Is The US Ready For A New Global Health Threat?

Summary

Podcast Summary: "Is The US Ready For A New Global Health Threat?"

Podcast: What A Day
Host: Jane Coaston
Guest: Apoorva Mandavilli, Science and Global Health Reporter, The New York Times
Date: May 20, 2026
Episode Focus: Examining the state of America’s public health system amid global threats like Ebola and hantavirus, leadership gaps, and implications for U.S. and global pandemic preparedness.

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Episode Overview

Jane Coaston dives into mounting concerns over America’s ability to respond to rising global health threats, highlighting critical weaknesses in the U.S. public health infrastructure. With new Ebola and hantavirus outbreaks and key public health roles vacant under the Trump administration, Jane interviews journalist Apoorva Mandavilli to unpack how these developments impact readiness and response both domestically and internationally.

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Key Discussion Points & Insights

Opening: Public Health in Crisis

[00:30–02:15]

• Context: WHO addresses the Ebola outbreak in Central Africa (over 130 dead, 500+ cases; real numbers may be higher).
• Additional Threat: Hantavirus outbreak, isolated to a cruise ship (11 infected, 3 dead) with resulting quarantines.
• Leadership Void: U.S. currently lacks Senate-confirmed CDC Director and Surgeon General.

State of the U.S. Public Health System

[02:15–03:33]

• Apoorva Mandavilli describes a hollowed-out CDC:
  • Staff scientists keep things running, but absence of a permanent leader hinders advocacy and coordination.
  • Hundreds of employees lost, particularly affecting outbreak response capabilities.
• Quote:
  "Not having a permanent head of the CDC who can lobby for the agency, who can liaise with the White House and with the health secretary, Robert F. Kennedy, Jr. That's a real disservice to the agency." —Apoorva Mandavilli [02:44]

Decentralized System & Funding Cuts

[03:33–04:18]

• U.S. public health is fragmented, with CDC funds flowing directly to state and local health departments.
• Budget cuts at the federal level disproportionately hit “red states” more reliant on federal support.
• Quote:
  "When you cut the CDC's budget, you're actually cutting the budget for Americans’ public health services all across the country." —Apoorva Mandavilli [03:41]

New Nominees for Public Health Leadership

[04:18–06:50]

• Surgeon General Nominee:
  • Nicole Saphier, Fox News commentator and radiologist; not widely known or recognized in medical circles.
  • Mixed vaccine stance: supports some vaccines, leans toward “medical freedom” and allowing parental vaccine choice.
• CDC Director Nominee:
  • Erica Schwartz, former Coast Guard doctor, with law and biotech background.
  • Praised for competence by Trump-era officials, but largely unknown to public health peers. Concerns about military chain-of-command mentality possibly limiting independence.
• Quote:
  "She seems more pro vaccine and more into the idea of immunization on a broad scale than a lot of people that have been associated with Mr. Kennedy before." —Apoorva Mandavilli on Nicole Saphier [05:29]

Impact of Leaving the WHO & International Health Regulations

[06:50–08:39]

• After Trump administration’s exit from WHO and rejection of International Health Regulations, the U.S. receives outbreak information late and can't participate in international response teams.
• Case study: Hantavirus outbreak – CDC found out nearly a month after WHO; U.S. was absent while world agencies investigated, delaying response.
• Quote:
  "When the US is in the room, they're the leaders, they make everybody move faster, they coordinate, they make things happen. And that was not the case this time." —Apoorva Mandavilli [07:52]

U.S. Pandemic Preparedness: A System in Decline

[08:39–10:23]

• Major preparedness offices and roles remain unfilled (White House pandemic coordinator, Office of Pandemic Preparedness).

• Fewer CDC country officers, lost USAID surveillance programs—weakening early outbreak detection and rapid response capabilities.

• Reliance now on outside groups (WHO, European CDC) and diminished U.S. agency roles.

• Quote:
  "None of this is happening at the scale or the speed that we would need to really get on top of an outbreak before it becomes a pandemic." —Apoorva Mandavilli [10:17]

Closing Reflection

[10:23–10:28]

• Jane thanks Apoorva for examining what the U.S. system should do in a crisis versus what it is currently doing.

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Notable Quotes

• "Not having a permanent head of the CDC who can lobby for the agency... is a real disservice to the agency." —Apoorva Mandavilli [02:44]
• "When you cut the CDC's budget, you're actually cutting the budget for Americans’ public health services all across the country." —Apoorva Mandavilli [03:41]
• "CDC has said they found out [about Ebola] on May 14th. Nine days in an outbreak that moves this quickly is just an eternity, right?" —Apoorva Mandavilli [08:32]
• "None of this is happening at the scale or the speed that we would need to really get on top of an outbreak before it becomes a pandemic." —Apoorva Mandavilli [10:17]

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Key Timestamps

• 00:30 – WHO meets about Ebola; outbreak scope and risks
• 01:30 – Hantavirus cruise ship outbreak details
• 02:15 – Missing U.S. public health leaders overview
• 03:33 – Consequences of CDC funding cuts
• 04:29 – Details on Trump’s public health nominees
• 06:50 – U.S withdrawal from WHO and impact on outbreak response
• 08:54 – Assessment of U.S. pandemic preparedness
• 10:23 – Closing thanks and reflection

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Tone and Style

Jane Coaston leads with sharp wit, a critical eye, and a commitment to substantive reporting. Apoorva Mandavilli provides nuanced, clear, and sometimes worrisome analysis, sticking to facts seasoned with select, memorable observations.

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Conclusion

This episode of What A Day offers a concise, meaningful look at America’s weakening public health apparatus just as new global threats emerge. Jane and Apoorva highlight the profound effects of leadership gaps, funding cuts, and the disconnect from international cooperation. The conversation warns listeners of vulnerabilities in the current system, while maintaining clarity, urgency, and a dash of dark humor. The episode is essential listening for anyone concerned with how the U.S. might—or might not—weather the next pandemic.

Transcript

[Apoorva Mandavilli]

Foreign

[Jane Coston]

May 20th. I'm Jane Coston, and this is what a Day. The show celebrating Louisiana Republican Senator Bill Cassidy's new career as a big old hater. Since he lost his primary last weekend, Cassidy has said he would vote against funding President Donald Trump's ballroom and voted to support Democrats resolution to limit Trump's war powers. Hate, hate, hate. On today's show, Shrebs Waffner. Oh, sorry, you couldn't follow that. That was me trying to talk over the sound of the White House ballroom construction. And Trump makes an endorsement Republicans did not ask for. But let's start with America's public health system and what it is and isn't equipped to handle right now. The World Health Organization met on Tuesday in Geneva, Switzerland to discuss a deadly outbreak of Ebola in the Democratic Republic of the Congo and Uganda. According to the WHO, the outbreak, which has killed more than 130 people and infected more than 500, could last for months. And those numbers could be much, much higher than what officials have been able to determine. Trump is also concerned about Ebola. Well, as concerned as he gets about things that don't involve him personally. Here he is on Monday.

[Senator Chris Van Hollen]

Should Americans be concerned about Ebola?

[Donald Trump]

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

[Jane Coston]

The Ebola outbreak comes in the midst of another outbreak you've probably heard a lot about. Hantavirus. It's part of a family of extremely dangerous viruses that are primarily spread by rats and mice. It also infected 11 people on what became one of the worst sightseeing cruises ever. Three people died, and now many of the ship's passengers are in quarantine. And with all this going on in public health, you might be wondering, hey, who is running the Centers for Disease Control and Prevention? And who is the surgeon general of the United States? The answer to both no one. Who has been confirmed by the Senate. So what is going on with the American public health system right now? To find out, I spoke to Apoorva Amanda Villi. She's a science and global health reporter at the New York Times. Apoorva, welcome to Water Day.

[Apoorva Mandavilli]

Thanks for having me.

[Jane Coston]

Since Trump took office, the US Public health apparatus has been decimated. There's a lot of leadership missing in the cdc, including the head of the cdc. We still don't have a surgeon general. How is the US Public health system operating right now compared to two years ago?

[Apoorva Mandavilli]

Not very well. They are doing okay in that The CDC does have a lot of staff, scientists who've been there a long time who know what they're doing, and they can still sort of keep the ship moving. But not having a permanent head of the CDC who can lobby for the agency, who can liaise with the White House and with the health secretary, Robert F. Kennedy, Jr. That's a real disservice to the agency. And they also have lost hundreds and hundreds of employees who would be useful in certain situations, like in infectious disease outbreaks. And so they are not doing as well as they could be.

[Jane Coston]

So something about the U.S. public health system that is a little different from some other countries. It's decentralized. Can you explain quickly how all of these agencies work together and what happens when there are budget cuts or these big cuts of scientists and just missing officials? What does it look like when it's supposed to work, and what does it look like right now when it's not working?

[Apoorva Mandavilli]

Well, So I think one thing people don't realize about the CDC is that Most of the CDC's budget actually goes immediately out the door to states and local health departments. The CDC doesn't keep that money. And so when you cut the CDC's budget, you're actually cutting the budget for Americans. Public health services all across the country. And in fact, often it's the red states who are really dependent on federal funding that are going to suffer the most. So I've spoken to officials at state health departments in places like Alabama and Mississippi who talk about how much harder it is for them to do their job because they've had to fire a lot of their own people because of the funding cuts that they've experienced.

[Jane Coston]

Of course, this is the Trump administration, so more changes to the public health system are on the way. He recently nominated new candidates for both CDC director and surgeon general. Who are they?

[Apoorva Mandavilli]

Well, so we know very little about them because neither of them seems to have been particularly well known before they were nominated. Nicole Safir, who's the current nominee for surgeon general, is a Fox News commentator, but she's a radiologist. And when my colleagues reached out to some radiologists to ask about her, they. They were told that those folks had never heard of her. So she's probably best known in her commentator role. We do know a lot about what she thinks about various things because she's been in this role, and she's said various things about vaccines, about Tylenol and autism. The connection that President Trump had tried to make, we know that, for example, she does seem to support some childhood vaccines and thinks that measles vaccine is important. But she also is a big proponent of the idea of, you know, medical freedom and people being able to choose, at least for some vaccines like hepatitis B, that they should be able to decide. And so she's somewhere in the middle, I would say, seems more pro vaccine and more into the idea of immunization on a broad scale than a lot of people that have been associated with Mr. Kennedy before.

[Jane Coston]

Can you tell me a little bit about the potential CDC director?

[Apoorva Mandavilli]

Yeah. So Erica Schwartz was a Coast Guard in the Coast Guard for many years. She was a doctor again in the public health world. No one I know seems to have heard of her. They all think she has great credentials. They're excited about the fact that she's an MD she has studied biotechnology. She studied law. She seems to have a very broad background. She did serve in the first Trump administration. She was in charge of some of the testing during the early in the pandemic. And I've spoken to Trump administration officials from that term who said she was great and that she seemed to really think very carefully about things and that when she didn't think something was right, she did seem to speak speak up. At the same time, some public health experts I've talked to point out that, you know, she was in the military overall and that in certain circumstances, she may just be inclined to carry out orders that come from above, because that's what happens in the military in general. And so it's not clear exactly how she would serve. And, you know, she has really been a mystery to me because I know a lot of people in the public health world, and to encounter someone that no one seems to have really had much interaction with is pretty rare.

[Jane Coston]

We were talking earlier about what these institutions are supposed to be doing or supposed to look like when there's an emergency. And we are in the midst of two potential emergencies. Over the weekend, the World Health Organization declared the outbreak of the Ebola virus in Central Africa a global health emergency. It's especially concerning because it's a strain for which there is no treatment, nor is there a vaccine. We've also been hearing a lot about hantavirus, which hasn't been a part of the global health conversation, and people are very worried. But as you know, last year Trump pulled out of the World Health Organization. How does that decision affect our ability and the world's ability to fight global threats moving forward?

[Apoorva Mandavilli]

It makes it a lot harder, not just for us, but for everybody else. So when the US Withdrew from The World Health Organization. And it also rejected something called the International Health Regulations, which is this legal framework that binds countries together and obligates them to report outbreaks. So when the US Is not part of those things, it means that we don't hear about outbreaks when everybody else does. To give you an example, with the hantavirus outbreak, there were officials from the World Health Organization, from the European CDC, and from the Dutch Health Ministry on board the ship investigating what had happened. But nobody from the CDC was there, and we didn't find out about it and did not start our response till almost a month after the first patient had died. And everyone I talked to, WHO has been involved in these kinds of outbreaks before, talks about how when the US Is in the room, they're the leaders, they make everybody move faster, they coordinate, they make things happen. And that was not the case this time. And we're also seeing that play out with Ebola again. May 5th is when the WHO found out. CDC has said they found out on May 14th. Nine days in an outbreak that moves this quickly is just an eternity, right?

[Jane Coston]

Especially in a disease with a 50% fatality rate. Let's set aside these global threats, which is hard to do, but we'll do it. How would you rate the preparedness of our current public health system? In America, we have lost a lot

[Apoorva Mandavilli]

of the things we need to be ready for a pandemic. So when there is even a hint of a threat, we used to have several people whose entire job it was to coordinate responses. So we had somebody in the White House, a role that Congress had created. We had an entire office of pandemic preparedness that also Congress had created. Those things are not filled right now. Those are all vacant. We also don't have a lot of the infectious disease experts that the CDC would normally have. There are fewer people that the CDC has in country offices, you know, all across the world, especially in places like Africa, who would be able to contain an outbreak or at least tell us about it very quickly if it happened. We completely lost USAID with the US Agency for International Development, which funded much of the surveillance that we used to have to detect outbreaks really early. And when there was an outbreak, aid was what would go in and coordinate and make sure that, you know, people had the right kind of protective gear, they had the right kind of lab equipment, they would help pay for transport of lab samples, they would train health workers. None of that is happening right now in quite the same way. Some of it is happening because there are other organizations involved. The who, the European cdc, they're trying to do their best and even the US Agencies are providing some support. But none of this is happening at the scale or the speed that we would need to really get on top of an outbreak before it becomes a pandemic.

[Jane Coston]

Apoorva, thank you so much for joining me.

[Apoorva Mandavilli]

Thanks for having me.

[Jane Coston]

That was my conversation with Apoorva Mandavilli, science and Global Health Reporter at the New York Times. Don't worry, there is news that will not fill you with existential terror coming up, unless you're a big John Cornyn fan. If you like the show, make sure to subscribe. Leave a five star review on Spotify and Apple Podcasts, watch us on YouTube and share with your friends. More to come after some ads. This episode is sponsored by BetterHelp. Some days feel good and others feel overwhelming. Whatever's keeping you up at night, it's easy to feel like you have to figure it out all on your own. But the truth is, no one has all of the answers and no journey should be alone. May is Mental Health Awareness Month, a great time to check in with yourself and get the help you need to get where you want to go. Betterhelp therapists work according to a strict code of conduct and are fully licensed in the US. BetterHelp does the initial matching work for you so you can focus on your therapy goals. A short questionnaire helps identify your needs and preferences and their 12 plus years of experience and industry leading match fulfillment rate means they typically get it right the first time. If you aren't happy with your match, switch to a different therapist at any time from their tailored recommendations. You don't have to be on this journey alone. Find support and have someone with you in therapy. Sign up and get 10% [e-mail] wad that's betterhelp.com wad this episode is brought to you by IQ Bar, our exclusive snack, hydration and coffee sponsor. IQ Bar protein bars, IQ mix, hydration mixes and IQ Joe mushroom coffees are the delicious, low sugar, brain and body fuel you need to win your day. All IQ Bar products are packed with clean, delicious ingredients that keep you physically and mentally fit like magnesium, lion's mane and more. IQ Bars Plant protein Bars are the smarter snack choice with plenty of plant protein, tons of fiber and no added sugar. IQ Mix is a zero sugar drink mix that hydrates with electrolytes, improves mood and boosts clarity. IQ Joe is a mushroom coffee designed for mental clarity and packed with 200 milligrams of natural caffeine. Plus it comes in four different flavors that will totally transform your morning routine. With over 20,000 5 star reviews and counting, more people than ever are fueling their busy lifestyles with IQ Bars, Brain and Body Boosting Bars, Hydration mixes and Mushroom Coffees. Their Ultimate Sampler Pack includes all three IQ Bars are a delicious part of my post workout routine. And right now IQ Bar is offering our special podcast listeners 20% off all IQ bar products including the ultimate sampler pack plus free shipping. To get your 20% off text WAD to 64,000 text WAD to 64,000. That's WAD to 6 to 4,000. Message and data rates may apply. See Terms for details.

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[Jane Coston]

what else we're following today.

[Apoorva Mandavilli]

Head of Lines

[Donald Trump]

we have to have a safe country. We have to have a great country. We have to make sure that Iran doesn't get a nuclear weapon. All of the things that you see me fighting for so hard.

[Jane Coston]

Actually, I see you fighting for the construction of that 400 million dollar ballroom you're standing in front of, shouting over the sounds of heavy equipment. Trump said he's giving Iran just days to make progress in negotiations to avoid strikes. He said, quote, maybe Friday, Saturday, Sunday, something. Maybe early next week, a limited period of time. Sir, you are not scheduling a brunch. Trump covered a lot of ground during that press gaggle.

[Donald Trump]

I'm going to be putting out an endorsement in a little while in Texas, the great state.

[Jane Coston]

And that he did. Trump endorsed Texas Attorney General Ken Paxton ahead of next week's runoff in the Republican Senate primary. Trump's endorsement puts him at odds with his party's establishment, which pushed for incumbent Senator John Cornyn. The Republican nominee will face Democratic State Representative James Talarico. President Trump's hand picked candidate Ed Gallerin defeated Kentucky Republican Representative Thomas Massie in Tuesday's primary. Trump sought to unseat Massie after the eight term representative broke with him on issues like the release of the Epstein files. The president, who had waged a social media campaign against Massie, posted a photo showing him and Gallerain under the words Ed Gelleron wins endorsed by President Trump. We'll discuss the other winners and losers in Tuesday's primary on tomorrow's show. More than 3,500 stock trades were made on Trump's behalf in the first quarter, according to government filings. It's unclear how much Trump made, but the Financial Times estimates that he made hundreds of millions of dollars. Here's what Maryland Democratic Senator Chris Van Hollen told Whataday when asked about the trades.

[Senator Chris Van Hollen]

This is by far the most corrupt administration in American history. I mean, Donald Trump has literally turned the White House into a pay to play casino. And in this latest example, he is making critical decisions that will have a direct impact on the value of the stocks he's selling. And this is the most blatant example of conflict of interest. That's putting it very mildly.

[Jane Coston]

There's currently bipartisan support in Congress to ban stock trading for members of Congress and the president. We'll see how that goes.

[Senator Chris Van Hollen]

Mr. Let me ask you this. Are there going to be rules that say that if you've assaulted a Capitol Hill police officer or committed a violent crime, you will not be eligible? Why not make that a rule?

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I expect that. Well, because I'm not one of the commissioners setting up the rules.

[Senator Chris Van Hollen]

I expect more of the five members. Aren't you, Mr. Attorney General?

[Jane Coston]

Pardon me, he's actually appointing all five members. That was Senator Van Hollen. During a Senate Appropriations hearing on Tuesday, he asked Acting Attorney General Todd Blanche some fun questions about Trump's $1.776 billion anti weaponization slush fund. During the hearing, Democrats and Republicans both expressed concerns about the obvious pitfalls of a MAGA slush fund. And it turns out giving more than a billion dollars to Trump's backers and allies who claim the Department of Justice has been, quote, weaponized against them isn't even going over well with conservatives. Both the Wall Street Journal editorial board and the National Review came out against the fund on Tuesday. A judge has ruled that federal agents can no longer make arrests in and around three Manhattan buildings where immigration proceedings occur. The decision on Monday brings an abrupt halt to a Trump administration practice that enabled agents to take into custody people who follow requirements to appear before immigration judges. And that's the news. Before we go, AI is evolving faster than most of us can keep up with, raising big questions about work, power, creativity, and what the future might actually look like. In Assembly Required, Stacey Abrams talks with Katie Drummond from Wired and Tim Net Gabru from the Distributed AI Research Institute for a candid conversation about the fears and possibilities surrounding AI. Listen to this episode and future episodes of assembly required on YouTube or wherever you get your podcasts. That's all for today. If you like the show, make sure to subscribe, leave a review and subscribe. Listen to these University of Central Florida students booing their commencement speaker after she praised AI and tell your friends to listen. The rise of artificial intelligence is the next industrial revolution. What happened? And if you're into reading and not just about how a number of universities have had commencement speakers who bring up AI and AI technologies get heavily booed by graduates like me, what areday is also a nightly newsletter. Check it out and [e-mail] subscribe I'm Jane Costen, and when you're talking to young people you've been telling for the last five or so years that AI would destroy their jobs. Are you really surprised when they don't like that? Weird Water Day is a production of Crooked Media. Our show was produced by Caitlin Plummer, Emily Foer, Erica Morrison and Adrienne Hill. Our team includes Hayley Jones, Greg Walters, Matt Berg, Joseph Dutra, Johanna Case and Desmond Taylor. Our music is by Kyle Murdoch and Jordan Kanter. We had help today from the Associated Press. Our production staff is proudly unionized with the Writers Guild of America east.

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