What ‘America First’ Means for Global Health

Summary

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Podcast Summary: Radio Atlantic – What ‘America First’ Means for Global Health

Host: Adam Harris
Guest: Hana Quiros (The Atlantic)
Release Date: August 3, 2026

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Episode Overview

This episode of Radio Atlantic explores the devastating Ebola outbreak in the Democratic Republic of the Congo (DRC) and examines how the U.S. government’s shift to an “America First” global health policy—withdrew or restructured vital foreign aid—has impacted global capacity to respond to epidemics. Host Adam Harris and reporter Hana Quiros provide a deep dive into the specifics of the outbreak, changes in U.S. foreign aid, the human impact of global health decisions, and the broader implications for international health security.

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Key Discussion Points and Insights

1. Scale and Challenge of the DRC Ebola Outbreak

• Alarm over Outbreak Size
  • The DRC is facing one of Africa’s largest Ebola outbreaks in history, with nearly half of those infected dying. The outbreak escalated from roughly 500 to 1,500 deaths in one month. (03:16 – 03:35)
• Factors Behind the Crisis
  • Late detection and delayed response fueled uncontrollable spread.
  • The outbreak’s epicenter is a gold mining town within a war zone, complicating containment and movement. Refugee camps lack testing and resources. (03:35 – 04:26)
  • “It was caught so late in its spread... Ebola was sort of, you know, this runaway train.” — Hana Quiros (03:35)
  • The Bundibugio Ebola virus strain evaded the usual tests, causing misdiagnoses and delayed interventions. (05:22 – 06:33)

2. Human Stories and Cultural Complexities

• The Human Toll
  • Personal anecdotes illustrate suffering: Delays in testing mean families—sometimes young children—are left in limbo, and the perception of treatment centers as places to die discourages early care-seeking. (06:53 – 08:46)
  • “If people... you have a much better chance of surviving if you’re treated earlier... there’s this perception that the Ebola treatment wards are like places where you go to die.” — Hana Quiros (07:30)
• Cultural Traditions Fueling Spread
  • Traditional funeral rituals involve physical contact with the deceased—major transmission points for Ebola. Disrupting traditions breeds both grief and skepticism.
  • “Imagine your mother died... there’s this way that you honor her... and you can’t do that anymore because of a virus.” — Hana Quiros (08:06)
• Mistrust and Violence Against Aid Workers
  • Some communities, suspicious of outside intervention, have burned treatment centers and attacked burial teams, fearing hidden agendas or resenting disruption to daily life. Still, most do not believe Ebola is a hoax, and many do cooperate. (09:25 – 11:12)

3. The Shifting U.S. Global Health Policy

• U.S. Foreign Aid Cuts and Structural Changes
  • After President Trump’s 2025 return, a 90-day freeze and eventual 90% cut erased most USAID foreign health programs.
  • Health aid has shifted from the expertise of the CDC to a State Department-dominated, diplomacy-driven model—termed “America First.” (13:44 – 14:18)
  • “If you don’t have public health experts... whose primary purpose is not statecraft, but in preventing disease spread—how does that impact our global health security?” — Hana Quiros (14:18)
• The “A la Carte” Model
  • Recipient countries are increasingly asked to pick specific interventions, threatening holistic, system-wide responses and preparedness for unpredictable threats. (14:18 – 15:05)

4. Impact on Outbreak Response and Global Health Security

• Narrowing U.S. Engagement
  • U.S. priorities now emphasize border security and preventing domestic risk over broad humanitarian aims.
  • “We care about Ebola... but our number one priority will always be making sure it doesn’t come to the United States.” — Adam Harris (14:08)
• Ripple Effects
  • The halving or closure of clinics in the DRC due to funding shortfalls and U.S. withdrawal affects global surveillance and rapid response networks.
  • Aid to countries like Somalia, on the brink of famine, has virtually disappeared for political reasons—some nations have been blacklisted or dropped entirely. (19:33 – 20:09)
• Programs Lost
  • Effective, ongoing campaigns against neglected tropical diseases have collapsed: when U.S. logistics and distribution support stopped, pharmaceutical donations dried up, leaving debilitating illnesses unchecked.
  • “That’s one of those things where I think there are a lot of examples like that... we just lost interest... things were dropped from the agenda.” — Hana Quiros (18:43)

5. What’s Next – Concerns and Open Questions

• Sustainability of Aid and Global Infrastructure
  • The World Food Programme is facing a $100 million shortfall for the regional Ebola response; U.S. willingness to restore previous levels of support remains bleak. (15:35 – 16:31)
  • Even diseases that briefly capture the U.S. Administration’s attention (like Ebola, as evidenced by Trump and prominent tweets) are dealt with in ways that prioritize “fortress America” rather than systemic global action. (16:31 – 17:26)
  • “Progress was being made on a major global health problem... and we—the U.S.—just lost interest.” — Hana Quiros (18:58)
• Declining U.S. Leadership
  • On the ground, locals notice the U.S. no longer leads outbreak response; WHO capabilities have grown, but a “leadership gap” in global coordination persists. (21:54 – 23:49)
• Recognition of the Human Element
  • Caregivers—many unpaid—risk their lives combatting Ebola, often at personal cost. “People call Ebola a disease of compassion, because the people that are the caretakers often are the ones that get infected and die from it.” — Hana Quiros (23:33)

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Notable Quotes & Memorable Moments

• “Ebola was sort of, you know, this runaway train that was spreading through the DRC... the response hasn’t moved as fast as Ebola has through the country.”
  — Hana Quiros (03:35–04:26)

• “There’s always been this dual justification for providing foreign aid—you know, we should nip it in the bud before it comes to our borders, but also we don’t want innocent people and babies to die of things that are very preventable.”
  — Hana Quiros (15:17)

• “The U.S. has been successful in the past—saving millions of people from famine in Somalia. If there’s a famine and the U.S. doesn’t respond, a lot of people... are going to die—more than would have otherwise.”
  — Hana Quiros (20:09)

• “Global health is, at the end of the day, really a human endeavor. It’s about preventing unnecessary human suffering... a fundamental part of being human.”
  — Adam Harris (23:49)

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Timestamps for Important Segments

• [03:16] – Why this Ebola outbreak became so severe
• [05:22] – Diagnostic challenges with a new Ebola strain
• [06:53] – Personal and cultural obstacles in outbreak response
• [09:25] – Community mistrust and violence toward responders
• [13:44] – The U.S. “America First” health doctrine explained
• [15:35] – Funding gaps and collapsing humanitarian systems
• [17:41] – How U.S. policies influence neglected tropical disease intervention
• [21:54] – Waning U.S. visibility and WHO’s role on the ground
• [23:33] – The compassion and risk of frontline health workers

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Conclusion

This episode paints a sobering picture of the consequences when the U.S. retreats from global health leadership and shifts its aid strategy from compassion to narrow self-interest. It underscores that rapid disease response requires robust, coordinated, expert networks—and that the erosion of those structures leaves both vulnerable countries and the world at large less prepared for inevitable outbreaks. The conversation closes with urgent, unanswered questions about the international community’s ability to step up where U.S. engagement has faltered, and the profound human courage and sacrifice at the heart of global health work.

Transcript

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[Adam Harris]

This is Radio Atlantic. I'm Adam Harris and this week we need to think about Ebola and the crumbling global health infrastructure. The Democratic Republic of the Congo is in the throes of one of the largest Ebola outbreaks in the history of the African continent. Nearly half of those who have contracted the virus have died since the outbreak began in May. The international community has been playing a game of catch up, but perhaps it should have seen this coming. On the day President Trump returned to office in 2025, the administration issued a 90 day freeze on foreign aid. In February of that year, they eliminated 90% of the USAID foreign aid contracts before they finished dismantling usaid. A few months later, the shuttering sent shockwaves through the international aid community. The resources the US Was withdrawing weren't just good pr, they were critical to the public health of poorer nations. And now, as Ebola ravages the Congo, advocates say that this is exactly the sort of outbreak that money and coordination was intended to contain. How will this outbreak end? And could this level of catastrophe have been avoided? With me to discuss is my colleague Hana Quiros, who's been covering the decimation of the U.S. s global health aid and the current Ebola outbreak. Let's get to questions. Hana, thanks so much for joining me today.

[Hana Quiros]

Thanks for having me.

[Adam Harris]

When we spoke at the office maybe about a month ago, there had been roughly 500 deaths from Ebola on the African continent to that point. Now there are roughly 1500. Why has this breakout been so difficult to contain?

[Hana Quiros]

I think there are a couple of factors, but the biggest one is probably just that it was caught so late in its spread. There was a lot of disease transmission that occurred before an international response was mounted. Ebola was sort of, you know, this runaway train that was spreading through the drc. And then, you know, it's in an active war zone, which complicates things. There's, you know, there's not really any testing in refugee camps. And it's also a gold mining town where the epicenter of the outbreaks, where people just sort of come in and out. So it's a place where people. Ebola was spreading and spreading to a lot of different places before we started trying to contain it. And now it's just, you know, the response hasn't moved as fast as Ebola has through the country.

[Adam Harris]

Yeah. And so you're talking about the drc, the Democratic Republic of the Congo. Where else in the region is it? I know there were cases in Uganda. Has it spread beyond the DRC or is it still primarily located in the drc?

[Hana Quiros]

So it's primarily located in the DRC and specifically in the eastern drc. There's a health zone that's near South Sudan that has had its first cases of Ebola. Uganda has had a few cases, but the outbreak there has been declared over. They have a really robust healthcare system. South Sudan, much less so. So there's fear of that happening, but right now it's still within the DRC.

[Adam Harris]

The West African Ebola outbreak in the 2010s where something like 30,000 people were infected, over 11,000 people were killed. Killed. What is different about this strain of

[Hana Quiros]

Ebola, the one that's tearing through the DRC right now is a different virus entirely. So it's the Bundibugio Ebola virus. And because of that, this virus has evaded, it evaded detection. And that's a really big part of why it was caught so late. Because the machines that were being used to test for Ebola were giving back negative results because they were looking for one Ebola, not all five of them. So that's one way that this outbreak is different. We don't have the regular arsenal of vaccines, treatments, diagnostic capacity that we know works. And then in terms of the actual scale, so now the outbreak is over 3,000 cases and it's very nearly the second largest Ebola outbreak in recorded history. And the big difference is that this is the fastest moving Ebola outbreak that we've seen. So there's an explosion of cases that's happened within a very short period of time. Again, we're not really sure what the period of time is. We don't know who patient zero is in this outbreak. So yeah, that's I think the main

[Adam Harris]

differentiator when you mentioned patient Zero, it's almost a reminder that these are individuals, right, that make up these larger numbers. Can you sort of humanize this for us? What has that experience been like traditionally or historically during these outbreaks?

[Hana Quiros]

You know, I was speaking to a woman at Doctors Without Borders who's coordinating their response to the outbreak in the drc and she was saying that like the current case fatality rate is like 40%. She talked about a mother that showed up to an Ebola treatment facility with symptoms and with two kids. And because of delays in testing, you know, it can be 48 hours, 72 hours before you get a positive or negative result. So there's a question of like, oh, like, you know, where do the kids go while you're waiting? If you're at home with a fever, you know, you might be hesitant to go to this place where, you know, almost half of people don't come back from. So I think that, you know, there's this perception that the Ebola treatment wards are like places where you go to die. And health care workers have said that that's really something they, they want to fight against. Because if people you have a much better chance of surviving if you're treated earlier in the disease progression. So there's a lot of fear. I think 90% of people are dying before they ever reach a hospital, you know, according to the World Health Organization. And also just like cultural practices and in the drc, like funerals are a multi day affair where you celebrate the life of the person, you touch the body, and that's a major way that Ebola spreads. So this like, very basic cultural practice, you know, like, imagine your mother died and you think of, you know, you think about, there's this way that you honor her before, you know, you put her in the ground, and you can't do that anymore because of a virus. It reminds me of COVID in a lot of ways. In the way that there's disruption, there's a lot of suspicion. Some people think it's a hoax, but yeah, it's just caused a lot of disruption in the drc.

[Adam Harris]

Yeah, to that point of people thinking that it's a hoax. There is the hoax that leads people to a hesitancy to go to a doctor to go and be seen. But there's also the. This sort of mistrust that leads to an almost like anger. Right. This idea that maybe they're withholding something from us that could help people. How are folks in the Congo sort of dealing with that and their response to the international community sort of attempts to help contain the spread. Is there a sort of violent response to those efforts?

[Hana Quiros]

So there has been in some cases. I think most people in the Congo don't think that Ebola is a hoax. There was a survey recently that I think 30% of people thought that it wasn't a real disease, which is significant, but it's not. You know, it's not the majority of people. But Ebola treatment centers have been burned. The people there are teams that are. They're called safe and dignified burial teams. And they go out and basically hazmat suits. And then they. They will. If someone's tested positive, they'll go to their home and try and disinfect everything so that bodily fluids that can transmit Ebola don't infect other people. And then they sort of wrap the person up in a special tarp and they try to bury them in a way that ensures the disease doesn't spread. Those people have been attacked because they're highly visible. And I think from. From the perspective of someone in the drc, like, you know, you're much more likely to die from the conflict that's happening there or from malaria or malnutrition, issues related to displacement than you are from Ebola. But when an Ebola outbreak spreads, there is this parachuting of international aid, which is apt to make sure that the spread doesn't continue. But if you look at even the worst case scenario in the minds of some people, there are bigger fish to fry. And so I think that there is a lot of gratitude, people that are cooperating. There's a lot of really great radio programs that have positive public health messaging. But there's also a lot of distrust and just wariness of how much people's daily lives have changed.

[Adam Harris]

When we come back, Hanna and I discuss the efforts to rebuild the global health infrastructure.

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[Hana Quiros]

So yeah, intense.

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[Adam Harris]

Bio threats happen all the time. It's something that governments are sort of always thinking about. And scientists have estimated or believe that there's about a 5050 chance of another Covid level pandemic materializing in the next 25 years. And that probability jumps significantly when you're talking about these sort of smaller scale outbreaks and epidemics.

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[Adam Harris]

They're things that are going to happen. There was a playbook that sort of developed out of some of these previous outbreaks to deal with things like this. Is that playbook still a thing? Does the International community still know how to manage these sorts of outbreaks?

[Hana Quiros]

I hope so. The Trump Admin published it's America first global Health Strategy. And it promotes this sort of like a la carte model of funding global health responses. So it takes the sort of the control of global health away from the CDC and puts it in the hands of the State Department.

[Adam Harris]

We care about Ebola. We don't want anyone dying or being affected by Ebola. But our number one priority will always be making sure it doesn't come to the United States. That's our number one obligation.

[Hana Quiros]

And there was a really great substack post that I read. I think it was headlined, like, you know, would you want Henry Kissinger running? Like the COVID response, where, like, if you don't have public health experts, epidemiologists, you know, people that are specialized in running global health responses and whose primary purpose is, you know, not statecraft, but in preventing disease spread, how that impacts our global health security, like, how it affects all of us that are alive, Like, I, you know, I don't know. And also the a la carte model asks countries to decide basically, like, do you want bed net? It leads me to worry about how comprehensive future responses will be and how prepared we'll be.

[Adam Harris]

Yeah, it's almost like when you move it to the sort of State Department, it becomes more of a play for diplomacy as opposed to a care, a sort of compassionate, compassionate aid. Right.

[Hana Quiros]

Yeah. I think there's always been, you know, this dual justification for providing foreign aid and health aid specifically. You know, we should nip it in the bud before it comes to our borders. But also we want innocent people and babies to die of things that are very preventable.

[Adam Harris]

The World Food Program was talking about. They just put out a report recently that talks about the compound factors that make the sort of public health crisis and the DRC worse. And they're requesting over $100 million over the next six months for Ebola response in the region. $76 million for the Congo alone. You've reported on the sort of deep cuts for international aid out of the United States. And I wonder if the US Will ever get back to funding international health aid in the same way that it did before this Trump administration. Are there any indications that they will get that $100 million and then have some for the future to prevent? Outbreak 17 outbreak 18 outbreak 19 so

[Hana Quiros]

the world Food Program is really broke currently. They've had to pull back from a lot of really critical places where they were providing food aid, cut rations. But I will say, I think that Trump really cares about ebola. Like, in 2014, he was a prolific Ebola poster. Like, I think he made like, 100 tweets about Ebola within, like, a. A span of, like, a few months. It's at the intersection of, like, hypochondriac Trump and border control Trump. He really was adamant that no one that had the virus should enter the country, even if they're Americans that caught the virus while abroad. And you see that he's implemented that this time around. So if. If an American doctor goes to the DRC, gets Ebola, instead of sending them back to the U.S. we're sending them to Europe. So, I mean, like, Trump is engaged on Ebola. Go ahead.

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[Adam Harris]

Should Americans be concerned about Ebola? I'm concerned about everything, but certainly am. I think that, you know, it's been confined right now to Africa, and. But it's something that has had a breakout.

[Hana Quiros]

Ebola is sort of like. Even when Elon Musk was discussing the US Aid cuts, he was like, we cut Ebola. Whoops. Like, everyone knows we should keep doing that. So I actually, I do think that when there's an Ebola outbreak out of a desire to protect national security, there is typically sort of a surge in response. And we've seen that even this time that the research and development money that's gone into developing a vaccine for the species of Ebola, developing treatments the US has provided that. I think what I'm skeptical about ever coming back is really, there were some things that were just dropped from the global health aid agenda that the US no longer funds so neglected tropical diseases. They're this sort of package of diseases like river blindness or different type of parasitic diseases that are disabling but typically aren't deadly. But, you know, they can make someone blind permanently or, you know, make it so that they're unable to work, unable to go to school. And the US had really successful programs that were eliminating these diseases in many countries, and most of the drugs were donated from pharmaceutical companies in the US Was just helping with, you know, distribution. And we've. We've stopped doing that, and those companies have stopped donating the drugs because a lot of the infrastructure is gone. And. And that's. That's one of those things where. I think there are a lot of examples like that where, you know, progress was being made on, you know, a major global health problem, and we. The US Just lost interest. And that's without really an explanation. You know, things were dropped from the Agenda. I don't know if we ever get back. I think it's harder to argue for the reinstitution of something than, like, the continuation of it.

[Adam Harris]

Yeah.

[Hana Quiros]

And then I also think that aid has been politicized in a way that makes it difficult. Like, you know, the US provides virtually no aid to Somalia anymore, even though they're on the brink of famine. You know, certain countries have been blacklisted for lack of political interest. You know, so I think that we're seeing a narrowing of ambition. And then also, you know, some countries have just been dropped from the aid agenda by the Trump admin. So those are the major changes I see and the things that I think might not come back.

[Adam Harris]

If those things don't come back, what risk does that pose to the global health picture?

[Hana Quiros]

Zooming in on Ebola, specifically. There's just a lot less healthcare in the DRC because humanitarian funding, not just from the US but from most other wealthy countries is down pretty significantly because the US has always been a leader in global health. So I think a lot of people took our lead and brought it down. The International Rescue Committee, for example, in this region of the drc, they've had. They closed, I think, like, more than half of their healthcare facilities. And there's a relationship between these NGOs and the World Health Organization. You know, the US government sort of tipping off the right authorities when they see something that is suspect and could be, you know, a pathogen that's a real threat to biosecurity. So I think that there's, you know, there are just sort of all of these holes in, you know, our picture of disease spread and, you know, diseases. Diseases will come. So I think that that's. That's something to worry about. But I also think that the main impact will be just, you know, if there's a famine in Somalia and the US doesn't respond, a lot of people in Somalia are going to die. Like, you know, more than would have otherwise. The US has been successful in the past of like, you know, like, saving millions of people from famine in Somalia.

[Adam Harris]

If you were to open your sort of reporter's notebook, think about the questions that you still have about the outbreak, about the spread, about the global international response to it. What are those questions that you still have about the outbreak that you would like answered or that. That you want to pursue?

[Hana Quiros]

When I've talked with people that are in the drc, in Bunya, which is current epicenter of the outbreak, have asked, like, where are the Americans? Do you see Americans? Is the US Playing a clear leadership role. And a lot of the people I've talked to have been like, it's not really the US Leading anymore. And part of that, I think, is because after the. The Obama administration really took the lead on the 2014 Ebola outbreak and the World Health Organization was like, quite sort of. It floundered and was not as useful as the US Was. So there was effort put into sort of training up the World Health Organization and making building capacity so that they were more capable of leading an international outbreak response. And so I think that part of the story is that the World Health Organization is capable of taking the lead, but also sort of the leadership gap, if there is one, is interesting to me. And then I also think that this is like a massive, massive human effort. So there are doctors, there are nurses, there are healthcare workers that are donning hazmat suits, basically, and are in 80% humidity in the summer heat. Doctors, they have to. They can only work for an hour because otherwise they'll pass out due to the heat and they're not being paid. So there's strikes that are happening amid the outbreak, which are, I mean, really disrupting care for people in really critical condition. And there are also these healthcare workers that are working in extremely dangerous situations. People call Ebola a disease of compassion because the people that are the caretakers often are the ones that get infected and die from it.

[Adam Harris]

Yeah, absolutely. You know, it's, as you mentioned, that. Right. The sort of human element, global health is really, at the end of the day, really sort of a human endeavor. Right. A moral endeavor. It's about, you know, preventing unnecessary human suffering. Right. I think that human element of folks sort of putting themselves in harm's way to help other people is such a fundamental part of being human. Hanna, thank you so much for your time today and sharing all of this with us. And we'll be following your reporting as the effort to contain the outbreak continues.

[Hana Quiros]

Thanks so much.

[Adam Harris]

That's all for today's show. This episode of Radio Atlantic was produced by Mike Pisoli. It was edited by Hadley Robinson and engineered by Miguel Carrascal, and has original music by Rob Smerziak. Claudina Baid is the executive producer of Atlantic Audio, and Andrea Valdez is our managing editor. If you like what you saw here, new episodes of Radio Atlantic drop every Monday and Thursday. You can subscribe on the Atlantic's YouTube page, on Apple or Spotify or wherever it is you get your podcasts. And if you want to support this work and the work of my colleagues. You can subscribe to the [e-mail] listener until next time, I'm Adam Harris.

[Hana Quiros]

Logging off Rebuilding our attention spans, Trading in smartphones for dumb phones. Why are people trying to get off their screens, and what are they really after? I'm Natalie Brennan, a producer at the Atlantic. And I'm Julie Beck, a staff writer at the Atlantic. This season, we're exploring the often fraught, always changing relations people have with technology and examining the ways our devices affect our connection with one another. New episodes of how to Touch Grass come out every Monday. Subscribe wherever you get your podcasts.