US-affiliated islands facing greater risk

Microwaves By Jack Niedenthal

Majuro—The United States-Affiliated Pacific Islands (USAPI) have always counted on the Centers for Disease Control and Prevention and other U.S. government health organizations for help during public health crises. During our recent dengue and Covid-19 outbreaks in the Marshall Islands, U.S. support was an absolute lifeline.

But under the current climate of U.S. federal workforce reductions, including cuts to the CDC and other health agencies, the USAPI is facing a growing threat to its ability to handle serious health crises.

According to Dr. Anne Schuchat, former acting director of the CDC, the situation is nothing short of a “five-alarm fire.” She warns that “the kinds of changes that are happening are going to take decades to recover from, and many people will die because of these interruptions.” This dire assessment highlights the severity of the current cuts, which are not just a matter of budget adjustments but represent a profound crisis with life-threatening consequences for all of us in the region.

The USAPI includes the Marshall Islands, the Federated States of Micronesia, Palau, the Northern Mariana Islands, Guam and American Samoa. These islands are spread across a vast ocean, but share close ties through trade, travel and culture. Despite these connections, we face big challenges in healthcare.

Many of our under-resourced islands rely on support from the United States to keep their health systems running smoothly. For decades, agencies like the CDC, the U.S. Department of Health and Human Services, and USAID have helped strengthen our local healthcare capacity, providing training, funding, and direct support during health emergencies.

The current cuts to the CDC and other U.S. health agencies are not just about budget reductions—they are dismantling a critical support system that the USAPI has depended on for decades. Positions are being eliminated, programs are scaled back, and funding is slashed. This is not a case of overreacting or “Chicken Little” alarmism.

As a former secretary of health for the Marshall Islands, I have seen the impact firsthand. I am an alumnus of the Association of State and Territorial Health Officials, a network of experienced health leaders across the United States. We once met quarterly to discuss public health challenges. Now, these calls are held monthly, and the mood has shifted dramatically. The voices on these calls—veterans of American public health—are filled with fear, frustration, and anger. They are watching the slow erosion of the systems they helped build.

Nowhere is this impact more evident than in the potential loss of CDC’s technical support. For years, CDC experts have been the backbone of our region’s public health response, providing hands-on guidance during outbreaks, training local health workers, and helping us conduct emergency preparedness exercises. In the Marshall Islands, this support was a lifeline.

Our weekly CDC calls during the 2019 dengue outbreak expanded to include all USAPI countries when Covid-19 struck, providing critical expertise for more than two years across 120 sessions. Without such support, our already overburdened health departments would have been left to navigate these crises alone.

Michael Beach, former CDC deputy director of the Division of Foodborne, Waterborne, and Environmental Diseases, put it bluntly: “They’re decimating CDC. They’re decimating public health in the states. That’s not efficient — that’s shooting yourself in the foot.”

The loss of training is another critical issue. For years, CDC programs ensured our health workers stayed current on disease detection and treatment. With these programs cut, our workers risk losing vital skills needed to combat emerging health threats—a serious concern in a region where diseases can spread rapidly. When Covid-19 finally reached the Marshall Islands in August 2022, CDC reported that our infection rate was the fastest in the world, outpacing other countries by a factor of seven.

The cuts have also crippled essential laboratory support. In the past, the CDC and other U.S. agencies provided lab equipment, training and direct diagnostic support for diseases like dengue, tuberculosis and Covid-19. With shrinking budgets, this support is fading, forcing USAPI health departments to send samples abroad for testing, a process that can take weeks, delaying diagnosis and treatment and making it harder to contain fast-spreading diseases.

Dr. Daniel Pollock, a retired CDC branch chief, captured the frustration: “It’s been so deeply undermining of people’s lives, of the agency, of the mission.”

These cuts also mean that the USAPI has lost a valuable safety net for pandemic preparedness. The CDC and other U.S. health organizations used to help support our governments develop and update their emergency response plans, identifying gaps and running practice exercises to make sure everyone was ready. But without that guidance, our health departments are left to figure things out on their own.

This isn’t just a problem for public health — it’s a problem for U.S.-USAPI relations. Through the Compact of Free Association, the United States has a special responsibility to help the USAPI with defense and public health. But as the U.S. government cuts back on public health support, USAPI countries may have to look for help elsewhere. This opens the door for other countries, like China, to step in and offer health assistance, which can shift the region’s political balance.

Trust is another casualty of these cuts. For a long time, USAPI governments saw the United States as a reliable partner in public health. But as CDC and other health agencies lose capacity, that trust is starting to erode. If USAPI countries can’t rely on the U.S. during health crises, we may start to question the value of our partnership.

Looking ahead, the current cuts to CDC and other U.S. health agencies should be a wake-up call. They show how quickly public health capacity can be lost and how vulnerable the USAPI is without strong support. If another pandemic-like outbreak hits, our region could be left struggling to respond.

To prevent this, the United States needs to restore funding and staffing to the CDC and other health agencies, making sure they can continue to support the USAPI. But here in the islands, we also need to build our capacity, investing in local training, better diagnostic labs, and stronger health systems that can stand on their own.

In the end, the cuts to the CDC and other U.S. health agencies are putting the USAPI at greater risk. Without the training, expertise, and emergency support they once had, our islands are more exposed to health threats than ever before. As Dr. Kenneth Castro, a former assistant surgeon general and CDC alum, warns, “Many people who would have been here have been RIF’ed.”

Rebuilding trust and support should be a priority for both U.S. and our USAPI leaders because in a world where new health threats are always emerging, being prepared is our only way to stay safe.

Jack Niedenthal is the former secretary of Health Services for the Marshall Islands, where he has lived and worked for 43 years. He is the author of “For the Good of Mankind, An Oral History of the People of Bikini,” and president of Microwave Films, which has produced six award-winning feature films in the Marshallese language. Send feedback to jackniedenthal@gmail.com

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