Global health preparedness starts at home. What does that mean for the U.S.?

The global community is dealing with a hantavirus outbreak and an Ebola emergency simultaneously. We asked Dr. Debra Houry, MD, MPH, a distinguished physician and public health leader, for her insights into the two outbreaks, and our preparedness to respond to them at home.

Dr. Houry was the chief medical officer and deputy director for program and science at the Centers for Disease Control and Prevention (CDC) until August 2025. A board-certified emergency physician, Dr. Houry joined the Yale School of Public Health as a senior lecturer in January 2026. At the CDC, she oversaw nine national centers and the Office of Science. She also served as acting principal deputy director, the agency’s most senior leader after the CDC director.

In both cases, there has already been an impact, and unfortunately these outbreaks may be an early signal of what is to come. For hantavirus, particularly the Andes virus of the current outbreak, the disease is not high on many physicians’ differential diagnosis — the list of conditions with the same symptoms — making early recognition more difficult. The World Health Organization (WHO) did an excellent job coordinating internationally and helping return exposed cruise ship passengers safely home. However, historically the CDC would likely have been more engaged earlier in the response.

For Ebola, reductions in global health funding for USAID and the CDC have meant fewer personnel on the ground in affected countries, limiting support for surveillance, testing infrastructure, infection control, and rapid response. Delays in diagnosis and containment become more likely when those systems are weakened.

The U.S. Department of State recently announced additional changes to CDC global health funding beginning in October, which will further reduce CDC’s presence in countries such as Senegal, the Democratic Republic of the Congo, and Rwanda. The hantavirus and Ebola outbreaks demonstrate why sustained public health partnerships and technical assistance are so important before emergencies occur.

The expertise and communication coming from the WHO give me confidence. The Director-General has held regular press briefings, met with affected communities, and the organization has issued science-based guidance for both Ebola and hantavirus. The CDC also continues to have skilled scientists and laboratories that can provide important technical guidance during outbreaks.

What worries me is when public health actions appear inconsistent with scientific guidance. That raises concerns about interference or decisions that are not fully evidence based. For example, the WHO has advised against broad travel restrictions to non-border countries during Ebola outbreaks because such measures can drive travelers to take indirect routes, potentially complicating monitoring, and increasing the risk of spread. Yet the United States has implemented travel restrictions that allow only U.S. citizens to return directly — even though a passport itself offers no protection against infection.

Similarly, for hantavirus, current guidance indicates that transmission risk is associated with the symptomatic phase, and that home monitoring may be appropriate in some situations. Yet two Americans have remained unable to leave quarantine in Nebraska. These kinds of inconsistencies can undermine public trust and create confusion during stressful situations.

For both responses, the CDC is dealing with staffing issues: 30% fewer staff and a leadership vacuum, with 80% of the most senior career leaders having resigned, retired, or been terminated since January 2025.

Protecting the public starts long before a disease reaches U.S. borders. It requires a strong overseas presence of CDC and USAID personnel working alongside ministries of health and local public health partners. Emergencies are not the time to build relationships for the first time; trust, coordination, and communication networks take years to establish.

Protecting the public also requires sustained investment in surveillance systems, sequencing capacity, laboratory testing, infection prevention, and contact tracing. Those investments allow countries to identify outbreaks quickly and share information early. Without those systems in place, the U.S. loses valuable situational awareness and risks responding reactively rather than proactively. In global health, preparedness overseas is a core part of protecting people at home.