The White House appeared to declare victory this week for an Obama-era initiative to stamp out disease outbreaks around the world even as it moved to scale back the program.
The National Security Council released a report on Monday trumpeting the achievements of the multinational Global Health Security Agenda, which helps low-income countries halt epidemics before they cross borders. The report "clearly shows how the investments made by taxpayers to improve global health security are paying dividends," White House officials said in the announcement .
But the United States is set to sharply shrink its contributions to the initiative, a point that the report omitted. The Centers for Disease Control and Prevention is preparing to narrow epidemic work from 49 countries to 10, an agency spokeswoman said.
That has alarmed health policy experts.
"It's not a matter of if — but when — there will be another Ebola or Zika, and right now, the world isn't ready," said Dr. Thomas R. Frieden, who led the C.D.C. during the West African Ebola outbreak . "Many life-threatening gaps have been identified, but most of them haven't been closed."
The Global Health Security Agenda first received almost $1 billion from a $5.4 billion emergency spending package in 2015 during the Ebola outbreak that killed more than 11,000 people. Program directors had hoped that, after the five-year package expires in October 2019, a comparable funding level would be added into the C.D.C.'s budget.
President Trump proposed an additional $59 million next fiscal year to make up for the loss of the emergency spending in the C.D.C.'s Global Health Security Agenda activities. But that amount would fall far short of the emergency supplement, and even that sum would be drawn from other global health programs at the agency.
Over all, Mr. Trump's February budget proposal offered the C.D.C., the United States Agency for International Development and the Defense Department's health security programs about the same funding those agencies received between 2006 and the Ebola crisis, "objectively inadequate for the agencies' activities" since the outbreak, said Jennifer Kates, who studies global health policy at the Kaiser Family Foundation.
Without more funding, the C.D.C. would have to cut its health security fieldwork by 80 percent, according to its plan reported by The Wall Street Journal . The new priority list would exclude nations like the Democratic Republic of Congo, Haiti and Sierra Leone, where past outbreaks of diseases like cholera and Ebola have rampaged.
Administration officials said their commitment to disease management should not be judged by budget numbers.
"Countering biological threats, infectious diseases, and pandemics is a priority of the administration — a key pillar of our national security strategy," Rear Adm. R. Timothy Ziemer, the director for global health security and biothreats at the National Security Council, said in an interview on Monday. "A budget line is not the only indicator of commitment. Budgets come and go."
At a health security panel on Monday, Dr. Anne Schuchat, the acting director of the C.D.C., said, "The administration, C.D.C., the partners across government and the private sector are very keen for us to not lose the progress." She added, "It's a few years ago, but people remember Ebola."
Publicly, top administration officials have been supportive. Last year, Mr. Trump and Secretary of State Rex W. Tillerson, who was ousted on Tuesday, publicly endorsed the initiative, and Mr. Tillerson vowed that the American commitment "will remain constant. "
At the initiative's summit meeting in Uganda last October, Admiral Ziemer and Dr. Brenda Fitzgerald, the head of the C.D.C. at the time, gave speeches urging the global community to extend the initiative until 2024 — but suggested no financial support to do so.
Since then, the language from the administration has changed. Admiral Ziemer said that decreased American funding could be an opportunity for other countries like Britain and Japan to "step up to the plate."
Critics of such multinational agreements agree.
"I'm not sure we're getting bang for our buck with World Health," Senator Bill Cassidy, Republican of Louisiana, said of the World Health Organization's investment in the partnership during a public health hearing on Capitol Hill in January. He said additional C.D.C. funding "doesn't seem — in a time of scarce resources — a wise use of resources."
In 2016, an independent panel convened to assess the government's Ebola response concluded that the Department of Health and Human Services, the C.D.C.'s parent agency, needed an ongoing contingency fund to prepare for future outbreaks.
Dr. Thomas Inglesby, the head of the Johns Hopkins Center for Health Security, who testified during the January hearing, said that neglecting such programs would jeopardize national security.
"It's true that we have shouldered responsibilities," he said in an interview. "But it is in our own interest. If other countries are vulnerable to epidemics, that makes our country, too. We saw only a glimpse of it with Ebola, a few patients here. But had it been more contagious — we were lucky."
Earlier this year, several coalitions representing over 200 health security groups sent a letter to Alex M. Azar II, the health secretary, expressing concerns over the C.D.C.'s fieldwork cutbacks. Dr. Frieden, who led the C.D.C. during the Ebola outbreak, said the United States ought not "pull the rug out before the world is ready for the next epidemic."
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