The Trump administration has initiated a series of executive orders that have created significant disruption in global public health efforts. The President recently announced the United States' withdrawal from the World Health Organization (WHO) and directed Centers for Disease Control and Prevention (CDC) employees to cease communications with the organization. In addition, a 90-day funding pause has been implemented for US foreign development assistance to evaluate "programmatic efficiencies and consistency." These actions have sparked considerable concern across the international public health community, with experts warning of severe repercussions.
The United States' contribution to global health funding reached approximately $12.4 billion in 2024. Around 40% of this funding supported the President's Emergency Plan for AIDS Relief (PEPFAR) and other HIV programs, crucially providing treatment for over 20 million individuals in more than 50 countries. However, the recent directives have cast uncertainty over these vital programs. Amidst the turmoil, the Trump administration has placed several officials at the US Agency for International Development on leave, while a stop-work order from the State Department has halted foreign aid work. Consequently, organizations abroad have been instructed to cease distributing HIV medications purchased with US aid.
"It's basically a declaration of war on public health," said Gostin, reflecting the sentiment of many in the international health sector.
The US allocated nearly $5 billion to PEPFAR in 2024 alone. While this figure represents a significant investment in global health, it remains a small fraction of the total US budget, which amounted to roughly $6.8 trillion in fiscal year 2024. Despite its relatively modest share of overall spending, the funding pause is expected to have an immediate chilling effect on international-based health initiatives and could ultimately erode trust in the United States' commitment to global health.
"The United States is no longer going to blindly dole out money with no return for the American people," a spokesperson for the State Department explained, underscoring the administration's stance on foreign aid.
Experts contend that the abrupt halt in funding and communications will have far-reaching consequences. Michael Merson noted that the US provides substantial support not only for HIV programs but also for malaria, global health security, maternal and child health, tuberculosis, family planning, and nutrition. The disruption to these programs could hinder progress in combating these critical health issues globally.
"We also give quite a lot of support for malaria, for global health security, for maternal and child health, for [tuberculosis], for family planning and for nutrition," stated Merson.
The crisis has emerged from a flurry of executive orders and surprise actions by the Trump administration, leaving the international public health community grappling with uncertainty. Experts warn that restarting these interrupted programs will not be straightforward.
"It's not as though you can just flip a light switch and turn them back on," Cappello remarked, highlighting the complexity of resuming halted operations.
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