Kenya Confirms Third Ebola Case as US Scales Back Global Health Support

Kenya has confirmed a third case of Bundibugyo ebolavirus, marking the country's first Ebola outbreak on record, as the second-largest outbreak in regional history has killed more than 4,300 people and infected over 9,000.

The development comes as the US role in outbreak response has shrunk sharply: Washington has set up a controversial quarantine site in Kenya, slashed global health assistance and imposed travel bans on citizens of some countries. Experts say these moves weaken the ability to detect and respond to outbreaks and fuel public distrust.

A disputed quarantine site

The US established a quarantine centre at Kenya's Laikipia air base, where American citizens returning from the Democratic Republic of Congo (DRC) are to be quarantined. The facility has drawn local opposition, fuelled suspicion of the Kenyan government, prompted protests and led a Kenyan court to order a temporary halt to its operations.

Allan Maleche, executive director of the Kenya Legal and Ethical Issues Network on HIV and AIDS (Kelin), said many Kenyans are worried because there is no information on what the quarantine centre is for, who will use it and on what legal basis. He said the court case will be heard in November. Until then, Kenyans are "very cautious about any information the government gives about Ebola".

Americans who question Washington's legal authority to quarantine US citizens on foreign soil and block them from returning home have also opposed the facility, even as Kenya confronts its first Ebola cases.

Jennifer Nuzzo, director of the pandemic centre at Brown University's School of Public Health, asked whether this remains a viable solution for the US, whether bringing American citizens there places an undue burden on the Kenyan government and whether it is the safest place. She stressed that the US already has "world-class" Ebola treatment units built with American taxpayers' money for exactly this purpose, and leaving them empty is hard to understand. In previous outbreaks, symptomatic patients were safely evacuated to these units and recovered without spreading the virus.

Cuts to global health aid

The concerns follow deep US cuts to health assistance worldwide, including the dismantling of the US Agency for International Development (USAID) and reductions in funding and staffing at health agencies such as the US Centers for Disease Control and Prevention (CDC).

On 1 October, the CDC closed its HIV offices in Angola and South Sudan and plans to close its office in Zimbabwe. The US has scaled back programmes around the world, including in the DRC – the centre of the Ebola outbreak – and in countries such as Kenya that are preparing for the virus to spread.

According to Maleche, after the US abruptly cut funding for HIV programmes without guidance, many clinics had to close, causing widespread anxiety. The US is now negotiating bilateral agreements with individual countries, including Kenya, but the process lacks transparency, he said, leaving it unclear what the plans contain, who will implement them and what they cover.

Nuzzo said cutting programmes built up over decades not only leaves the countries involved and the US with less visibility and a reduced ability to contain and end outbreaks, but also leaves those countries less prepared for both everyday threats and future emergencies.

The US formally withdrew from the World Health Organization (WHO) in January, making coordination on crises like this far harder. Maleche said that by leaving the WHO, the US also "pulled out a significant amount of funding", weakening the agency's response capacity.

How the cases unfolded

A Kenyan man contracted the disease in the DRC, then travelled overland to Uganda and flew to Nairobi on 3 October, dying in hospital two days later. On Wednesday, officials announced that a close contact – reportedly a 39-year-old man related to the first patient – had developed symptoms while in isolation. On Friday, officials confirmed the third case: a 65-year-old woman who is a close relative of the two earlier patients.

Kenya's health ministry stressed the effectiveness of contact tracing and isolation, with about 108 people in quarantine in Nairobi. Maleche said the contact tracing system is generally working well, but Kenyans are also asking why there are still "many gaps" that allowed an infected person to travel across several countries. The border between the DRC and Uganda has been closed since May, and Uganda was declared Ebola-free in August after recording 20 cases and two deaths.

A French doctor who returned from the DRC in June tested positive, and several Americans were evacuated from the DRC to Europe for treatment or monitoring.

In Kenya, according to Maleche, the biggest worry is how other countries react to the outbreak, especially the risk of travel bans. The US imposed a travel ban on the DRC and its neighbours Uganda and South Sudan when the outbreak was detected in May; he said it would be "very ironic" if the US issued a travel ban while maintaining its quarantine centre in Kenya.

Political reaction in the US

Senator Raphael Warnock (Democrat, Georgia) and Senator Bill Cassidy (Republican, Louisiana) wrote to the Senate Appropriations Committee in June opposing the Trump administration's plan to cut HIV prevention and surveillance programmes.

Warnock said dismantling USAID, withdrawing from the WHO and abruptly cutting foreign aid are "weakening America's ability to prepare for and respond to outbreaks" and "severely undermining our ability to protect the American people from infectious disease". He said the cuts erode the international disease surveillance infrastructure – the very thing that detects threats like Ebola before they reach US shores – at the moment the world most needs American leadership. The US should strengthen these systems rather than abandon them, he said.

Nuzzo agreed, saying it is important to understand systems and conditions in other countries and to have "eyes and ears" on the ground to spot unusual developments and get information as early as possible – something that benefits both the US and other countries. She also said programmes such as HIV prevention "can be repurposed", because links to clinical care, drug delivery capacity, testing and the movement of specimens are all capabilities needed in other disease emergencies.