Welcome back, readers of The Breakdown. Today’s newsletter is about a public health story in the news—partly to explain what’s happening, partly to dig into what it says about the damage Donald Trump has done to some of our most important agencies and programs. A challenge in this article—and, really, in many of the articles I write—is trying to strike the right tone. I don’t want to be alarmist. And I don’t want to minimize real dangers. My solution is to do as much reporting as I can—talking to whomever I can get on the phone, reading whatever I can get my hands on—and to let the facts speak for themselves as much as possible. It’s what I like to do. I’m a reporter, after all! But it’s also a labor-intensive effort, the kind that would not be possible without the support of our Bulwark+ members. I hope you’ll consider becoming one yourself. On the fence? Find out whether Bulwark+ is right for you with a two-week trial membership for FREE by clicking here: –Jonathan But Seriously, How Nervous Should We Be About Hantavirus?What I’m hearing from experts about the outbreak—and the state of our biothreat readiness under Donald Trump.
IT SOUNDS LIKE the premise of a horror film. A small ship is making its way across the South Atlantic, ferrying roughly 150 tourists to explore remote lands and glimpse rare birds, when an older man suddenly develops fever and a cough—and dies. Symptoms quickly appear in a half dozen more passengers and crew, including the ship’s doctor, and soon the death count is up to three. Testing reveals they’ve been stricken with an animal-borne virus that can infect humans, but that in most forms does not jump from person to person. By this point, more than 30 passengers have already disembarked and scattered across a dozen countries, setting off a mad scramble by health authorities to find and isolate them. Meanwhile, the rest are still on the boat—also isolated, and under the watchful eyes of newly arrived medical staff observing to see who else will develop this disease for which there is no cure. If you’ve been following the headlines, you know this isn’t fiction. It’s the story of a hantavirus outbreak aboard MV Hondius, an expedition vessel that set sail from Argentina in April. And the good news—yes, there’s good news—is that this tale isn’t likely to have a horror-film ending, at least on a mass scale. The form of hantavirus known to be transmissible among humans is thought to spread for a relatively short period as symptoms appear, and primarily through prolonged, close-up contact.¹ That’s very different from, for example, COVID, which was airborne and which people could spread before they even realized they had the virus. With hantavirus, contact tracing has a better chance of catching up to people who might have been exposed—most of whom, in turn, are unlikely to contract the disease.² “We have contained this in the past and I’m very confident it’s going to be contained again,” Katelyn Jetelina, a former CDC consultant who founded and writes for the newsletter Your Local Epidemiologist, told me in an interview. “To the average person, your risk is essentially nil.” 
But if you talk to people who work in public health, you will pick up a clear level of concern. And it’s not simply because the spread of any lethal virus is, quite rightly, a reason for them to be vigilant. They know that Donald Trump has spent much of his second presidency waging an all-out assault on America’s global health infrastructure—by downsizing or eliminating existing agencies and programs, and transforming them in ways that make them instruments of other goals like extracting mineral rights or ending DEI. This assault has also included withdrawing from the World Health Organization, and from global health cooperation more generally. That has left the federal government without some of the tools, systems, and personnel it has deployed in the past. The result is a federal response to outbreaks that is weaker overall, and could falter in the face of a more serious threat. HANTAVIRUS IS A DISEASE CARRIED mainly by rodents. Estimates suggest it infects tens of thousands of people worldwide each year, which sounds like a lot until you remember more than eight billion people live on this planet. The majority of cases come from Europe and Asia, where the common strains can cause renal failure. The versions in the Americas usually cause respiratory problems, and are more likely to kill. What these variants have in common is that transmission for the majority of observed strains takes place through one method: Somebody inhales particles of rodent excrement that have accumulated in dust or are floating in the air. That is why the few cases³ that pop up in the United States frequently come from people who didn’t wear masks while cleaning out old attics or basements, or from people who were living in places that turned out to have rodent infestations. This is what officials believe killed the wife of actor Gene Hackman last year (leaving the ailing Hackman without a caretaker). One of the few versions of hantavirus known to be capable of transmission among people is the Andes strain, so called because of its prevalence in South America. And that is likely how the virus made its way onto Hondius in April. The first passenger to die had been visiting Argentina with his wife, observing birds, in some cases going to sites with large rodent populations. Reportedly one of the stops was right near a landfill. He got sick shortly after the boat left Argentina, likely infecting his wife and possibly the doctor, both of whom would have had the kind of close contact necessary for human-to-human transmission.⁴ The wife ended up disembarking during a stopover at Saint Helena, the remote island about 1,200 miles west of the Angolan coast, and flying to South Africa. She had planned to return home to the Netherlands, via a flight on KLM, but the airline says the crew determined she was too sick to fly and removed her. She died one day later. The woman was not the only one to get off the boat in Saint Helena. Between thirty and forty other passengers did as well. (There are conflicting reports of the precise number.) One of the most urgent tasks for health authorities has been to find all of these people, and anybody who might have come into close contact with them. But the news so far has been reassuring. A KLM flight attendant who had been in contact with the woman has tested negative for hantavirus. Nobody on the ship has developed symptoms since May 1, according to the most recent WHO update. And there have been reports that passengers and crew are handling the ordeal well—even taking part in deck-side activities, albeit with social distancing—as the ship makes its way to the Canary Islands for a carefully controlled evacuation that Spanish authorities have said they plan to oversee on Sunday. Maybe the best news of all has come from genetic testing, which confirmed that the pathogen is the Andes strain with no unusual mutations that would allow it to spread more easily or quickly than what researchers have seen in the past. “The [genetic] sequence has been published, posted publicly, and it looks like the sequences that are known from Argentina,” Tara Palmore, an infectious-disease specialist and epidemiologist who spent more than two decades at the National Institutes of Health, told me. That is why public health authorities are treating the outbreak as something they can handle. They will watch for any new information that suggests something about the virus has changed, but they aren’t sounding alarm bells—and on a personal level, they aren’t stocking up on quarantine supplies either. “It’s probably going to burn itself out,” Jeanne Marrazzo, an internationally recognized physician who now leads the Infectious Diseases Society of America, told me on the phone. “These things that are sustained by individual chains of probable close contact, with a limited duration of infectivity, there’s an end in sight. With COVID, there was no end in sight. It became pandemic, and now it’s endemic. That’s how I would draw the distinction.”
THE ABILITY TO ASSESS this hantavirus outbreak so quickly is testimony to the sophisticated international infrastructure now in place for disease surveillance and response. And that infrastructure didn’t appear out of thin air. It was constructed over time, with much of the essential money, leadership, and expertise coming from the United States. The worry now—for Marrazzo and so many of her counterparts here and abroad—is that the infrastructure is losing American support, thanks to Trump. Consider the testing that pinpointed the hantavirus strain this month. It took place in South Africa, which has cutting-edge research facilities full of world-class virologists. And a big reason for that is years of investment from the President’s Emergency Plan for AIDS Relief, the wildly successful 2003 George W. Bush initiative to fight HIV. PEPFAR was among the programs that Trump hit with a stop-work order shortly after taking office, temporarily freezing funds and disrupting activities with little notice. And although the administration subsequently restored some funding, it continues to restrict the program in multiple ways—including a dramatic reduction in aid to South Africa, which Trump has (along with former adviser and South Africa native Elon Musk) alleged is undertaking a campaign of “genocide” against white farmers. “It is the work that was done setting up infrastructure through PEPFAR to do genetic sequencing of HIV that is now paying off, in being able to do genetic screens, sequencing of viruses like this [hantavirus],” Carlos del Rio, another internationally recognized scientist who is a professor of medicine and public health at Emory University, told reporters during a briefing last week. “I worry that, as we disinvest in global health, we’re losing our capacity—our global capacity—to deal with diseases.” And this isn’t happening just in South Africa. The Trump administration has been dialing back on global health assistance to all countries—sometimes by refusing to spend appropriated money, sometimes by making assistance conditional on countries agreeing to U.S. demands, like ceding mineral rights. “There’s so many ways that this is so crazy,” Emily Bass, a longtime journalist, expert, and activist on global health who is also a consultant to Physicians for Human Rights, told me. “Through PEPFAR and through our support for labs, if there was a new disease outbreak—if there was a new anything—we knew about it immediately because we were working alongside people. And we were paying for the GeneXpert machines that were diagnosing and sequencing whatever the respiratory virus was, and so we had access at a level few people even realize.”⁵ And that’s just one way the Trump administration yanked funds from biothreat programs. Another was the defunding of a fifty-nation disease surveillance and response network that physician and author Atul Gawande once described as a “global immune system,” because it gave the United States a way to spot new outbreaks—and backstop or help direct local responses—just as they were emerging. Gawande helped to set up this network while he was the assistant administrator for global health at USAID, the international aid agency that Trump effectively dismantled early last year. “There are parts of that network that they have re-funded,” Gawande told me on the phone last week, “but the network, the surveillance system, the advancement towards strengthening a comprehensive system of detection and response and prevention—that’s all gone.” Join Bulwark+ today and get your first two weeks free. You’ll have access to all our locked content, you’ll be able to join the comments section, and you’ll be part of this amazing, growing community. TRUMP ADMINISTRATION OFFICIALS have said that these and other changes will not interfere with their ability to monitor global health threats or protect American lives. And it’s not as if the United States has completely turned its back on the world. Officials at the WHO say they’ve been in communication with U.S. counterparts during the hantavirus outbreak—exchanging information and expertise, while cooperating on matters like how to evacuate and repatriate American passengers from the boat. But because Trump had the U.S. officially withdraw from the WHO, these sorts of communications must take place quietly and often through backchannels—an approach that public health experts told me is slower and clunkier, and can mean key information never gets conveyed. And to the extent international communication takes place informally, it’s going to depend more heavily on existing relationships. Those inevitably deteriorate when the administration is laying off or purging leaders at agencies like the CDC—which, by the way, has gone eight months without a permanent director. One visible sign of that, Marrazzo told me, is the agency’s slow public response to the hantavirus outbreak. The CDC hasn’t “had a press briefing, we haven’t heard anybody talk about mobilizing investigators across the world who are already working on potential treatments,” Marrazzo said. She added that it wasn’t until Wednesday evening that Jay Battacharya—the NIH head who is overseeing the CDC while the director’s post remains vacant—posted a tweet announcing that the CDC was monitoring the situation and working with international officials. When we spoke, Marrazzo mentioned she had recently realized the Health Action Network—an online tool for alerting health care providers around the country of possible health threats—had nothing on its website about hantavirus. “My jaw dropped,” Marrazzo said. That was Thursday morning. A note finally posted late Friday. As always with Trump, it’s an open question what’s driving the changes he has unleashed. Is it a deliberate effort to reshape global health agencies, policies, and priorities? An expression of grievances against institutions like the WHO, which he continues to think sabotaged him during the COVID-19 epidemic? Sheer indifference to how government works? All of these things? But it seems pretty clear he thinks about global health the same way he thinks about other global issues: As a contest for supremacy among self-interested nations, rather than as an opportunity for cooperation. The problem for Trump—and, more important, for all Americans—is that deadly pathogens frequently cannot be stopped without truly global efforts. And the next one might pose a much bigger threat than hantavirus.
1
2
At least at this moment, federal and state authorities are saying they have no plans to isolate people who have been exposed but have not shown symptoms. Instead, they are making sure those people are watching for symptoms until the potential incubation period—about six weeks—is over.
3
As of late 2023, the CDC had recorded fewer than a thousand cases in the United States since it began recording them in 1993.
4
For an account of what it was like on the boat, I recommend Katherine J. Wu’s Atlantic article about a retired physician who was a passenger and ended up filling in for the ship’s doctor.
5
Bass is also the author of a Substack that’s well worth following. Its latest edition details how the administration is now planning to change the funding of CDC work abroad, in ways that could further compromise future responses. You’re a free subscriber to The Bulwark—the largest pro-democracy news and analysis bundle on Substack. For unfettered access to all our newsletters and to access ad-free and member-only shows, become a paying subscriber.We’re going to send you a lot of content—newsletters and alerts for shows so you can read and watch on your schedule. Don’t care for so much email? You can update your personal email preferences as often as you like. To update the list of newsletters or alerts you received from The Bulwark, click here. Having trouble with something related to your account? Check out our constantly-updated FAQ, which likely has an answer for you.
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