Dr. Craig Spencer MD, MPH is an emergency medicine physician, epidemiologist and an Associate Professor of Health Services, Policy, and Practice at the Brown University School of Public Health. Dr. Spencer has over a decade of international field experience in Central America, the Caribbean, Africa, and Southeast Asia examining access to healthcare services, delivering humanitarian relief, and practicing at the intersection of public health and human rights. Dr. Spencer coordinated Doctors Without Borders’ national epidemiological response in Guinea during the Ebola outbreak—and now serves on the board of Doctors Without Borders. Dr. Spencer is sounding the alarm bell in response to the Trump administration’s intention to shutter USAID, and he has emerged as a critical voice during this inflection point about the intersection of global health and human security. Following Dr. Spencer’s interviews with MSNBC’s Rachel Maddow and CNN’s Anderson Cooper, BPR sat down with him to discuss the impact of the Trump administration’s policies on global health and his advice to the Brown community.
Matthew Kotcher: You were recently asked in an interview on CNN with Anderson Cooper if it was true what Elon Musk said about fixing the problem and canceling Ebola funding. Could you elaborate on that answer for our readers?
Craig Spencer: He said we accidentally canceled Ebola funding very briefly, then said that it was quickly fixed, and then said we all want Ebola funding. So there’s three things in there.
The first thing: “We accidentally canceled, very briefly, Ebola funding.” There was no such thing as Ebola funding. The reality is that all of the things we use to prevent Ebola are the same things that we use to detect and respond to influenza abroad, or outbreaks of Marburg, of chikungunya, of dengue, whatever it may be. Sure, there are teams who have expertise in Ebola, but they are not just individuals. They are part of a larger system that has been built over a long time to detect these threats and to respond to them. So when he says, “we cancel very briefly, Ebola prevention,” that’s just not possible because there’s no such thing as just Ebola prevention. There are a whole host of other things that are part of this. USAID, a lot of the people that were responsible for disease detection abroad were put on administrative leave or fired. Many of them would have done Ebola prevention, but their dayto-day was also doing a whole host of other forms of disease prevention.
The second part, he said, was that it was “swiftly fixed.” All the things that were actually cut were not swiftly fixed. Most of the contracts for Ebola work in Uganda, where there was an active outbreak, were actually cancelled. Not only did they say that they had cut them and put them back, they actually cancelled them.
And then the last line is that he says, kind of clear exact wording. Everyone wants Ebola prevention. That’s true. Everyone agrees. Even Elon Musk and the Department of Government Efficiency (DOGE) and all the people that were sitting at Trump’s first cabinet meeting agree that this is something that we need because it’s financially disastrous if you have outbreaks of Ebola or other diseases in the US. So I’m glad they agree that it’s needed. Unfortunately, they have been responsible for dismantling all of these systems that we’ve built over a long period of time. I would say that whatever Ebola prevention we have as of today just pales in comparison to what we had two months ago.
MK: You’ve said in your recent interviews that we will regret this. Could you clarify what this is and how we will regret it?
CS: Cutting USAID. Withdrawing from the World Health Organization (WHO). Muzzling the Center for Disease Control and Prevention (CDC). Cutting any of those is bad. Doing one of them is bad. Doing them all together at the same time means that not only do we not know what’s happening with diseases around the world, but we’re also unable to respond to them effectively here at home. We have people in charge of our health response that are unqualified, including Robert F. Kennedy Jr., an environmental lawyer who unfortunately does not know what he’s talking about when it comes to many of the most important health issues. So we are going to regret, really, all of it. Cutting disease detection systems abroad means that we will not be able to pick up on disease threats early on. They will get bigger abroad and they will eventually come here to the United States. It will cost American lives, American money, and American support. It will impact our infrastructure. It will impact our healthcare workers. We will regret doing this.
At the same time, we’re dismantling a lot of the public health infrastructure in the United States. I think we’re going to regret destroying the systems that are meant to protect us abroad by detecting threats, as well as undermining our ability to respond to such threats. Here in the United States, losing either of those is really bad. Losing them both at the same time is something that we will regret.
MK: Do you think that the WHO is able to handle the lack of American participation?
CS: The US gives $481 million to the WHO, which is a big chunk of money. But in terms of what we get in return and how that compares to what we spend on other things, the sense of security and the collaboration that we get by working alongside WHO and how that keeps the United States safe—481 million is a pretty small investment, especially when you think about the fact that it’s one eighth of what Americans spend every year. It’s not a lot of money, especially to support an organization that is responsible, ostensibly for the health of every person on the face of the Earth. If we undermine our support at the same time that we’re dismantling our own ability to do this work, then there’s no one else left to do it.
MK: Related to the WHO—but also more broadly about our role in global cooperation when it comes to public health—as we’ve removed ourselves from these institutions, is anyone outside the US stepping up? Do you see that happening?
CS: There will be private philanthropies. There’ll be other donors and other big groups that work on these types of issues that will step up. But the reality is, they can’t fill that gap. Maybe they’ll be able to fill in a little bit, but they’re not going to be able to fill it all in. This means that there will be a funding gap between what we need to do and the actual kind of finances and support that are available to do it. That means people will die. There were decent projections yesterday. Dr. Tedros from the WHO laid out how many people will die of HIV, TB, or Malaria in the coming years due to the withdrawal of US funding and support. That’s also leading other countries to cut back on their own funding. The UK said that it’s going to decrease the amount it spends on foreign aid. Argentina plans to withdraw from the WHO as well. So you could potentially see a catastrophic cycle of lower support for the international organizations that do this health work. At a time when the number of Ebola outbreaks and the number of public health emergencies around the world is increasing, it doesn’t take a whole lot of mental energy to see that undermining all of these systems at the same time is a recipe for disaster.
MK: Can you talk about the domestic measles outbreak and what it means?
CS: So measles outbreaks in the United States are not particularly rare. But let me tell you why. RFK Jr.’s comments that what we’re seeing now is not unusual is not true. In the year 2000, measles was eliminated. Elimination from the United States meant that there wasn’t any kind of natural transmission. Most, really all, cases since then have been imported. Those were normally detected relatively early and snuffed out. But nearly every year, there’s been some measles outbreaks. What’s unusual about this outbreak is that we’re already seeing over 300 cases. So this would be just in the first few months of this year—much bigger than the number we had all of last year. What’s also important is it’s coming at a particularly problematic time. We already see it spread from Texas to New Mexico to Oklahoma.
Twelve other states have cases, and a bunch of kids are about to go on spring break and move around the country. So I think the likelihood of risk of exportation across state lines is probably pretty high. We also see that there’s a decline in the number of people who are willing to vaccinate their kids, even if over 90 percent of kids are vaccinated for measles. One of the rare bipartisan things that most people agree on is you need a 95 percent vaccination rate for measles because of how contagious it is. So if one person can infect 20 others, which is what measles can do, you need to have at least 19 of those people vaccinated. If one person can only infect one person, then an outbreak can’t grow. But if only 18 of those people are protected, you have 90 percent. That means that one person can infect two people of that 20. And that can continue growing and growing and growing and growing. So a lower percentage of people protected allows outbreaks to grow rapidly, especially in primarily unvaccinated communities.
So what does this mean? It means there are obviously communities that, recently, have not trusted public health and have not followed public health guidance. Understandably, we need to do more to reach those communities. What this means is that it’s probably a kind of a canary in the infectious coal mine. What we’re seeing in lagging support for measles vaccines will translate to other diseases. We’ll see the people that are in charge of our country’s health infrastructure today are undermining a lot of our ability to do good health work—making it harder for public health to do its job. So you’ll probably see outbreaks of other things. I wouldn’t be surprised if we see more polio cases, and a lot of the things that we’ve had under control in the past come back. That potentially threatens us all, especially when there seems to be an increasing likelihood of attacks on things like Medicaid and Medicare and other important systems that are essential to keeping people healthy.
MK: Do you think that another pandemic is likely in the near future, in the next, say, five to 10 years?
CS: I don’t think that you could find anyone who says it’s not impossible. Is it possible? Absolutely. Is it likely? I think that’s a question of modeling and probabilities. I think we need to be prepared for that potentiality. H5n1 (Bird Flu), as it stands, is still low risk to most Americans, but every week, it seems to be doing something along this path of relatively innocuous to potentially catastrophic. Is it possible that we have an H5n1 avian influenza pandemic in the next five years? Absolutely. Is it possible that this doesn’t evolve in a way that impacts humans as much as we fear? Sure. We don’t know. The reality is, if we don’t prepare and it does hit, we’re going to be in a really tough spot. What we’re seeing now is that a lot of the systems put in place, built through the learning of the Covid-19 pandemic, are being actively dismantled or hobbled.
So in many ways, sure, we’re better off in terms of preparation for the next pandemic. We have a lot of people that have gone through one. We know we can create mRNA vaccines really quickly. But when it comes to if we learned any kind of governance issues from the pandemic? Maybe not. Is our infrastructure much stronger? Probably not. Are people more likely to have a primary care physician now than a couple of years ago? Probably not. So, we don’t know. We could easily have a pandemic that makes Covid look relatively mild in comparison. But we need to prepare for those eventualities, because if we don’t and it hits, we’ll be in big trouble.
MK: As much of the infrastructure and public health is being undermined as elements of government websites are being outright erased, what resources for accurate information about the threats we’re facing would you point readers to?
CS: If it’s in the health space, there have been initiatives to basically copy and post all content from health sites that existed before they were taken down, deleted, or altered. Though there are resources out there that exist, if you’re having difficulty finding good guidance on health issues that don’t exist in current CDC pages, they have been maintained on other servers and through other organizations. So you can find those quite easily.
At the state level, there’s still a lot of really good work being done on health. Your local public health offices may remain a really important resource, especially for public health issues that may be more of an issue in your community. We need to continue to support them. We need to continue to lobby to make sure that they’re funded and have their support and their ability to speak up.
Then, the scientific community itself is continuing as much as it can, despite cuts, despite muzzling, despite all these other things to speak up and continue to advocate for science. It’s going to be a little bit harder to find the accurate information that we all need to keep ourselves safe in the coming years, but it’s still out there. There are people still doing it. It just means that you’re going to have to look a little bit harder and be a little bit more circumspect. When you come across things, particularly on social media, they may not be true. The problem is that right now, they may unfortunately be coming less from Russian bots and more from official US government accounts.
MK: Is there anything else that you would like to add, as we close, to the Brown community?
CS: It’s easy for Brown students to think that all this stuff that’s happening at a higher level won’t impact them, or it will all shake out by the time that they’re out of school. Or maybe they’re young—so it doesn’t necessarily matter. The reality is, what is happening now is setting the stage for even broader attacks—not just on public health, but on the other systems that Brown students might be thinking about working in in the next couple of years. The attacks on USAID, our international infrastructure, and foreign aid support are only the beginning of an undermining of , the philosophical tenets that we at Brown have long relied on—which is that empathy is important, domestic security comes from international security, and that the United States has played a long role in keeping the rest of the world—as well as ourselves—safe.
That matters not just from a political angle, but also from a health security angle. All of these things that are being torched and dismantled may seem far away and may seem like they might not matter to you, but they do. What’s happening today will reverberate for years and potentially decades. Even if we were able to stop everything right now and try to rebuild it, it’s going to take time. And that means that it’s not just next week, next year, maybe even the next decade. It could be potentially longer before we have the security when it comes to detecting health threats and responding to what we had even just a few months ago. That potentially makes us all much more susceptible for some time to come.
*This interview has been edited for length and clarity.