How USAID’s elimination hit US efforts on cyclospora

When the Trump administration and Elon Musk’s Department of Government Efficiency (DOGE) dismantled the U.S. Agency for International Development (USAID) last year, it set off a chain of events that is still being felt in the sluggish federal response to a record number of cyclosporiasis infections.  

USAID helped fund key divisions of the Centers for Disease Control and Prevention (CDC), such as the Division of Parasitic Diseases and Malaria. Much of that division was focused on the President’s Malaria Initiative (PMI), a program to combat malaria abroad, as well as other programs to fight neglected tropical diseases. 

PMI was run jointly by the CDC and USAID. The money supported lab and epidemiological work in the field and at the agency. 

But when USAID was gutted, the CDC suddenly found itself with a $30 to $40 million hole in its budget that needed to be plugged.  

“That’s more than half of the amount of money that they get, so that’s a significant cut in funds,” said Daniel Jernigan, former director of the CDC’s Emerging and Zoonotic Infectious Disease division. “So last year, when I was still there, we had to make difficult decisions.” 

The remaining parasitic and malaria funds had to be stretched to cover all the money that was lost from USAID. Cyclospora work was collateral damage. 

“The cutting of USAID funds for malaria and neglected tropical diseases were on top of an insufficiently funded base, essentially disabling the group to where they could not perform optimally for the cyclospora surge,” Jernigan said.  

The CDC would typically bring in additional staff with different areas of expertise to help with a large parasitic outbreak, but Jernigan said those people no longer work at the agency.  

Because of the Trump administration’s hiring freeze, expert scientists weren’t allowed to renew their term employment and were removed from the CDC, Jernigan said.   

Staff left because of DOGE’s “fork in the road,” and contractors were let go because there was no malaria and neglected tropical disease funds to pay them. 

Should an expert leave or be cut, “you can’t take someone from down the hall” and just put them in the empty lab, said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota and has helped investigate previous cyclospora outbreaks. 

“It’s not just do you have a person there, but what is that person’s expertise?” Osterholm said. 

Nationwide, the CDC said it has confirmed 4,173 cases of cyclosporiasis since May 1, though some states are seeing much higher case numbers than others. The worst year in the U.S. for infections was 2019, when about 4,700 illnesses were reported, according to federal data on confirmed and suspected cases.  

The CDC is investigating more than 7,400 additional cases that are not yet laboratory confirmed.

Many of the additional illnesses have been reported by Michigan and Ohio, and health officials and experts have said that the actual number of infections is likely higher.  

Osterholm said the federal response has been much slower than it should be, because the CDC is taking too long to process samples and determine if there are multiple strains of the parasite. That can help determine which cases are linked. 

The worst of the outbreak has been concentrated in the Midwest, but without additional information from the CDC, it can seem more widespread, Osterholm said.  

“This is a complicated outbreak, and it’s likely more than one source causing it. It’s hard to discern if we’re seeing hundreds of cases, but in three outbreaks caused by three different sources, or just one,” Osterholm said.  

For instance, there are case clusters in states on the West Coast, but no evidence that they are tied to the outbreak that’s sickened thousands of people in Michigan, Ohio, West Virginia, Indiana and Kentucky. 

The Food and Drug Administration (FDA) has linked the outbreak across those five states to iceberg lettuce from Taylor Farms facilities in Mexico. The lettuce was supplied to Taco Bell locations in those states, as well as selected Walmart locations across the country.  

The company has since issued a recall of a variety of packaged products containing iceberg lettuce across 27 states that were sourced from central Mexico.   

The illnesses are caused by cyclospora, a parasite transmitted through contaminated food and water. Health authorities do not have a definitive answer to what products are making people sick.      

Acting FDA Commissioner Kyle Diamantis told reporters on Monday the agency is investigating several “subclusters” of cyclosporiasis cases across the country.  

Still, Health Secretary Robert F. Kennedy Jr. said Tuesday the outbreak was “under control.”   

Updated at 7:23 a.m. EDT

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