Science
How Foreign Aid Cuts Are Setting the Stage for Disease Outbreaks
Dangerous pathogens left unsecured at labs across Africa. Halted inspections for mpox, Ebola and other infections at airports and other checkpoints. Millions of unscreened animals shipped across borders.
The Trump administration’s pause on foreign aid has hobbled programs that prevent and snuff out outbreaks around the world, scientists say, leaving people everywhere more vulnerable to dangerous pathogens.
That includes Americans. Outbreaks that begin overseas can travel quickly: The coronavirus may have first appeared in China, for example, but it soon appeared everywhere, including the United States. When polio or dengue appears in this country, cases are usually linked to international travel.
“It’s actually in the interest of American people to keep diseases down,” said Dr. Githinji Gitahi, who heads Amref Health Africa, a large nonprofit that relies on the United States for about 25 percent of its funding.
“Diseases make their way to the U.S. even when we have our best people on it, and now we are not putting our best people on it,” he added.
In interviews, more than 30 current and former officials of the United States Agency for International Development, members of health organizations and experts in infectious diseases described a world made more perilous than it was just a few weeks ago.
Many spoke on condition of anonymity for fear of retaliation by the federal government.
The timing is dire: The Democratic Republic of Congo is experiencing the deadliest mpox outbreak in history, with cases exploding in a dozen other African countries.
The United States is home to a worsening bird flu crisis. Multiple hemorrhagic fever viruses are smoldering: Ebola in Uganda, Marburg in Tanzania, and Lassa in Nigeria and Sierra Leone.
In 2023, U.S.A.I.D. invested about $900 million to fund labs and emergency-response preparedness in more than 30 countries. The pause on foreign aid froze those programs. Even payments to grantees for work already completed are being sorted out in the courts.
Waivers issued by the State Department were intended to allow some work to continue on containing Ebola, Marburg and mpox, as well as preparedness for bird flu.
But Trump administration appointees choked payment systems and created obstacles to implementing the waivers, according to a U.S.A.I.D. memo by Nicholas Enrich, who was the agency’s acting assistant administrator for global health until Sunday.
Then last month, the Trump administration canceled about 5,800 contracts, effectively shuttering most U.S.A.I.D.-funded initiatives, including many that had received permission to continue.
“It was finally clear that we were not going to be implementing” even programs that had waivers, Mr. Enrich recalled in an interview.
The decision is likely to result in more than 28,000 new cases of infectious diseases like Ebola and Marburg, and 200,000 cases of paralytic polio each year, according to one estimate.
Secretary of State Marco Rubio “has been working diligently since being sworn in to review every dollar spent,” the State Department said in an emailed statement.
“We’ll be able to say that every program that we are out there operating serves the national interest, because it makes us safer or stronger or more prosperous,’” the statement quoted Mr. Rubio as saying.
Most U.S.A.I.D. staff members were terminated or placed on administrative leave without warning. The agency had more than 50 people dedicated to outbreak responses, the result of a Congressional push to beef up pandemic preparedness.
Now it has six. Those who were fired included the organization’s leading expert in lab diagnostics and the manager of the Ebola response. “I have no idea how six people are going to run four outbreak responses,” said one official who was let go.
Also sent home were hundreds of thousands of community health workers in Africa who were sentinels for diseases.
In early January, the Tanzanian government denied there were new cases of Marburg, a hemorrhagic fever. It was a community health worker trained through a U.S.-funded Ebola program who reported the disease a week later.
The outbreak eventually grew to include 10 cases; it is now under control, the government has said.
Even in quieter times, foreign aid helps to prevent, detect and treat diseases that can endanger Americans, including drug-resistant H.I.V., tuberculosis and malaria, and bacteria that don’t respond to available antibiotics.
Much of that work has stopped, and other organizations or countries cannot fill the gap. Compounding the loss is America’s withdrawal from the World Health Organization, which has instituted cost-cutting measures of its own.
“This is a lose-lose scenario,” said Dr. Keiji Fukuda, who has led pandemic prevention efforts at the W.H.O. and the C.D.C.
The slashing of foreign aid deprives the world of American leadership and expertise, but it also locks the United States out of global discussions, Dr. Fukuda said: “For the life of me, I cannot see the justification or the reason for this very calculated, systematic approach to pull down public health.”
Trying to Adapt
U.S.A.I.D.’s intense focus on global health security is barely a decade old, but it has mostly received bipartisan support. The first Trump administration expanded the program to 50 countries.
Much of the aid was intended to help them eventually tackle problems on their own. And to some extent, that was happening.
But confronted with a new virus or outbreak, “there’s so many things that one has to do and learn, and many countries can’t do that on their own,” said Dr. Lucille Blumberg, an infectious diseases physician and expert on emerging diseases.
U.S.A.I.D. and its partners helped countries identify the expertise, training and machinery they needed, brought together officials in various ministries and engaged farmers, businesses and families.
“It actually doesn’t cost the U.S. government that much,” said an official with a large development organization. “But that sort of trust-building, communication, sharing evidence is a real strength that the U.S. brings to health security — and that’s gone.”
In Africa, some countries have reacted to the disappearance of aid with alarm, others with resignation. “We’re doing our best to adapt to this development,” said Dr. Muhammad Ali Pate, Nigeria’s health minister.
“The U.S. government is not responsible, ultimately, for the health and the security of Nigerian people,” he said. “At the end of the day, the responsibility is ours.”
A successful outbreak response requires coordination of myriad elements: investigators to confirm the initial report; workers trained to do testing; access to test kits; transport of samples; a lab with enough workers, running water, electricity and chemical supplies for diagnoses; and experts to interpret and act on the results.
In broad strokes, the C.D.C. provided expertise on diseases, U.S.A.I.D. funded logistics and the W.H.O. convened stakeholders, including ministries of health.
Before the aid freeze, employees from each organization often talked every day, sharing information and debating strategy. Together, they lowered response time to an outbreak from two weeks in 2014 to five days in 2022 to just 48 hours most recently.
But now, C.D.C. experts who have honed their expertise over decades are not even allowed to speak to colleagues at the W.H.O.
U.S.A.I.D. funding for sample transport, lab supplies, fuel for generators and phone plans for contact tracers has ended. Much of its investment in simple solutions to seemingly intractable problems has also stopped.
In West Africa, for example, rodents that spread Lassa fever invade homes in search of food. One program in U.S.A.I.D.’s Stop Spillover project introduced rodent-proof food containers to limit the problem, but has now shut down.
In Congo, where corruption, conflict and endless outbreaks mean that surveillance “looks like Swiss cheese even at the best of times,” the mpox response slowed because there were no health workers to transport samples, said a U.S.A.I.D. official familiar with the response.
More than 400 mpox patients were left stranded after fleeing overwhelmed clinics. Before a waiver restarted some work, the United States identified two new cases of mpox, both in people who had traveled to East Africa.
In Kenya, U.S.A.I.D. supported eight labs and community-based surveillance in 12 high-risk counties. Labs in the Marsabit, Mandera and Garissa counties — which border Ethiopia and Somalia — have run out of test kits and reagents for diseases including Rift Valley fever, yellow fever and polio, and have lost nearly half their staff.
Kenya also borders Uganda and Tanzania and is close to Congo — all battling dangerous outbreaks — and has lost more than 35,000 workers.
“These stop-work orders would mean that it increases the risk of an index case passing through unnoticed,” Dr. Gitahi said, referring to the first known case in an outbreak. His organization has terminated nearly 400 of its staff of 2,400.
Many labs in Africa store samples of pathogens that naturally occur in the environment, including several that can be weaponized. With surveillance programs shut off, the pathogens could be stolen, and a bioterrorism attack might go undetected until it was too late to counter.
Some experts worried about bad actors who may release a threat like cholera into the water, or weaponize anthrax or brucellosis, common in African animals. Others said they were concerned that even unskilled handling of these disease threats might be enough to set off a disaster.
Funding from the U.S. government helped hire and train lab workers to maintain and dispose of dangerous viruses and bacteria safely.
But now, pathogens can be moved in and out of labs with no one the wiser. “We have lost our ability to understand where pathogens are being held,” said Kaitlin Sandhaus, founder and chief executive of Global Implementation Solutions.
Her company helped 17 African labs become accredited in biosafety procedures and supported five countries in drafting laws to ensure compliance. Now the firm is shutting down.
In the future, other countries, including China, will know more about where risky pathogens are housed, Ms. Sandhaus said: “It feels very dangerous to me.”
China has already invested in building labs in Africa, where it is cheaper and easier to “work on whatever you would like without anyone else paying attention,” said one U.S.A.I.D. official.
Russia, too, is providing mobile labs to Ugandans in Mbale, on the border with Kenya, another official said.
Some African countries like Somalia have fragile health systems and persistent security threats, yet minimal capacity for tracking infections that sicken animals and people, said Abdinasir Yusuf Osman, a veterinary epidemiologist and chair of a working group in Somalia’s health ministry.
Each year Somalia exports millions of camels, cattle and other livestock, primarily to the Middle East. The nation has relied heavily on foreign aid to screen the animals for diseases, he said.
“The consequences of this funding shortfall, in my view, will be catastrophic and increase the likelihood of uncontrolled outbreaks,” Dr. Osman said.
In countries with larger economies, foreign aid has helped build relationships. Thailand is a pioneer in infectious diseases, and U.S.A.I.D. was funding a modest project on malaria elimination that boosts its surveillance capabilities.
The abrupt end to that commitment risks losing good will, said Jui Shah, who helped run the program.
“In Asia, relationships are crucial for any type of work, but especially for roles that work with surveillance and patient data,” she said. “Americans will suffer if other countries hesitate to engage with us about outbreaks.”
Tens of thousands of people in southeast Los Angeles County have been engulfed in a dense cloud of smoke for nearly a week as a fire continues to tear through a massive refrigerated warehouse in Boyle Heights. Toxic air has covered the San Gabriel Valley and beyond at times, as the fire continues to burn and the wind shifts the pall in different directions.
People have reason to be concerned about their loved ones breathing in the plume, experts say.
“There’s no safe level of exposure to particle pollution,” said Will Barrett, assistant vice president for nationwide clean air policy at the American Lung Assn.
Soot can be deadly. The charred microscopic particles can travel deep into a person’s lungs and bloodstream, causing swelling and triggering heart attacks and strokes.
People aren’t just being exposed for hours. They’ve been exposed for days in Boyle Heights, unincorporated East Los Angeles, Maywood, Montebello and Bell, according to the South Coast Air Quality Management District.
“There are some pollutants where just breathing in a little bit of it can cause some serious issues for people,” said Dr. Afif El-Hasan, a pediatrician with Kaiser Permanente. He said he’s most concerned about particles, carbon monoxide, volatile organic compounds and chemical gases from incinerated insulation, plastics and paint in the smoke.
“Those chemicals can cause irritation in the lungs, they can cause long-term lung damage, and sometimes they can even cause cancer,” he said. “I also worry about children, because children breathe in more air per volume of their body than adults do and they tend to be more active.”
“People also need to remember that even if you are healthy, these chemicals are going to put you at risk. It’s not just people who are vulnerable, anyone is in danger.”
The fact that the smoke continues to billow into the sky for a sixth day matters, said Jill Johnston, associate professor of environmental and occupational health at UC Irvine. “The longer the exposure time, the more dose you’re getting, or the more potential chemicals that you’re inhaling. So you’re gonna be increasing a potential risk,” she said.
Pregnant women and their babies in utero are known to be vulnerable to smoke from wildfires, she said. But less is known about city fires. “We see increased risk of low birth weight and preterm birth connected to exposure to wildfire smoke. This isn’t exactly the same composition of smoke, but would anticipate … there could be potentially similar risk.”
A fire like this can leave people with no good choices. They can stay home with an air filter if they have one. But homes need “fresh” air, and a fire can make getting that impossible.
For that reason, some people believe that the official response to the gravity of the fire at Lineage Logistics has been inadequate. Jane Williams, executive director of California Communities Against Toxics, is among several activists who criticized the Los Angeles Fire Department and city officials who appeared to downplay health risks from prolonged smoke, and ultimately decided against evacuating these areas. They think many more people should have been evacuated.
“They always under-warn, they under-evacuate, they bring people back too fast,” Williams said. “I get that there’s a societal desire to return to normalcy.”
Local officials have opened a pair of shelters to house residents who want to temporarily relocate. The Los Angeles Unified School District also canceled summer programming for schools in the smoke-affected communities.
But “there is nothing in the air that is so dangerous that we have to do evacuations or even shelter in place,” LAFD Chief Jaime Moore said. Asked at a recent news conference whether the air was dangerous, Mayor Karen Bass said, “not to the extent that required a mandatory evacuation.”
Yet Williams pointed to the burning chemical-laden insulation foam inside the building, which could release several other highly toxic gases, including hydrogen cyanide, an asphyxiating gas, and isocyanates, chemical vapors that can cause serious lung damage.
“It’s about what you value and who you value,” Williams said. “If you value truth, you cannot sit there in front of a burning building and say the air is safe.”
A Fire Department spokesperson declined to comment when asked why the department considered a shelter-in-place order more appropriate than issuing an evacuation. It’s not clear that evacuation would have been purely a city responsibility. Lineage Logistics sits along the city boundary, with unincorporated Los Angeles County and other cities nearby.
mark! Lopez, a community organizer with East Yard Communities for Environmental Justice, also said the recently lifted shelter-in-place orders were not enough to protect residents from the heavy smoke and potential chemical releases. Residents, he said, have complained about smoke seeping into homes through cracks in doorways and windows, giving them sore throats and breathing problems.
Lopez said many of the smoke-affected communities have long suffered from poor air quality from decades of heavy polluting industrial facilities, highway traffic and rail yards. He said the public statements from Fire Department and elected officials that cast doubt on the risks from smoke were unacceptable.
“This is what happens when the Fire Department says there’s not a threat to human health. … The LAFD, they aren’t public health experts.”
Times staff writer David Zahniser contributed to this report.
Just days after the Trump administration completed millions of dollars in renovations on the Lincoln Memorial Reflecting Pool to make it American flag-blue, residents and online users noted it had turned a phosphorescent green.
Here’s why:
The calm, still waters of the Reflecting Pool make it an ideal nursery for algae growth. Algae need nitrogen and phosphorus to grow, and the Reflecting Pool is primarily fed by the Potomac River, which gets heavy doses of those nutrients from nearby urban and agricultural lands.
The Potomac also absorbed one of the largest sewage spills in U.S. history earlier this year when a pipe burst five miles upstream of Washington, although that event probably happened too long ago to contribute to the algal bloom today.
Untreated sewage is high in nitrogen and phosphorus. When nutrient levels are high, feasting algae can quickly reproduce.
The Department of the Interior said when the algae first appeared that it was “residual,” from the supply lines to the pool.
Experts also speculate that the darker blue color may be helping the Reflecting Pool absorb more heat. The higher temperatures promote algae growth by allowing their metabolisms to shift into overdrive.
Summer temperatures in D.C. aren’t helping. This week, temperatures are as high as 95 degrees in the city, prompting a heat alert.
The combination probably explains the excessive growth, turning the water surface an opaque green and preventing onlookers from seeing the new blue hue of the concrete basin.
Algae are important and beneficial organisms when the ecosystem is in balance. They’re the base of the aquatic food chain, fed on by herbivores of all shapes and sizes, including shrimp and juvenile fish, which in turn feed organisms higher up the food chain. The single-celled organisms use the power of the sun to produce energy through photosynthesis, similar to houseplants on your balcony.
In an effort combat the algae in the Reflecting Pool, employees of the National Park Service were seen pouring in gallons of hydrogen peroxide, a chemical commonly used in pool maintenance.
The Department of the Interior also is employing a “high-tech nanobubble ozone technology” to destroy the cells of the algae.
Ozone — yes, the same irritant that is in smog — is a gas composed of three oxygen molecules, and the small size of the bubbles allow the most gas transfer into the water, where it can damage algal cells, similar to how it irritates our lungs.
This only treats the symptoms, however. Generally, ozone nanobubbling is effective as a temporary solution for algae blooms. Longer-term fixes would have to address what makes the Reflecting Pool so ideal for algae, such as its depth, darker color and inflow of nitrogen and phosphorus.
In California, ozone nanobubbles also have been used in a project to improve water quality in the Tijuana River. The 120-mile river that runs near the border in northern Mexico and Southern California was the site of a pilot study in 2025. The U.S. section of the International Boundary and Water Commission reported that the nanobubbling reduced “odors and bacteria,” but the project concluded prematurely after a flood swept some of the instrumentation into the river.
A plant extract that’s gaining popularity as a pain cure-all and has been associated with multiple California deaths in its concentrated, synthetic form has been approved for research as a treatment for opioid addiction by the federal government.
Kratom is derived from the leaves of Mitragyna speciosa, a tree native to Southeast Asia, and is commonly made into a powder or pill.
Researchers say people in the U.S. are using kratom to alleviate anxiety, treat chronic pain or as a remedy for the symptoms associated with quitting opioids, due to its ability to bind with opioid receptors in the body. But recently, public health officials have raised alarms about a component of the leaf called 7-hydroxymitragynine, also known as 7-OH, an alkaloid that has the potential for abuse and addiction in high doses.
Last year, the Los Angeles County Public Health Department linked the deaths of six county residents to the use of 7-OH mixed with other substances. The toxicology screens for some of the deceased revealed both kratom and 7-OH, leading to a countywide crackdown of products with either compound because they’re unregulated.
Although there is no scientific consensus on whether kratom has therapeutic value, the Food and Drug Administration has recommended that its potent 7-OH form be classified as a controlled substance. Consumers who use 7-OH as a pain reliever expecting an experience similar to consuming kratom are at risk, said Dr. Mason Turner, president-elect of the California Society of Addiction Medicine.
“I have a couple of patients that I work with who use 7-OH for chronic pain management, not realizing the potential of the medication, and then developed an opioid use disorder,” Turner said. “I think in that case it was very clear they were seeking it for the chronic pain, not to get high, not to have some kind of experience, but really to reduce their pain.”
About two decades ago, Turner said, the healthcare industry started acknowledging the limits and risks of prescribing opioids for chronic pain. Some doctors pulled back on prescriptions, recognizing the potential for abuse.
That led some patients to find alternative solutions, he said.
“Maybe they don’t get a good benefit, or maybe the benefit from some of the other treatments is not as robust as what they got from opioids,” Turner said. “So they seek out some of these illicit products … or they look for kratom or 7-OH to be able to mitigate the pain.”
Turner said he supports further research into kratom and regulation because “it could be worth exploring as a treatment for chronic pain.”
On June 1, the National Institutes of Health announced that researchers from the University of Florida would begin the first phase of clinical trials on kratom to evaluate it as a potential treatment for opioid addiction. The research would be done with the FDA’s approval, according to officials.
“This … is a major step toward expanding treatment options for the millions of Americans struggling with opioid use disorder, which has contributed to historically high overdose mortality rates,” said Dr. Nora Volkow, director of NIH’s National Institute on Drug Abuse, in a statement.
Interest in kratom surged in the last couple of years as users have reported consuming the compound in the form of a pill, powder or tea to treat various ailments. A John Hopkins survey conducted in 2020 reported that 91% of respondents used kratom to treat chronic pain, 67% to treat anxiety, 64% for depression and 41% to treat opioid dependence.
A more recent study by the University of Michigan and Texas State University found that more than 5 million people in the U.S., including more than 100,000 children ages 12 to 17, have used kratom, the compound experts say is growing in popularity with young adults.
In the study, which analyzed data from the National Survey on Drug Use and Health collected between 2021 and 2024, researchers say that despite numerous state-level bans on kratom across the nation, its use is at an all-time high and is increasing.
People between the ages of 21 and 34 said they used kratom at least once and 1% said they used it in the last year. The share of children ages 12 and older who said they had used kratom increased from 1.6% in 2021 to 1.9% in 2024.
The FDA has stated that neither kratom nor 7-OH are approved as drug products, dietary supplements or food additives, but that hasn’t stopped storefronts and companies from selling them as such.
Up until November you could find kratom and 7-OH products in smoke shops and specialty stores in California, but that has stopped.
“Until kratom and its pharmacologically active key ingredients mitragynine and 7-OH are approved for use, they will remain classified as adulterants in drugs, dietary supplements and foods,” the California Department of Public Health told The Times via email.
Kratom “Feel Free Classic” liquid products are displayed at a smoke shop in Los Angeles in 2024 before they were banned.
(Michael Blackshire / Los Angeles Times)
In May, the California Department of Public Health and Atty. Gen. Rob Bonta filed a complaint against Ashlynn Marketing Group Inc., accusing the company of repeatedly flouting the state’s regulations on kratom products.
The filing, submitted in the San Diego County Superior Court, seeks a judge’s order to condemn and destroy the embargoed kratom products, halt ongoing unlawful manufacturing and impose civil penalties.
The California Department of Public Health “is pursuing legal action because Ashlynn’s continued manufacture and sale of these products pose a clear and preventable public‑health risk and violates state and federal law,” said Dr. Erica Pan, the department’s director and state public health officer. “7-OH and kratom-derived products have been associated with addiction, serious health harms, overdose and death.”
The state is alleging its inspectors visited Ashlynn Marketing Group’s facility in Santee in May 2025 and found kratom powders, capsules, liquids and chewable tablets being manufactured and held for sale.
During the visit, inspectors issued an embargo to prohibit the sale and distribution of all kratom-related materials on-site, according to the complaint.
Public health inspectors conducted follow-up visits at the facility in October and April, “collecting evidence at both inspections that indicated embargoed kratom products had been moved, tampered with and repackaged,” according to public health officials.
“In addition, investigators observed evidence of continued manufacturing and distribution of kratom materials,” officials said. “The firm’s owner continues to manufacture kratom products and ships orders weekly.”
To date, the California Department of Public Health has seized more than $5 million worth of kratom and 7-OH products, a spokesperson for the department told The Times.
California and Los Angeles County are considering whether to tighten regulations or ban the compounds altogether.
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