolerate life with the depression that haunted him for three decades.
Last year, after a panel of medical experts found he had “unbearable mental suffering,” a doctor came to his home and gave him medicine to stop his heart, with his partner and two best friends at his side.
Argemiro Ariza was in his early 80s when he began to lose function in his limbs, no longer able to care for his wife, who had dementia, in their home in Bogotá.
Doctors diagnosed A.L.S., and he told his daughter Olga that he wanted to die while he still had dignity. His children threw him a party with a mariachi band and lifted him from his wheelchair to dance. A few days later, he admitted himself to a hospital, and a doctor administered a drug that ended his life.
Until recently, each of these deaths would have been considered a murder. But a monumental change is underway around the world. From liberal European countries to conservative Latin American ones, a new way of thinking about death is starting to take hold.
Over the past five years, the practice of allowing a physician to help severely ill patients end their lives with medication has been legalized in nine countries on three continents. Courts or legislatures, or both, are considering legalization in a half-dozen more, including South Korea and South Africa, as well as eight of the 31 American states where it remains prohibited.
It is a last frontier in the expansion of individual autonomy. More people are seeking to define the terms of their deaths in the same way they have other aspects of their lives, such as marriage and childbearing. This is true even in Latin America, where conservative institutions such as the Roman Catholic church are still powerful.
“We believe in the priority of our control over our bodies, and as a heterogeneous culture, we believe in choices: If your choice does not affect me, go ahead,” said Dr. Julieta Moreno Molina, a bioethicist who has advised Colombia’s Ministry of Health on its assisted dying regulations.
Yet, as assisted death gains more acceptance, there are major unresolved questions about who should be eligible. While most countries begin with assisted death for terminal illness, which has the most public support, this is often followed quickly by a push for wider access. With that push comes often bitter public debate.
Should someone with intractable depression be allowed an assisted death?
European countries and Colombia all permit people with irremediable suffering from conditions such as depression or schizophrenia to seek an assisted death. But in Canada, the issue has become contentious. Assisted death for people who do not have a reasonably foreseeable natural death was legalized in 2021, but the government has repeatedly excluded people with mental illness. Two of them are challenging the exclusion in court on the grounds that it violates their constitutional rights.
In public debate, supporters of the right to assisted death for these patients say that people who have lived with severe depression for years, and have tried a variety of therapies and medications, should be allowed to decide when they are no longer willing to keep pursuing treatments. Opponents, concerned that mental illness can involve a pathological wish to die, say it can be difficult to predict the potential effectiveness of treatments. And, they argue, people who struggle to get help from an overburdened public health service may simply give up and choose to die, though their conditions might have been improved.
Should a child with an incurable condition be able to choose assisted death?
The ability to consent is a core consideration in requesting assisted death. Only a handful of countries are willing to extend that right to minors. Even in the places that do, there are just a few assisted deaths for children each year, almost always children with cancer.
In Colombia and the Netherlands, children over 12 can request assisted death on their own. Parents can provide consent for children 11 and younger.
Denise de Ruijter took comfort in her Barbie dolls when she struggled to connect with people. She was diagnosed with autism and had episodes of depression and psychosis. As a teenager in a Dutch town, she craved the life her schoolmates had — nights out, boyfriends — but couldn’t manage it.
She attempted suicide several times before applying for an assisted death at 18. Evaluators required her to try three years of additional therapies before agreeing her suffering was unbearable. She died in 2021, with her family and Barbies nearby.
The issue is under renewed scrutiny in the Netherlands, where, over the past decade, a growing number of adolescents have applied for assisted death for relief from irremediable psychiatric suffering from conditions such as eating disorders and anxiety.
Most such applications by teens are either withdrawn by the patient, or rejected by assessors, but public concern over a few high-profile cases of teens who received assisted deaths prompted the country’s regulator to consider a moratorium on approvals for children applying on the basis of psychiatric suffering.
Should someone with dementia be allowed assisted death?
Many people dread the idea of losing their cognitive abilities and their autonomy, and hope to have an assisted death when they reach that point. But this is a more complex situation to regulate than for a person who can still make a clear request.
How can a person who is losing their mental capacity consent to dying? Most governments, and doctors, are too uncomfortable to permit it, even though the idea tends to be popular in countries with aging populations.
In Colombia, Spain, Ecuador and the Canadian province of Quebec, people who have been diagnosed with Alzheimer’s disease or other kinds of cognitive decline can request assessment for an assisted death before they lose mental capacity, sign an advance request — and then have a physician end their life after they have lost the ability to consent themselves.
But that raises a separate, challenging, question: After people lose the capacity to request an assisted death, who should decide it’s time?
Their spouses? Their children? Their doctors? The government? Colombia entrusts families with this role. The Netherlands leaves it up to doctors — but many refuse to do it, unwilling to administer lethal drugs to a patient who can’t clearly articulate a rational wish to die.
Jan Grijpma was always clear with his daughter, Maria: When his mind went, he didn’t want to live any more. Maria worked with his longtime family doctor, in Amsterdam, to identify the point when Mr. Grijpma, 90 and living in a nursing home, was losing his ability to consent himself.
When it seemed close, in 2023, they booked the day, and he updated his day planner: Thursday, visit the vicar; Friday, bicycle with physiotherapy and get a haircut; Sunday, pancakes with Maria; Monday, euthanasia.
All of these questions are becoming part of the discussion as the right to control and plan one’s own death is pushed in front of reluctant legislatures and uneasy medical professionals.
Dr. Madeline Li, a Toronto psychiatrist, was given the task of developing the assisted-dying practice in one of Canada’s largest hospitals when the procedure was first decriminalized in 2015. She began with assessing patients for eligibility and then moved to providing medical assistance in dying, or MAID, as it is called in Canada. For some patients with terminal cancer, it felt like the best form of care she could offer, she said.
But then Canada’s eligibility criteria expanded, and Dr. Li found herself confronting a different kind of patient.
“To provide assisted dying to somebody dying of a condition who is not happy with how they’re going to die, I’m willing to assist them, and hasten that death,” she said. “I struggle more with people who aren’t dying and want MAID — I think then you’re assisting suicide. If you’re not dying — if I didn’t give you MAID, you wouldn’t otherwise die — then you’re a person who’s not unhappy with how you’re going to die. You’re unhappy with how you’re living.”
Who has broken the taboo?
For decades, Switzerland was the only country to permit assisted death; assisted suicide was legalized there in 1942. It took a further half century for a few more countries to loosen their laws. Now decriminalization of some form of assisted death has occurred across Europe.
But there has recently been a wave of legalization in Latin America, where Colombia was long an outlier, having allowed legal assisted dying since 2015.
Paola Roldán Espinosa had a thriving career in business in Ecuador, and a toddler, when she was diagnosed with A.L.S. in 2023. Her health soon deteriorated to the point that she needed a ventilator.
She wanted to die on her terms — and took the case to the country’s highest court. In February 2024, the court responded to her petition by decriminalizing assisted dying. Ms. Roldán, then 42, had the death she sought, with her family around her, a month later.
Ecuador has decriminalized assisted dying through constitutional court cases, and Peru’s Supreme Court has permitted individual exceptions to the law which prohibits the procedure, opening the door to expansion. Cuba’s national assembly legalized assisted dying in 2023, although no regulations on how the procedure will work are yet in place. In October, Uruguay’s parliament passed a long-debated law allowing assisted death for the terminally ill.
The first country in Asia to take steps toward legalization is South Korea, where a bill to decriminalize assisted death has been proposed at the National Assembly several times but has not come to a vote. At the same time, the Constitutional Court, which for years refused to hear cases on the subject, has agreed to adjudicate a petition from a disabled man with severe and chronic pain who seeks an assisted death.
Access in the United States remains limited: 11 jurisdictions (10 states plus the District of Columbia) allow assisted suicide or physician-assisted death, for patients who have a terminal diagnosis, and in some cases, only for patients who are already in hospice care. It will become legal in Delaware on Jan. 1, 2026.
In Slovenia, in 2024, 55 percent of the population who voted in a national referendum were in favor of legalizing assisted death, and parliament duly passed a law in July. But pushback from right-wing politicians then forced a new referendum, and in late November, 54 percent of those who voted rejected the legalization.
And in the United Kingdom, a bill to legalize assisted death for people with terminal illness has made its way slowly through parliament. It has faced fierce opposition from a coalition of more than 60 groups for people with disabilities, who argue they may face subtle coercion to end their lives rather than drain their families or the state of resources for their care.
Why now?
In many countries, decriminalization of assisted dying has followed the expansion of rights for personal choice in other areas, such as the removal of restrictions on same-sex marriage, abortion and sometimes drug use.
“I would expect it to be on the agenda in every liberal democracy,” said Wayne Sumner, a medical ethicist at the University of Toronto who studies the evolution of norms and regulations around assisted dying. “They’ll come to it at their own speed, but it follows with these other policies.”
The change is also being driven by a convergence of political, demographic and cultural trends.
As populations age, and access to health care improves, more people are living longer. Older populations mean more chronic disease, and more people living with compromised health. And they are thinking about death, and what they will — and won’t — be willing to tolerate in the last years of their lives.
At the same time, there is diminishing tolerance for suffering that is perceived as unnecessary.
“Until very recently, we were a society where few people lived past 60 — and now suddenly we live much longer,” said Lina Paola Lara Negrette, a psychologist who until October was the director of the Dying With Dignity Foundation in Colombia. “Now people here need to think about the system, and the services that are available, and what they will want.”
Changes in family structures and communities, particularly in rapidly urbanizing middle-income countries, mean that traditional networks of care are less strong, which shifts how people can imagine living in older age or with chronic illness, she added.
“When you had many siblings and a lot of generations under one roof, the question of care was a family thing,” she said. “That has changed. And it shapes how we think about living, and dying.”
How does assisted dying work?
Beyond the ethical dilemmas, actually carrying out legalized assisted deaths involves countless choices for countries. Spain requires a waiting period of at least 15 days between a patient’s assessments (but the average wait in practice is 75 days). In most other places, the prescribed wait is less than two weeks for patients with terminal conditions, but often longer in practice, said Katrine Del Villar, a professor of constitutional law at the Queensland University of Technology who tracks trends in assisted dying
Most countries allow patients to choose between administering the drugs themselves or having a health care provider do it. When both options are available, the overwhelming majority of people choose to have a health care provider end their life with an injection that stops their heart.
In many countries only a doctor can administer the drugs, but Canada and New Zealand permit nurse practitioners to provide medically assisted deaths too.
One Australian state prohibits medical professionals from raising the topic of assisted death. A patient must ask about it first.
Who determines eligibility is another issue. In the Netherlands, two physicians assess a patient; in Colombia, it’s a panel consisting of a medical specialist, a psychologist and a lawyer. The draft legislation in Britain would require both a panel and two independent physicians.
Switzerland and the states of Oregon and Vermont are the only jurisdictions in the world that explicitly allow people who are not residents access to assisted deaths.
Most countries permit medical professionals to conscientiously object to providing assisted deaths and allow faith-based medical institutions to refuse to participate. In Canada, individual professionals have the right to refuse, but a court challenge is underway seeking to end the ability of hospitals that are controlled by faith-based organizations and that operate with public funds to refuse to allow assisted deaths on their premises.
“Even when assisted dying has been legal and available somewhere for a long time, there can be a gap between what is legal and what is acceptable — what most physicians and patients and families feel comfortable with,” said Dr. Sisco van Veen, an ethicist and psychiatrist at Amsterdam Medical University. “And this isn’t static. It evolves over time.”
Jin Yu Young in Seoul, José Bautista in Madrid, José María León Cabrera in Quito, Veerle Schyns in Amsterdam and Koba Ryckewaert in Brussels contributed reporting.
In a sterile Bristol Myers Squibb lab about an hour north of Boston, scientists in scrubs and hairnets transfer living cells to a 2,000-liter stainless steel bioreactor that grows them for weeks. The goal is to produce proteins that are genetically engineered to attack cells that cause disease.
Tiny variations in heat, light or pH level can stop the cells from growing, causing drug shortages that endanger patients. Typically scientists would have to wait to see what went wrong during that fragile process, but now artificial intelligence is used to carefully monitor important variables — such as temperature and oxygen levels — and alert technicians if there are problems.
Every year the World Economic Forum and McKinsey recognize manufacturers that are on the cutting edge of technology, including artificial intelligence. This year, the Bristol Myers Squibb facility in Devens, Mass., was the only manufacturer in the United States that made the list of 23.
While American companies typically lead in artificial intelligence research and capital investment, U.S. manufacturers often struggle to translate those breakthroughs into productivity gains on the factory floor.
Of the 223 factories that have made the World Economic Forum’s Global Lighthouse Network list since 2018, 14 have been in the United States, while 99 are in China. Of the American ones, four are in the pharmaceutical and life sciences sector.
“China is scaling faster,” said Rahul Shahani, a partner at McKinsey who works with the World Economic Forum on the initiative. He added, “They have technologists in the factories — hundreds of them — while in the U.S. we’re competing for that same talent with Silicon Valley.”
Large American pharmaceutical companies have been a rare bright spot in the use of A.I. Many drugmakers, including Pfizer and Eli Lilly, are investing billions in A.I. and related technologies to accelerate drug discovery and streamline manufacturing. The trend coincides with President Trump’s demands that drugmakers produce more drugs on U.S. soil.
Scientists at the Devens facility use artificial intelligence to discover molecules that can target cancer and other diseases with greater precision. A.I. can comb through data sets from past experiments to identify possibilities that a human might not have considered. Researchers then test those molecules in the virtual world — a process referred to as “in silico.” Only the most promising are tested in a physical laboratory. The company can run multiple “in silico” experiments at a time.
“Drug discovery and bio-manufacturing are definitely areas where A.I. can have the most impact,” said Kyle Chan, a fellow at the Brookings Institution’s John L. Thornton China Center. “These are areas where A.I. has some of the largest advantages over previous approaches given the need to process and synthesize large, complex data sets.”
Still, there’s no guarantee that technological advantages will instantly equate to benefits for patients. The history of drug development is filled with failures, and it is unknown whether molecules identified by A.I. will pass muster in clinical trials.
The Bristol Myers Squibb facility sits on an 89-acre campus where buildings are decorated with portraits of cancer survivors..
Previously, scientists and technicians were never sure why some batches of cells produced a large amount of proteins, while others failed completely. But now A.I. uses information from past batches to identify what variables need to change. For example, if oxygen levels are lower than previous batches, the system will suggest that oxygen be added. If the pH levels are higher than previous batches, it will recommend a fix. It also makes suggestions about the best time to harvest the cells.
These innovations have boosted the volume of drugs produced for clinical trials and commercial use at the facility by about 40 percent, according to a company spokeswoman.
“We are able to now intervene in the batches during the manufacturing process and not have to wait until we get to the end,” said Karin Shanahan, executive vice president, chief supply chain and operations officer for the company.
These innovations have helped stabilize production of Orencia, a drug that treats autoimmune conditions such as rheumatoid arthritis using cells that are extremely difficult to grow. In 2024, manufacturing challenges resulted in a shortage in some parts of the world.
The company is just beginning to use A.I. in its manufacturing process of another drug, Breyanzi, which turns a cancer patient’s own white blood cells into a personalized therapy. Currently, the Devens plant is authorized by the Food and Drug Administration to produce treatments for just 12 patients at a time.
Ms. Shanahan said she hoped that eventually A.I. would increase production of the treatment, often viewed as a last resort for people with blood cancers such as leukemia.
Bristol Myers Squibb has embarked on a series of cost-cutting measures as the key patent for its cancer drug Opdivo expires in 2028. The drug, which uses proteins that have been genetically engineered to target cancer cells, generated more than $10 billion of the company’s $48 billion in revenue last year.
The company is trimming $2 billion in costs by the end of 2027 in addition to $1.5 billion in cuts announced in 2024. More than 1,000 positions are being eliminated, many of them at a research facility in Lawrenceville, N.J., heightening anxiety about A.I.’s taking jobs away in the sector.
At the Semafor World Economy summit last month, Bristol Myers Squibb’s chief executive, Chris Boerner, said the company had a responsibility to use A.I. to further its mission but acknowledged that it could adversely affect some employees.
“We are engaging with those employees to make them more marketable around this technology — with the company or elsewhere,” he said.
The facility in Devens, which was completed in 2009 at a cost of $750 million, wasn’t designed with A.I. in mind. As recently as 2020, employees used Excel spreadsheets for some tasks. Batch records that document every step of production were filled out by hand. But in recent years, the company has prioritized digitizing and automating its processes.
“We needed to make sure that we could formulate our products faster, that we could commercially scale them faster,” Ms. Shanahan said. “And so that’s really what forced us to start to go down that path.”
Overall the company aims to cut the time it takes to bring a drug to market to about six years, from nine, she said.
Other factories that received recognition from the World Economic Forum this year included Yueda Textile in Yancheng, China, which collects sensor data to detect machine maintenance issues before they occur, reducing costs; and Midea, a manufacturer of microwaves and air-conditioners in Thailand that uses A.I. to investigate customer complaints, generating recommendations for corrective action that cut resolution time from months to days.
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As investigations continue into the hantavirus outbreak that originated on the expedition cruise ship MV Hondius, concerns swirl about the prevalence of the virus in the U.S.
Among passengers of the ship, which was traveling from Argentina across the Atlantic, there have been three deaths and at least eight reported cases, several of them laboratory-confirmed, according to the World Health Organization and subsequent health reports.
At least five states are now monitoring residents who returned from the MV Hondius, including Texas, Virginia, Georgia, Arizona and California, reports have noted.
HANTAVIRUS DEATHS ON CRUISE SHIP HIGHLIGHT DANGERS OF RODENT-BORNE DISEASE
In the U.S., there have historically been around 800 to 900 cases of hantavirus, according to Luis Marcos, M.D., professor of medicine and director of the Infectious Diseases Fellowship Program at Stony Brook Medicine in New York.
CDC data supports this, showing that 890 cases of hantavirus disease have been reported in the U.S. from 1993 through the end of 2023.
As investigations continue into the hantavirus outbreak that originated on the expedition cruise ship MV Hondius, concerns swirl about the virus’ prevalence in the U.S. (iStock)
“Most of these cases have been west of the Mississippi River, and classically the risk factors are being in contact with feces and urine from rodents,” Marcos told Fox News Digital.
The most common strain is called Sin Nombre, which is not transmitted from human to human, the doctor said.
“The transmission is not as efficient as other viruses.”
Most strains of hantavirus spread from inhaling contaminated particles from rodent urine, droppings or saliva – or, less commonly, from touching contaminated surfaces and then touching the mouth, nose or eyes – and are not transmitted person-to-person.
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Typical scenarios include people who have been camping or hiking in remote areas and were inadvertently in contact with these feces or urine.
“The only proven human-to-human transmission has been with the Andean virus from South America — and that’s what’s happening now,” Marcos told Fox News Digital.
Among passengers of the ship, which was traveling from Argentina across the Atlantic, there have been three deaths and at least eight reported cases, several of them laboratory-confirmed. (Getty Images)
The current cruise ship outbreak reportedly originated with a couple who contracted the virus while traveling in Argentina.
“They were not symptomatic at all — the incubation period can be one, two, three or four weeks,” Marcos said.
Most strains of hantavirus spread from inhaling contaminated particles from rodent urine, droppings or saliva. (iStock)
Most infected people become ill with symptoms that are similar to flu and COVID, such as fever and muscle pain.
“Some people may have mild disease, so not everybody will be very, very sick,” the doctor noted.
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In rare cases, hantavirus can lead to hantavirus pulmonary syndrome (HPS), which causes the lungs to fill with fluid and can be fatal, the doctor noted.
“The mortality rate [among those with HPS] is between 30% and 60% — so yes, it’s a deadly virus,” the doctor added.
In terms of transmission, Marcos emphasized that those at highest risk are the people in “close contact,” which typically means living in the same environment where fluids can be exchanged.
“The longest incubation period has been 56 days or so.”
“It has to be really, really close contact,” he said. “The transmission is not as efficient as other viruses.”
While it’s possible for the virus to be airborne via droplets, Marcos pointed out that those transmissions are “not as effective” as COVID, influenza or cold viruses.
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“For this cruise, it’s important to have people in quarantine for a period of time,” he said.
The virus has a long incubation period, which means the quarantine duration will likely be several weeks. “The longest incubation period has been 56 days or so, so two months, roughly,” Marcos said. “But most cases will get sick within two to three weeks.”
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There are not currently any antiviral treatments for hantavirus.
“So what happens is the patient will end up in the hospital. We will do supportive care, which means if your lungs are full of fluid, you will require a ventilator until you know the virus runs its course,” Marcos said.
“We will do supportive care, which means if your lungs are full of fluid, you will require a ventilator until you know the virus runs its course,” the doctor said. (iStock)
Although there is not currently a vaccine for hantavirus in the U.S., Marcos noted that several are in development.
The doctor said he believes the risk of hantavirus leading to a pandemic is “pretty much almost zero.”
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“I don’t feel a strong risk of a pandemic,” he told Fox News Digital. “The transmission is not like COVID. It’s very different.”
“I really think this is going to go away in the next two to three weeks, and we will know exactly the number of cases,” he added.
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To prevent hantavirus, Marcos recommends wearing gloves and a mask in environments where mice might be present, such as cleaning a basement.
Proper ventilation and frequent hand-washing can also help curb spread.
On April 24, nearly two weeks after the first person aboard a cruise ship died of hantavirus, 30 passengers, including six Americans, disembarked in St. Helena, a remote island in the Atlantic Ocean.
The Americans are now back on U.S. soil, and three states are monitoring them; none have shown symptoms so far. That information came on Wednesday — not from the Centers for Disease Control and Prevention or from the State Department, which is coordinating the nation’s response to the hantavirus outbreak, but from the medical news publication MedPage Today. (The New York Times confirmed the report with state officials.)
More than four hours after the news emerged, the C.D.C. issued its first public statement about the outbreak, saying, “We are working closely with our international partners to provide technical assistance and guidance to mitigate risk.” It did not mention the Americans who were back in the country or efforts to monitor them.
It was only a day earlier, on Tuesday, that the agency had set up a team to respond to the outbreak, nearly a month after the first patient had died.
To some public health experts, the alarming thing about this situation is not the hantavirus, which they note spreads among people rarely, and only with close contact over a period of time rather than casual interactions. It is that the administration’s sluggish response and lack of communication suggest the United States is ill prepared for a larger health crisis, such as another pandemic.
“We should be able to deal collectively with a hantavirus outbreak much more quickly and effectively than this is happening,” said Stephanie Psaki, the coordinator for global health security during the Biden administration.
“An outbreak of a known pathogen on a cruise ship is a relatively easy scenario,” she said. “It can get much harder than this.”
Because of deep staffing cuts the Trump administration has made to the C.D.C. and other health agencies, the government has far fewer people to respond to outbreaks, from trainees and contractors who can be deployed to do boots-on-the-ground epidemiology to senior leaders who can coordinate responses across the U.S. government and elsewhere. And because President Trump withdrew the country from the World Health Organization, the United States does not receive regular information from member states about emerging health threats.
The State Department did not respond to questions about plans to repatriate the 17 Americans still on board the ship or to monitor those already back home. “We are closely tracking reports of the suspected hantavirus outbreak on a cruise ship in the Atlantic Ocean and are in close contact with the cruise ship and U.S. and international health authorities,” the department said in an emailed statement.
It directed questions about quarantining the passengers to the C.D.C. The Health and Human Services Department, which manages communications from the agency, also did not respond to questions about repatriation or quarantine.
The first patient aboard MV Hondius, a Dutch cruise ship, was an older man who developed fever, headache and mild diarrhea on April 6. He died of respiratory distress five days later, but his body stayed on the vessel till April 24. The second patient, a close contact, died on April 26 and a third on May 2. As of Thursday, five other people have symptoms resembling those of hantavirus infection.
South African scientists identified hantavirus as the cause of the illnesses on May 2. But if the U.S. government had been more involved, “things could have happened more quickly at every step along the way,” Dr. Psaki said.
The World Health Organization was notified of the cluster of illnesses via International Health Regulations, a legal framework that requires member countries to disclose outbreaks. After the Trump administration withdrew from the W.H.O. in January 2025, it rejected the latest regulations that July. As a result, the United States is not privy to many of the conversations between member states.
Even if the C.D.C. and the W.H.O. are talking now, “what you want is to have an ongoing dialogue,” said Dr. Daniel Jernigan, who ran the C.D.C.’s emerging disease center before resigning in August in protest of the administration’s handling of the agency.
“C.D.C. is not a part of that routine engagement,” he said. “And therefore when something emerges, we’re not going to get that call immediately.”
The agency’s delay in setting up a team to respond to the outbreak is worrying, infectious disease experts said. Ideally, the risk to Americans should be assessed and communicated to health agencies and the public as soon as a threat emerges, usually within 24 to 48 hours, Dr. Psaki said.
“The point is early decision making, proactive plans to protect Americans, and people with outbreak response expertise in the lead,” she added.
Unless the administration fills crucial leadership roles focused on infectious disease threats, it is likely to be hamstrung when bigger threats come along, she and others said.
“Leaders with convening power and influence are key,” said Dr. Jeanne Marrazzo, chief executive of the Infectious Diseases Society of America. Dr. Marrazzo directed the National Institute of Allergy and Infectious Diseases but was fired after filing a whistle-blower complaint against the Trump administration.
“They can work from the White House to the H.H.S. agencies to industry and academic partners to be sure there is a coordinated effort to galvanize the response,” she added. “We don’t have that right now.”
Dr. Psaki’s former role, created by Congress in 2023 to oversee preparedness to biological threats, is vacant. The White House Office of Pandemic Preparedness and Response Policy, established by Congress in 2022, is also unstaffed — fulfilling in spirit, if not in fact, President Trump’s threat during his campaign to shut it down.
In February 2025, the administration appointed Gerald Parker, a former commander of the U.S. Army Medical Research Institute of Infectious Diseases, to lead the biosecurity and pandemic response directorate within the National Security Council. But he resigned less than six months into the job, and has not been replaced.
The White House did not respond to questions about those roles.
Last year, alongside massive cuts to research on mRNA and other vaccines, the Trump administration shuttered a network of research centers focused on preventing pandemics by studying pathogens like hantavirus that can jump from animals to people.
In its 2026 budget request, the administration said it planned to refocus the C.D.C. on outbreak investigations and preparedness. But at the same time, it proposed eliminating about $750 million in preparedness grants that states rely on to cope with natural and man-made disasters including outbreaks. It also zeroed funding for the Hospital Preparedness Program, which strengthens health care systems to respond to emergencies, saying the program “has been wasteful and unfocused.”
Nearly all of the C.D.C.’s center directors were appointed recently or are serving in an acting capacity. The agency has also lost the heads of several important divisions, including the Division of High-Consequence Pathogens — which includes hantavirus — who now works for the New Zealand government.
“You don’t have the captains and admirals in order to run a big, big response,” Dr. Jernigan said. The agency has also added layers of bureaucracy to get travel approved for scientists who might need to investigate outbreaks, he said.
The layoffs largely spared other staff from the agency’s infectious disease centers. But because of a hiring freeze, the agency has not renewed contracts for Title 42 workers, a category that includes scientists hired for specialized roles. It has also let go of younger fellows, including in a program called ORISE, who could be deployed for various tasks, including testing at air or seaports.
The thinning numbers have shrunk the number of qualified scientists who can assist states with testing and management of dangerous pathogens. By July, the C.D.C.’s rabies team will be down to just one person with the clinical expertise to advise state and local officials, and the pox virus team will have none.
The administration twice fired, then brought back, the C.D.C.’s vaunted “disease detectives,” Epidemic Intelligence Service fellows who conduct outbreak investigations. Many of the reinstated fellows have left the agency for other jobs, and applications for the incoming class are roughly 20 percent of what they would be by this time, according to data shared at a recent conference of the fellows.
The effects of the Trump administration’s cuts to infectious disease research are also being felt more globally. South Africa has the capacity to sequence the hantavirus at least in part because of investments prior administrations made through the President’s Emergency Fund for AIDS Relief, Dr. Carlos del Rio, an infectious disease expert at Emory University, told reporters on Thursday.
But the Trump administration has decimated the research system in South Africa and is pulling back support for PEPFAR.
“I worry that as we disinvest in global health, we’re losing our capacity, our global capacity, to deal with diseases,” Dr. Del Rio said.
Tulio de Oliveira, director of the Centre for Epidemic Response and Innovation at Stellenbosch University in South Africa, said the W.H.O.’s advisory group on viruses with pandemic potential would meet on Monday to discuss the latest findings on the hantavirus.
The group includes about two dozen experts from various countries including Brazil, Britain, India and the Netherlands. It does not include anyone from the C.D.C.
“Especially at the moment, it doesn’t seem that the C.D.C. is very functional,” he said.
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