Global attention is once again focused on an emerging disease threat—this time it’s Andeshantavirus. As of May 12, this known, but relatively rare, virus has led to 11 cases (9 confirmed, two probable) and three deaths among 147 passengers and crew aboard a cruise ship that departed from Argentina on April 1st. 23 different nationalities were represented among the ship’s passengers, most of whom have been repatriated to their home countries at this point. This includes at least 18 Americans, one of whom has tested positive for hantavirus infection thus far, and one who has shown symptoms, according to the U.S. Department of Health and Human Services (HHS). While limited in size, the Andes hantavirus outbreak is a reminder of how quickly disease threats can emerge and spread, and how dependent the world is on international cooperation to identify and contain cross-border outbreaks like this.
The hantavirus outbreak is also a kind of test case for how well the U.S. is positioned to respond to global disease threats under the Trump administration. Since early last year, the administration has pulled back U.S. engagement on global health, which has included completing a withdrawal from membership in the World Health Organization (WHO), de-prioritizing multilateral cooperation generally, reducing funding for U.S. global health efforts, and dissolving the United States Agency for International Development (USAID). Administration actions have also affected U.S. domestic public health capacities through staffing and budget reductions, and the continued absence of a confirmed leader at CDC.
Practically, this has meant that the U.S. response to hantavirus has proceeded differently compared to previous international outbreaks. WHO serves as the coordinating hub for information on the outbreak and response but the U.S. is no longer a WHO member state, which closed off some direct avenues for communication, requiring more informal channels during this outbreak. In the past, CDC and other federal agency staff have directly participated in international outbreak response efforts to lend their expertise in the field, but did not do so in the early stages of this response. Further, there has so far been only limited public communication regarding the circumstances of the outbreak from federal leaders. For example, the outbreak was reported initially reported to WHO on May 2, and CDC sent a team to the affected ship on May 6th, though did not release a health alert to U.S. health care providers until May 8. To date, CDC has not held a briefing on the hantavirus outbreak to provide information directly to the public, despite media coverage and growing public awareness. In the early days of the COVID-19 pandemic and prior outbreaks such as Ebola, CDC and other federal experts regularly briefed the public. The absence of a confirmed CDC Director for over nine months has compounded the public messaging challenges, as there is no clear federal spokesperson to provide information and give announcements on the outbreak for the wider public.
That Trump administration policy actions may have affected U.S. capacity to address health threats is not news to many Americans. In fact, a KFF poll released this week found that nearly half of Americans believe the federal government’s pullback from global health has negatively affected the country’s ability to prevent infectious diseases from spreading to the United States.
To be clear, none of this means the current hantavirus outbreak will become a major global crisis or spread widely in the U.S. In fact, there are good reasons to believe the outbreak will remain limited. Public health authorities have some experience managing hantavirus exposures, and past outbreaks of this disease were effectively contained including the first imported case of Andes hantavirus in the U.S. in 2018. Initial genetic analysis indicates the virus involved in this outbreak is very similar to those from prior outbreaks, demonstrating no new mutations of concern. Even so, there are still unanswered questions about the virus, and why it spread in this particular environment at this time. This incident does, however, drive home the lesson that international outbreaks will occur and that rapid coordination, international partnerships, clear public health leadership, and sustained investments in public health capacity can make a difference in how well we can respond to them.