分类： health

Since dissolving the United States’ longstanding foreign aid body, the U.S. Agency for International Development (USAID), last year, the Trump administration has rolled out a new approach to global health assistance, pushing direct bilateral agreements with individual nations across Africa, Latin America and the Caribbean. While the administration frames the strategy as a fix for the inefficiencies and dependency created by traditional aid models, it has sparked sharp pushback from multiple African governments over its transactional terms, threats to national sovereignty, and ties to U.S. strategic and commercial priorities.

The framework was launched in December 2023 with a landmark $2.5 billion health partnership with Kenya, where the U.S. pledged $1.6 billion in funding over five years, and the Kenyan government committed $850 million of its own funds. Speaking at the signing, U.S. Secretary of State Marco Rubio hailed Kenya as an ideal first partner and expressed optimism that up to 50 nations would join the initiative. The deal survived a high-profile court challenge from Kenyan activists concerned about patient privacy and finally won cabinet approval last month, but it set the tone for widespread controversy that would follow.

Under the new strategy, the U.S. has walked away from the multilateral global health system anchored by the World Health Organization (WHO), withdrawing from the body earlier this year over claims the organization mismanaged the COVID-19 pandemic, lacked transparency, and gave other nations an unfair funding advantage at U.S. expense. Unlike previous aid models that channeled most funding through non-governmental organizations, the new framework centers direct partnerships with national governments, requiring them to increase domestic health spending to build self-sustaining health systems. The administration argues this cuts wasteful overhead, eliminates donor-led dependency, and empowers local leaders to shape their own health outcomes.

“Our aid to those countries will not just be dollars distributed to an NGO who then will go into the country and impose programmes,” Rubio told a congressional committee last month. “Not only are we treating the acute situations on the ground of people that are sick, we are helping them build the capacity and the capability to do this for themselves.”

Critics point out that the restructuring of U.S. aid has already created immediate gaps in frontline health response. Most notably, the current Ebola outbreak in the Democratic Republic of the Congo (DRC) — one of the first African nations to sign on to the new framework — has exposed severe disruptions from USAID cuts. Amadou Bocoum, country director for the humanitarian organization Care in the DRC, told reporters his team was forced to lay off 36 workers, a third of his staff, including specialists focused on Ebola prevention and community outreach. When the new outbreak emerged, prepositioned emergency supplies were gone, and understaffing delayed the response by 10 critical days. Jeremy Konyndyk, who led USAID’s response to the 2014 West African Ebola epidemic, noted that the dismantling of longstanding U.S.-funded health programs left critical gaps in outbreak detection, arguing the previous network would have caught the spread of the virus far earlier. The Trump administration disputes these claims, pointing to its $270 million donation for the outbreak response and saying the new structure is more aligned with U.S. priorities and more effective.

By mid-May, 32 countries across the Americas, Caribbean and Africa had signed the proposed health memoranda of understanding, but at least three African nations — Ghana, Zimbabwe and Zambia — have openly rejected the deals, citing a range of sovereignty and economic concerns. In Zambia, the government pushed back against U.S. attempts to tie health aid to a separate critical minerals agreement that would grant Washington preferential access to the country’s natural resources. Zambian Foreign Minister Mulambo Haimbe said his government wanted to negotiate the two deals separately on their own merits, rather than accepting them as a bundled package. A State Department spokesperson did not explicitly confirm the linkage but affirmed the administration’s “America First” approach, noting U.S. foreign assistance is “strategic capital” designed to advance American interests, and that recipient nations are expected to prioritize U.S. strategic and commercial goals.

The most widespread point of contention across countries that rejected the deals is data and biosecurity sovereignty. Ghana rejected a proposed $109 million bilateral health deal in April specifically over data protection concerns. Arnold Kavaarpuo, executive director of Ghana’s Data Protection Commission, said the deal required Ghana to share a broad scope of domestic health data, including patient information and disease-causing pathogen samples, with U.S. authorities, with no reciprocal protections for Ghanaian data or guarantees that Ghana would retain control over the information once it left the country. Zimbabwe similarly rejected a deal over data access concerns, noting that the agreement did not guarantee that local populations would get access to drugs or vaccines developed from their country’s pathogen samples — pointing to the existing, equitable data sharing framework already in place through the WHO.

The U.S. maintains that the data it requests is the same aggregated, de-identified data that has been used for global infectious disease research for decades through previous programs like USAID and PEPFAR, and that sharing is critical to advancing global scientific progress. But global health governance experts say the context of the data requests has changed dramatically. Nelson Aghogho Evaborhene, a PhD fellow at Denmark’s Roskilde University, noted that while past data sharing relationships were unequal, they could be framed to domestic populations as altruistic efforts to improve public health. Today, he argues, the arrangement is clearly a transactional form of leverage that prioritizes U.S. interests.

Many African nations also draw lessons from the COVID-19 pandemic, when African countries held large amounts of valuable pathogen data but were left struggling to access vaccines developed from that data. More than 50 African civil society groups have signed an open letter warning that the new U.S. terms do not align with African national or regional interests, a position echoed by South Africa’s government. South Africa has already seen the U.S. withdraw all funding for its national HIV/AIDS programs over what Washington called Pretoria’s failure to meet unconnected policy requests, including a debunked claim that the country is carrying out a “white genocide” against the Afrikaner community. “Frankly speaking, no nation on Earth that respects itself should accede to [these requests],” South African Health Minister Dr Aaron Motsoaledi told the BBC, noting the U.S. seeks permanent access to local pathogen genome data in exchange for just five years of funding.

Public health experts warn that the shift to a purely bilateral approach to global health ignores the transnational nature of pandemic and disease response. “Global health, by definition, is transnational, crosses borders, does not concern just one country,” said Dr. Kevin DeCock, a former director at the U.S. Centers for Disease Control who spent decades leading infectious disease response efforts. “Global health problems require global approaches, and no country can go it alone.”

A small number of policy analysts argue the new strategy deserves a chance to prove its effectiveness. Writing for the conservative American Enterprise Institute, analysts Brett Schaefer and Roger Bate acknowledged the risks of walking away from the multilateral system, particularly the withdrawal from WHO, but argued the shift is not the end of U.S. global health leadership. Instead, they frame it as a test of whether conditional, results-driven bilateral partnerships deliver better outcomes than reliance on a multilateral institution that has repeatedly failed to reform itself.

Months after the first deal was signed in Kenya, adoption of the new framework across Africa remains patchy and deeply divisive. While Tanzania has recently joined the partnership, the growing number of African nations rejecting the terms leaves the future of the Trump administration’s reshaping of global health aid far from certain.

A rapidly spreading Ebola outbreak in the Democratic Republic of the Congo has crossed a grim threshold, with official data confirming more than 500 fatalities from over 1,500 confirmed infections, even as the response effort faces a fresh crisis: frontline workers battling the outbreak have threatened to suspend work over unmet pay and unsafe working conditions.

Congo’s Ministry of Health released the updated statistics in a Sunday night briefing, reporting that since the outbreak was first declared on May 15, a total of 1,561 confirmed cases have been documented, with 506 people succumbing to the virus. Current data shows the virus’ transmission continues to outpace the ability of response teams to contain it, according to the official update.

The strike threat was issued Sunday by frontline teams deployed in Ituri province, the geographic epicenter of the current outbreak. Workers gave authorities a 24-hour deadline to address their grievances, warning that work would stop if demands were not met. The vast majority of these frontline staff are local health professionals, who have worked for months with minimal rest while navigating two extraordinary additional challenges: violent attacks from hostile local communities, and deep-rooted public skepticism about the existence of the virus.

A copy of the workers’ formal notice to the national government, obtained by the Associated Press, details multiple long-running grievances. Workers both inside hospital facilities and out in the community conducting contact tracing and testing report they have not received earned hazard benefits since the outbreak was declared, and still lack sufficient basic supplies to carry out their high-risk work. Additional complaints include chronically low base salaries, disrespectful treatment from elite response teams deployed from the capital Kinshasa, a pattern of bringing in outside labor from other provinces instead of prioritizing hiring of local Ituri workers, and persistent shortages of adequate personal protective equipment and other critical medical gear.

The timing of the strike threat has amplified concerns among public health officials, as it comes just days after enrollment opened for experimental clinical trials for Ebola treatments in the region. A work stoppage would not only derail the trial process, but also significantly slow broader efforts to curb transmission of the virus, which has already spread beyond Ituri to two additional eastern provinces: North Kivu and South Kivu.

Response efforts have been complicated from the start by key biological characteristics of the current outbreak: this event is caused by the Bundibugyo strain of Ebola, for which there are no currently approved vaccines or specific antiviral treatments. By contrast, Congo’s 16 previous Ebola outbreaks were almost all caused by the more common Zaire strain, for which an effective, widely deployed vaccine already exists.

Public health officials also still face major gaps in basic investigation of the outbreak: investigators have not yet identified patient zero, the initial case that sparked the current transmission chain, and are still working to trace tens of thousands of potential contacts who may have been exposed to infected people, a core step to stopping further spread. The World Health Organization has already warned that the first month of this outbreak was the worst on record for early Ebola spread in Congo.

KINSHASA, July 6 — The ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC) has reached a grim new milestone, with the total number of fatalities surpassing 500, national health authorities announced in an official update released Sunday.

As of the latest data compilation, the outbreak has recorded 1,561 laboratory-confirmed Ebola infections, of which 506 have resulted in death. So far, 254 patients have successfully recovered from the virus, while 628 confirmed cases are currently receiving care in isolation facilities or hospital settings. Health officials are also investigating 354 additional suspected cases, which have already been linked to 110 deaths.

The outbreak has spread across 36 separate health zones distributed across three DRC provinces, and transmission trends continue to move in a worrying direction. Official epidemiological data shows weekly confirmed case counts have kept climbing, with the 25th and 26th epidemiological weeks of the outbreak marking the highest infection levels recorded since the event began. Each of these two weeks reported more than 300 new confirmed cases, providing clear evidence that sustained community transmission is still ongoing across affected regions.

In response to the growing public health crisis, the World Health Organization announced Thursday that a new clinical trial has begun recruiting patients in the DRC to test promising candidate treatments for the current strain of the virus. The ongoing outbreak is caused by Bundibugyo ebolavirus, a pathogen for which no approved vaccine or specific, standardized treatment currently exists. The trial is being hosted at the CME Ebola treatment center located in Rwampara health zone, Ituri Province — the geographic epicenter of the current outbreak.

In the heart of the expanding Ebola outbreak in the Democratic Republic of the Congo’s Ituri Province, local residents are clinging to new hope as international and Congolese health officials launch an urgent clinical trial of two experimental treatments for the rare Bundibugyo strain of the Ebola virus. The outbreak, which has already claimed more than 400 lives and infected over 1,400 people, has no approved vaccines or targeted therapies to date, making the new study a critical turning point in the public health response.

The launch of the trial at Bunia’s Evangelical Medical Center Ebola treatment unit on Thursday proceeded with no fanfare, only quiet urgency. While ambulances ferried new suspected patients to the facility and healthcare workers suited up in multiple layers of heavy protective gear to enter isolated wards, the research initiative integrated seamlessly into the daily, life-or-death work of treating infected people. World Health Organization Director-General Tedros Adhanom Ghebreyesus confirmed the same day that the first trial participant had already been enrolled.

The multi-partner trial, led by the WHO in collaboration with Congo’s National Biomedical Research Institute (INRB), Britain’s University of Oxford, the Antwerp Institute of Tropical Medicine, and the Africa Centres for Disease Control and Prevention (Africa CDC), is designed to test three treatment approaches: the standalone antiviral remdesivir, the experimental antibody therapy MBP134, and a combination of the two drugs. Researchers will track patient survival outcomes for 28 days following the start of treatment, explained WHO research advisor Dr. Vasee Moorthy.

For the first phase of the trial, only confirmed Ebola patients receiving care at specialized treatment units will be eligible, according to Africa CDC emergency response head Professor Yap Boum. A second phase will expand eligibility to frontline healthcare workers, close contacts of confirmed cases, and other people at high risk of infection, who will also be able to access the experimental treatments. Placide Mbala, who coordinates laboratory operations for the outbreak response, noted that the trial could run between three and six months, with the timeline tied directly to how the outbreak progresses in the coming weeks.

For many residents of Bunia, the launch of the trial has brought a rare glimmer of hope after weeks of rising fear and loss. Audrey Tengetenge, a local community member, described the research as a “light at the end of the tunnel,” saying “I hope everything moves very quickly so that we can find relief. We want nothing more than an end to this very dangerous disease, which continues to bring us grief.”

Gladys Munguro, a Bunia resident who survived Ebola and was discharged from a treatment center just two weeks before the trial launched, shared that she watched multiple fellow patients die while receiving care herself. Now fully recovered, she says she is eager to contribute to the research: “This experimental phase is necessary for us. I will volunteer as soon as the next phase of the trials begins for high-risk individuals.” Munguro added that she hopes the new treatments will boost survival rates for current patients and help bring the worsening outbreak under control.

Despite this widespread hope for progress, the trial and broader outbreak response still face significant barriers. Community mistrust of medical interventions runs deep in some pockets of the region: local shopkeeper Nelson Dhebi noted that while he supports scientific research and wants the outbreak to end, he worries the untested treatments could cause harm, and suggested that elected leaders should participate first. “Research should be carried out first and foremost on our elected representatives, as they are the ones who represent us,” he said.

Mistrust is far from the only challenge. Overcrowded treatment facilities in the hardest-hit areas, delays in patients seeking care after developing symptoms, and ongoing regional violence that restricts access to conflict-affected communities continue to hamper response efforts. Nearly 75% of all Ebola deaths during this outbreak have occurred outside of formal health facilities, confirmed Pierre Akilimali, incident manager at Congo’s National Institute of Public Health, on Friday.

For now, the trial is only being conducted at the Bunia treatment site, located in a region that has seen repeated violence targeting healthcare workers responding to the outbreak, which spreads through direct contact with infected patients’ bodily fluids. Officials have said they will expand the trial to additional locations once security conditions improve to allow safe operations. The report was filed by AP correspondent Banchereau from Dakar, Senegal, with on-the-ground contributions from Constant Same Bagalwa in Bunia. AP’s global health and development coverage for Africa is supported by funding from the Gates Foundation, with the AP retaining full editorial control over all content.

The ongoing cross-border Ebola outbreak that first emerged in the Democratic Republic of the Congo (DRC) and Uganda back in May has entered a new phase of response, after the World Health Organization (WHO) announced the launch of clinical trials for untested, potentially life-saving treatments for the rare virus strain driving the current spread.

WHO Director-General Tedros Adhanom Ghebreyesus confirmed Thursday that the first patient has already been enrolled in the trial at a treatment site in the DRC, marking a critical milestone in the global fight against the outbreak, which the WHO previously designated a public health emergency of international concern.

As of the end of June, official WHO data puts the total confirmed case count at 1,406 in the DRC alone, with an additional 301 suspected cases and 438 recorded deaths across the Central African nation. The outbreak has since spread beyond DRC borders: Uganda has reported 20 confirmed cases and two deaths as of July 1, while one imported confirmed case has been detected in France.

What makes this outbreak particularly challenging for global health authorities is that it is caused by the Bundibugyo strain of Ebola – one of six known Ebola species, for which there are currently no globally approved vaccines or specific treatments. Bundibugyo is a highly infectious strain that, like other Ebola variants, targets the body’s immune system and vital organs, often leading to severe complications and death if left untreated.

The multi-institutional trial is led by the WHO, with on-the-ground coordination and research support from three leading scientific bodies: the DRC’s own Institut National de Recherche Biomédicale, Belgium’s Institute of Tropical Medicine, and the University of Oxford in the United Kingdom. The trial will evaluate the safety and efficacy of two separate therapeutic candidates for treating Bundibugyo Ebola infections.

Addressing reporters at WHO headquarters in Geneva on Thursday, Tedros emphasized that even in the absence of approved targeted treatments, some patients have already recovered from the current outbreak. However, he added that access to proven, safe interventions would drastically reduce mortality from the disease.

“Even without approved therapeutics, people are recovering from this disease, but of course, we could save many more lives with safe and effective therapeutics in our toolkit,” Tedros told reporters.

Ebola, which originates in animal populations primarily carried by fruit bats, typically spills over to humans when people handle infected animal carcasses. Human-to-human transmission only occurs once an infected person develops symptoms, with an incubation period ranging from two to 21 days. Early symptoms mirror common tropical illnesses like influenza and malaria, starting with sudden onset of fever, headache, and fatigue, which can make early diagnosis challenging. Because Ebola strains are genetically distinct, vaccine and treatment development must be done separately for each variant to ensure effectiveness.

A long-awaited clinical study to evaluate two potential Ebola treatments officially got underway Thursday in the Democratic Republic of the Congo, with the World Health Organization (WHO) confirming the enrollment of the trial’s first participant. The launch comes as a still-expanding outbreak of the rare Bundibugyo strain of Ebola continues to devastate eastern regions of the country, leaving global and local health officials scrambling for targeted solutions.

Unlike the more widespread Zaire strain of Ebola, the Bundibugyo variant has no approved, specific vaccines or treatment protocols available for use today. As of Thursday, WHO Director-General Tedros Adhanom Ghebreyesus reported that the outbreak has already infected more than 1,400 people and claimed 438 lives. While basic supportive care – when administered early in the course of infection – can improve patient outcomes, with more than 200 people having recovered so far, public health leaders emphasize that more effective interventions are desperately needed to curb the outbreak’s growth.

In his official statement marking the trial’s launch, Tedros framed the research initiative as a critical source of optimism for affected communities, noting that it “offers real hope that we can deliver concrete results for – and with – the communities at the heart of the outbreak.”

The trial will compare the survival outcomes of patients receiving two experimental antiviral therapies against current standard care. The first candidate, remdesivir, is a broad-spectrum antiviral already approved for the treatment of COVID-19, manufactured by Gilead Sciences. Preliminary laboratory testing has already yielded early signs that the drug may be active against the Bundibugyo strain now spreading in Congo. The second candidate, MBP134, is an experimental monoclonal antibody treatment developed by Mapp Biopharmaceutical, engineered specifically to bind to and neutralize multiple strains of Ebola, including Bundibugyo.

Dr. Vasee Moorthy, a research adviser at the WHO, explained the trial’s methodology: all enrolled participants will receive the current best available standard care, then be randomly assigned to one of four groups: remdesivir alone, MBP134 alone, a combination of both drugs, or no additional experimental treatment. Researchers will track patient survival rates for 28 days after the initiation of treatment.

Moorthy cautioned that clear, definitive results will not come quickly. The study may require several months of data collection and up to 1,000 total participants to confirm whether either treatment improves survival. He added, however, that if one of the candidates proves to be highly effective, researchers could reach a conclusion sooner with a smaller patient pool.

At present, the trial is only open to patients at a single Ebola treatment center located in Congo’s Ituri province, a region that has been severely impacted by ongoing armed violence. Targeted attacks against healthcare workers responding to the outbreak have made operating in much of the region unsafe, so officials plan to expand the trial to additional treatment sites only once security conditions improve to allow safe operations.

According to Moorthy, pharmaceutical developers and government partners have already donated a sufficient supply of both experimental drugs to complete the trial. Gilead has donated its supply of remdesivir, while the U.S. government – which funded MBP134 development and owns the trial doses – has contributed the supply of the antibody treatment. If either candidate is found to be effective, stakeholders will immediately move to expand access to the treatment for all patients affected by the outbreak, not just those enrolled in the clinical study.

The WHO-backed trial is the product of a global collaborative effort, bringing together Congo’s national biomedical research institute INRB, the University of Oxford in the United Kingdom, the Institute of Tropical Medicine in Antwerp, and multiple other international public health organizations.

This reporting is part of coverage from The Associated Press Health and Science Department, which receives grant support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP maintains full editorial control over all published content.