A leader of the 2014 U.S. Ebola response compares then to now

Politics A leader of the 2014 U.S. Ebola response compares then to now Without USAID, lessons learned in the earlier crisis have been lost, says former official Susan Reichle Manage alerts for this article Email this article Share this article By Annalisa MerelliJune 9, 2026 Contributing Writer Annalisa Merelli[email protected]Annalisa (Nalis) Merelli is focused on boys’ and men’s health: She looks into reproductive health, trending treatments, screening approaches, mental health, and everything in between. In October 2014, when the Centers for Disease Control and Prevention warned that the Ebola outbreak in West Africa risked infecting 1.4 million Africans by 2015, Susan Reichle was the counselor to USAID in Washington, D.C. At the time, the CDC mounted the largest response in history, and for the first time in an Ebola outbreak. USAID was involved in the response, too. It was a very different situation compared to the current outbreak in the Democratic Republic of the Congo and Uganda. In 2014, the world learned about the outbreak when there were 49 confirmed cases, and it took two-and-a-half months to get to 300 cases. This time, there were already hundreds of suspected cases by the time the CDC began its response, and 300 confirmed cases were reached within two weeks. Advertisement The countries affected in 2014 — Guinea and, later, Liberia and Sierra Leone — were safer for international health workers to operate in than the outbreak zone in the DRC, where over 120 armed militias operate in the Ituri province alone. And, of course, USAID existed at the time, and the U.S. was still part of the World Health Organization. As the U.S. (and the world) deals with an outbreak with strong momentum, projected to reach up to 20,000 cases unless rapidly contained, Reichle, who retired from foreign service in 2019 and in 2025 co-founded Aid Transition Alliance to support former USAID professionals, spoke with STAT about how the Trump administration’s decision to dismantle USAID and the WHO is impacting the country’s ability to intervene, and what can and should be done now. The interview was edited for clarity. How did shutting down USAID delay information about the current outbreak?Advertisement The WHO found out [about a suspected case] on May 5th. We didn’t learn about it until May 15th, so we lost 10 days to even respond. USAID had almost 200 people at the [DRC] mission on the ground and then thousands of partners. And it’s the partners and our team on the ground who often learn about things immediately, and so even without the official notification our partners that were networked all across the country would have found out immediately. They would have picked up some chatter about an unknown disease — that’s often how we find out things. How are things different for the civil servants who are still on the ground after the U.S. withdrew much of its investments in aid? The trust has been broken and there’s not that level of confidence to even share information, but there just aren’t enough people on the ground for [partners] to share information with. They took out so many people who worked on these issues representing the United States, so our presence is much lighter. Just to give you a sense, the entire [USAID] budget for DRC was about $1 billion and a lot of it was humanitarian assistance. The health office alone in USAID had 40 people working across the country. Those people don’t exist anymore. These people also carried a know-how acquired in previous crises which is now harder to come by. Yes. We know how to do this. Actually, 2014 was the first time USAID got involved in the response to the Ebola outbreak. Normally, the CDC took the lead, but [the outbreak] was too big in 2014. We quickly provided critical protective equipment, lab support, contact tracers, training on safe burial of Ebola victims, and many other interventions. We learned a lot of hard lessons. For example, we didn’t have enough protective equipment but we put out a grand challenge to develop a protective suit for medical professionals or anyone exposed to a potential case of Ebola, and Johns Hopkins and a dressmaker in Baltimore partnered together and won the prize, if you will, and developed a PPE suit specifically for Ebola. Advertisement There was a lot of innovation that happened in 2014 and so obviously when there were other outbreaks that happened over the years since, we used those lessons and unfortunately right now so much of that is lost because we lost the people. One of the crucial lessons learned was the importance of having PPE already in place, rather than trying to procure it when the emergency is underway. What is the situation now with regard to that? For any type of absolutely critical commodity that is needed in times of emergency or a disaster, USAID had warehouses around the globe that were stocked with those commodities to respond to disasters. [The one for DRC] was in Kenya. It was managed by the WHO, which is another issue because even when the Ebola outbreak occurred in 2025 in Uganda and DOGE and the Trump administration had just taken over they wanted to get the PPE out of the warehouse in Kenya, but they did not want the WHO to do that. This is documented in Nicholas Enrich’s book “Into the Wood Chipper: A Whistleblower’s Account of How the Trump Administration Shredded USAID,” and as he describes, he was told he had to get on a plane, go to Kenya, get the PPE, and have it delivered to the Ugandans that were battling Ebola. Absolute nonsense. Is the warehouse still stocked? We do not know. The only thing we know is that the supply contract [for the PPE] was broken. The DRC presents inherent challenges and safety threats which make it difficult for the CDC to send much personnel there. Would it be easier for USAID to mobilize? There’s always a danger going into these zones, and we do always face that challenge of how do you make sure that the people you’re sending in are protected. One of the things that we did in 2014, for example, is we set up a medical unit on the ground for people who were trying to treat those who had been infected by Ebola. And that was absolutely essential because then we were able to get volunteers, we were able to get the experts to come in. Without that, those people really ran a risk that they might not be able to get treatment in the country — which is what you need when you get sick so quickly — and that they might not be able to be transported back to their home country. Advertisement And so there are similarities now, as we are talking about the unit in Kenya. I’m kind of confused as to why it’s in Kenya, which is still a bit away from the [outbreak] zone, and how they would transport Americans to that so that they could get treatment, because you really do want to have a treatment center as close to where the infection potentially could occur. You need massive manpower to go in when you have a real severe outbreak, and I don’t know if they’re doing that level of planning right now. USAID also had a unique surge capacity. Was it different from funds that are being committed by the State Department for the response? Secretary [of State Marco] Rubio’s announcement that the State Department has committed $162 million in aid unfortunately does not translate into immediate action on the ground by local organizations who do not have the resources to respond. Our NGO partners in Congo are not able to fully activate because the U.S. had canceled contracts unnecessarily last year, and they have no assurance that funds are going to arrive on time. One of the unique assets that USAID had is that we did have countless partners on the ground who were working on everything from education to agriculture, that then once the chief of mission — in our case, President Obama — said we are going to do everything to combat [Ebola], all of those funds and those people shift to fighting the outbreak, so you have immediate resources on the ground. Then what we have at USAID is a capacity of flexible funding through our Bureau of Humanitarian Assistance: a disaster is declared, the disaster declaration then unlocks what is considered flexible funding, and so you can immediately get those additional funds and also people on the ground with the skills. In our case, they were called the Disaster Assistance Response Teams, DARTs, and those DARTs would get into the country very quickly and they would be able to start providing the technical assistance along with having the resources for everything you need.Advertisement One of the stories I heard is that [this time] they weren’t able to actually test the initial sample from somebody who was infected because it hadn’t been transported correctly, and when it got to Kinshasa it was no longer active. The samples that need to be collected and analyzed — all of that involves logistics and the technical capability to be able to do that quickly, and that’s what USAID was able to provide. The CDC does excellent work, obviously, they just don’t have the people on the ground and they don’t have that surge capacity, that’s not how they were designed. What is the impact of the U.S. withdrawal from the WHO and the dismantling of USAID on the global response and the international organizations leading it? The international community has decreased the number of resources that are available for outbreaks as well. Plus, everything from FCDO (the U.K.’s Foreign, Commonwealth and Development Office) to AusAID and others have decreased their financial or foreign assistance and so it’s complicating things even further. You have highlighted before how the U.S. has all but relinquished its role of global health leader, focusing instead only on protecting the health of Americans. Is the current strategy effective? What we see right now and we’ve seen in the early response since May 15th is that the biggest concern has been about Ebola coming into the U.S. And of course we do not want Ebola to come into the U.S. or any disease. But they’re not using the tools in order to actually go to the source, and that is the only way you stop an outbreak — you have to go to the source, you have to be able to develop the relationships with the community members and to stop it there. The concern we have now is that it has been several weeks, if not even several months since the first case, and we don’t know how far it’s spread. The State Department did set up a task force, I think about two weeks ago now, and I’m hoping that leadership can get on top of this because it requires very strong direction, and obviously working with the international community. Even not being a member of the WHO, we have to work with the international community, because the way they’re trying to get the funding out right now is through the U.N., through OSHA, and it’s rather ironic since this administration didn’t want to work with the U.N. But those are pooled funds, and that takes time for the U.N. to get those funds out again, it’s not the same as having people on the ground and direct funding that already exists.Advertisement What do you think are the most important interventions to make now? Getting as much PPE in there as possible to protect everybody who is in an area of exposure to prevent the transmission. A woman going in to have a baby needs to make sure that she’s protected and her baby is protected. Making sure communities are engaged in community health work training, and just developing that confidence within the community level that this exists. Creating temporary labs that can start testing specimens, particularly in neighboring countries. We know about Ebola in Uganda and in DRC, but South Sudan has no ability to test for this strain of Ebola. The disease surveillance networks and data-sharing systems too are absolutely critical and right now not having the tracking and contact tracing mechanisms in place is a huge vulnerability. And then the safe burials: that was a huge challenge for us in 2014, and that that’s very concerning to see that still the safe burials are not happening because that means there’s potentially more people who are infected. Are you still in touch with some of the civil servants who have remained on the ground? What are their concerns? I still am in touch with [USAID] colleagues who are still at CDC and now at the State Department and one of the main things I hear from them is [the need for] clear leadership and interagency coordination because right now there isn’t clear leadership. [In 2014] we had a White House coordinator named very shortly after the Ebola outbreak.I did hear Secretary Rubio talk about having a White House coordinator. For those who are in government right now and those who are on the ground trying to respond to this [outbreak] there is just no clear coordination and leadership, and you waste a lot of time. We are so fortunate to have valiant civil servants and foreign service officers and partners who want to fight this epidemic, and they deserve a better response. You have to have clear roles and responsibilities in any disaster situation, and we do not right now.Advertisement health policy, infectious disease, public health, who Submit a correction requestReprints Annalisa Merelli Contributing Writer Annalisa (Nalis) Merelli is focused on boys’ and men’s health: She looks into reproductive health, trending treatments, screening approaches, mental health, and everything in between. 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