All health is Global

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ASTMH Tropical Medicine Meeting

The recent meeting of the American Society of Tropical Medicine and Hygiene was a reminder of how global funding cuts and this year’s changes in priorities have undermined public health and pandemic preparedness.

This conference brings together attendees from all over the world to encourage global cooperation and health, advance technologies, and exchange knowledge. It’s a great mixing bowl, combining the real-world experience of clinicians and researchers on the ground with that of those in wealthier countries. Much of the learning is not from the didactic sessions, which can be delivered virtually, but from on-the-ground networking and lively discussions.

There was a dark undercurrent at this meeting, driven by political tensions and despair over funding cuts. The Trump administration, through Robert F. Kennedy Jr’s control of the Department of Health and Human Services, has eliminated funding for the U.S. Agency for International Development and withdrawn from the World Health Organization, with devastating repercussions.

Attendance dropped from 4,700 last year in New Orleans to about 3,500 this year in Toronto, according to Jamie Bay Nishi, ASTMH’s Chief Executive Officer. Funding cuts, job losses, and difficulty getting visas for Canada contributed to the drop. “The biggest groups we lost were international students studying in the US who didn’t feel safe crossing borders and US government representatives. We lost 45 US government speakers from the program, mostly from NIH, CDC and DoD,” Nishi added. The absence of CDC speakers was particularly striking to me, stemming from the government shutdown. She also stated, “Many Europeans and Canadians have already told us they love the meeting but won’t be traveling to Washington, DC.” Given the heightened presence of ICE and their racial profiling, other international attendees might also bow out.

Global Public Health – Wafaa El-Sadr

In the opening plenary session, Wafaa El-Sadr, MD, MPH, MPA, professor of epidemiology at Columbia University, focused on HIV and inequity in access to treatment, noting that high-prevalence countries have limited access to medication, while low-prevalence countries have greater access. The President’s Emergency Plan for AIDS Relief (PEPFAR), begun under President George W. Bush, “is credited with having saved 26 million lives and enabling 7.8 million babies to be born without HIV infection,” KFF recounts. Innovation occurred, yielding easier-to-take medications requiring only one pill per day, pre-exposure prophylaxis, and long-acting regimens. While funding was $12 billion per year, she noted that it was less than 1% of our budget.

In contrast, the U.S. spent $872 billion on defense, more than the next nine countries’ combined spending and nearly 40 percent of global military expenditures in 2024; this is 2.7 times China’s defense spending, the second-largest spender.

El-Sadr noted that we not only have to worry about traditional vector-borne infections (e.g., from mosquitoes and ticks), but also about worsening outbreaks driven by antimicrobial resistance and migration and displacement from wars and climate change. All of this will be more difficult due to the U.S. withdrawal from the WHO.

Why The U.S. Should Care About Global Health – Sten Vermund

The theme of U.S. isolation and withdrawal from the global community was echoed in the next plenary session, where Sten Vermund, MD, PhD, Dean of the University of South Florida College of Public Health, spoke about why the U.S. should care about global health.

Vermund emphasized the importance of early disease control and the successes of Project Warp Speed and early Chinese vaccines. But a number of the researchers awarded presidential commendations for their work on a COVID-19 vaccine have since been fired.

We failed in response to the Ebola outbreak 2014-16; we were totally unprepared. There were >11,000 deaths in Africa. The U.S. spent $2.5 billion for preparedness here, but < $250 million of that was spent in Africa, where almost all of the cases occurred. Shockingly, in 2012, NIAID stopped development of an Ebola vaccine.

Citizen protection has served not only to protect foreign countries, but our own population, Vermund said. He noted the success of former President George W. Bush’s PEPFAR program, which saved millions of lives from AIDS. The U.S. was successful in transitioning HIV care in South Africa to local management. PEPFAR was not only a humanitarian success but was also strategically important to the U.S. by stabilizing African countries that would have otherwise likely become security threats. In contrast, our response to COVID-19, particularly with inadequate personal protective equipment for frontline workers, let alone the public, showed our lack of preparedness and led to countless deaths.

Research in tropical medicine leads to important rewards for us, too, by building a global infrastructure and fostering cross-border collaborations. Such alliances proved useful during the Ebola and COVID-19 outbreaks. Vermund explained that the priority review voucher program, which incentivized development of drugs for neglected tropical diseases, has dual-use potential for biodefense. It’s also helped prevent the importation of diseases like Chagas and trachoma into the country. Global health systems are critical for the early detection of pandemics. But then programs like ENVISION, which targeted five neglected tropical diseases (lymphatic filariasis, trachoma, onchocerciasis, schistosomiasis and three soil-transmitted helminths (roundworm, hookworm and whipworm)) were canceled when USAID lost funding.

Vermund said that international clinical trials, which speed drug development and collaborative innovation, have been canceled. $800 million in NIH grants were frozen or cancelled. BARDA cuts $500 million in mRNA vaccine research, also hurting promising cancer therapies. The CDC faces a 53% cut ($5 billion loss in FY26 budget), eliminating 42,000 jobs and >60 major programs in chronic disease (cancer, diabetes, and heart disease) prevention; global and domestic HIV/AIDS programs, immunization programs, and substance use prevention. These research cuts profoundly weakens our pandemic preparedness.

Finally, Vermund focused, as have others, on soft diplomacy. He contrasted China’s successful Belt and Road initiative in Africa with its medical aid and cooperative alliances, along with the U.S. withdrawal from WHO funding, which undermines our credibility and international relationships.

CDC Losses – Daniel Jernigan, Demetre Daskalakis, Deb Houry

Daniel Jernigan, MD, MPH, former director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, further detailed the impact of funding cuts to me in an email interview. The President’s Malaria Initiative lost its staffing and contracts due to USAID cuts that had funded it. Global Health Security/AMR/Flu funds and those for PEPFAR/TB have remained. Jernigan stressed that the “CDC is hamstrung” with micromanagement and has lost “available staff to respond to big outbreaks.” He noted, “For an administration that espouses government efficiency, the reality is that the path to rapid response has been significantly obstructed.” Jernigan expressed great concern about the loss of scientists and their replacement with political appointees. “There is not a single scientist, there is not a single career staff, and there is not a single person with public health management experience [in the immediate Office of the Director at CDC]. This is unacceptable for what was a premier scientific powerhouse.” Jernigan continued, “CDC has lost the pipeline of young scientists that fuel the work at CDC and who become the next generation of CDC experts. With DOGE cuts and hiring controls, CDC no longer is able to hire young scientists (bioinformaticists, laboratorians, epidemiologists, statistician/data analysts). This is perhaps the most dangerous damage to the agency.

“Some young public and global health scientists are struggling to find jobs in the current market,” Melinda Rostal, DVM, MPH, PhD, told me. “They find themselves competing with up to 1000 health professionals for these jobs, many of whom are also highly qualified. We are going to lose a generation of health care workers. This will be a disaster for American health,” she explained.

The impact of the administration’s cuts and reorganizations on pandemic preparedness and our status in scientific leadership was a major concern in this week’s Association of Health Care Journalists webinar with the former high-level CDC officials—Drs. Deb Houry, Demetre Daskalakis, and Daniel Jernigan— who resigned in response to the firing of CDC Director Susan Monarez. They further elaborated on the dismantling of the CDC and what that means for our country’s future safety. Afterwards, Daskalakis told me (via email), “One of the most concerning messages was that the US is trying to make “aid” a transaction for intelligence.” Countries will be required to share biological specimens and genetic sequences of “pathogens with epidemic potential” without any guarantee they will receive any resulting vaccines or medicines.

Wafaa El-Sadr aptly quoted Dr. Anthony Fauci, who said, “When it comes to emerging infectious diseases, it’s never over. As infectious-disease specialists, we must be perpetually prepared and able to respond to the perpetual challenge.”