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In 1995, a year into my assignment to West and Central Africa for the New York Times<\/em>, I was pulled away from covering one of the conflicts then raging in that part of the continent to report on another kind of crisis, one that was new and utterly terrifying in the way it killed indiscriminately without resort to guns or violence: the Ebola virus.<\/p>\n Although by no means medically unfamiliar, before that year\u2019s outbreak in Kikwit, Zaire (now the Democratic Republic of the Congo), this pathogen was still largely unknown to the world. That changed dramatically in the space of about a week, as international scientists and reporters rushed to Bandundu, the west-central province of Zaire where the disease was spreading, transmitting news of its extraordinary mortality rate and gruesome symptoms. Among others, these included bleeding from every orifice and projectile vomiting.<\/p>\n<\/p><\/div>\n In 1995, a year into my assignment to West and Central Africa for the New York Times<\/em>, I was pulled away from covering one of the conflicts then raging in that part of the continent to report on another kind of crisis, one that was new and utterly terrifying in the way it killed indiscriminately without resort to guns or violence: the Ebola virus.<\/p>\n Although by no means medically unfamiliar, before that year\u2019s outbreak in Kikwit, Zaire (now the Democratic Republic of the Congo), this pathogen was still largely unknown to the world. That changed dramatically in the space of about a week, as international scientists and reporters rushed to Bandundu, the west-central province of Zaire where the disease was spreading, transmitting news of its extraordinary mortality rate and gruesome symptoms. Among others, these included bleeding from every orifice and projectile vomiting.<\/p>\n By the time I reached Zaire\u2019s capital, Kinshasa, that May, most of the front-line coverage had ended. Doctors and scientists were still at work in Kikwit trying to contain the epidemic and understand the horrifying virus better, but when I landed there by a small, chartered plane, almost all of the reporters had gone out of fear of contamination. Most anyone else who could leave the city was rushing to do so as well.<\/p>\n This was a time of great human naivete about virulent pathogens and pandemics. In those days, I\u2019d never seen one of the N95 respirators that became commonplace in the wake of the global spread of COVID-19; before leaving my base in Ivory Coast for Zaire, the best my local doctor could recommend was a common cotton facemask, along with surgical gloves and a paper bib to wear in the proximity of Ebola patients.<\/p>\n Thus equipped, I interviewed relatives of people who were in the death throes of Ebola in Kikwit\u2019s main hospital and watched others bury their dead nearby. Later, I spent an afternoon wandering a village where the virus was clearly still spreading, despite official statements from international health agencies that the Ebola outbreak had been contained.<\/p>\n In my follow-up coverage, I lambasted wealthy nations for their role in Africa\u2019s calamitous public health situation. This was not just a failure of recent investment, but also, in significant part, the unacknowledged legacy of minimal investment in public health and education, including medical schools, during the colonial era.<\/p>\n Ebola was barely the tip of the iceberg. It had received such attention only because of its ease of transmission and lurid symptoms, which fed fears in the West that it would reach the rich world. Meanwhile, malaria, which scarcely drew any outside notice, was still killing millions of people in Africa, while diseases long eliminated or contained elsewhere, from measles to yellow fever and meningitis, among others, wiped out countless others.<\/p>\n Zaire\u2019s 1995 Ebola outbreak had other major dimensions that I was unable to foresee. Together with the previous year\u2019s Rwandan genocide, it contributed to sweeping changes in U.S. policy toward Africa. Some of these had a compelling surface logic, but many of their effects have inadvertently contributed to the continent\u2019s present-day crises. The Clinton administration correctly understood that both the era\u2019s genocide and Ebola outbreak had their roots in state failure, but from this it drew the wrong conclusions. The need to protect Western interests, whether against violent disorder and refugee flows or virulent diseases, gave crises like these a lively national security dimension, which paved the way for an increasingly Pentagon-centered approach to the continent.<\/p>\n To address political instability in Africa, Washington deemphasized democratic rule and set about prioritizing relations with what it perceived as tightly ruled authoritarian regimes in places such as Ethiopia, Eritrea, and post-genocide Rwanda. It also aspired to continue in this direction in the region\u2019s biggest country, Zaire, by supporting the 1997 overthrow of its longtime client, Mobutu Sese Seko, with a new Rwanda-backed dictator named Laurent-D\u00e9sir\u00e9 Kabila. Rather than leading to peace and stability, though, every one of these countries subsequently became wracked by or engaged in calamitous wars.<\/p>\n Washington was simultaneously pushing security-based approaches to the perceived threat to the world that Africa posed through communicable diseases. In June 1996, U.S. Vice President Al Gore announced something called the Presidential Decision Directive on Emerging Infectious Diseases, which led to the Pentagon monitoring disease outbreaks through border surveillance and military networks.<\/p>\n As much sense as this made from an early-warning standpoint, it did nothing to strengthen local healthcare delivery in Africa or address the endemic poverty that favored disease transmission in the first place.<\/p>\n The fruits of this shortsightedness became notably apparent with repeated subsequent outbreaks of Ebola, including the largest one, in West Africa between 2013 and 2016. From the disease\u2019s resurgence in Guinea, it quickly spread to neighboring countries such as Sierra Leone and Liberia and as far away as Nigeria\u2019s largest city, Lagos. Before it was quelled, more than 11,000 people had died out of a total of more than 28,000 cases. The lesson seemed clear: The world needed more investment in African public health infrastructure, not less, and sustained engagement rather than crisis-driven attention. What has followed under President Donald Trump has been precisely the opposite.<\/p>\n Washington\u2019s policy toward Africa in recent years under Trump\u2019s leadership has been more destructive to public health on the continent than anything seen in modern times. Over his two terms, Trump has downgraded Africa in terms of diplomatic relations and engagement. He has also presided over the liquidation of the most important foreign assistance arm of the U.S. government, the U.S. Agency for International Development, through which most public health support has traditionally been provided. Many critics say he has badly weakened the U.S. Centers for Disease Control and Prevention. And in January, he pulled the United States out of the World Health Organization (WHO), making it the first country to leave this arm of the United Nations since its founding in 1948. This was more than a political statement. Washington had traditionally been the WHO\u2019s largest source of funding.<\/p>\n Moves like these have radically accelerated the West\u2019s shrinking commitments to public health and development in Africa. According to many healthcare experts, the short-term consequences of this can be heavily felt in the current Ebola crisis<\/a> in Congo, which has slowly but steadily gained worrisome momentum in recent weeks. Since Trump took office last year, U.S. laboratories that once did pioneering work studying the disease have been closed; one Trump political appointee has reportedly<\/a> even dismissed Ebola as a \u201cscam.\u201d U.S. support for public health services in Africa, in general, has been wound down. And U.S. contributions to WHO emergency efforts for crisis management have dried up.<\/p>\n What makes the present outbreak most worrisome is that it took so long for news of it to reach the outside world, favoring its spread by delaying any emergency response. The WHO announced the crisis on May 16, but scientists believe that by that time it had already been spreading for days or weeks. Like previous crises, this one will end. The question is only a matter of time and toll.<\/p>\n Crises are opportunities, though, and what this one teaches us is that if the Clinton administration got many things wrong, it got one big thing right: It proclaimed that where infectious diseases are concerned, global health is everyone\u2019s problem. As such, nations such as the United States, with the greatest financial means and scientific capacities, have both moral and self-interested reasons to embrace responsibility.<\/p>\n In today\u2019s political climate, it seems almost unimaginable that Washington could see things this way, even though self-interest would be served by working harder for the greater good. But if the United States ever returns to a broad-shouldered view of its role in the world, it should think about Africa from the ground up. Supporting the provision of public goods\u2014starting with healthcare and education\u2014at the local level is the surest foundation for progress. But it requires forging strong partnerships with governments that are democratically accountable to their people, and not just to Washington or to the interests of foreign donors.<\/p>\n<\/p><\/div>\n