No quick dispatching of disease investigators. No televised news conference to inform the public. No timely health alerts to doctors.
In the midst of a hantavirus outbreak that involves Americans and is making headlines around the world, the U.S. government's top public health agency, the Centers for Disease Control and Prevention, has been uncharacteristically missing in action, according to a number of experts.
To President Donald Trump, "We seem to have things under very good control," as he told reporters Friday evening.
To experts, the situation aboard a cruise ship has not spiraled because, unlike COVID-19 or measles or the flu, hantavirus does not spread easily. It has been health experts in other countries, not the United States, who have been dealing primarily with the outbreak in the past week.
“The CDC is not even a player," said Lawrence Gostin, an international public health expert at Georgetown University. “I've never seen that before.”
Not until late Friday did CDC actions accelerate.
Health officials confirmed the deployment of a team to Spain's Canary Islands, where the ship was expected to arrive early Sunday local time, to meet the Americans onboard. They said a second team will go to Offutt Air Force Base in Nebraska as part of a plan to evacuate American passengers from the ship to a quarantine center. Also, the CDC issued its first health alert to U.S. doctors, advising them of the possibility of imported cases.
The CDC's diminished role in this outbreak is an indicator the agency is no longer the force in international health or the protector of domestic health that it once was, some experts said.
The hantavirus outbreak is “a sentinel event” that speaks to “how well the country is prepared for a disease threat. And right now, I’m very sorry to say that we are not prepared,” said Dr. Jeanne Marrazzo, chief executive officer of the Infectious Diseases Society of America.
How the outbreak unfolded
Early last month, a 70-year-old Dutch man developed a feverish illness on a cruise ship traveling from Argentina to Antarctica and some islands in the South Atlantic. He died less than a week later. More people became sick, including the man's wife and a German woman, who both died.
Hantavirus was first identified as a cause of sickness of one of the cases on May 2. The World Health Organization swung into action and by Monday was calling it an outbreak. About two dozen Americans were on the ship, including about seven who disembarked last month and 17 who remained on board.
It's WHO taking center stage
For decades, the CDC partnered with the WHO in such situations. The CDC acted as a mainstay of any international investigation, providing staff and expertise to help unravel any outbreak mystery, develop ways to control it and communicate to the public what they should know and how they should worry.
Such actions were a large reason why the CDC developed a reputation as the world's premier public health agency.
But this time, the WHO has been center stage. It made the risk assessment that has told people the outbreak is not a pandemic threat.
“I don’t think this is a giant threat to the United States,” said Jennifer Nuzzo, director of Brown University’s Pandemic Center. But how this situation has played out “just shows how empty and vapid the CDC is right now,” she said.
Tumult until Trump
The current situation comes after 16 tumultuous months during which the Trump administration withdrew from the WHO, has restricted CDC scientists from talking to international counterparts at times and embarked on a plan to build its own international public health network through one-on-one agreements with individual countries.
The administration has laid off thousands of CDC scientists and public health professionals, including members of the agency's ship sanitation program.
As this was playing out, Trump's health secretary, Robert F. Kennedy Jr., said he was working to “restore the CDC’s focus on infectious disease, invest in innovation, and rebuild trust through integrity and transparency.”
Waiting to hear from the CDC
The CDC has not been completely silent on hantavirus.
The agency on Wednesday issued a short statement that said the risk to the American public is “extremely low,” and described the U.S. government as “the world’s leader in global health security.”
Said Nuzzo: “Not only was that not helpful, it actually does damage because a core principle of public health communications is humility.”
The CDC's acting director, Dr. Jay Bhattacharya, posted a message on social media that the agency was lending its expertise in coordinating with other federal agencies and international authorities. Arizona officials this week said they learned from the CDC that one of the Americans who left the ship — a person with no symptoms and not considered contagious — had already returned to the state. WHO officials said the CDC has been sharing technical information.
The CDC also is “monitoring the health status and preparing medical support for all of the American passengers on the cruise,” Bhattacharya wrote.
But federal health officials have mostly been tight-lipped, declining interview requests.
COVID-19 comparison
In interviews this week, some experts made a comparison with a 2020 incident involving the Diamond Princess, a cruise ship docked in Japan that became the setting of one of the first large COVID-19 outbreaks outside of China.
The CDC sent personnel to the port, helped evacuate American passengers, ran quarantines, shared genetic data on the virus, coordinated with the WHO and Japan, held public briefings and rapidly published reports “that became the world’s reference data on cruise ship COVID transmission,” said Dr. Tom Frieden, a former CDC director.
Some aspects of the international response to the Diamond Princess were criticized, and it did not halt the outbreak or stop COVID-19’s spread across the world. But some experts say it was not for the CDC's lack of trying.
“The CDC was right on top of it, very visible, very active in trying to manage and contain it,” Gostin said, while the agency's work now is delayed and subdued.
Instead of working with nearly all of the world's nations through the WHO, the Trump administration has pursued bilateral health agreements with individual nations for information sharing, public health support, and what it describes as “the introduction of innovative American technologies.” Roughly 30 agreements are currently in place.
That's not sufficient, Gostin said. “You can't possibly cover a global health crisis by doing one-on-one deals with countries here and there,” he said.
