• What 30 years of outbreaks taught one Congolese aid veteran.

• A billion dollars, and few local hires.

• Fear-indexed aid.

• Trust belongs to the ones who never left.

• A machine that bypasses locals.

• Pledged 25%, delivered 4.5%.

• Other Ebola news…

What 30 years of outbreaks taught one Congolese aid veteran.

When Ebola arrives in eastern Congo, as it has many times before, Karume B. Augustin told me the aid agencies arrive with it, “like hyenas on a dead animal body.” Augustin (aka “Gang”) is an advocate for stronger political and economic control and a technical advisor to humanitarian agencies. He’s spent 30 years watching outbreaks land in his country. The last big Ebola response left behind new Land Cruisers, big salaries for outsiders, and a hardened belief that the disease is a hoax. When I asked him why people call it a fake, he talked about money.

The outbreak gives that warning new weight. It is now the third largest on record — more than 708 confirmed cases across the Democratic Republic of the Congo and Uganda, and 141 deaths — and the machinery for containing it is failing. On June 11th, fewer than 3 in 10 contacts of known cases were tracked down, far short of the 95% needed to box the virus in. After his second visit to the zone, WHO director-general Dr. Tedros Adhanom Ghebreyesus told STAT News’ Helen Branswell he was “really worried,” and that the response’s deepest problem was the community’s distrust. To many residents, he said, Ebola has become “a lesser evil” beside war, hunger, and the diseases that kill more of them. His answer was political. Augustin’s answer starts with the money.

A billion dollars, and few local hires.

Augustin traces it to the last big response. That one, in 2018 and 2019, cost close to $1 billion, and people watched nearly all of it drive past them.

“First, they could see brand new Land Cruisers circulating, people coming from Goma, from Bukavu, from worldwide, making $10,000 a month, $15,000 a month, $30,000 a month, and they did not hire any person locally,” Gang said. “Even the people to manage the Ebola treatment centers, all of them they’re coming from outside.”

An outbreak is supposed to pour money into a local economy: rented trucks, hired hands, leased buildings, orders at the local pharmacy. Instead, Gang says, the cash circled among outsiders and drove off, leaving behind body counts and quarantine cordons. People began saying Ebola meant dollars more than a deadly virus. They started calling the whole response a business.

Some of what grew from that is false, and Gang relays it without endorsing it: that health workers fill patients with poison, that burial teams lower empty coffins into the ground, that the wards exist to kill people for money. But the suspicion about the money tracks something real, that people did watch a dollars arrive and leave them with nothing.

Fear-indexed aid.

The suspicion has a history. For years, Augustin says, armed groups swept through Ituri, “machete-ing people like cows or burning houses,” and no aid convoy came. Then Ebola arrived, and so did everyone. “You’re coming for something else,” he says people concluded. If the outsiders really wanted to help, he said, “way, way before, you’ve been there to see all these people who are killing us.”

This is fear-indexed aid: money chases the threat the donor fears could reach them, not the threats the community is already dying from. In Ituri, malaria kills more. The militias kill more. Neither summons emergency funding, a global declaration, or the full machinery of international alarm. Ebola does, because Ebola can board a plane. People there have learned exactly which of their killers makes the world come running.

Trust belongs to the ones who never left.

Gang draws a hard line between the people who stay and the ones whose embassies fly them home. “When a crisis strikes, international organizations are the first to pull off,” he said.

The ones who stay are the churches and the small outfits. Caritas was in the village before the outbreak and still there when it hits. Pastors, priests, and imams hold their ground when everyone else scatters, so people listen to them. The war sharpens the divide. With Rwanda-backed M23 holding Goma and the government holding Beni, an outsider who crosses the line between them gets taken for a spy by whichever side he reaches. Someone rooted in the community can move through territory where a flown-in expert would be stopped at gunpoint.

Then there is the matter of who gets sent into the wards. The easy retort is to ask local health workers why they need to be paid to save their own neighbors. Augustin flips it. “You want me to be motivated, and put my life at stake to die for an outside person, even if it’s within my community,” he said. “But if I die, that person will never take care of my wife and of my children. And the government or the rebellion, they don’t have the resources to pay us. Why would I take that risk?”

A machine that bypasses locals.

Augustin’s deepest objection is to the architecture itself. Tedros framed his trip as listening rather than dictating. Augustin’s point is that the system dictates no matter who runs it.

“International organizations and the UN, they take advantage of the government weaknesses to come and dictate the rules,” he said. “That is the root cause.” In Congo, he says, the humanitarian plan is drawn up not by the government but by OCHA, the UN’s coordination office, and the big international agencies rather than the government or the groups rooted in the villages. When the WHO declares an emergency, the billions flow through the WHO, the World Food Programme, and UNICEF — not through Caritas, or a parish, or a Congolese organization.

So the director-general can mean every syllable about listening and still command a machine built to do the opposite. The one thing the response cannot do without, trust, sits with the local actors the budget doesn’t reach. A funding system that routes around them cannot buy the trust it runs on.

Pledged 25%, delivered 4.5%.

Routing money through local responders gets waved off as politics, or charity, or a dream that corruption will always wreck. In an outbreak it’s also pragmatic. Getting contact tracing to 95% takes people who can slip across front lines and be believed when they knock: someone the household already knows, not a stranger who flew in for the outbreak.

In 2016, donors and aid groups signed the Grand Bargain and pledged to send at least 25% of humanitarian funding straight to local and national responders. By 2023, the share landing there directly was a mere 4.5%.

“The virus is ahead of us,” Tedros said. In eastern Congo, the distrust got there first, earned by watching where the money went.

Other Ebola news…

• The outbreak is now the third largest on record. Uganda, with political stability and past experience, looks largely contained at 19 confirmed cases and two deaths. Northeastern DRC is not.

• Contact tracing is the failure point. Only 28.4% of known contacts were followed up on June 11th, against a 95% target. WHO ties the collapse to insecurity in Ituri and to communities hiding the sick. Without it, isolation and testing fall apart.

• Ebola reached a displacement camp for the first time. Two deaths were reported in the overcrowded Kpangba IDP camp in Ituri, a new setting where crowding and poor sanitation invite rapid spread.

• The US pledged $50 million for a Bundibugyo countermeasure. The U.S. State Department said on June 12th it intends to fund the Coalition for Epidemic Preparedness Innovations (CEPI) to develop a vaccine and treatment for this specific Ebola specis, for which none are approved. Any product is months away at best, so it doesn’t change the current outbreak.

• Washington is pressing Europe on travel restrictions. A State Department cable instructs diplomats to push European governments to match US Ebola travel measures before the World Cup, or face possible “unilateral measures.”

• Pledged funding has nearly halved. Africa CDC says voluntary commitments fell from about $500 million to roughly $290 million since June 1st, though the Pandemic Fund’s $220.6 million offsets part of the gap.

The acknowledgment is due today.

On June 9th, a group of senior staff at the National Institutes of Health got an email giving them three days to sign a form and send it back.

These are the people who decide which medical research the government pays for: which vaccine gets tested, which treatment moves ahead, which outbreak gets a fast response. The email was about their own jobs.

It told them their jobs had been moved into a new category six days earlier, listed what they had lost, and asked them to sign that they understood. The change had already happened, so signing wouldn’t undo anything. It just put on the record that they had been told.

The official story: routine, not punishment.

The Office of Personnel Management, which runs federal hiring, calls these “career, non-political jobs” in its guides. The change, it says, is “not intended to be punitive.” One handout even has a Myth vs. Fact box promising that employees can’t be fired “for any reason” and are still protected from retaliation.

The NIH email said the same thing. The change is about the type of job, it explained, not about anyone’s performance or conduct. Administrative, not punitive. And the line employees were meant to hold onto: at this time, the department is not planning to take any action against them because of it.

On a quick read, it sounds like a bureaucratic formality, but the form actually strips away job protections these employees had the day before.

How firing a federal worker used to work.

The rules made it slow on purpose. To let someone go for bad work or misconduct, an agency usually had to document the problem, give written warning, offer a chance to fix it, and, if the person pushed back, defend the decision to the Merit Systems Protection Board, a referee that sits outside the agency. The slowness was the safeguard. It’s what keeps a boss from firing people for political reasons and calling it something else.

The new category takes most of that away. These employees are now “at will,” the footing a lot of private-sector workers are on: they can be let go with little more than a written notice, and there is no outside board to appeal to.

The watchdogs are also getting moved in-house. A complaint that a firing broke the rules used to go to an independent office, the U.S. Office of Special Counsel. Now it goes to the agency’s own lawyers, who work for the same bosses doing the firing. Whistleblower complaints stay inside the agency, too.

This new category has a tangled backstory. It started in 2020 as “Schedule F,” was canceled, came back in 2025, and became a final rule in early 2026. On June 3rd, the president signed an order putting about 8,000 federal jobs into this category, most of them senior: program managers, the staff who hand out research grants, the lawyers, the people who write regulations.

The reassurance and the fine print do not match.

The guide says you are still protected from retaliation. The form says the people who now judge retaliation work inside the same agency that just reclassified you. Both are technically true. “You are still protected” really means protected by the same administration that did this, reviewed by its own lawyers, with no outside appeal.

The email’s wording is just as careful. “At this time” is true today and promises nothing about tomorrow. Saying the department won’t act “based on this conversion” rules out one reason for firing someone and leaves every other reason open. This is careful lawyering: every word is true today and commits the agency to nothing tomorrow.

This did not land at a calm agency.

In the weeks before the email, NIH’s infectious-disease institute lost its acting director, Dr. Jeffrey Taubenberger, days before a Senate hearing. Senator Patty Murray pressed NIH director Dr. Jay Bhattacharya about him and about seven other senior officials who had been pushed out or moved, including two who ran the institute’s grant money and were shipped off to a different institute. All of this during Ebola and hantavirus outbreaks. Dr. Bhattacharya described a plan to steer the institute away from biodefense and toward “conditions that people actually have.”

Why a parent, a traveler, or a farmworker should care.

It helps to picture what these people do all day. They decide which research the government funds, which means they decide what gets studied and funded, and, when an outbreak hits, how fast the country can respond. The work is slow and mostly invisible, which is part of why it is easy to treat as expendable. The staffer who keeps a tuberculosis vaccine trial alive through a decade of flat results does not make the news. Neither does the one whose funding decision, years later, becomes the twice-a-year HIV prevention shot that in NIH-supported trials kept every woman who got it from being infected. The payoff shows up long after the decision, usually for someone who never knew a government employee made it.

Meanwhile, infectious diseases aren’t on pause. The country had more than 2,100 measles cases in 2025, its worst year in three decades, and is now close to losing its “measles eliminated” status, which it has held since 2000. Whooping cough killed at least 13 people in 2025, several of them babies, as childhood vaccination rates slipped. Dengue, carried by mosquitoes moving north with the warming climate, now turns up in Florida, Texas, Arizona, and California. Bird flu has spread through nearly a thousand dairy herds and infected dozens of farmworkers. Ebola and hantavirus are spreading right now.

Then there is the work the administration has decided to scale back. The January plan called for moving NIAID away from biodefense and toward “conditions that people actually have.” AI and lab tools are making it cheaper and faster to intentionally build a dangerous germ. A 2025 study found that AI design tools could slip past the safety checks meant to flag dangerous genetic recipes before they get made. The threats most likely to need a fast, expert government response are the ones being pushed down the list by moving and reclassifying the very experts who could handle them.

What still stands between this and a purge.

The fear within NIH is that firings come next, targeting people seen as disloyal.

Being “at will” means you can be let go one at a time, without much process. A layoff, officially a “reduction in force,” has its own rules about who stays. This reclassification does not trigger a layoff. It takes away the place a fired employee could go to argue that the firing was really about politics. That’s the real change.

A few things still stand between this and the worst case. Someone would have to build a cover story for each firing. Clearing out a whole division at once would be obvious, the kind of thing that draws lawsuits and questions from Congress, which NIH is already getting. The reclassification is already being challenged in court: unions and watchdog groups say the president overstepped and that it violates due process. Higher courts are allowing this to proceed while the case continues, and no court has yet ruled on the core question. If the courts eventually trim it back, the changes could be undone.

Together, these documents describe an agency quietly putting in place the tools that would make punishment easier later. None of this predicts a purge. But it shows how few protections would now stand in the way of one.

The thing that would catch a politically motivated firing is the outside appeal, and that is exactly what the reclassification is taking away. Everything left, the reassurances and the promises, now rests on the good faith of whoever happens to be in charge.

• Why the wait

• The regulatory logjam

• What actually fixed it

• What the new ingredient actually does

• The credit-claiming

• Sunscreen denialism

• Bottom line

Why the wait

This week the FDA cleared a new sunscreen ingredient called bemotrizinol for sale in the United States. It is the first new sunscreen filter the agency has added since the late 1990s. Products using it are expected to reach U.S. stores later this year.

If you live in Europe, Asia, or Australia, none of this is news. People there have been putting bemotrizinol on their kids for about 25 years. It is a well-studied broad-spectrum filter, meaning it blocks both UVA and UVB rays. So the real question is why a country with some of the best science in the world was so behind on something as basic as sunscreen.

The answer lies in how the U.S. regulates sunscreen.

The regulatory logjam

In the United States, the active ingredients allowed in sunscreen are set by something called a monograph. Think of it as the official rulebook of which filters are approved and at what strength. For decades, changing that rulebook required a slow formal process called notice-and-comment rule-making. It could take many years to move a single ingredient through it.

The FDA had not approved a new sunscreen filter since 1999. By the 2010s, the U.S. had roughly 10 approved UV filters while Europe had more than 30. That gap mattered most for UVA protection, the deeper rays tied to skin aging and skin cancer, where many older American sunscreens were weaker.

Congress tried to fix this once before. In 2014 it passed the Sunscreen Innovation Act, pushed hard by dermatologists, skin-cancer groups, and sunscreen makers working together as the Public Access to Sun Screens Coalition. The bill passed both chambers unanimously. And then it did almost nothing, because it left the broken approval framework in place. The FDA responded by asking for more safety and skin-absorption data, and the backlog stayed frozen. A law that everyone agreed with failed because it did not change the machinery underneath.

What actually fixed it

The fix that worked arrived in an unlikely place: the 2020 CARES Act, the giant COVID relief bill. Tucked inside it was a long-pending, bipartisan reform of how the FDA reviews over-the-counter drugs, sponsored in the Senate by Bob Casey and Johnny Isakson and carried in the House by the leaders of the Energy and Commerce Committee.

It did two practical things. It replaced the slow rule-making process with a faster administrative order process, so the FDA could add or update an ingredient by order instead of a years-long rule. And it created industry-paid user fees that gave the agency dedicated staff and money to actually do the reviews.

It rode a pandemic bill for practical reasons. It was ready, it was bipartisan, the user fees made it look like it paid for itself, and it gave the FDA faster authority over products like hand sanitizer, which fit the moment. The muscle behind the text came mostly from the over-the-counter drug industry’s trade group and the FDA, which had negotiated the deal years earlier. Public-health and dermatology groups supplied the urgency and the headlines.

Bemotrizinol is the first sunscreen filter to go all the way through that new path. Its maker, DSM-Firmenich, filed its request in 2024, and the FDA finalized the approval this week, up to a 6% concentration, for adults and children 6 months and older.

What the new ingredient actually does

Bemotrizinol earns its place for a few concrete reasons. It gives strong protection in the UVA range where older U.S. filters lag. It is also unusually photostable, which is the useful part most people never hear about. Some common filters break down in sunlight and lose strength within a couple of hours. Bemotrizinol holds up, and it can help keep other filters in the bottle from breaking down too.

It also barely soaks into the skin, rarely causes irritation, and showed no estrogen-like activity in lab testing, which has been a worry with some older chemical filters. And it tends to feel lighter and leaves less of the white cast that mineral sunscreens can. That sounds like a cosmetic detail, but it isn’t. The sunscreen that protects you is the one you are willing to put on every day.

The credit-claiming

The political framing arrived fast. The Department of Health and Human Services tied the approval to the administration’s Make America Healthy Again agenda, with Secretary Robert F. Kennedy Jr. presenting it as the government finally bringing a new sunscreen to market.

The timeline doesn’t support that. The law that made this possible passed in 2020. The company’s application came in 2024. The review was done by career FDA scientists working through a process Congress built years earlier. This crossed more than one administration, and it was driven for over a decade by advocates and industry, not by any single White House.

There is a useful lesson buried in that history about how change actually happens. Ordinary people did help force this. Melanoma survivors, dermatologists, and patient groups kept a dull regulatory problem in front of Congress year after year until it moved. That kind of steady, organized pressure works better than any single voice. It is also worth knowing that these campaigns often blend patient advocacy with industry money, so the smart move is always to ask who is funding the message.

Sunscreen denialism

The same online world that rewards health populism is now full of videos telling people that sunscreen is the real danger. One reel asking whether SPF even matters has about 3 million views. The claims range from “SPF doesn’t work” to “the sun isn’t the enemy, sunscreen is.”

This is happening at the worst possible time, just as the U.S. finally gets a better-tested filter. Skin cancer is the most common cancer in the country, and about 1 in 5 Americans will develop it. Both UVA and UVB rays raise that risk. Skipping sunscreen is the real gamble. And a lot of the doubt being sold online runs right next to ads for supplements and “natural” routines, because there is money in making you afraid of a cheap product that helps prevent cancer.

Bottom line

A new sunscreen ingredient is good news. The better story is the system around it. For 25 years the obstacle was a regulatory process with no working way to approve safe, widely used ingredients. It took an industry user-fee deal embedded in a pandemic bill to fix that.

• What happened in New Orleans

• What the researchers say

• The apology

• What the fight is really about

• What is being cut

What happened in New Orleans

On the first morning of the American Diabetes Association’s annual meeting, police walked five doctors out of the convention center in New Orleans. The doctors were not shouting. They were handing out copies of an editorial. It warned that cuts to federal research money were taking apart American science. It had been published a few weeks earlier in Diabetes Care, the ADA’s own journal.

One of the five was Dr. Steven Kahn, the editor of that journal. Another was a past president of the ADA. Video of the scene spread within hours, and MedPage Today, Washington Post, and the New York Times had the story the same day.

What the researchers say

Dr. Kahn told me the ADA was “tipped” in advance that his group planned to pass out 1,000 copies of the editorial, and that the scale of the police response had to be a leadership decision. “The final decision to have those people be there had to be from the top of the organization,” he told me, “because I cannot believe that somebody at the middle level of the organization would give an order that there’d be not one or two, but a large number of police folks there.”

He disputes the ADA’s account on almost every point. The society said the group was asked to stop and refused. “That statement by the ADA is completely wrong,” Dr. Kahn said. “100% wrong.” He says they were standing outside the lecture hall, handing the paper to people who wanted it. “Somebody’s handing out an ad to a pizza joint. You say yes, you’ll take one. No, you won’t. That’s what we were doing.”

The ADA also said badges were taken only because people would not give up their papers. Dr. Kahn calls that “a total lie.” He says the official running the removals asked for “one more” badge, and staff then took the badge of a senior member who held no papers and was not even an author.

Dr. Kahn also says the ADA quietly added two disclaimers to his editorial after he approved the final proof, distancing the society from its own editors. He said, “What all it is, in my mind, is a CYA for the Trump administration.” He added that no one from the government had complained about their handing out copies of the editorial.

The backlash built fast. More than 6,500 people signed an open letter to the ADA. Two ADA leaders resigned, including the chair of the committee that planned the meeting, who Dr. Kahn says, told colleagues the society’s defense “did not reflect” his view.

The apology

This week, after days of silence on whether anyone would say sorry, the ADA’s CEO, Chuck Henderson, released a video. “I want to personally apologize to Dr. Steven Kahn, Dr. Desmond Schatz, Dr. Aaron Kelly, Dr. Maureen Gannon, and Dr. Justin Ryder, who were escorted out and denied access to scientific sessions,” he said. “I am deeply sorry for the hurt, frustration, and the pain that resulted.” This video was emailed to me in response to my request for comment. The ADA press office did not respond to my specific questions.

Henderson said the society would “commission a thorough independent review of the events that occurred, as well as the policies, procedures, and decision-making process that guided our actions.” He added a line that Dr. Kahn and others will likely hold him to: “Trust, once shaken, must be earned back through actions and not just words.” He closed by saying, “What transpired is not reflective of who I am, the values I hold, or the way I was raised.”

What the fight is really about

Federal research works a lot like the highway system. The government builds the roads, and car companies build the cars that drive on them. Research money mostly pays for the slow, early science that no company will fund, because there is no product at the end of it. Pharmaceutical companies then turn that science into the treatments you can pick up at your local drug store. That groundwork is the reason we have many of the diabetes drugs people use now.

Take teplizumab. It is the first drug shown to delay type 1 diabetes in children. It exists because the NIH spent about 20 years and tracked more than 200,000 relatives of people with type 1 diabetes to learn how the disease starts. A company then turned that science into a product.

Or take GLP-1 drugs, like Ozempic. The hormone behind them was mapped in the 1980s in university and government labs, and the first drug in the class grew out of a federally funded study of Gila monster venom. No company would have paid, up front, to test lizard venom on a hunch.

Even when the government does not invent a drug, it often shows how to use it. The NIH-funded Diabetes Prevention Program showed that metformin and lifestyle change can prevent diabetes before it starts. Another NIH study, DCCT, proved that tight blood-sugar control prevents blindness, amputation, and kidney failure. No company would fund a 30-year study with no drug to sell.

What is being cut

Grant Witness, a group tracking the cuts, counts more than 1,200 canceled NIH grants, with about $513 million in committed money left unspent when the work was stopped. Ninety-three of those grants name diabetes. The diabetes institute at NIH has made 533 fewer awards this year than it had by the same point in 2024.

But researchers like Dr. Kahn say the bigger threat is a rule still on the table. A proposed Office of Management and Budget rule would let a political appointee review every grant before it is awarded and end any grant whenever it “no longer advances agency priorities or the national interest,” with no appeal. The public comment period is open until July 13th, and more than 14,000 comments have already poured in, nearly all opposed. One called the plan “a deadly attack on science and democracy” and “the death knell for scientific research in our country.” Another wrote that “science has already been greatly hindered by this administration, and this particular revision just continues this trend.” A young researcher said the rule left them “horrified,” “furious that science is being politicized,” and “terrified of the precedent this regulation would set about government censorship of fact.” As that commenter put it, “We’ve all read 1984.”

Many of the comments are personal. A diabetes patient wrote simply that “diabetes research saved my life.” A prostate cancer survivor described an MD Anderson study that found his cancer when earlier scans could not, and asked the government to “continue and increase funding for life saving science.” A pediatric endocrinologist pointed to continuous glucose monitors, automated insulin delivery, and prevention research “that have reduced morbidity and improved the lives of children with diabetes.” Another commenter named what is at stake: “lung cancer... pancreatic cancer, ovarian cancer, brain cancer, kidney cancer, and stomach cancer.”

If the OMB rule is finalized, Dr. Kahn said, it would not matter how strong a grant application was. “They could just decide, ‘It’s Steven Kahn. We’re not funding him.’”

Dr. Kahn said he spoke with the ADA’s Chief Scientific and Medical Officer, Dr. Rita Rastogi Kalyani. “I made it clear that I wanted to see them make the case for biomedical research and speak out about the damage being done,” he said. “But it cannot be just through the halls of Capitol Hill as they have been doing, but publicly.”

He added, “One hopes this energizes people to fight for research funding.”

The 2026 World Cup brings fans to stadiums across three countries: the United States, Canada, and Mexico. But besides thinking about which matches to catch and where to eat, there’s something else worth keeping on your radar: mosquitoes.

Mosquitoes carry serious viruses. Some cause mild symptoms. Others can land you in a hospital. The good news: knowing what to watch for and how to protect yourself makes a huge difference.

The Main Threats

Dengue is the biggest concern if you’re heading to Mexico. The virus is endemic across central and southern Mexico, especially along the Pacific and Gulf coasts and in the southeast. Cases have risen sharply in recent years, jumping from 29 per 100,000 people in 2022 to 279 per 100,000 in 2024 according to epidemiological surveillance data.

Dengue causes fever, headache, muscle pain, and rash. Most people recover in a week or two, but about 1 in 20 cases become severe and life-threatening. There’s no specific treatment, so prevention is everything.

West Nile Virus is spread across all 48 U.S. states and parts of Canada, with the highest rates in the Great Plains — states like North Dakota, South Dakota, and Nebraska. Most people infected have no symptoms at all. But some develop fever, body aches, or fatigue. Rarely, it causes serious neurological disease.

Eastern Equine Encephalitis (EEE) is less common but serious. It’s found along the Atlantic Coast, Gulf Coast, and Great Lakes regions. Only about 1 in 150 infected people get sick, but when they do, roughly a third die or face lasting brain damage.

La Crosse Virus primarily hits the Appalachian region and upper Midwest. It causes fever and headache, mostly in children under 16.

How to Protect Yourself

The steps are straightforward but important:

Use insect repellent. Apply EPA-approved repellents containing DEET or picaridin to exposed skin and clothing. Reapply after swimming or sweating. Higher concentrations (20-30% DEET) last longer — up to 5 hours.

Cover up. Wear long sleeves, long pants, and socks, especially during dawn and dusk when mosquitoes are most active. Light colors help you spot mosquitoes before they bite.

Stay in screened areas. Mosquitoes can’t get through window screens or closed doors. Your hotel room is safer than a patio.

Avoid standing water. Mosquitoes breed in puddles, birdbaths, flower pots, and gutters. If you’re staying somewhere with poor drainage, ask the property to fix it.

Watch the forecast. Mosquito activity peaks in warm, wet weather. Check the forecast and plan outdoor activities accordingly.

When to See a Doctor

Seek medical care if you develop fever, severe headache, muscle pain, rash, or neurological symptoms like confusion or weakness, especially if you’ve traveled recently. Tell your doctor where you’ve been.

Most mosquito-borne infections clear on their own, but catching them early helps. Dengue, in particular, can turn serious fast. If you’re in a high-risk area and get symptoms, don’t wait.

Sources:

• Centers for Disease Control and Prevention

  • https://www.cdc.gov/dengue/index.html

  • https://www.cdc.gov/dengue/prevention/index.html

  • https://www.cdc.gov/easternequineencephalitis/index.html

  • https://www.cdc.gov/westnile/index.html

• DeVita, T. N., Morrison, A. M., Stanek, D., et al. (2025). Public health response to the first locally acquired malaria outbreaks in the US in 20 years. JAMA Network Open, 8(1), e2535719.

• Goldman, T., & Hamer, D. H. (2024). Current status of La Crosse virus in North America and potential for future spread. American Journal of Tropical Medicine and Hygiene, 111(2), 322-330.

• Gould, C. V., Staples, J. E., Guagliardo, S. A. J., et al. (2025). West Nile virus. JAMA, 333(14), 1375-1387.

• Mendoza-Cano, O., Danis-Lozano, R., Trujillo, X., et al. (2024). Spatial patterns and clustering of dengue incidence in Mexico: Analysis of Moran’s index across 2,471 municipalities from 2022 to 2024. PLoS ONE, 19(4), e0305048.

• Staples, J. E., & Gould, C. V. (2025). Eastern equine encephalitis in the US. JAMA, 333(16), 1603-1614.

• Five million tickets sold, zero dollars for disease preparedness.

• The MMR vaccine is your best defense at a mass gathering.

• Prepare for the heat.

• Wash your hands. Watch what you eat.

• Protect against mosquitoes.

• Be smart about alcohol and drugs.

• Protect yourself sexually.

• If you’re sick, stay in your hotel.

• Tell your doctor where you’ve been.

• Watch for symptoms after you get home.

Five million tickets sold, zero dollars for disease preparedness.

The 2026 FIFA World Cup starts Wednesday. More than five million tickets have been sold across 16 cities in three countries over 39 days. As my investigation for Sports Illustrated found, the federal government allocated $625 million on World Cup security and nothing on public health. No host city received additional federal funding for disease preparedness. The CDC hasn’t done a risk assessment for the tournament.

That means protecting yourself is largely up to you. Here’s what to do: guidance from me and the Pan American Health Organization (PAHO).

The MMR vaccine is your best defense at a mass gathering.

This is the single most important thing you can do. Measles cases in the Americas are up fourfold this year, and measles has already been detected in Kansas City wastewater. Kansas City is hosting six matches. A single infected person can spread measles to up to 18 unvaccinated people. A packed stadium or fan zone is a perfect setting.

PAHO recommends confirming you’ve had two doses of the MMR vaccine, ideally at least two weeks before you travel. Also, check that you’re up to date on Tdap (tetanus, diphtheria, pertussis), influenza, COVID-19, and hepatitis A and B vaccinations.

Prepare for the heat.

These matches and fan festivals run all day outdoors in June and July. In 2024, extreme heat killed over 1,300 Hajj pilgrims. Stay hydrated. Drink water, not just beer. Wear sunscreen. Seek shade during the hottest hours. If you feel dizzy, nauseous, or stop sweating, get out of the sun and get help. Heat illness can become dangerous fast.

Wash your hands. Watch what you eat.

This sounds basic because it is. Norovirus hit the athletes’ village at the Milan-Cortina Winter Olympics just four months ago. Wash your hands with soap and water often, especially before eating. Choose foods that are fully cooked. Drink bottled or treated water if you’re unsure about the local supply, particularly in Mexico.

Protect against mosquitoes.

If you’re attending matches in Mexico, mosquitoes can carry dengue, Zika, and chikungunya. Use insect repellent with DEET or picaridin. Wear long sleeves and pants when you can, especially around dawn and dusk. Here’s a separate post on mosquito-borne infections in the US, Mexico, and Canada.

Be smart about alcohol and substances.

Alcohol worsens dehydration, especially in the heat. It also impairs your judgment in crowded, unfamiliar settings. Pace yourself. Alternate alcoholic drinks with water. Know your limits. Recreational drugs carry additional risks: you don’t know what’s in them, you’re in an unfamiliar city, and emergency services may be stretched thin during tournament events.

Protect yourself sexually.

Large international events bring millions of people together, and sexual activity increases. Use condoms. They protect against HIV, gonorrhea, chlamydia, syphilis, and other sexually transmitted infections. If you think you may have been exposed to HIV, post-exposure prophylaxis (PEP) is available at emergency departments and various clinics, but it must be started within 72 hours.

If you feel sick, stay at home or in your hotel.

Do not go to a packed stadium or fan zone with a fever, rash, cough, or diarrhea. You could spread an infection to thousands of people. This is especially true for measles, which is airborne and contagious before you even develop a rash.

Tell your doctor where you’ve been.

This may be the most important piece of advice after vaccines. If you see a doctor during or after the tournament, tell them which cities you visited and which events you attended. Travel history can be the difference between catching something early and missing it entirely. Standard diagnostic tests don’t screen for diseases like MERS. A doctor won’t order the right test if they don’t know where you’ve been.

Watch for symptoms after you get home.

Some infections don’t show up right away. Measles symptoms appear 7 to 14 days after exposure. Dengue, Zika, and mpox can develop on a similar timeline. If you get a fever, rash, or trouble breathing in the weeks after the tournament, see a doctor and tell them where you’ve been.

The federal government left public health preparedness to the host cities, and many of them are stretched thin. But the basics — vaccines, hygiene, hydration, common sense — are still in your hands.

• What the study actually found.

• Why “no increased risk” isn’t the same as “safe.”

• How many pregnancies it would take to spot a 1-point rise.

• A limit is not a flaw.

• The clever fix: comparing unhealthy women to unhealthy women.

• Why you can’t just run a randomized, placebo-controlled clinical trial among pregnant women.

• Fans hear “safe,” skeptics hear “danger.”

• The question it answers, and the one it doesn’t.

What the study actually found.

Somewhere this week, a headline will tell a worried woman that Ozempic is safe in pregnancy. It will be based on a careful, honest study that did not find that, could not have found that, and whose authors were at pains to say so.

A study published in the Annals of Internal Medicine addressed a question more women face every year: what happens if you keep taking a GLP-1 drug — semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound) — into early pregnancy, before you know you’re pregnant. Using insurance records from about 3,572 pregnancies between 2011 and 2024, they compared women who kept taking the drug after conceiving to women who stopped. Both groups had been taking it for diabetes or obesity. They looked at pregnancy loss, abnormal fetal growth, and major birth defects, and found no clear increase in any of them among the women who continued.

For the many women who take one of these drugs and then discover, a few weeks in, that they’re pregnant, that is genuinely reassuring. The trouble starts when reassurance gets promoted to proof.

Why “no increased risk” isn’t the same as “safe.”

The study did not find that GLP-1 drugs are safe in pregnancy. It failed to find harm. Those sound alike. They are not. Finding nothing is not the same as proving nothing is there. Search a dark room with a weak flashlight and see no cat, and you haven’t shown the room is empty. You’ve shown the flashlight is weak.

This study had a weak flashlight for birth defects, not because the researchers did anything wrong, but because of how numbers work.

How many pregnancies it would take to spot a 1-point rise.

Major birth defects already happen in about 3% of births in the U.S., roughly 1 in 33 babies, with no drug involved. That’s the normal background rate, and it’s why birth defects are the leading cause of infant death. Now suppose a drug pushes that rate from 3% to 4%. That’s a real increase — a third higher in relative terms. To prove it, you have to reliably tell “3 in 100” apart from “4 in 100,” against a background that already drifts on its own from chance. To hear that one extra case per hundred over the noise, you need a lot of exposed pregnancies.

To reliably catch a rise from 3% to 4%, you’d need somewhere around 10,000 to 14,000 pregnancies split between the groups. This study had 3,572 pregnancies in total, and only a fraction of those women continued the drug. At a 3% background rate, that’s about 100 expected birth defects across the whole sample, and far fewer among the continuers. There weren’t enough cases to spot a small increase if one existed.

A limit is not a flaw.

So “no increased risk of birth defects” has an honest translation: we couldn’t detect a difference against a 3% baseline with a sample this size. Reassuring, yes. Proof of safety, no. The researchers said as much. They called their estimates imprecise and called for more research. A good study is honest about what it can’t see. The distortion gets added later, by a headline that rounds “couldn’t detect harm” up to “safe.” When a study reports “no increased risk,” ask how many cases it actually had. A handful means the study couldn’t see a small risk, not that there isn’t one.

The clever fix: comparing unhealthy women to unhealthy women.

The researchers compared women who continued the drug to women who stopped — both groups living with diabetes or obesity. The lazy version of this study would compare women on a GLP-1 drug to women not on it. But those groups differ in an obvious way: one is sicker. Find worse outcomes, and you can’t tell whether the drug did it or the underlying disease did. You might be measuring the diabetes and blaming the drug. Researchers call this “confounding by indication,” and comparing continuers to stoppers mostly factors that out, because the main thing separating the two groups is whether they kept taking the medication.

Why you can’t just run a randomized, placebo-controlled clinical trial among pregnant women.

You cannot ethically assign pregnant women at random to a drug you suspect might harm a fetus, and no one wants that loophole closed. So the researchers did the next best thing: they used insurance records to rebuild what a trial would have looked like — defining the groups, the starting point, and the comparison the way a real trial would — a method called target trial emulation. It’s rigorous, but it’s still a reconstruction. Insurance records show a drug was dispensed, not that it was swallowed. Early miscarriages and some defects go uncounted.

This is all within the context of a systemic failure. Pregnant women are routinely left out of drug trials, so when a medication becomes popular, we often have almost no pregnancy safety data for it. We end up rebuilding answers from claims data years later, one drug at a time. The thin evidence here isn’t a quirk of one analysis. It’s the predictable output of a system that treats pregnancy safety as something to reconstruct after the fact rather than study up front. The people asked to absorb that uncertainty are the patients, who get told to “ask their doctor” about safety questions that haven’t been answered.

Fans hear “safe,” skeptics hear “danger.”

People who like these drugs will read “no harm found” as “safe.” People who distrust them will resurface the old animal studies that prompted the caution in the first place and call the same data alarming. Same numbers, two wrong stories. The data are consistent with no large increase in risk, but they cannot rule out a real one. Anyone who tells you it’s settled in either direction is reading their own preference into the gaps.

Match the evidence to the question, because a study usually answers one specific question, though not necessarily the one you most want answered. This study answers, “I took a GLP-1 drug early, before I knew I was pregnant. Should I panic?” The honest answer is reassuring. This study does not answer, “Should I start, or stay on, one of these drugs while pregnant?” That answer hasn’t changed: these drugs are not recommended in pregnancy, and this study doesn’t change that.

The question it answers, and the one it doesn’t.

If you had an accidental early exposure, this is reason for calm, not alarm. If you’re planning a pregnancy or could become pregnant, the standing guidance holds. Talk with your clinician about stopping these drugs and about contraception while you’re on them.

The World Cup kicks off on Wednesday. My husband should be covering it.

Grant Wahl fell in love with soccer during the 1994 World Cup, the last time the United States hosted the tournament. He covered his first World Cup final for Sports Illustrated in 1998, when France beat Brazil, and he covered every tournament after that for the next quarter century. We named one of our dogs after Zinedine Zidane.

Grant died at the 2022 World Cup in Qatar. He was 49. The 2026 tournament — on American soil, in the country whose soccer culture he did more to shape than almost any journalist — was what twenty-five years of work had been building toward.

I didn’t come to soccer on my own. That was all Grant.

In 2014, I went to Guinea during the Ebola outbreak in West Africa. I was gone for two months. Grant kept everything running at home without complaint. He described what I did as “my World Cup,” the highest compliment he knew how to give.

Both are back now. The tournament opens on June 11th. And the Ebola outbreak in eastern Congo has reached more than 350 confirmed cases and at least 60 confirmed deaths, making it the third worst Ebola outbreak on record. The World Health Organization has declared a global emergency. There is no vaccine or specific treatment for this species of Ebola. Contact tracing has improved but is still reaching fewer than half the people who need to be monitored. Treatment centers have been burned to the ground. The outbreak may have started as early as January, months before it was detected.

Both of these worlds are colliding again, and I am standing in the middle of them without him.

Grant is not here for this World Cup.

Grant’s career had a throughline that went beyond soccer. He used the game — its institutions, its money, its spectacle — to ask who profited and who bore the cost.

In 2022, he traveled to Qatar and spent days visiting FIFA-designated hotels, talking to migrant workers. The country had promised labor reforms. Grant went to see whether the reforms reached the people they were supposed to help. He found passports still confiscated. Recruitment fees still extracted. Workers who built the infrastructure for the tournament still treated as invisible.

On November 21st of that year, he put on a rainbow soccer t-shirt and walked into the U.S.-Wales match. His brother Eric is gay, and Grant had written about LGBTQ rights in soccer for years. Security guards stopped him, held him for about 25 minutes, seized his phone, and told him the shirt was not allowed. He would not take it off. A commander eventually apologized. So did FIFA. In the piece he wrote about it afterward, Grant asked what would happen to a Qatari citizen wearing that shirt once the press and the cameras were gone.

That was how he operated. He put himself where official promises met reality and recorded the distance between the two.

I keep thinking about that distance.

On May 18th, the U.S. government issued a Title 42 order suspending entry for anyone who had been in the Democratic Republic of Congo, Uganda, or South Sudan in the prior 21 days. Four days later, it extended the order to lawful permanent residents (green card holders) for the first time in the statute’s history. The government’s rationale, in the Federal Register: some permanent residents maintain “stronger ties to families and communities outside the United States,” so they can more easily be kept out. That same day, the WHO Emergency Committee explicitly recommended against flight suspensions and entry denials.

The public health case for categorical travel bans is weak. They reduce disease importation risk by less than 1%. They push border crossings into informal routes with no screening. They obstruct the movement of health workers and supplies into the outbreak zone. Rwanda has closed its border with Congo, severing the main corridor for getting international aid in. The outbreak area is increasingly sealed off. People still move. They just move where no one is watching.

The administration also built a quarantine facility for Americans in Kenya rather than bringing them home to any of the 13 specialized biocontainment units the U.S. built for exactly this situation. A Kenyan court blocked it. Two people were killed in protests outside the gates. The CDC’s own workers’ union called the policy “a sharp departure from every previous administration.”

The DRC’s national soccer team, which is based in Europe, arrives in Houston on June 12th. La Línea de la Concepción in southern Spain has already refused to host their warm-up match, citing Ebola concerns.

All of this is framed as public health. But my investigation for Sports Illustrated found that the federal government spent $625 million on World Cup security — law enforcement, background checks, cybersecurity — and allocated nothing for disease preparedness. Not one host city has received additional federal funding for public health. The CDC has not produced a risk assessment for the tournament. The White House Task Force created to coordinate the World Cup has not delivered a single biological threat briefing to the Senate Homeland Security Committee. Measles has already appeared in Kansas City wastewater. Kansas City is hosting six matches. Georgetown University stood up its own health surveillance operation for the tournament in the absence of federal leadership. The United States has also withdrawn from the WHO, dismantled USAID, and left the CDC without a Senate-confirmed director for all but 28 days of this administration.

In the DRC, where U.S. funding covered 70% of health supplies, nearly 3,000 doctors and nurses have been dismissed. Some have turned to farming to survive. The former head of USAID disaster response told The New York Times that the outbreak would not have been missed for so long if those programs were still in place.

Grant spent his career watching powerful institutions say one thing and do another. Qatar told the world its stadiums were open to all. Grant wore a t-shirt and was detained at the gate. FIFA said workers were protected. Grant talked to the workers and found the protections hadn’t reached them.

A government acting in the public interest would not host the largest mass-gathering event in its history without dedicated disease-preparedness measures.

Grant did not live to see this World Cup. He left no words on the 2026 Ebola outbreak or the Title 42 order, and I will not invent them for him. But I spent twenty years watching him work. He went where the story was, and he told the truth about what he found there. He is not here to cover this, but I know he would want this story covered.

• A 65% chance

• 452 confirmed

• Two response systems, running in parallel

• What 70% means

A 65% chance

The CDC released its own modeling yesterday, and the numbers are stark. If isolation of Ebola patients stays at the levels the agency believes are closest to current conditions on the ground, there is a 65% chance the outbreak will exceed 20,000 cases within three months. That could make it the largest Ebola epidemic in history.

The agency’s Center for Forecasting and Outbreak Analytics modeled a range of scenarios, varying both the assumed number of deaths and the percentage of patients who are detected and isolated within two days of symptoms. The finding that matters most: at 20% isolation, which is where CDC’s incident manager said conditions currently appear to be, the worst-case scenarios dominate. At 70% isolation, the probability of exceeding 10,000 cases drops to 5%. And this is why it’s important to surge resources to control the outbreak now.

The modeling also estimates that the virus first spilled over from an animal host in mid to late February, weeks earlier than even the WHO’s estimate. The outbreak had a three-month head start before the first case was confirmed on May 15th.

452 confirmed

The DRC’s Institut National de Santé Publique published SitRep N°021 today with data through June 4th. The numbers are higher than anything CDC or WHO has reported: 452 confirmed cases, 82 deaths. Seventy-one new confirmed cases in a single day, the highest daily count of this outbreak.

Ituri province accounts for 94% of confirmed cases. But North Kivu’s case fatality rate is 60%, which the DRC attributes to delayed care and confirmed cases absconding from treatment facilities. Contact tracing has improved to 57.8% but is still far below the 70% threshold the CDC’s own modeling says is needed to change the trajectory.

Two response systems, running in parallel

Yesterday, the WHO and Africa CDC launched a $518 million joint response plan: “one plan, one budget, one team.” It covers June through November and brings in UNICEF, UNHCR, WFP, IFRC, and FIND alongside the two lead agencies.

Separately, the U.S. State Department announced another $38 million, bringing its direct Ebola funding to more than $200 million. Combined with $350 million through OCHA, the total U.S. commitment is now roughly $550 million, comparable in scale to the WHO/Africa CDC plan.

But the money flows through two completely separate channels. The WHO plan is a unified command structure. The U.S. money goes to bilateral implementing partners — IOM, UNICEF, World Vision, FHI 360, IMC, WFP — outside that structure. I asked CDC’s incident manager directly whether U.S. money or CDC staff would coordinate with the WHO-led plan. He did not answer the question.

The U.S. has withdrawn from the WHO. It is now the largest funder of the Ebola response and simultaneously absent from the unified command running it.

What 70% means

The CDC’s modeling is a planning tool, not a prediction. It answers a conditional question: if this level of isolation holds, what happens? The answer, at current levels, is that the outbreak is on track to become catastrophic.

But the modeling also shows the path out. At 70% isolation — detecting and isolating seven out of every ten cases within two days of symptoms — the outbreak is controllable. The WHO set the same target during the 2014 West Africa epidemic through UNMEER, and when they hit it, cases started falling for the first time in seven months.

Getting from where we are now to 70% requires exactly what the $518 million plan describes: more health workers, more treatment capacity, more diagnostic labs, more community engagement, and more trust.

• Rubio’s reversal

• What Tedros saw in Bunia

• What Rubio’s reversal actually means

• The World Cup starts in 8 days

The Ebola outbreak has reached more than 350 confirmed cases and more than 60 deaths. A confirmed case traveled through the UAE, where 16 contacts are now isolated in Dubai. No approved vaccine or treatment exists for the Bundibugyo species. The WHO needs $115 million for the next three months. Only 35% is funded.

Today, the union representing over 2,400 CDC workers issued a statement demanding the administration bring exposed workers home. AFGE Local 2883 President Yolanda Jacobs called the Kenya plan “a sharp departure from every previous administration” and said the government is abandoning the people it needs most.

Rubio’s reversal

Late today, Secretary of State Marco Rubio appeared to reverse himself. At a Senate hearing, he said Americans who test positive in Kenya would be sent to “the nearest treatment facility, either in Europe or in the home or in the United States.” One week ago, he said the administration “cannot and will not allow any cases of Ebola to enter the United States.” He called the controversy a “misunderstanding.” He also announced $660 million for Gavi, the vaccine alliance HHS Secretary Kennedy cut last year.

What Tedros saw in Bunia

WHO Director-General Dr. Tedros Adhanom Ghebreyesus says the virus still has a big head start. A superspreader funeral in late April sent it spreading for weeks before detection. The outbreak may have started as early as January. Contact tracing is at 45%, which is an improvement, but it needs to be 90%. Community leaders told Tedros they don't believe Ebola is real.

In the DRC, where US funding covered 70% of health supplies, nearly 3,000 doctors and nurses were dismissed after USAID cuts. Less than 30% of healthcare workers remain. My sources on the ground tell me that five of six active Ebola cases in North Kivu have escaped isolation.

What Rubio’s reversal actually means

It would be easy to hear Rubio say “in the United States” and conclude the policy has changed. I’m not sure it has.

He said the Kenya facility is for “observation” (i.e. quarantine) not treatment. Americans who test positive would be sent to “the nearest treatment facility, either in Europe or in the home or in the United States.”

That language is hedged. “The nearest treatment facility” could mean Europe in most scenarios, since Kenya is closer to Europe than to the US. “Or in the United States” could be an option that exists on paper but is never used.

The State Department also published formal guidance today that still routes asymptomatic high-risk Americans to Kenya and describes the process as “voluntary,” with fine print that those who decline remain “subject to relevant measures.” In accordance with the CDC assessment, the State Department may offer the following assistance:

• Not high-risk of Ebola exposure: US embassy staff will reach out to the US citizen and may offer assistance, including a loan, if available, or coordination with local governments to facilitate the US citizen’s departure.

• High-risk of Ebola exposure but US citizen is asymptomatic: State Department and US embassy staff may arrange transportation to a facility in Kenya for a 21-day quarantine period from the last date of Ebola exposure, to include access to appropriate medical care provided by expert US clinicians. US citizens who become symptomatic during quarantine may be transported via specialized aeromedical evacuation for appropriate treatment.

• High-risk of Ebola exposure and US citizen is symptomatic or has tested positive for Ebola: State Department and US embassy staff may arrange specialized aeromedical evacuation to a designated safe location for appropriate treatment.

The World Cup starts in 8 days

The tournament opens June 11th. Congo’s World Cup team arrives in Houston on June 12th. D.C. United has already canceled a July match against Ethiopia over Ebola concerns. La Línea de la Concepción in southern Spain has refused to host Congo’s warm-up game against Chile.

But Ebola is probably the wrong thing to worry about at the World Cup. As my friend, infectious disease physician and fellow Ebola veteran Dr. Krutika Kuppalli, argued in STAT News, Ebola isn’t airborne, people aren’t contagious before symptoms, and transmission requires direct contact with bodily fluids. The real threats at a mass gathering this size are measles, flu, COVID, and norovirus. A single measles case at a stadium could expose hundreds, and the US is already seeing rising outbreaks from declining vaccination rates. The country enters this World Cup with a domestic public health system weakened by underfunding, workforce losses, and political attacks on health agencies.

• The tobacco moment for food

• Cigarette engineering, applied to food

• Why you can’t stop eating them

• The damage to the brain

• 80% of Americans want action

• What comes next

The tobacco moment for food

The American Journal of Public Health published a special issue today with 17 studies, editorials, and reviews on ultra-processed foods. Together, they build a case that these products are a public health crisis on the same scale as tobacco. And in many cases, they were made by the same companies using the same techniques.

A group of leading researchers is also launching a public education campaign called Fed UP to bring the science directly to consumers. No one involved takes food industry money.

Here is what the research found, and what it means.

Cigarette engineering, applied to food

Philip Morris, the maker of Marlboro cigarettes, bought into the food industry in the 1980s and spent two decades applying cigarette engineering to food. One study traces the history of Lunchables, which Philip Morris launched in 1988 while it owned Kraft General Foods. The company used the same consumer psychology behind the Marlboro Man, designing products to blur the line between food and toys. When parents started worrying about childhood obesity in the 1990s, Philip Morris used a technique it had developed to extract nicotine from tobacco leaf to remove fat from food. It brought flavor scientists from its German tobacco lab to work on making low-fat versions taste better.

A second study shows this was not limited to the U.S. Tobacco companies spread ultra-processed foods worldwide using the same distribution networks they had built for cigarettes. They acquired local food companies across the globe, streamlined production, and developed king-size food items modeled directly on king-size cigarettes. Philip Morris expanded aggressively into Canada, Europe, and Asia. R.J. Reynolds focused on Central and South America.

Those companies have since sold their food divisions. The products and formulations they created are still on shelves.

Why you can’t stop eating them

Another paper in the issue analyzed what makes certain foods hard to stop eating. Researchers tested more than 200 nutrient signatures to identify which foods Americans reported losing control over. Whole foods, fruits, vegetables, beans, fish, triggered no addictive responses.

The products that did were ultra-processed. The key: a combination of rapidly absorbed refined carbs and fat, delivered in concentrated doses. That combination does not exist in nature. It hits dopamine circuits the same way addictive drugs do, the same pathways that GLP-1 drugs like Ozempic appear to quiet. A separate national study found that more than 12% of older adults in the U.S. now meet clinical criteria for ultra-processed food addiction.

Ultra-processing breaks food down at the molecular level so the body absorbs nutrients almost instantly. It is why eating a whole orange and drinking a glass of orange juice hit the body so differently. The processing is the problem.

The damage to the brain

A separate study followed more than 5,000 Americans over 50 for nearly a decade. Those who ate the most ultra-processed foods had a 58% higher risk of developing dementia and a 46% higher risk of cognitive impairment. Processed meats drove the highest risk.

This is observational. It cannot prove cause and effect. But the association held after adjusting for income, education, smoking, exercise, alcohol, and existing chronic disease. It is consistent with prior studies. And there are plausible biological mechanisms: additives like emulsifiers alter the gut in ways that trigger inflammation, and inflammation is one of the key drivers of dementia. Nitrites in processed meats drive inflammation independently. In animal studies, artificial sweeteners like aspartame have caused problems with learning and memory.

The researchers found no safe threshold. Even moderate intake was linked to higher risk. People who ate the most whole foods had a 41% lower risk of dementia.

80% of Americans want action

The issue includes nationally representative polling. Seven in 10 Americans, across parties, believe ultra-processed foods are addictive. Over 80% want more safety testing, warning labels, and restrictions on marketing to children. Only about 1 in 10 trust that food companies can make healthy products. Support for tobacco-style lawsuits against food companies has jumped from 6% in 2003 to a majority today.

These are not fringe positions. This is bipartisan supermajority support for government intervention in a product category that makes up 60% to 70% of the American food supply.

What comes next

The dietary guidelines released in January told Americans to limit “highly processed foods” for the first time in 45 years. The FDA has identified ultra-processed foods as a 2026 priority and is working on a formal definition. Getting it right matters. A panel of researchers has proposed an operational definition based on the NOVA classification: a food is ultra-processed if it contains cosmetic additives like colors, flavors, or emulsifiers, or non-culinary ingredients like high-fructose corn syrup or protein isolates. Foods meeting the FDA’s criteria for “healthy” would be exempt. State bills that have tried narrower definitions have captured only about 13% of actual ultra-processed foods.

State attorneys general are exploring litigation similar to what broke open the tobacco industry in the 1990s. Those lawsuits forced the release of internal documents that showed how cigarettes were engineered to be addictive. That evidence shifted public opinion and opened the door for regulation. The food industry is already pushing back, lobbying for federal preemption laws that would block states from acting on their own, the same playbook tobacco used.

The food industry will argue the definition is not settled, that more research is needed, that personal responsibility is the answer. The 80% of Americans asking their government for help appear to disagree.

• A $2.5 billion deal and its consequences.

• Tariffs, deportations, and mineral deals came first.

• Table 1. Countries and documented actions.

• Table 2. Inaugural donors with commercial operations in MOU countries.

• Table 3. Countries that rejected or challenged MOUs.

A $2.5 billion deal and its consequences.

Last week, two people were killed in Kenya during protests over a US Ebola quarantine facility being built at Laikipia Air Base. The plan: fly Americans exposed to Ebola in the DRC to a 50-bed unit on Kenyan soil. Kenyan doctors opposed it. A court blocked it. The government pushed ahead anyway.

Kenyan President William Ruto said he agreed because President Trump asked and because it fit inside their bilateral health deal. That deal, signed in December 2025, is worth $2.5 billion in total. The US share is a 22% cut from its previous spending. And it comes with strings: data-sharing access up to 25 years, pathogen specimen sharing within five days, and now, an Ebola quarantine facility Kenya didn't ask for. Dr. Jean Kaseya, Director-General of the Africa CDC, has said publicly: “There are huge concerns regarding data, regarding pathogen sharing.”

Kenya is one of 32 countries that signed bilateral health agreements with the Trump administration. These deals, worth $20.3 billion total, restructured the delivery of the President’s Emergency Plan for AIDS Relief (PEPFAR), launched by President George W. Bush in 2003, which channeled billions through both bilateral country programs and the multilateral Global Fund. Now each country negotiates alone, one-on-one, with the US.

According to the Center for Strategic and International Studies, the administration’s trade architect Robert Lighthizer prefers bilateral deals because they are “easier to negotiate (only one country, usually smaller than us, to push around).” In a group, small countries can team up and push back. Alone, they can’t, especially when what’s on the table is medicine their people need to survive.

Tariffs, deportations, and mineral deals came first.

The three figures below show what I could find based on public records:

• Table 1. Countries and documented actions.

• Table 2. Inaugural donors with commercial operations in MOU countries.

• Table 3. Countries that rejected or challenged MOUs.

Table 1. Countries and documented actions.

Table 1 maps the more than 30 countries that signed bilateral health agreements with what the US did before or during each deal. Some patterns show up. Countries that got the highest tariffs — Lesotho at 50%, Madagascar at 47%, Botswana at 37% — signed health deals within months. In Latin America, countries that signed deportation agreements — Guatemala, Honduras, El Salvador — got health deals afterward. That doesn’t prove the health deals were rewards. But the timing is consistent.

In some cases, the link is on the record.

In Guinea, the US signed a critical minerals partnership on February 5, followed by the health deal on February 27 — [a sequence the Observer Research Foundation noted](https://www.orfonline.org/expert-speak/critical-minerals-pathogen-data-and-the-new-turn-in-us-global-health-engagement) "underscores how critical minerals have emerged as a focal point in health assistance negotiations."

Al Jazeera reported Guinea’s health deal was “conditional on signing agreements granting the US access to critical minerals.” In the DRC, the US signed a mining partnership in December 2025, giving American companies preferential access to cobalt and lithium. The health deal came about three months later. In Zambia, the State Department set a deadline: sign a minerals deal by April 30th or lose HIV drugs for 1.3 million people. Zambia’s foreign affairs minister pushed back, objecting to “the coupling of the proposed agreements.” Hospitals there are now reporting more AIDS cases.

Table 2. Inaugural donors with commercial operations in MOU countries

Table 2 adds another layer: Trump inaugural donors who have business in the countries getting these deals. Chevron gave $2 million to the inauguration. It is one of the biggest oil producers in Nigeria, which got the single largest health deal at $5.1 billion. ExxonMobil gave $1 million. It has a $30 billion gas project in Mozambique, which got up $1.8 billion in US health funding. Gilead Sciences, another $1 million donor, secured a deal to supply its HIV prevention drug lenacapavir to up to 3 million people across nearly all of these countries through PEPFAR and the Global Fund.

Correlation isn’t causation. This doesn’t prove these donations resulted in those outcomes. Chevron was in Nigeria long before this deal. Gilead’s drug lenacapravir is a real medical advance, and the company has also licensed generic manufacturers. But the pattern — give money to the inauguration, then benefit from policy in countries getting health deals — shows up across many donors and many sectors.

Table 3. Countries that rejected or challenged MOUs.

Table 3 shows what happened to the countries that said no. Zimbabwe walked away from $367 million, calling the terms “inequitable.” Ghana turned down $109 million in US funding over data privacy concerns. Kenya signed the deal, but its High Court suspended it, citing violations of the country’s Data Protection Act and other laws. The countries that pushed back had something in common: stronger courts, data protection laws, or civil society groups.

Table Sources

• KFF Tracker: America First MOU Bilateral Global Health Agreements, KFF, updated April 27, 2026

• Trump Vance Inaugural Committee filings, Federal Election Commission, Filing #1910509

• US Tariff Tyranny and Africa: An Update, Center for Global Development, August 13, 2025

• Trump threatens Nigeria with military action, Euronews, November 3, 2025

• Kenyans protest planned US Ebola quarantine facility, Al Jazeera, June 1, 2026

• Minerals for aid: Are new US health deals exploiting African countries? Al Jazeera, April 1, 2026

• Zambia delaying US deals over minerals and data demands, Al Jazeera, May 4, 2026

• Is Trump demanding Zambia hand over mineral rights or lose access to lifesaving HIV/AIDS meds? Snopes, May 3, 2026

• Kenya’s High Court suspends US health deal, Health Policy Watch, December 11, 2025

• Ghana rebuffs US health deal; South Africa and Zambia struggle without aid, Health Policy Watch, May 2026

• PEPFAR freeze shuts clinics in Uganda, Foreign Policy, March 14, 2025

• US deportation agreements: Honduras, Uganda, CBS News, August 21, 2025

• ExxonMobil Rovuma LNG project, ExxonMobil

• Mozambique: ExxonMobil final investment decision on LNG project expected in second half, Club of Mozambique

• Trump’s health-aid overhaul faces a critical test in Mozambique, Bloomberg, May 29, 2026

• USAID cuts and Tigray HIV crisis, Boston Globe, March 26, 2025

• US-DRC Strategic Partnership Agreement, US State Department, December 4, 2025

• US-DRC Strategic Partnership Agreement faces constitutional challenge, Oakland Institute, February 4, 2026

• Trump hosts Congo and Rwanda leaders to sign deal on peace, critical minerals, PBS, December 4, 2025

• Lesotho scrambles to save vital textile industry from Trump tariff tantrum, Daily Maverick, April 9, 2025

• Burkina Faso signs Trump health deal, Africa Briefing, March 2026

• Trump’s Panama Canal threats, Carnegie Endowment, February 19, 2025

• Trump’s Panama threats paying off, Newsweek, February 3, 2025

• Darién Gap crossings fall 99 percent, VisaVerge, April 11, 2025

• Third Country Deportation Watch, Refugees International and Human Rights First

• Honduras Asylum Cooperative Agreement, Immigration Policy Tracking, July 8, 2025

• US paid $6 million for CECOT prison deal with El Salvador, PBS Frontline, April 7, 2026

• US deportations to El Salvador double, NBC News, May 13, 2026

• Trump visa sanctions targeting Cambodia, American Immigration Council

• Bolivia’s shift to the right renews ambition to mine vast lithium reserves, Climate Change News, October 28, 2025

• Bolivia country report, Congressional Research Service, September 14, 2017

• Central Asia critical minerals diplomatic deals summit, Radio Free Europe/Radio Liberty, November 7, 2025

• Trump hosts Central Asian leaders as US seeks to circumvent China on rare earth metals, PBS, November 7, 2025

• Chevron in Nigeria, Chevron

• Expanding faith-based healthcare in Nigeria through the America First Global Health Strategy, US State Department, December 20, 2025

• Empowering resilience in Mozambique under the America First Global Health Strategy, US State Department, December 15, 2025

• Erik Prince strikes mineral security deal with Congo, Mining.com, April 17, 2025

• PEPFAR and the Global Fund expand investment in Gilead’s lenacapavir, Gilead Sciences, April 14, 2026

• PEPFAR viral load diagnostics contracts, Global Health Supply Chain Program, October 27, 2020

• FDA’s new food chief previously defended infant formula company in lawsuits, Environmental Health News, March 6, 2025

• Pfizer names Cavazzoni Chief Medical Officer, BioPharma Dive, February 24, 2025

• Peter Marks joins Eli Lilly, STAT News, October 7, 2025

• Billionaires and the Trump administration: Peter Thiel, Revolving Door Project, April 8, 2025

• Africa CDC head cites major concerns over data, pathogen sharing in US health deals, CNBC Africa, February 27, 2026

• US winds down health programmes after Mnangagwa rejects $367 million deal, The Zimbabwean, February 25, 2026

• Ghana becomes the latest African country to reject a US health deal, citing data sharing concerns, US News / Associated Press, May 1, 2026

• US ties global health aid to data sharing on pathogens, Health Policy Watch, July 11, 2025

• Africa stuck between global pathogen-sharing talks and conflicting US bilateral agreements, Health Policy Watch, January 12, 2025

• The headline says 30%.

• 2.3% versus 1.6%.

• This study can’t prove the drug did anything.

• Metformin was supposed to prevent cancer, too.

• Social media isn’t waiting for a clinical trial.

• What this means for Medicare and for you.

The headline says 30%.

A study presented yesterday at the American Society of Clinical Oncology annual meeting made headlines: women taking GLP-1 drugs like Ozempic and Wegovy had a “30% lower risk” of breast cancer.

Here’s what that actually means.

2.3% versus 1.6%.

Researchers at Penn Medicine reviewed health records from over 100,000 overweight women who had mammograms or other breast imaging. About 15,000 had been prescribed a GLP-1 drug.

Among women not on the drug, 2.3% were diagnosed with breast cancer. Among women on the drug, 1.6% were. That’s a difference of 0.7%.

That’s where the “30%” comes from. It’s the relative risk reduction — how much smaller one number is compared to the other. The absolute risk reduction — the actual change in how many women got cancer — is less than 1%.

Here’s the math: (2.3% - 1.6%) / (2.3%) * 100% = 30%

This study can’t prove the drug did anything.

Nobody was randomly assigned to take a GLP-1 or not. The researchers didn’t account for income, exercise, alcohol use, family history, genetic risk, or other medications. Any of those could explain the difference. The authors themselves call this a starting point, not proof.

Metformin was supposed to prevent cancer, too.

About ten years ago, observational studies suggested metformin, a common diabetes pill, cut cancer risk by 20% to 40%. The numbers looked a lot like what we’re seeing now with GLP-1 drugs. But when researchers ran better-designed studies, the benefit disappeared. The problem was how the studies were set up, not a real drug effect.

This GLP-1 study has the same weaknesses.

Social media isn’t waiting for a clinical trial.

The story is spreading faster than the data supports. In a sea of social media hype, Stanford oncologist Dr. Shruti Patel put it plainly: “NONE of this data suggests people who don’t have weight/endocrine issues should be taking GLP1s.”

What this means for Medicare and for you.

Medicare is about to start covering GLP-1 drugs for weight loss. A study like this will probably be used to argue for broader coverage. It shouldn’t be. Spending billions based on a question we haven’t answered yet is the kind of decision that should wait for a clinical trial. And a trial is being planned.

In the meantime: do not take a GLP-1 drug to prevent breast cancer based on this study. If you’re already on one for weight loss or diabetes, nothing changes. Focus on maintaining a healthy weight, exercise, a diet rich in whole foods and plants, moderating alcohol, and quitting smoking.

What happened

• Thursday: The Kenyan High Court blocked the facility, calling it a threat to life.

• Saturday: American officers landed at the base anyway.

• Today: Hundreds of protesters at the gates. Soldiers in tanks. Anti-riot police. The local governor said the facility will expose his people to Ebola because many local residents work inside the base.

The outbreak

• As of May 29th, WHO reported 134 confirmed cases across DRC and Uganda, including 18 confirmed deaths, an increase of 49 confirmed cases and 8 confirmed deaths in eight days.

• By June 1st, confirmed cases had risen to 282 — more than doubled in three days.

• The apparent drop in suspected cases is likely a data artifact tied to a leadership change in the outbreak response. Data collection and specimen transport were improved. Lab capacity in Bunia scaled from 48 to 240 samples per day, clearing a testing backlog. Many suspected cases tested negative and were reclassified.

The care gap

• The U.S. has 13 biocontainment units built for this. In 2014, nine Americans with Ebola were treated in them. Staff trained for years. None got infected.

• The Kenya facility is a field hospital. Staff got three days of training. Ebola patients may need ventilators, dialysis, or heart-lung bypass. A field hospital can’t do that.

Why Kenya can’t say no

• Last December, Kenya signed a $2.5 billion health deal with the U.S., replacing all PEPFAR and USAID funding. Kenya’s public health system, including HIV treatment for millions, now depends on Washington.

Two constitutional crises

• In Kenya, the government is defying its own court order. The Law Society, Katiba Institute, and doctors’ union are fighting it.

• In the US, the Fifth Amendment protects your right to come home. The government can’t legally stop a citizen from boarding a flight.

• The administration is using the same public health powers it criticized during COVID.

The backfire risk

• If reporting exposure means Kenya instead of home, some workers won’t report. They’ll fly commercial, unmonitored. That’s how a policy meant to keep Ebola out becomes the thing that brings it in.

What’s next

• Kenyan court hearing: June 2nd

• World Cup kicks off: June 11th

• The shift happened on TikTok.

• The research is real. The videos skip the risks.

• Tell your doctor.

The shift happened on TikTok.

Creatine went from a gym supplement to a brain supplement in about a year. The shift didn’t happen in a lab. It happened on social media.

In the last month, I found more than 350 videos on TikTok, Instagram Reels, and YouTube Shorts promoting creatine for brain health, memory, and anti-aging — 37.5 million views in 30 days. Many of those creators are selling creatine through TikTok Shop or collecting affiliate commissions. I found another 141 paid ads ran on Meta for creatine brands, some placed through publisher pages like Us Weekly and the New York Post. I’m sure there were many more.

The research is real. The videos skip the risks.

There is real science underneath the hype. Creatine helps muscles produce energy during intense exercise. Long-term data shows it helps older adults preserve muscle mass and strength. There’s early evidence that it may support brain energy metabolism and cognitive function under stress. For healthy people, studies up to five years show no serious side effects at standard doses of 3 to 5 grams a day. It doesn’t damage healthy kidneys or liver.

But social media skips past what we don’t know yet and past who shouldn’t be taking it at all.

The new creatine audience — older adults, women in perimenopause, people managing chronic conditions — is exactly the group that faces risks the videos don’t mention. People with kidney disease, diabetes, or high blood pressure should talk to a doctor before starting, because higher doses can stress kidneys that are already vulnerable. People with bipolar disorder should avoid it entirely. One clinical trial found about 12% of patients switched into mania.

Creatine also raises a blood marker called creatinine that doctors use to estimate kidney function. If your doctor doesn’t know you’re taking it, that test can look abnormal. That can lead to wrong doses of medications like lithium or metformin, or getting pulled off a drug you actually need.

Tell your doctor.

Creatine isn’t dangerous for most people. It’s one of the best-studied supplements on the market. But the gap between what the research shows and what’s being sold on social media is wide, and the people in that gap are the ones with the most to lose.

If you’re taking creatine, tell your doctor. Especially if you’re on medications dosed by kidney function. That one conversation is worth more than any TikTok.

• The report checks the boxes. It doesn’t answer the question.

• A perfect score on the wrong test.

• Weight up, blood pressure down. The numbers don’t add up.

• The stroke risk no one is talking about.

• A drug disappeared. A lab value jumped tenfold.

• One physician, no independence, total presidential control.

• What a real assessment would look like.

The report checks the boxes. It doesn’t answer the question.

The White House released a three-page memorandum on Friday evening detailing the results of President Trump’s annual physical at Walter Reed. His physician, Captain Sean Barbabella, declared Trump in “excellent health” and “fully fit to carry out all duties of the Commander-in-Chief.”

The report is thorough by the standards of presidential physicals. Cardiac imaging, blood work, a cognitive screen.

But the question the public is asking is not whether Trump’s labs are in range. It’s whether a 79-year-old president can discharge the powers and duties of the office. That’s a functional question — about judgment, processing speed, decision-making under pressure — and this report does not answer it. Nothing in the structure of presidential health disclosure requires that it does.

Here’s what the report shows, what it contradicts, and what it leaves out.

A perfect score on the wrong test.

Trump scored 30 out of 30 on the Montreal Cognitive Assessment (MoCA). He has now taken this test at least three times in official physicals — in 2018, in April 2025, and now in May 2026 — and by his own account also in 2020.

The MoCA is a 10-minute screening tool. It asks you to name animals from a drawing, copy a cube, draw a clock. A score of 26 or above is considered normal. It was designed to catch moderate cognitive impairment in a doctor’s office. It was not designed to assess fitness-for-duty.

Two problems. First, repeating the same screening test creates a practice effect. You perform better just because you’ve seen it before. The MoCA’s own guidelines say it should not be used repeatedly for longitudinal monitoring. Second, and more fundamental: the MoCA doesn’t test the cognitive abilities that matter most for the presidency. It doesn’t measure decision-making under pressure, processing speed, complex planning, impulse control, judgment under ambiguity, or the ability to adapt when conditions change.

A comprehensive neuropsychological evaluation does. It takes 4 to 6 hours. It’s administered by a licensed neuropsychologist. It’s the standard for fitness-for-duty determinations in airline pilots, nuclear plant operators, and military commanders.

No sitting president has undergone one publicly.

Weight up, blood pressure down. The numbers don’t add up.

Trump weighed 224 pounds at his April 2025 physical. He now weighs 238. That’s a 14-pound gain in 13 months, putting his BMI at 29.7, one decimal point from clinical obesity.

His blood pressure was 128/74 in April 2025 and is now reported as 105/71. On its face, that’s normal. But a 23-point drop in systolic pressure in a patient who gained 14 pounds is paradoxical. Weight gain typically raises blood pressure. The memo lists no blood pressure medication.

The stroke risk no one is talking about.

Trump has no documented cardiovascular disease. His coronary CT angiography was clear. His carotid ultrasound was normal. His cholesterol is well-controlled on two medications.

But he has multiple risk factors for stroke and neurocognitive decline that the report either doesn’t address or actively worsens.

Age and sex. At 79, ischemic stroke risk doubles every decade. Male sex adds further risk at every age.

High-dose aspirin. Trump takes 325 mg of aspirin daily, more than three times the 81 mg most guidelines recommend, and against his own physicians’ advice. He has said publicly that he prefers the higher dose. The memo itself recommends “low-dose aspirin” while the president takes four times that amount.

This matters. The ASPREE trial, which studied 19,114 adults over 70, found that aspirin produced a 38% increased risk of intracranial hemorrhage (bleeding) with no significant reduction in ischemic (blockage) stroke. That was at 100 mg. At 325 mg, the hemorrhagic risk is higher. At his age, high-dose aspirin is more likely to cause a stroke from bleeding than prevent one from blockage.

COVID history. Trump’s medical history includes COVID infection in October 2020, which required hospitalization and experimental treatment. SARS-CoV-2 causes cerebromicrovascular damage through ACE-2 depletion in cerebral blood vessels. In older adults who are overweight or obese, there’s an increased risk of persistent neurocognitive effects from COVID, including processing speed deficits and executive dysfunction.

Obesity and sedentary lifestyle. At BMI 29.7 and gaining, Trump is near the obesity threshold. The memo recommends “increased physical activity,” meaning current activity is insufficient. Sedentary behavior is independently associated with dementia through reduced cerebral blood flow and metabolic pathways.

Obstructive sleep apnea, likely unscreened. No sleep study appears in any of the four memos. Trump’s profile — male, overweight, and 79 — puts OSA prevalence above 50%. OSA is an independent stroke risk factor and causes hippocampal damage via chronic intermittent hypoxia, accelerating cognitive decline.

No brain imaging. No MRI or CT of the head is mentioned in any of the four reports since Trump returned to office. For a 79-year-old with the risk profile described above, this is a significant gap. Silent strokes, white matter disease, and cerebral microbleeds are common at this age and directly predict future stroke and cognitive decline.

A drug disappeared. A lab value jumped tenfold.

Trump was on finasteride, a prostate and hair-loss drug, from at least 2016 through 2020. It disappeared from his medication list in the April 2025 memo without explanation. It’s still absent in 2026. No reason was given.

This matters because finasteride suppresses PSA by approximately 50%. Trump’s PSA went from 0.10 in April 2025 to 1.0 in May 2026 — a 10x increase. A PSA of 1.0 is normal for a 79-year-old. But the jump is not interpretable without knowing the drug timeline. If he stopped finasteride, the rise could be drug rebound. If he didn’t stop it, the rise warrants investigation.

This is the pattern throughout the report: individually defensible data points presented without the context that would allow longitudinal clinical assessment.

One physician, no independence, total presidential control.

There is no legal requirement for the president to release information about their health. Every finding comes from one military physician who serves at the president’s pleasure, with no independent review.

Presidential physicians have a long track record of shading the truth. During Trump’s first term, his physician Dr. Sean Conley admitted he wasn’t upfront about how sick the president was during his COVID hospitalization because he wanted to project an “upbeat attitude.” FDR’s doctors concealed a fatal heart condition. Garfield’s physician lied about the severity of his wounds. Cleveland had secret cancer surgery on a yacht.

The physician’s role is advisory. The actual question of whether a president can do the job is a political judgment that falls to the vice president and the cabinet under the 25th Amendment.

What a real assessment would look like.

Five of nine components of a comprehensive fitness assessment were not done. Brain imaging, comprehensive neuropsychological testing, sleep screening, intracranial vascular imaging, and independent medical review are all absent.

The physical exam tells us about the patient’s body. It does not tell us whether the president can govern.

• Two doctors in Goma, both out of work.

• A collapsing health system.

• Responding with what little they have.

Two doctors in Goma, both out of work.

Dr. Joaquim was a physician at Keshero Hospital in Goma until USAID funding was cut. He was one of the doctors let go. Now he’s unemployed, as is Dr. Raymond, his colleague. Both spoke to me from North Kivu while a Bundibugyo Ebola outbreak, declared a global health emergency on May 17th, spreads toward Goma from neighboring Ituri Province.

A collapsing health system.

USAID was the largest bilateral health donor to the DRC, providing over $838 million in 2024. Over 70% of humanitarian action in the country was U.S.-funded. When that money stopped, Dr. Joaquim traveled to a rural health zone to see what remained. He found empty supply shelves and a chief medical officer who had become a farmer.

“I changed profession,” the chief medical officer told him. “I became a farmer while still being the chief medical officer, because 70% of the supplies I received came from USAID.”

Doctors spent years in training are now growing cassava and fishing. Patients who can’t afford care bring sweet potatoes to the hospital to cover treatment costs. Nurses left alone at their posts carry every responsibility themselves. One doctor now covers 10,000 people.

Free maternity care, funded largely by USAID, ended. Women stopped receiving prenatal kits, deworming, and mosquito nets. Malaria treatment that had been free in rural areas disappeared. Malnutrition, premature births, and maternal deaths followed. “People were dying, frankly,” Dr. Joaquim said.

With hospitals stripped, patients turned to traditional healers. Dr. Joaquim described patients treated at home with herbs, preventable amputations, and complications of peritonitis.

Responding with what little they have.

This is the health system into which Ebola has arrived. The outbreak has reached 134 confirmed cases across the DRC and Uganda, with 18 confirmed deaths. There is no approved vaccine for the Bundibugyo variant. Across North Kivu Province, Dr. Raymond said only two partners have signed on to support the Ebola response in M23-controlled territory. Doctors and nurses are among the dead.

When I asked what worries them most about their capacity to respond, Dr. Joaquim’s answer was brief: personal protective equipment, infection control, and awareness campaigns.

Dr. Raymond put it more plainly: “We will not give up. We’ve always said you must respond with what you have.”

What they have is almost nothing.

She was upset. She wasn’t ranting. She was careful, almost apologetic. But she had a question she couldn’t let go of. Here’s a short clip of our conversation:

Her grandson, Dr. Patrick LaRochelle, has spent most of his career in the Democratic Republic of Congo. He’s 46, an internist and pediatrician, and he works at Centre Medical Evangelique Bunia Hospital in eastern Congo with his wife, Anna, a nurse practitioner. They have three children.

Dr. LaRochelle treated patients with Ebola. He wasn’t infected. But because he’d been exposed, he needed 3 weeks of monitoring in a facility that could handle a high-consequence infection if he got sick. So he was sent to Bulovka Hospital in Prague, not to the United States.

“I wonder why President Trump wouldn’t let him come here,” Stottlemyer told me. “He is a U.S. citizen. And we have plenty of places in this country where he could have been.”

She’s right that the facilities exist. The U.S. has 13 federally designated Regional Emerging Special Pathogen Treatment Centers (RESPTCs). Nebraska’s National Quarantine Unit alone has 20 single-occupancy rooms with negative air pressure, built for exactly this purpose.

But the Trump administration has made its position clear. Secretary of State Marco Rubio said last week: “We cannot and will not allow any cases of Ebola to enter the United States.” The administration’s plan is to quarantine exposed Americans at a facility in Kenya and send anyone who tests positive to Europe for treatment. A Kenyan court has since blocked the facility in Kenya.

Dr. LaRochelle isn’t even sick. He’s asymptomatic, sitting in an isolation chamber in Prague, waiting out the clock. The Czech Republic took him in. His own country wouldn’t.

This is the Bundibugyo strain of Ebola — no approved vaccine, no specific treatment. As of May 28th, the DRC has reported over 1,000 suspected and confirmed cases and more than 200 deaths. The WHO declared it a public health emergency of international concern on May 17th.

Dr. LaRochelle has been doing this work for years. He was evacuated once before, in 2018, for a previous Ebola exposure. He went back. “He has a religious commitment,” Stottlemyer said. “Always he wanted to help other people.”

His colleague, Dr. Peter Stafford, actually contracted Ebola and was evacuated to Berlin in critical condition. Stafford’s wife and four children are being monitored.

“I hate to say anything bad about our government,” Stottlemyer said. She wasn’t trying to make trouble. She just wanted to understand how her grandson could give his career to treating people in one of the most dangerous places on earth, and when he needed to come home for three weeks of monitoring — in a facility built for exactly that — the answer was no.

The WHO declared the Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern on May 16th. As of this week, there are 125 confirmed cases and over 900 suspected cases across three provinces. The virus has reached Goma and Bukavu — major urban centers with heavy population movement — and cases have crossed into Uganda.

This is the Bundibugyo species of Ebola, for which there is no approved vaccine or specific treatment.

I spoke with Dr. Abdou Sebushishe, Senior Health Advisor at International Medical Corps, who is on the ground guiding the response. He describes what Goma could look like in a month — no public gatherings, schools and churches shut down, healthcare workers falling sick, health facilities closing — and makes the case for why the world needs to act now.

What Dr. Sebushishe is asking for is concrete: trained Ebola specialists, isolation capacity, PPE stock not just for Ebola units but for regular health facilities so routine care — childhood vaccinations, maternal health — doesn’t collapse alongside the outbreak response.

The only way to stop this, he says, is strict infection control, rapid isolation, and full community participation. But the community can’t do it alone.

• What I learned on today’s White House presser.

• You don’t need a travel ban to lose the right to travel.

• Four tests. The Kenya facility fails all of them.

• The clinical story doesn’t hold up.

• The distance argument doesn’t hold up.

• The PHS officers didn’t volunteer for this.

• Where the administration’s defense breaks down.

• And more in the news…

What I learned on today’s White House presser.

The Trump administration says it will not bring Americans with Ebola back to the United States. Instead, sick and exposed citizens will be sent to a facility the government is building at Laikipia Air Base in Kenya. Secretary of State Marco Rubio put it plainly at a Cabinet meeting this week: the administration “cannot and will not allow any cases of Ebola to enter the United States.”

In 2014, Americans who caught Ebola in West Africa were flown home. They were treated at Emory, Nebraska Medical Center, the NIH, and Bellevue in New York. These are the best isolation units in the world. Eight of those nine patients survived. The one who died — Dr. Martin Salia, a Sierra Leonean-American surgeon — arrived in extremely critical condition after delayed evacuation.

Now the government is building something else. A White House press call today laid out the details: Phase 1 is a 50-bed quarantine unit, opening May 29th. Phase 2 adds 12 isolation beds and 4 high-level containment beds, but no timeline. The facility will have antibody drugs, antivirals, and respiratory support (supplemental oxygen?). It will be staffed by US Public Health Service officers trained at Andrews Air Force Base.

According to senior administration officials, patients requiring higher level care will be flown to tertiary care centers in Europe, but the administration hasn’t identified which European hospitals would be receiving those patients. And the US isolation units, built with billions of US tax dollars and with a proven track record, will sit empty.

The moral objections are obvious. Dr. Craig Spencer, the emergency physician who survived Ebola in 2014, called it moral abdication. Lawrence Gostin, who directs the O'Neill Institute for National and Global Health Law at Georgetown, called it “reckless, unethical & possibly unlawful.”

You don’t need a travel ban to lose the right to travel.

The Fifth Amendment says the government cannot take away your liberty without due process of law. The Supreme Court has held that the right to travel, including the right to leave the country and come back, is part of that liberty.

In Kent v. Dulles in 1958, the Supreme Court struck down the State Department’s refusal to issue passports based on political beliefs. It held that travel is a liberty interest. The government needs a strong reason and a fair process to limit it. Six years later, in Aptheker v. Secretary of State, the Court struck down a law that barred certain citizens from using passports. Americans have a right to enter their own country, it ruled.

The Kenya policy doesn’t formally bar anyone from coming home. There’s no executive order. No travel ban naming US citizens. But it gets the same result through logistics. If you’re an American health worker who gets Ebola while working in eastern Congo, you cannot get yourself home. You are too sick, too remote, and too contagious to fly commercial. The US government controls the only way out. And it has decided to send the plane to Kenya.

The government isn’t saying “you can’t come back.” It’s saying “we won’t help you come back, and you can’t do it on your own.”

Courts tend to look past the form to the substance. What matters is whether the government’s actions block you from using a right.

Four tests. The Kenya facility fails all of them.

The federal government does have the power to quarantine people to stop the spread of disease. Section 361 of the Public Health Service Act gives the HHS Secretary broad authority to keep communicable diseases from entering the country. That power is real.

But it was designed to set the terms of entry: screening, isolation on arrival, and watched release. It was not designed to stop citizens from entering at all.

The US tested those limits during the 2014 Ebola outbreak. Kaci Hickox was a nurse who treated Ebola patients in Sierra Leone. When she flew back to New Jersey, Governor Chris Christie ordered her held in a tent even though she had no symptoms and tested negative. The ACLU and Yale found the 2014 quarantines were medically unjustified and unconstitutional. West African immigrants in Connecticut sued over their quarantine orders.

From those cases came a set of rules courts now use. Quarantine must be narrow. It must be based on a case-by-case risk review, not a blanket rule. It must use the least harsh option. And it must include basic protections: notice, the right to a lawyer, and the right to fight the order.

The Kenya facility meets none of these. There’s no case-by-case review. The policy covers all Americans in the region. There’s no hearing. There’s no way for an American to challenge where they’re being sent. And it is not the least harsh option: the US has a network of biocontainment units across the country. The government is choosing not to use them.

The clinical story doesn't hold up.

The Fifth Amendment doesn’t just protect procedure. It protects substance. The government cannot act in ways that “shock the conscience,” as the Supreme Court put it in County of Sacramento v. Lewis.

The US has isolation units that are the global gold standard for Ebola care. Eight of nine Americans treated in them in 2014 survived. The Kenya facility, by the administration’s own telling, is like the Monrovia Medical Unit from 2014-15 — a field hospital, not a high-level ICU. The backup care chain hasn’t been built.

Sending Americans to a field hospital with no clear backup plan if patients get worse — a court could find that shocks the conscience.

The distance argument doesn’t hold up.

There’s also an equal protection problem. In 2014, American Ebola patients got the best care in the world. In 2026, the plan is to keep them in Kenya. Same disease. Same kind of people: health workers who went to fight an outbreak. What changed?

The administration says distance. Senior administration officials argued that flying patients to Kenya takes less time than flying them to the US, and faster care saves lives.

But the government said on the same call that it can give antibody drugs during the flight. And antibody drugs aren't the only thing you can deliver in the air. The aircraft used for these evacuations — Phoenix Air's modified jets with containment pods, or the military's systems on C-17s — are flying ICUs. They carry IV fluids, antivirals like remdesivir, drugs to maintain blood pressure, oxygen, cardiac monitors, and portable lab analyzers to track blood chemistry in real time. The time-to-treatment argument gets a lot weaker when treatment starts in the air.

Nearly everything the Kenya facility offers can be given on a longer flight home. What requires a higher level of care? Mechanical ventilation, dialysis, and ECMO (heart-lung bypass machine). The care gap between “on the plane” and “Kenya” is small. The care gap between “Kenya” and “Emory or Nebraska” is enormous.

The flight times make this concrete. From Kenya to Europe, where the administration says tertiary patients will go, it's 8-9 hours. From Kenya to the East Coast, it's 13-15 hours, 5-6 hours longer. If a patient is stable enough to fly 8-9 hours to an unnamed hospital in Europe, they are stable enough to fly 13-15 hours to Emory or Nebraska — on a plane that can deliver ICU-level care the whole way. In 2014, direct flying time from Monrovia to Atlanta was roughly 10-11 hours, with fuel and crew stops adding to the total journey. Every patient who was evacuated to the US survived the flight.

Senior administration officials answered that keeping Ebola out of the US and giving good care are “not mutually exclusive.” If a court finds the routing choice is driven by politics, the equal protection claim gets stronger. The government is treating the same kind of people differently based on the political mood, not the medical facts.

The PHS officers didn’t volunteer for this.

Thirty-plus Public Health Service officers trained at Andrews this week and deployed to Kenya Wednesday night. More are training this weekend. If any of them get sick, they will depend on the same field-level facility the government just built.

The government-created danger doctrine, recognized in several federal courts, says that when the government puts someone in danger through its own actions, it takes on a duty of care. These officers are being sent into an Ebola zone by federal deployment. The government built the care system they’ll rely on. And that system, as described, tops out at field-level isolation, with a backup plan that leads to unnamed hospitals in Europe.

If an officer gets sick and the system fails — if the backup hospital hasn’t been lined up, if the flight to Europe takes too long, or if the field unit can’t handle a critical case the way Emory or Nebraska could — the government faces a claim that it created the danger and then failed to provide the care.

Where the administration’s defense breaks down.

The most likely legal fight starts with the American Foreign Service Association, which has already called on the State Department to bring exposed workers and their families home. A lawsuit filed for a sick or quarantined American in Kenya might argue:

First, that the policy takes away a protected liberty, the right to come home, without due process. No notice, no hearing, no case-by-case review, no way to fight the decision.

Second, that the government has less extreme options, domestic biocontainment units, and is choosing not to use them for political reasons.

Third, that the policy shocks the conscience: turning citizens away from better care in their own country, without a clear backup plan.

The administration might defend based on the Public Health Service Act, the president’s broad power over foreign affairs and military operations, and the medical case that being closer to the outbreak zone means faster care. The administration may think it’s safe because no document says “Americans cannot return.” But the Constitution doesn’t need a signed order to apply. It kicks in whenever the government takes away your liberty.

And more in the news…