In 2009, I spent nine months working with Doctors Without Borders in the Democratic Republic of Congo. I traded my job as a physician in London and my flat in a leafy suburb, for a guarded compound in a little village among verdant hills in North Kivu, a tumultuous region of the Democratic Republic of Congo (DRC); where armed conflict between government troops and opposing militia, and high numbers of displaced people living in temporary camps, resulted in poor health care and shortened lifespans.
People died from lack of clean water which spread typhoid fever. From lack of vaccinations, spreading measles. From misinformation and a lack of education about health, spreading tuberculosis. Toward the end of my time there, cholera broke out. I treated patients in mobile clinics, and in a hospital with obstetrics, adult medicine, and pediatrics wards, and an ICU that had no ventilators.
A U.S. surgeon recently returning from Gaza said people are dying there because of a lack of basic medicines, soap, X-rays, etc. I can well imagine, since this was my experience for nine months in the DRC, and the people of North Kivu's ongoing reality.
It is ironic that the DRC is back in the news due to escalating conflict, whilst simultaneously resources for these countries such as those from the U.S. Agency for International Development (USAID) (of which DRC was previously a major recipient) are being stripped. Equally worrying is how resources for public health here in the United States are also being gutted.
Ten years after leaving the DRC, I worked at the CDC, during the Covid pandemic. Trying to keep the population safe from a novel infectious disease, battling to understand the virus, but also navigating people's suspicion of vaccines and science, and their desire to use bleach and ivermectin, egged on by charlatans.
The U.S. pandemic response was criticized, and this was before people at the nation's leading health care agency were let go. The latest round of cuts to the federal government was recently announced with 10,000 people cut from Health and Human Services (HHS), including 2,500 from the Centers for Disease Control and Prevention. This is not the pruning of a smattering of supernumerary employees, these are entire branches of the CDC felled.
There are cuts to pandemic preparedness, even though we are barely emerging from the Covid pandemic, and it was less than 10 years ago that we experienced the largest epidemic in history of the highly contagious hemorrhagic fever, Ebola. There is already an ongoing measles outbreak in the U.S.
At a Harvard Law School negotiation class I took as part of my master's in public health, I learned an interesting concept: that we cannot appeal to people's sense of justice to effect change. We cannot appeal to their sense of right and wrong. That while we all believe ourselves to be altruistic, ultimately the main thing that people care about is, what does this look like for me? We have to paint a picture of why people should follow us or do as we advise—one that speaks to their priorities and ideals. So let me paint this picture:
An imaginary year from now, Ebola spreads once again in the DRC, like it did in 2022. In the 2022 Ebola outbreak the CDC supported the outbreak response with surveillance and laboratory capacity, but in this imagined future, since the CDC remains defunded, weakened surveillance systems do not detect this outbreak promptly. They eventually do and America cares enough to send funds and personnel, but one week previously, someone boarded a plane in the DRC bound for New York City... and developed a high fever mid-flight.
As American planes are landing in DRC, Ebola breaks out in Brooklyn. Followed by Chicago, followed by Boston. Within a fortnight, a farmer in rural Georgia is hospitalized with a high fever and vomiting blood; a week later his son in San Antonio succumbs, becoming the first U.S. Ebola death. The CDC, long decimated, is powerless as Ebola and terror spread.
Is this far-fetched? Hopefully, yes, given that Ebola is transmitted through direct contact with infected bodily fluids, and thus spreads less easily than pathogens with respiratory transmission, such as measles, avian flu and coronaviruses. But nine months in the DRC taught me that the standard of health we are accustomed to, is precarious and built on the basics—vaccination, clean water, basic medicines, good education, surveillance systems—much more than cutting-edge surgery and expensive new medications. The Covid pandemic taught us that we do not live in isolation. That infectious agents do not care for our man-made borders, and they regard our arbitrary immigration rules with bug-eyed disdain.
While we strip back education, health care and public health in the name of efficiency, we leave ourselves vulnerable to infectious diseases, epidemics, and pandemics. The ordinary people of America will suffer. You and me. Our neighbors, friends, and family. Our grandparents and our children. Republicans, Democrats, and independents, because viruses do not care who you voted for.
Now is the time to take to the streets, to call your elected officials, to speak with your friends on both sides of the political aisle.
Measles is already here. Other diseases will come.
Pavithra Natarajan is an infectious diseases physician and a writer. She has worked in England's NHS, at the CDC, and has a master's in public health from Harvard. She is currently writing a memoir about her time working in the Democratic Republic of Congo with Doctors Without Borders.
The views expressed in this article are the writer's own.
