As Ebola Spreads, Congress Must Press Rubio on Global Health Cuts
Secretary of State Marco Rubio will appear before four congressional committees this week to defend the administration’s budget. He will do so as a Bundibugyo Ebola outbreak, undetected for two months before anyone confirmed it, spreads into new areas of Central Africa. The detection failure is not a coincidence. Before this outbreak began, the administration shut down USAID, gutted CDC’s global health programs, and pulled out of the World Health Organization.
The Ebola outbreak is the most visible consequence of what this administration has done to global health. It is not the only one. PEPFAR, the U.S. program that has saved 26 million lives, is being dismantled. The supply chain that delivers HIV medications to dozens of countries is being wound down with no real plan. Funds Congress appropriated for vaccines are sitting unspent, and the U.S. has lost its seat on the Gavi board.
Public Citizen’s Access to Medicines Program has five questions that Secretary Rubio needs to answer:
Ebola and the Failure of Global Health Surveillance
The Bundibugyo Ebola outbreak was likely circulating for two months before anyone confirmed it. WHO’s Director-General said the detection delay means the response is now “playing catch-up with a very fast-moving epidemic.” Former CDC Director Tom Frieden called the gutting of USAID, CDC staff cuts, and U.S. withdrawal from WHO a “1-2-3 punch” to global health architecture. U.S. humanitarian funding in DRC is down nearly 80 percent since this administration took office.
- The administration cut U.S.-funded disease surveillance in DRC before this outbreak began. USAID previously provided the basic logistics that got viral samples from remote areas to labs for testing, and that function no longer exists. Did the administration’s cuts contribute to the detection delay, and what exactly is the plan to rebuild what was dismantled?
- One CDC expert working on the response told CNN the agency is “incredibly short-staffed across the board.” The White House Office of Pandemic Preparedness, established by Congress to coordinate exactly this kind of response, is not operational. Who is in charge of this response, and can the Secretary name the person filling the role of U.S. Global Health Security Coordinator that Congress mandated by law?
- The 2018–2020 DRC Ebola outbreak cost the U.S. $324 million. The administration has already committed over $162 million in bilateral assistance to this response, and the outbreak is still spreading into new areas. What did the surveillance and early warning programs this administration cut cost per year, and how does that compare to what we’re spending now?
Secret Bilateral Health Agreements
The administration has signed more than 30 bilateral health MOUs restructuring billions of dollars in congressionally appropriated global health funds. Country implementation plans that were due two months ago, on March 31, have not been released. The State Department has refused to comply with FOIA requests for the texts.
- The administration has signed over 30 bilateral health agreements, restructuring billions of dollars in congressionally appropriated global health funds, and the American public still cannot read them. On what legal authority is the administration restructuring congressionally appropriated funds through agreements it’s refusing to make public, and will the Secretary commit today to releasing all signed agreements to the public?
- With Bundibugyo virus disease now a declared international public health emergency, and no licensed vaccine or treatment, some MOU provisions on outbreak notification and specimen sharing diverge from WHO and International Health Regulations frameworks. How is the administration ensuring its hodgepodge of country-by-country terms doesn’t break the cross-border coordination this outbreak crisis demands right now?
PEPFAR and the HIV Prevention Drug the Administration Won’t Fight For
PEPFAR has saved an estimated 26 million lives. The administration is cutting bilateral HIV programs. CDC’s Division of Global HIV and TB has lost more than half its staff. Meanwhile, lenacapavir, a twice-yearly injection nearly 100 percent effective at preventing HIV, was named Science’s Breakthrough of the Year in 2024 and received FDA approval in June 2025.
- Secretary Rubio called PEPFAR one of America’s greatest achievements. Lenacapavir, a twice-yearly injection, nearly 100 percent effective at preventing HIV, is now here. In April, the U.S. Government and the Global Fund announced a commitment to reach up to 3 million people with lenacapavir through 2028. But experts say five million people a year is the floor for real impact, and UNAIDS says we need 20 million people on pre-exposure prophylaxis by 2030 to actually bend the curve. Gilead won’t sell it directly to MSF for humanitarian use. The countries that hosted the clinical trials — Brazil, Mexico, Peru — are locked out of the generic license. PEPFAR has procurement leverage over Gilead. Why isn’t this administration using that leverage?
Gavi Funding
Congress appropriated $300 million for Gavi, the Vaccine Alliance, in both FY25 and FY26. The administration is withholding those funds, citing vaccine safety concerns that Gavi and the global scientific community flatly reject. The U.S. has lost its seat on the Gavi board. Gavi’s latest replenishment came up nearly $3 billion short of its target.
- Congress appropriated $600 million for Gavi across FY25 and FY26. When will the administration release the funds Congress appropriated before they expire on September 30? The U.S. has already lost its board seat. With Ebola spreading and Gavi’s immunization infrastructure more critical than ever, what is the legal basis for continuing to withhold it?
Supply Chain Collapse
The State Department is winding down the Global Health Supply Chain – Procurement and Supply Management (GHSC-PSM) contract. Emergency closeout planning began in March. A closeout timeline from May 5 shows two-thirds of the 37 countries served ending all technical activities on September 30, 2026, just four months from now. Procurement is being shifted to Wambo, the Global Fund’s platform, but Wambo doesn’t do warehousing, last-mile delivery, or in-country logistics.
- Countries like Haiti, where PEPFAR funds nearly 80 percent of the national HIV response, now have four months to replace an entire end-to-end supply chain system. What is the plan for those functions after September 30, and which countries is the administration prepared to watch run out of HIV medications?