In recent weeks, the global public health system has had to contend with two complex outbreaks arising from contagious viruses. A Dutch passenger aboard the ship MV Hondius died of a viral illness on April 11. It was not until early May – and several more illnesses – before international health authorities determined there was an outbreak of a strain of hantavirus capable of human-to-human transmission. The ship’s 86 passengers and 61 crew from 23 countries now are quarantined around the world – some in their homes and others in government facilities. Separately, in the Democratic Republic of the Congo (DRC) and Uganda, the Bundibugyo virus of the Ebola genus of viruses has caused a large outbreak in remote regions. On May 17, the World Health Organization (WHO) labeled the Ebola outbreak a public health emergency of international concern (PHEIC), but determined the outbreak does not meet the definition of a pandemic emergency.
To consider the status of global health governance, Good Authority editor Christopher Clary chatted with Catherine Worsnop, an associate professor in the School of Public Policy at the University of Maryland, College Park. Worsnop’s work focuses on WHO and international cooperation in global health. Their chat, lightly edited for clarity and length, is below.
Christopher Clary: We last chatted in early 2025, after President Trump announced his intent to withdraw from WHO. What has happened to the global public health infrastructure since then?
Catherine Worsnop: For one thing, the administration made good on its pledge to leave WHO and the U.S. exit became official on January 22, 2026, a year after that announcement. But it’s worth noting that WHO member states have not formally accepted the withdrawal because of outstanding dues owed by the U.S.
The Trump administration’s response to current global health emergencies is unfolding. One of the administration’s first actions following the PHEIC declaration was to restrict entry to all foreign nationals – including permanent U.S. residents – who had been in the DRC, Uganda, or South Sudan in the past 21 days. The U.S. also plans to keep U.S. citizens exposed to Ebola out of the country for monitoring and treatment. A facility in Kenya was one option, but this has been temporarily blocked by that country’s high court.
These U.S. measures are unprecedented. The United States never used entry restrictions during past Ebola outbreaks and has always repatriated exposed U.S. citizens for monitoring and treatment without evidence of onward transmission. Even during COVID-19, U.S. entry restrictions never applied to permanent residents.
Though WHO has recommended that all countries discourage travel to affected countries and prepare to detect and treat potential cases, it recommended against entry restrictions because the harms likely outweigh the benefits in this case. COVID-19 did show that some international travel restrictions can be useful under certain conditions. But Ebola is different. Especially for countries outside of the affected region, like the U.S., entry restrictions are likely unnecessary because Ebola does not spread easily between people. Such restrictions have not been needed to stop prior Ebola outbreaks from becoming pandemics.
The U.S. is providing medical and funding assistance to the region and recently announced it may reengage with Gavi, an organization that distributes vaccines to low-income countries. However, the status of these initiatives is not currently clear and comes on the backdrop of significant cuts to foreign aid overall.
Official development assistance (ODA) declined by around 23% in 2025, with the U.S. leading in the extent of cuts but certainly not alone in doing so. Unfortunately, rather than step in to fill the void left by U.S. cuts, most other major contributors also reduced ODA. U.S. cuts to global health assistance and programs were smaller than originally feared, but programs on the ground continue to report issues accessing funds and it’s unclear how many of the allocated funds will be dispersed over the year. Relatedly, the U.S. Department of State is restructuring PEPFAR, the U.S. government’s initiative to end HIV/AIDS transmission, and reducing overall support for combatting HIV/AIDS. The administration claims that this restructuring will result in increased country ownership of HIV/AIDS programs. While country ownership may be desirable, the administration has a poor record of making such shifts as evidenced by the way in which USAID was dismantled.
The PEPFAR shift is part of the Trump administration’s September 2025 America First Global Health Strategy. In practice, this involves making bilateral deals rather than working through global organizations, like WHO. In most cases, these deals provide countries with less aid than they were receiving previously and tie that aid to U.S. access to health information and natural resources. It is unclear whether the U.S. will gain from this new approach. For instance, the Trump administration’s recent proposal to build a global disease surveillance system – exactly what the U.S. formerly had access to as part of WHO – has an estimated price tag of up to three times as much as U.S. annual contributions to WHO and is unlikely to match what WHO can already do now.
Did anything surprise you about the public health response to the hantavirus outbreak?
The hantavirus outbreak itself shows how surprising infectious diseases can be. Hantavirus is not typically associated with cruise ships. And hantavirus was not high on the list of global health risks – like measles, avian flu, and now Ebola – that experts have been most worried about recently. While the recent fatalities are certainly a tragedy, a welcome surprise is that the hantavirus response was largely a success for international cooperation at a difficult time for multilateralism and global governance institutions more broadly.
Hantavirus demonstrates the value of WHO, in fact. WHO coordinated the response with cruise ship passengers, scientists, health authorities, and governments from over 20 countries. For instance, the WHO director general worked to ensure that Spain would receive the Hondius in the Canary Islands, consistent with its commitments under international global health law codified in the WHO’s International Health Regulations. When the ship arrived, WHO coordinated with several countries to facilitate evacuation of ill passengers and the quarantine of others. This outbreak shows that global coordination is often required even when the virus is known and has little pandemic potential.
Like all organizations, WHO is not perfect. For instance, it could have more fully acknowledged some uncertainty about pre-symptomatic transmission and the type of contact necessary for person-to-person spread. Yet, the hantavirus episode shows that no country alone can substitute for WHO.
In contrast, former U.S. health officials and public health experts criticized the U.S. for being slow to communicate with the public, with the CDC described by one expert as “not even a player” in the global response.
I have seen reports that international health organizations say they are understaffed and underfunded to confront the Ebola outbreak in east Africa. How do you think about how funding and policy choices relate to global health risks?
They directly relate. Others have explained how the dismantling of USAID and cuts to foreign assistance and changes to PEPFAR have caused vast harms as well as left the U.S. and the world more vulnerable to outbreaks, including the ongoing Ebola outbreak. Past U.S. investments in capacity in other countries have paid off – for instance, the South African National Institute for Communicable Diseases, which identified the Andes hantavirus within 24 hours of receiving samples, was supported by long-term U.S. investment. Policy choices to move away from this kind of investment and away from a U.S. presence on the ground in other countries will hamper current and future surveillance and response capacities. For example, the Trump administration cut funding for research in the past year to better understand hantavirus transmission dynamics. This research would not have been ready for the current outbreak, but it is the kind of investment that might help in the future.
Cuts to foreign assistance and investment in global health undoubtedly have a negative impact on outcomes and outbreak response. But many countries around the world are quite capable themselves. For instance, the DRC and Uganda have responded to and contained many outbreaks of Ebola in the past, though there have only been two previous documented outbreaks of Bundibugyo virus.
Turning to WHO, it is worth noting that the organization has a long history of operating under financial constraints and has managed fraught times before. And despite the funding crunch, WHO has excelled so far in its coordination of the responses to hantavirus and Ebola. For now, the U.S. continues to free ride. Even though it has left WHO and no longer contributes its money or human resources to the organization, the U.S. still benefits from WHO helping to contain outbreaks that otherwise would have spread further. But given the size of U.S. cuts to WHO, the organization’s performance with so many fewer resources is unsustainable.
What are you looking for next?
There are so many important global health issues to watch. I’ll mention two.
On the Ebola outbreak, the risk is high to people in currently affected countries. The scope of the outbreak in those countries and those nearby remains unknown because it was going on for some time before detection. I’ll be watching whether countries step up to assist those currently affected or just try to protect themselves. Unfortunately, there is already evidence of the latter as some countries have walked back initial pledges of financial support. The U.S. is also not alone in its imposition of entry restrictions. Canada, Bahrain, Jordan, and Rwanda have adopted similar restrictions. We know that countries are particularly likely to adopt these kinds of international travel measures following signals of increasing outbreak severity, like WHO’s declaration of a public health emergency.
Sometimes, these restrictions can help to manage outbreaks and reassure the public. The problem is that they can disrupt lives and economies and undermine the public health response by pushing people to informal and unmonitored border crossings, discouraging information sharing by individuals and governments, and distracting from more useful interventions. This is why a key WHO goal is to get countries to only use measures at the border that are necessary and have public health benefits. This has been tough to achieve during past outbreaks. But WHO’s guidance so far on international travel measures during this outbreak does a good job trying to balance the benefits and harms.
As this outbreak evolves and there are other triggering events like additional cross-border spread or spread to other regions, will countries follow the example of the U.S. and others? Or, will countries follow WHO’s guidance?
And, as WHO rightfully devotes resources to this outbreak, what health threats or other outbreaks will get less attention?
Finally, I’ll be watching whether other institutions compensate for the U.S. and other countries’ retrenchment in global health. U.S. states are of particular interest here. Domestic political dynamics often play a role in global health cooperation; and some U.S. states today may find there is political will to reengage in global cooperation. Several U.S. states recently joined together through initiatives like the Governors Public Health Alliance to compensate for the Trump administration’s approach to public health at home. Some of these same states, including New York, Wisconsin, Illinois, and California, also announced they would join WHO’s Global Outbreak Alert and Response Network (GOARN). GOARN, a group of public health institutions, governments, academic centers, and laboratories around the world, makes up part of WHO’s disease surveillance and information sharing infrastructure.
Will more U.S. states follow suit? For instance, I’m in Maryland, a state that’s also a member of the Governors Public Health Alliance to help fill gaps domestically. Will we see Maryland and other like-minded states come together to engage with WHO or other global or regional health institutions? There is precedent in the climate change area where states have done something similar. The U.S. Climate Alliance, comprising 24 U.S. state governors, pledged to uphold the goals of the Paris Climate Agreement when the Trump administration announced its withdrawal early in 2025.
