US Funding Cuts Imperil Global Health

Billions in cuts to US health programs threaten decades of progress against malaria, HIV, food insecurity, and more. What’s next?

Since early 2025, US President Donald Trump has garnered considerable attention for his rapid-fire policy changes, including record-high tariffs and immigration raids. Some of his most significant changes to US policy, however, had little to do with border security or trade. Instead, they involved fundamental changes to America's global health involvement. These included Executive Order 14169, a 90-day freeze on international aid, and cuts by Elon Musk, Trump's government efficiency tsar, to US agencies involved in global health efforts, like Health and Human Services (HHS) and the State Department.

Global health was already in crisis following the COVID-19 pandemic. In addition to causing over 20 million excess deaths, the pandemic has driven stark increases in inequality and poverty, as well as healthcare disruptions and drops in vaccine uptake. Beyond COVID, the world is also facing several other new threats, like falling birth rates and antimicrobial resistance. Now, with the United States, the single largest source of international aid, withdrawing from the world stage, the situation is deteriorating.

Within months of Trump taking office, the new president’s policies had disrupted or shut down most of the US’s international aid programs. Many of the slashed initiatives targeted diseases responsible for millions of deaths each year—HIV, Malaria, Tuberculosis—and other issues like food insecurity and maternal mortality. The primary administrator of most American global programs, the US Agency for International Development (USAID), was dissolved entirely.

The changes were so severe that Trump himself called them “devastating.” He also acknowledged that issues previously targeted by US aid amounted to “a tremendous problem” while calling for other governments to step up. However, aside from mentioning conversations with other nations, Trump offered little in the way of progress to fill the gaps left by his cuts.

Americans gather to protest cuts to USAID. Source

There are, of course, legitimate concerns about USAID spending. Foreign aid is often misspent by local governments or even given to groups linked to terrorist governments, especially by agencies operating in war zones such as UNRWA. Significant improvements in terms of grant transparency and oversight are needed. Even program-wide funding cuts and pauses for review could become necessary. However, for every misspent dollar, many more go towards lifesaving emergency relief.

Trump’s Secretary of State, Marco Rubio, a long-time supporter of US global health programs, offered more concrete reasoning for spending cuts. In a Substack post, Rubio justified the dissolution of USAID as putting an end to “a near-infinite taxpayer budget” and “government-sanctioned inefficiency.” He discredited much of the agency's work, saying little progress had been made since the Cold War. Instead, Rubio alleged that many aid programs promoted “anti-American ideals” and “censorship and regime change operations."

However, these arguments for the dissolution of USAID merit significant criticism. For one, despite Rubio’s claims of “near-infinite” spending, USAID accounts for just 0.3% of the US budget. Currently, public opinion favors foreign aid spending of over 10%. Much of the support for aid cuts may simply come from people overestimating spending.

The US public is generally supportive of some foreign aid and vastly overestimates the scale of spending. Source

For another, many USAID cuts are difficult to justify as ending “anti-American ideals,” “censorship,” or “regime change.” For example, one of the organizations affected, Gavi, the Vaccine Alliance, paid for the vaccination of over one billion children. The US—the second largest national donor to Gavi after the UK—is eliminating $1 billion in funding for these vaccines. In another example, the President’s Malaria Initiative lost some $400 million in funding. Malaria programs were some of the US’s most lifesaving international health initiatives. They were only becoming more critical due to the disease’s expanding range, amplified by global warming and the spread of heat-resistant mosquitoes.

These are not cherry-picked examples. Reviewing the overall USAID budget reveals that a significant portion of its funding went towards emergency food relief or disease control. Now, around 80% of the agency’s global health awards have been cancelled, including 86% of maternal/child health and nutrition funding, 80% of malaria awards, and 79% of TB funds. Even though the global health category accounts for 12% of cancelled grants, it contains a majority of the $27.7 billion in spending cancelled.

Cuts to US international aid heavily affect global health programs. Source

Even more dubious are Rubio’s claims about USAID backing regime change and failing to make progress since the Cold War. After all, the US backing of regime change primarily occurred during the Cold War. Meanwhile, some of the few USAID programs saved under Rubio were ironically focused on undermining the current regime in Cuba.

Arguments about USAID's supposed failure since the Cold War further weaken when analyzing the benefits of its recent global health programs. The agency saved an estimated 91 million lives from 2001 to 2021—roughly a third being young children—largely due to now terminated or reduced programs combating HIV and diarrhoeal diseases. At the same time, aid cuts are creating previously unheard of forms of inefficiency, such as spending taxpayer dollars to burn 500 tons of food. After comparing these statistics to the relative lack progress by the Cuban regime programs, Rubio’s statements about efficiency become hard to reconcile with his actions.

USAID has saved tens of millions of lives, primarily by combating HIV/AIDS and various other infectious diseases. Source

PEPFAR cuts

Of the many programs and funds impacted, few are comparable to PEPFAR, or the President’s Emergency Plan for AIDS Relief. Far from being “inefficient,” PEPFAR was America’s flagship global health program and among the most successful public health initiatives in history. Before 2025, it enjoyed widespread bipartisan support, including from Marco Rubio himself. It still holds one of the strongest track records out of any US government program, accounting for over 25 million deaths prevented.

PEPFAR has been a primary source of funding for the global fight against HIV for decades. With an annual budget of less than $10 billion, it supports over 300,000 healthcare workers, treats nearly 21 million people with HIV, and provides testing to almost 84 million more. PEPFAR's budget has also not increased in recent years, except for a one-year surge during COVID-19, yet continues to progress. For example, PrEP prevention for HIV initiated by USAID has octupled since 2020, supporting 2.5 million people in 2024. 

Unsurprisingly, the disruption of PEPFAR prompted significant outcry, including from members of the president’s own party like Lindsey Graham and Susan Collins. It has also triggered multiple lawsuits over its shoddy implementation. It didn’t help that the cuts had messy, possibly unintended side effects. Elon Musk, who had a stint under Trump overseeing spending cuts, appeared unaware that deaths had occurred as a result. He also admitted to the accidental elimination of Ebola prevention programs, though those have yet to be restored, as he claimed.

Elon Musk wields a chainsaw symbolizing his spending cuts, which included Ebola prevention programs. Source

In response to PEPFAR-related backlash, Rubio issued a waiver for specific programs to continue, but even this had limited effect. Global Health Council President Elisha Dunn-Georgiou claimed that waivers were “not working” and aid organization MSF could not find “a single organisation able to resume work.” Concerningly, a KFF analysis concluded that around 71% of HIV-specific awards had still been cancelled, including nearly all of those funding prevention efforts. 

On the ground

In the wake of the US funding cuts, chaos has followed, hitting Africa particularly hard. As expected, funding cuts are proving particularly devastating for countries in Southern Africa facing some of the highest HIV rates in the world, like Lesotho and South Africa. 

HIV clinics like the one above have closed en masse due to US funding cuts. Source

South Africa has already reported a 21% drop in viral load testing for vulnerable groups, a development that four experts linked to US funding cuts. With little warning, healthcare and relief workers who had spent years on the frontlines suddenly found themselves unemployed and unable to reach patients.

HIV-affected children, still numbering in the hundreds of thousands in South Africa, also faced an uncertain future as support from US-backed groups like the Crystal Foundation dried up. While the local government provides much of the HIV treatments these children need, other forms of help, like food assistance and family support, disappeared without American aid. Other non-treatment programs like the Greater Rape Intervention Programme (GRIP), which reached thousands of sexual violence victims, were also shuttered.

Elsewhere, the World Health Organization (WHO) revealed that eight countries, including Nigeria and Kenya, faced shortages of HIV drugs. WHO Director Dr. Tedros Ghebreyesus warned the abrupt disruption could reverse decades of progress, sparking millions of additional HIV infections and deaths.

Shortages of HIV drugs are already a widespread problem following USAID cuts. Source

Meanwhile, HIV services in Mozambique and Zimbabwe have been reported to be at a standstill, and USAID clinics in Malawi, Uganda, and Lesotho are closing despite waivers. Bans on “gender and DEI programs” are affecting efforts to reach girls and treat transgender HIV patients in Africa, demographics with some of the worst AIDS rates in the world. 

People vulnerable to non-HIV diseases are at risk, too. At least 1.2 million people in war-torn Congo are now at risk of losing support, threatening efforts to combat a rising mpox epidemic and reach people in conflict zones. Efforts to fight cholera, malaria, and measles in conflict-ridden Sudan were similarly imperiled, putting 600,000 more at risk.

Research cuts

Beyond international aid, the Trump administration's elimination of countless research projects could have similarly devastating effects on global health. 2025 has seen massive cuts to NIH research grants, targeting those with flagged words like “vaccine” and “mRNA.” In one case, amidst record bird flu outbreaks and warnings that the virus could spark a pandemic, the US ended a contract researching mRNA vaccines for multiple bird flu strains. Considering bird flu’s effects on human and animal health, as well as the potential of flu pandemics to cause millions of deaths, the project’s cancellation could have severe effects down the road.

In another development, $258 million in funding for the Center for HIV/AIDS Vaccine Development was cut. While vaccines and treatments sponsored by PEPFAR currently make the most difference against the disease, an effective vaccine could provide a much more permanent solution to the 40-year HIV epidemic and allow the US to reduce foreign aid without risking millions of deaths.

Duke University is one of many prestigious US institutions that lost funding for lifesaving global health research. Source

The future of scientific progress in areas targeted by these research initiatives now looks increasingly uncertain. While other nations and NGOs can theoretically step up to replace the US in financing low-tech international aid, research is not so simple. The US’s technological prowess, famed research institutions, and concentration of top experts from across the globe put it in a unique position to create high-tech solutions to global health issues. With its contributions gutted, the potential impact on public health everywhere is hard to overstate.

Deadly consequences

All of these are just snapshots into the undeniable bigger picture: at the cost of saving less than 0.3% of US spending, global health is facing an unprecedented crisis that puts millions of lives at risk.

Even if all current funding cuts are temporary, it doesn’t change the fact that the infrastructure set up by US health programs was decades in the making, making the consequences of even a brief funding pause far from temporary. The disruptions caused by the initial total shutdown of global health spending, followed by 80% cuts, cannot be understated: hospitals closed, already paid-for shipments sitting in warehouses, long-time personnel fired, and computer systems shut down.

None of these changes are easy to quickly reverse if funding returns to normal, let alone with the current shoestring budget. Additionally, due to the scale of PEPFAR efforts, even the current short-term pause is devastating. As of mid-July, the estimated death toll from USAID cuts in six health areas had already exceeded 360,000, including over 240,000 children. Another 88 deaths are expected every hour.

While these numbers may sound unbelievable, they are actually relatively conservative estimates, excluding some major health threats and overlooking the benefits of specific programs like Malaria testing. If current trends continue until 2030, estimates based on all-cause deaths indicate a resulting death toll of 14.1 million, including over 4.5 million children under the age of five.

USAID cuts could cost over 14 million lives by 2030 if not reversed. Source

The sheer scale of such a rise in mortality is difficult to comprehend. Decades of progress in reducing maternal mortality, HIV death rates, and other significant causes of death would be undone in just a few years. Of course, fatalities alone do not capture the whole picture. Economic turmoil and collateral damage to communities and healthcare systems could prove even more significant than the initial wave of death.

If the deaths abroad aren't a compelling enough reason to restore funding or create a sustainable USAID replacement, US leaders should also consider their own self interest. Many of the diseases addressed by US aid are contagious, and in the era of modern air travel, an outbreak anywhere can become a problem everywhere. As shown by HIV, mpox, and Ebola, regions most affected by USAID cuts are hotspots for nightmarish viruses that can reach American shores. Cuts to vaccine initiatives like Gavi also raise the threat of older diseases like measles (currently at a 30-year high in the US). Leaders should also consider that increases in disease are often linked to political instability, which could increase the need for future US intervention.

Another less obvious potential consequence of cutting global health spending comes from the evolution of common viruses in immunocompromised patients, such as HIV patients. During the COVID-19 pandemic, dangerous new COVID variants likely evolved in immunocompromised people. Similar phenomena may occur with other viruses, like norovirus and influenza. If the US cares to avoid a repeat of the deadly Delta and Omicron variants of COVID, its current negelect of global health cannot be continued.

The world must step up

There is no question that the United States’ retreat from global health will leave behind a deadly vacuum. However, while restoring US funding would be the easiest and fastest way to avert catastrophe, such a reversal is far from certain. Support for cutting foreign aid is falling, but there remains limited public awareness of the impact of aid cuts, let alone widespread outcry.

Until circumstances change in the US, other nations have a major role to play. Several countries already spend similar or greater amounts per capita on foreign aid to the US, and can step up further. However, the key to sustainable globa health financing may lie with East Asian economic powerhouses like China, Japan, and Korea, that lag behind in foreign spending. Together, these nations can likely prevent the worst-case scenario of over ten million deaths. One example is the current mpox outbreak in Africa, where millions of donated vaccines from Japan are being deployed to fight the virus.

A map of global health finance recipients. Source

The unfortunate reality is that the US and other wealthy nations often view international aid as charity, not shared security. The long-term benefits of global health investments are easy to overlook in favor of short-term spending cuts and political gains. As such, poorer countries cannot depend on others for assistance when it comes to the health of their citizens. This means long-term campaigns to improve health on a community level, government reform, and greater investment in healthcare systems, all while building more sustainable international partnerships. 

Low- and middle-income countries can also assert global health leadership by coordinating amongst themselves, sharing medical resources when possible, and putting more towards health spending. International cooperation through ASEAN, the Africa CDC, and other similar organizations is already a reality, and can be extremely useful if expanded upon in the context of public health.

However, just as the most successful US programs saved lives over decades, none of these steps can immediately replace what the US once provided. For millions of patients previously supported by the US, change will come too late. Death on a massive scale is already here, not because we lack the tools to stop it, but because we choose not to use them. Before the damage increases further, the US must recognize that it isn’t merely financing a far-flung humanitarian crisis. Slashing funding today could bring tomorrow’s crisis to our doorstep.