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This Week in Global Development
The latest on the Ebola outbreak response
00:29:55
This week, we unpack https://www.devex.com/news/devex-checkup-who-is-funding-what-in-the-ebola-response-112624 in the Democratic Republic of Congo and Uganda. With no approved vaccines or treatments for the Bundibugyo species driving the spread, we...
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- [00:04]
A
My name is David Ainsworth, and you're listening to this Week in Global Development, hosted by myself, Richard Khamber and Adva Saldian. And I'm joined by my reporter colleagues, Michael Igoe and Sarah Jerry, to talk about everything that's happening this week in the world of global development. And it's quite a lot, as it often is. Sarah, you have been watching a particularly big issue that's been developing over the last couple of weeks, which is the Ebola response to happening right now in Democratic Republic of Congo, Uganda, and so on and so forth. Do you want to. You've written multiple stories about this this week. Do you want to tell us kind of what's happening, the state of the outbreak and the state of the response so far?
- [00:40]
B
So I've been talking to groups that are responding to the outbreak, and that includes msf, Aleema, Samaritan's Purse, and Save the Children. And what they're saying is that it's just particularly a challenging outbreak for a lot of reasons, and including that it was detected late. It's in a really challenging area where there's conflict and there's no vaccine or therapeutics because it's a rare species of Ebola. But one area that they really honed in on is that there's just like, immense logistical hurdles. And one issue is that they don't know how many cases there are and how it's spreading because of that late detection. So that creates a challenge around knowing where to set up treatment centers and also figuring out how much supplies you need and, like, where to position them and to kind of exacerbate that. There's the issue of Uganda and Rwanda closing their borders with drc, and then Ituri province, which is the epicenter of the outbreak, being under quarantine with civilian flights not going in and out of the capital, and then just kind of limited humanitarian plane movement. And that's really what experts have told me is just like border closures are not the norm for ebola outbreaks in DRC. This is the 17th outbreak of Ebola in DRC. So it's just really complicating the movement of responders and supplies. Like, for instance, you know, some. Some roads are off limits due to conflict. So humanitarian groups would use go through Uganda to bring staff and supplies in. And that's just not possible with border closers, border closures. And also experts in the area are kind of. Well, that kind of staff coming into the area are being told that they don't know when they can leave. So that impacts recruitment of deploying staff for some organizations. Yeah, so it's just, there's, there's many other challenges that are happening, but those are some of the highlights.
- [02:39]
A
Sounds like a real absolute mess, to be honest. Just very briefly, what's the. Can you talk a little bit more about the funding situation and the amount of money that's flowing into this?
- [02:48]
B
Sure. There have been a lot of pledges that have been announced kind of in recent, like the past two weeks since the outbreak has been announced. For instance, the Pandemic Fund Board approved up to 220.6 million in grant financing. Gavi has committed up to 50 million. CEPI is working to advance a vaccine into human trials. But there is kind of one continental plan that is being led by Africa CDC and the World Health Organization and they are working to raise 319 million for the first six months of the response. And one thing that Dr. Kaseya of Africa, the Director General of Africa CDC said last week is that they, they put out an announcement that they had raised nearly 500 million. But then he heard kind of from, from donors in the following days that there were some mistakes in those figures. So that was reduced down to more than half of that figure. One thing I've been told as well is, you know, like money. One expert said to me, you know, money will come. You know, we do people, the world does get, get freaked out about Ebola outbreak. So money will come in. But the issue is that it's just not there on the ground right now. So it takes a long time to translate from a pledge to actually like PPE and resources for the people there. So people are saying it's a really under resourced response. And one thing that I've heard as well is that like people who've kind of their veteran Ebola outbreak respond, they've said, you know, we'd usually see a lot more presence of UN agencies and NGOs on the ground at this point of an Ebola outbreak and that's not happening. And that more likely to be due to funding cuts as opposed to border restrictions. Another thing that I heard is that just because the WHO is dealing with a funding cut crisis as well, their in country capacity is not like it has been before for Ebola outbreaks.
- [05:11]
A
You've been speaking of funding cuts. Let's talk about the United States for a minute. Michael, you've been listening to Marco Rubio speak this week about among other things, how the United States is responding to the Ebola crisis, which is not quite how it might have done in past years. So do you want to talk to us a little bit about kind of. Rubio has been on the Hill. He's been answering questions. Tell us what he's been talking about and kind of what the overall impression was.
- [05:34]
C
Just to set the scene. This is two days with four hearings between them for Secretary of State Marco Rubio. He's on the Hill talking to lawmakers about President Trump's fiscal year 2027 budget request. So as many folks know, the president puts out a budget request, Congress sort of considers it to, you know, more or less degrees, depending on the sort of context. Then Congress ultimately comes up with its own budget, which might take some of the recommendations from the White House or not. But this is Secretary Rubio's chance to kind of explain to lawmakers and reporters who are following along how the administration is pursuing foreign policy writ large and foreign assistance specifically. So that's what's happening yesterday and today and our colleagues. Alyssa Miolene is on the Hill today following the hearings today. So Ebola came up several times yesterday, as you might expect, and often in the context of the foreign assistance cuts and restructuring that have happened over the last year and whether that has somehow influenced the nature and effectiveness and scope and scale of US Involvement in the Cbola outbreak. Rubio really tried to push back on that narrative. He said, you know, at one point, very specifically, the quote was the sort of slow detection of Ebola in this case. He said it had not the foreign assistance cuts. It had nothing to do with the Ebola outbreak. So I think he was really trying to push back on any sense that there was some connection between US Cuts or the, you know, dismantling of USAID and the fact that Ebola spread without detection for a while. And then in addition to that, he has sort of repeatedly pushed the message that US Responses to crises in general, both in the case of Ebola this time and other disasters, has actually been sort of faster and nimbler than it was previously under usaid. I think that's debatable. I think a lot of experts would disagree with that assessment and say that some of the crises that they're comparing to past ones are sort of apples to oranges in terms of how big the disasters have been that they've had to respond to. This is sort of the first major outbreak that has happened since the dismantling of usaid. So I think it really is a test case for a number of things. One is, can the State Department stand up an effective response to an outbreak, but also there was this sort of slew of prevention and detection programs that existed. And there's going to be, I think, a lot of retrospective analysis of what the impact has been of either not having those or having some sort of delays and disruptions to them. So that's still some analysis that I think remains to be done.
- [08:30]
A
Jaro, what would be your take on. My personal feeling would be that the US Is still responding nimbly and quickly as slightly to one side of the truth. But would you. What would be your position on this? What was the position, I guess from the ground, from people looking at this, how do they feel that the US has responded?
- [08:46]
B
Yeah, so that is one thing I'm hearing from responders is that they do think that the US Aid cuts have had a significant impact in kind of leading us to a situation that we are in right now. And one area is just kind of like the eastern Congo has. I mean, it's already been before the outbreak. It's amid a humanitarian crisis with high malnutrition rates, you know, conflict, displacement and whatnot. And one thing that I'm hearing is that just like the levels of surveillance have gone down in that area and there's less of. One of the big issues that we're dealing right now with this outbreak is that there's community resistance to messaging around the response. So there's rumors floating around that Ebola is, it's fake and it's kind of a money making machine for outsiders or that, you know, there's all sorts of kind of rumors. And one way that you kind of overcome that sort of thing is to have trusted partners that already have relationships with communities so that they feel comfortable coming into facilities and they trust, you know, people coming in and telling them because it's. The responders are asking people to do incredibly difficult things like, you know, not they're not able to bury their loved ones because the bodies are highly contagious. And so we're seeing a lot of community resistance right now. And that is one thing that I've heard from the responders is that this the kind of lesson that NGOs having less of a presence in eastern Congo from aid cuts has made a difference in areas like engagement and surveillance.
- [10:32]
C
Can I respond quickly to that? As you sort of anticipated in your question, Dave Rubio has really blamed sort of like the context rather than the aid cuts. So in other words, like, this is a war torn conflict situation. The lack of surveillance had nothing to do with our cuts. It was all because of this being A totally inaccessible area. So I think that's sort of like those are the sort of the lines of the argument here, or at least the spin that we're getting.
- [10:57]
B
Definitely truth to the fact that this is incredibly, there is areas of eastern Congo that are no go zones for humanitarians. And so there is truth that it's a very complicated, you know, for the aid sector in general. So kind of scaling back is not just aid cuts. It's also been kind of like groups assessing the security of their organizations as to. Is one thing I'm hearing.
- [11:25]
A
Yeah, I think, though I would question that slightly. Obviously, this is an extremely difficult environment in which to do healthcare well, and it's an extremely challenging environment in which to detect kind of an epidemic early on. But saying that it's difficult is not the same as saying that if you spend money, it doesn't get easier. And I guess my question would be, is there literally nothing you could have done to make this easier if there had been more NGOs on the ground, if there had been more international health response available? And I'm not sure that you can simply say it's difficult and use that as a reason for why your health cuts didn't make it more difficult. So I would question that a little bit.
- [12:02]
B
I don't know whether another layer to this is that it is the. It's a rare strain of. Of. Of Ebola or, excuse me, a species of Ebola. And so one thing that happened was that there, you know, there's. There people were tested, they came in with symptoms and they were tested for Ebola. And the tests weren't working because they were being for the Zaire species of Ebola. So that does also. That has contributed to this situation where the international rescue committee thinks that this might have been spreading for at least three months. And that was because. And one of the other issues is that the symptoms match, you know, malaria. And they're vague symptoms that people with other ailments will come into health facilities. And so we've actually seen some. The number of suspected cases drop in some senses because tests have taken a very long time, about a week to come back now. So people are. Suspected cases could end up with malaria. So that has played into it as well. It's a species or. Excuse me. Yeah, a species of Ebola that the world is not used to, the global health community is not used to responding to.
- [13:21]
A
Michael, what was the reaction to assertions that U.S. aid cuts had had no impact? How did lawmakers and others kind of
- [13:29]
C
come back on this Mostly they ran out of time to ask enough follow up questions. This has just sort of like become the pattern and dynamic in these hearings is Democrats will sort of come to them with these concerns or allegations that everything that has occurred in the foreign assistance space over the last 12 to 16 months has had deleterious impacts on the United States government's ability to operate in these situations. And then Rubio will come back and say, no, that didn't happen. Nobody has died. It had nothing to do with Ebola. We're faster, we're nimbler. Now his big refrain is putting money into something is not the same as getting results. And now we're much more focused on outcomes than we are just in pumping money into a perpetual system. And so it feels like this kind of feedback loop that just keeps going round and round in circles. And I don't know what it would take to kind of have any sort of resolution to that debate. It just seems to keep recurring. So anyway, that's sort of the dynamic on the Hill. I want to add a little bit about sort of the way that the US Ebola response seems to be adapting or changing, which I think is sort of telling in its own right. There were two things that came up yesterday that were really interesting. The first is that one of the lawmakers surfaced an op ed from 2014 that Rubio had written during the Obama administration in which heavily criticized them for not having a point person on the Ebola outbreak at that time, a single person in charge of the situation. And this lawmaker pointed out that the Trump administration does not have a single point person in charge of the Ebola outbreak right now. And so how is that any different or better than what Rubio criticized 12 years ago? And he shared that actually that's something that they're considering. So they have a couple of people in mind who might be appointed. He said he doesn't like the word Ebola czar. I'm not sure why, but somebody in that sort of coordinating role, maybe we'll, we'll hear about that at some point in the near future. And then the second piece, and I'm sure, you know, Sarah can say probably more about this and the sort of context surrounding it, but Rubio said that. So Sarah mentioned Gavi and the role that Gavi is playing in this outbreak, both in response and also, you know, funding a potential vaccine for this rare species of Ebola. The US Government has been like, blocking its contributions to Gavi largely or I believe entirely because of Secretary of Health and Human Services Robert Kennedy's concerns about vaccine safety. Noted vaccine skeptic. And what Rubio sort of explained yesterday in the hearings was that the president, President Trump, asked for Kennedy to sort of have that role, that decision making influence over the administration's engagement with Gavi. But now Rubio said it's time for the State Department to sort of reengage or reassert itself into that situation. And he never said explicitly that the administration is going to restart its contributions to Gavi, but he kept talking about driving towards an outcome or a resolution, sort of. These are our lead diplomat, so he knows how to say things without saying anything. But. But the picture was pretty clear that the State Department is sort of taking back ownership of that issue set and that we might anticipate some changes in terms of US Funding for Gavi. I just think it's interesting that both of those things, the sort of structure around outbreak response and putting somebody in charge and then resuming funding to an organization that's pretty deeply involved in this specific situation, the fact that those are happening now as this outbreak really ramps up and escalates, I think tells you something about how the decision making and the sort of incentives that are carrying weight at a particular moment are changing dynamically. And so their response is adapting as a result. I'm an objective reporter, Dave, you know,
- [17:30]
B
indeed, correct me if I'm wrong, Dave, or excuse me, Michael, but I think this is the first time the Trump administration has kind of suggested that the funding would be restored to Gavi, because it's been this, the kind of back and forth where the Trump administration says no funding towards Gavi, then Congress puts it in the budget. But we haven't kind of seen that Trump administration support before. And that's quite significant or kind of at least like, you know, verbalizing that there's a kind of going to be conversations moving forward.
- [17:58]
C
I think that's right. And certainly the, you know, the lawmakers who raised the issue were, were pleased to hear that Rubio was offering an outcome or a resolution. He kept phrasing it as an outcome that would reflect the wishes of both Congress and our goals on global health or something like that. So it was pretty unambiguous. He's talking about restarting funding to Gabi.
- [18:21]
B
Yeah, I wanted to raise another kind of difference with this response to previous Ebola responses because there has been quite a bit of controversy over an agreement with the Trump administration in Kenya over creating a quarantine facility in Kenya to send Americans that have either been exposed or are positive, have positive results of Ebola. And that's kind of created quite an uproar and court challenge in Kenya and protests about kind of this question about the risks of America bringing in cases of Ebola into a country that has no reported cases. But it's also kind of been challenged on the side of, you know, the US where there's questions about, you know, the constitutional right of Americans to return home for treatment, which has been the norm in previous outbreaks, as opposed to sending Americans to, to a foreign country for treatment.
- [19:16]
A
Yeah, this is a complete mess, isn't it? Really like just a gigantic kind of pr. Own goal, really. The, the response from the Kenyan leadership was health leadership. That Kenyan doctors union was really a textbook example of exactly how to say what you think in an unambiguous way and really build support. They really gave the. I can't remember any of the quotations, but they, they gave the administration absolutely both barrels. And it was. So after watching a lot of people putty footing around the issue to see someone actually play, they said, I believe if it's not, if it's not safe for Americans, then it's not safe for Kenyans, among other things. And it's had the desired effect, by the look of things. Is this project now effectively dead in the water or are they still trying to force it through? Do you know, Sarah?
- [20:03]
B
No. So both the Kenyan and the US Governments are standing behind this decision. And the court kind of situation is from what I understand is just that a hearing needs to be had around it. So there's still presidential and kind of like support from both sides. And the Kenyan and American relationship is really strong. The US Signed its first, first bilateral health agreement with Kenya last December, saying it will give Kenya up to 1.6 billion over five years. And last week, kind of amid all of this controversy, there was a conversation between the Trump administration and the Kenyan government around the US committing 13.5 million to Kenya for preparing against this part of Ebola within Kenya. So Rubio last December called Kenya one of its. Called it like the perfect. The perfect partner to roll out its health deal. So they, they are. Have a lot of arrangements and a strong partnership around health. So I think they're going to both push forward on this.
- [21:11]
C
I was just going to say I was surprised this didn't come up more extensively in the hearings, given the sort of international profile of the issue. But the only thing that Rubio said, said about it yesterday, you know, he may have said more today. He just talked about how it was the. As part of this interagency process that has been coordinating the outbreak response. It was the Department of War, formerly the Department of Defense, that apparently stood up this, this clinic in Kenya.
- [21:39]
A
There's briefly, I mean, it's a very interesting kind of thing, this, isn't it, like. And you, you can see in an ideal outcome for Kenya where the United States gives it some money and then there's a big court battle and then it's too politically difficult and then they don't to take any sick Americans and they get to keep the cash. We've certainly seen this before with the United Kingdom trying to ship people to Rwanda, for example. The Rwandans got a lot of money and they didn't have to take any refugees. In the end, I did want to move on briefly, Michael, to talk about the other things that Rubio was covering because he didn't just talk about Kenya and Ebola unhealthy. He had some other kind of key topics. What else did kind of dominated the conversation in the hearings?
- [22:18]
C
Yeah, I mean, these are always a whirlwind. So it's sort of a world tour of everything related to, in this case, foreign policy. You know, like, it used to be that you would have a USAID administrator who would occasionally take trips to Capitol Hill to talk specifically about development and foreign assistance. Now that USAID has been effectively dismantled and its programs have either been cut or folded into the State Department, it's Rubio. And so the result of that is that a lot of this discussion, a lot of the hearings are focused on big foreign policy issues. So the war in Iran dominated a lot of this. Questions about the NATO alliance, all sorts of things that are not specifically or explicitly connected to global health and development and foreign assistance. Within that realm, the latter realm, foreign assistance, a number of things popped up. The sort of usual litany of questions and concerns about the lingering effects of dismantling usaid. But on a more sort of forward looking basis, he got some interesting questions about, for example, Food for Peace, the flagship US Food assistance program, which has been moved into the US Department of Agriculture, you might think. Why is Rubio answering Questions about a U.S. department of Agriculture program that's no longer under his purview, even though he still has like six different jobs or whatever, including National Security Advisor and all of these other things. Department Secretary of Agriculture is not one of them. But something that I learned in this hearing, which I did not know before, was that it was apparently the State Department that made the decision about which countries should be selected and targeted for foreign assistance. Excuse Me food assistance under Food for Peace in some of these initial funding rounds. So even though Department of Agriculture is running the program, apparently the State Department still has this role in selecting those countries. And that process has come under scrutiny because the list of. I think it's seven countries that are included in some of the initial funding does not really overlap with a list of countries facing the highest level of food insecurity. It includes countries like El Salvador and Guatemala, and does not include countries like Sudan. So. So it's sort of hard to figure out exactly how and what. Rubio has consistently claimed that foreign assistance is now very highly targeted and it's going to those most in need and yet also serving sort of America first interests. So in this case, there's a lot of questioning as to how this list came together. Rubio did not answer that question. He sort of pivoted to some responses about how the US Government is providing assistance to Gaza, for example. And then he made an argument kind of similar to the Ebola argument, that in the case of Sudan, it's not about their unwillingness to provide funding, it's that they don't think the funding is currently able to be effectively used and aid is not able to be effectively distributed because of the ongoing conflict there. So he gave sort of this contextual reason for the administration choosing not to provide more funding to the Sudan crisis and specifically include that country on its list of food assistance targeted countries. So that was a really interesting exchange. I think we've been watching this issue really closely and trying to understand how Food for Peace will operate under the Department of Agriculture. This issue of targeting is a really big one, and we didn't, unfortunately, get a whole lot of clarity around how it came together.
- [26:03]
A
Yeah, not entirely surprisingly, perhaps. Okay, we've just got a couple of minutes left, and I know that there's one particular topic which you want to talk about, which is, obviously you've been studying what's happening here very closely, and you are launching your own podcast, which is digging into some of these issues in even more detail. So why don't you tell us a little bit about that podcast, what's happened so far where people can find it, all that sort of stuff.
- [26:27]
C
Yeah, thanks. This is something I'm really excited about. I've been reporting for DEVEX for, I think it's 13 years now, and always wanted to do a podcast, no offense. I love being a guest on this one, but I wanted my own. And so I'm really excited that yesterday we released the first episode of our new Devex podcast, which is called Theory of Change, I host it. It's a weekly podcast that features really like long form, in depth, candid conversations with people who are shaping the future of global development or global progress writ large. The first episode, which we released yesterday, is an interview with Alexander Berger, who's the co founder and CEO of Coefficient Giving. Some folks might still know them as open philanthropy. They rebranded last year. I thought it was an awesome conversation. We talked about about a lot of different things from the rise of AI philanthropy and what that means to Coefficient Givings. Like really stunning current growth trajectory. They spent over a billion dollars last year. They're looking to grow by 50% in their funding this year and another 50% next year. And they're sort of staffing up right now to execute on that. This is a funder that gets has gotten most of its resources from Facebook founder wealth. It was funded primarily by Dustin Moskowitz and his wife Carrie Tuna. Dustin was a founder of Facebook, but now they're really sort of expanding their model and they're looking to bring new donors in and do more sort of like pooled funding for different causes. The thing that's really interesting about them, I think, is this process that they go through for deciding which causes to focus on. They're sort of part and parcel of the effective giving movement, the effective altruism sort of threads flow through this organization and they have this, this whole sort of structured process that they go through for figuring out what to fund. They just launched a new pooled fund last week that focuses on STREP A, which is one of those sort of under the radar killers that still contributes to like almost 700,000 deaths a year, even though it's highly treatable, highly neglected in lower resource settings. So we talked a lot about that. Anyway, I could go on and on. This was a fascinating conversation and there are many, many more of them to come. We'll be releasing these weekly on Tuesdays. The next one is relevant to some of the things that we've been talking about today. I'm not going to spoil the guest, but I would really encourage people to find the subscribe link in the description that we have here on this episode of the podcast and follow along and also to reach out if you have ideas for future guests you can find a way to copy. No, just shoot me an email, Michael. Igovx.com I'm pretty easy to find. So yeah, really excited to keep this conversation going.
- [29:18]
A
Yeah, well, there we go. You heard it here first. If you want to be on Theory of Change, then drop Michael a line. Or if you know somebody that we think you think we should be talking to. It sounds like an absolutely fascinating conversation. So you should. You should sign up immediately. Okay. It just remains for me to say thank you very much to Michael and to Sarah and to you, our audience. Thanks so much for listening, and we'll see you next week. Thank you both.