Despite claims by the United States that it has made “more than $270 million in direct Ebola response funding”, countries and groups dealing with the outbreak centred in the Democratic Republic of Congo (DRC) are unclear where the money is.

Meanwhile, US health experts are unable to participate fully in the response as they are under instructions from Washington not to deal with the World Health Organization (WHO), sources told Health Policy Watch.

The Africa Centres for Disease Control and Prevention and the WHO are leading the continental Ebola response and recently launched a joint continental preparedness and response plan.

Although Africa CDC Director General Dr Jean Kaseya described the US as “the first partner for global health security” at a media briefing last Thursday, he acknowledged that he was unclear of the extent of the US financial contribution and where the money was going.

“We know that announcements were made by the US government, and we also know that they are supporting some organisations like OCHA [the UN humanitarian affairs office], and currently we want to understand how much money from what the US gave to a number of partners can really go to support the response,” Kaseya said in response to a question from Health Policy Watch.

On Tuesday, the Ebola response will be discussed during a high-level meeting of African Presidents, which is being convened by the President of Burundi, who is currently chairing the African Union, said Kaseya.

“We know that the US will attend the meeting on Tuesday, [and] they will have the opportunity to give us the reliable amount of money that they are putting into the response,” he added.

Meanwhile, the US State Department issued a statement last Friday stating that it had committed $270 million in “direct Ebola response money” and that, “working with Congress, intends to provide $50 million to the Coalition for Epidemic Preparedness Innovations (CEPI) to develop medical countermeasures for the Bundibugyo strain of Ebola” for laboratory studies and clinical trials.

Over the past weeks, Kaseya has criticised countries and donors for failing to turn their pledges for financial support into “real money”. By 4 June, less than $2 million had reached affected countries despite pledges of around $498 million.

Non-engagement with WHO?

The US State Department failed to respond to Health Policy Watch queries about how officials from the US CDC and other expert health bodies were assisting the Ebola response on the ground, and whether they have been instructed not to engage with the WHO – including addressing them in meetings.

Sources who asked not to be named told Health Policy Watch that US officials were unable to advise or engage with WHO officials on the ground in the DRC, which had sometimes meant that they ignored them in meetings. 

The US withdrew from the WHO when Donald Trump assumed office in January 2025, although WHO member states recently refused to recognise this move amid unpaid membership fees by the US.

Dr Chikwe Ihekweazu, WHO head of health emergencies, recently told the journal, Science, that he missed working with US scientists “at a technical level” to address the current Ebola outbreak.

“In the past, they would be part and parcel of any response, and just working without them is painful for me. I know it’s also painful for them, because we’re still friends and they’re just unable to engage as they would like to,” said Ihekweazu.

Kaseya did not respond to Health Policy Watch’s question about the nature of US interaction with WHO officials engaged in the response.

However, Lawrence Gostin, Distinguished Professor of Global Health at Georgetown University in Washington DC, said that Trump’s “instruction” to “US public health agencies, particularly the CDC, not to communicate directly with the WHO” has been handled “flexibly, if not bizarrely”.

“Sometimes, [US] CDC officials participate in WHO activities and communicate with WHO scientists. Other times, CDC officials refuse to attend WHO programs and activities, and do not communicate with the WHO,” Gostin told Health Policy Watch.

“Most bizarrely, I’ve heard that CDC officials are in the room but do not speak. This is an unpredictable, unhelpful, and unprofessional way to conduct business, especially when it involves life-and-death decisions,” added Gostin, who also directs the WHO Collaborating Center on National and Global Health Law.

“Collaborations are neither predictable nor professional. Very senior WHO and [US Health and Human Services] leaders do talk. I have firsthand knowledge of this. I also know that technical communication and sharing of scientific data occur at the field level. But all of this is inconsistent and erratic.

“CDC officials feel constrained and cautious in their interactions with WHO counterparts. Often, the sharing of scientific or epidemiologic information is mostly one-way: from the WHO to the CDC. This inconsistency, unpredictability, and constrained collaboration significantly impedes the response to the Ebola outbreak in the DRC.”

Gostin added that there was “incomplete and grudging communication” between US government offices and other UN agencies like UNICEF.

“When you combine the political constraints placed on the CDC with lost funding and staffing, it is obvious that the US has lost its global health leadership role. And the US is often seen as an obstacle to overcome in global health, rather than an invaluable partner,” Gostin concluded.

Image Credits: Joël Lumbala/ WHO.