The Human Toll of Gutting USAID: What the DRC's Ebola Outbreak Reveals

A child's fever, a mother's fear, a clinic with no medicine on the shelf — this is what the collapse of a global health program looks like up close. Right now, that scene is playing out across the Democratic Republic of the Congo, where an Ebola outbreak is spreading in the wake of deep cuts to the U.S. agency that once helped detect and contain it.

A Program Built to Stop Outbreaks Before They Start

For decades, the U.S. Agency for International Development (USAID) funded the kind of quiet, unglamorous work that keeps deadly diseases from becoming global crises: disease surveillance teams, rapid-response labs, vaccine campaigns, and maternal health clinics in some of the world's poorest regions. Last year, that work was gutted. Elon Musk, leading the short-lived U.S. "Department of Government Efficiency" (DOGE), oversaw the dismantling of USAID — an agency he once said he wanted to feed "into the woodchipper."

Now, as Ebola spreads in the DRC, public health experts say the consequences of that decision are playing out in real time.

"This is one of the reasons why there was not enough surveillance and preparedness for the outbreak of Ebola," said Davide Rasella, a research professor at the Catalan Institution for Research and Advanced Studies and head of the Global Health Impact Assessment and Evaluation Group at the Barcelona Institute for Global Health (ISGlobal) in Spain.

Jeremy Konyndyk knows this territory personally. He's a former top USAID official who oversaw the agency's Ebola response during the 2014-2015 outbreak and now serves as president of Refugees International. He says the current outbreak would likely have been caught much sooner if the detection programs Musk's team cut were still running. "I'm very confident about that," he said.

From Axing USAID to Human Cost

It's easy for funding cuts to sound abstract — line items, budget percentages, agency names. But behind those numbers are families who lose access to the vaccines, medicine, and maternal care that keep them alive. Konyndyk didn't mince words about what's happening on the ground: "People are absolutely dying. They're dying in significant numbers in some places."

The scale of the potential harm is staggering. A study published in The Lancet estimated that fully abolishing USAID could result in 14 million deaths worldwide, including 4.5 million deaths among children. Rasella, one of the study's authors, stands behind those numbers. When Democratic congressman Ro Khanna of California cited the study publicly, Musk threatened to sue him rather than engage with the research.

Rasella pushed back on the idea that the science behind the estimates is somehow less rigorous than the science Musk relies on in his own industry. Musk "uses science for launching rockets," Rasella said. "When we speak about public health and global health, we use the same statistical mathematical tools that we use to launch rockets into space."

He acknowledged it's impossible to predict an exact death toll. "But the important thing is the scale," he said, adding that millions of deaths are likely over the coming years. "This is really unquestionable."

Why This Matters Beyond the DRC

Global health funding isn't only about helping people far away — it's also a front line of defense for Americans at home. Rasella pointed out that the world just lived through a pandemic that killed roughly 20 million people worldwide. Given that recent history, he called it "absurd" to cut the very programs designed to detect and contain the next outbreak before it can spread across borders. Disease surveillance systems in places like the DRC act as an early-warning system for the entire world, including the United States — the sooner an outbreak is caught, the less likely it is to reach American shores.

These programs also carry economic weight closer to home. Much of U.S. foreign assistance is delivered through contracts with American companies — manufacturers, logistics firms, and health suppliers — meaning the work of fighting disease abroad also supports jobs and industry in the United States. And when foreign aid helps stabilize a struggling country and grow its economy, that nation often becomes a longer-term trading partner for American businesses down the road.

Rasella warned that global health systems are interconnected in ways that make isolated cuts especially dangerous. "When you disrupt a single piece of that aid, you can really create more and larger damage to the entire system," he said. "This is just the beginning."

Musk's Response

Musk has pushed back forcefully against criticism of the cuts. He has claimed on X that critics "cannot cite a single name of someone who died" as a result of the DOGE cuts, adding, "If there were, it would be worldwide headline news!" When journalists and public health figures — including physician and writer Atul Gawande — responded with the names of people, including children, who died because of the cuts, Musk called one journalist "an utter piece of shit and a liar" and "utterly evil." He has also claimed, without providing evidence, that U.S. tax dollars sent through USAID went to arming militants and to "corrupt politicians."

Notably, Musk has admitted to "accidentally" cutting the Ebola detection and response programs specifically.

Could This Have Been Prevented?

Konyndyk believes the damage to USAID is now central to how Musk will be remembered. "It's going to be a defining part of his legacy, and I do wonder if that's why he's scrambling so hard to rewrite that history now," he said.

He described Musk's approach as borrowed from the corporate playbook — "cut until people scream, and then when people scream, you've cut too far, and then you restore" — and said it was the wrong model for humanitarian work. "That's not how public funding works," Konyndyk said. "Here the cost is literal human lives."

Konyndyk believes USAID would likely still exist in some form if Musk hadn't personally driven its dismantling, alongside administrators like Pete Marocco. Other health and science agencies facing budget pressure have survived "much diminished, much weaker, but still existing," he said — but USAID's fate was different because of Musk's outsized influence.

"His personal investment in that project gave it the reach all the way up to the White House," he said.

Importantly, Congress had — and still has — the power to reverse course. USAID is required to exist by law, Konyndyk noted, though what remains of its programs has been slowed by the gradual release of funding from the State Department.

Beyond the immediate humanitarian toll, advocates argue that a functioning USAID also serves America's diplomatic interests, helping build the kind of international goodwill and cooperation that supports global stability — an asset that becomes harder to rebuild once it's lost.

There's Still a Window to Act

Despite the damage already done, Konyndyk believes some of the worst outcomes can still be avoided if action is taken soon. "We have a window here to try and bring some of this back before the worst of the harms set in," he said.