For decades, the United States has been among the largest donors of international health assistance, the mainstay for many programmes committed to fighting the most infectious and devastating diseases; building health workforce and health facilities; and providing a better outlook on maternal and child health across the world. The US has, therefore, been instrumental through initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR), contributions into the Global Fund, and a wide range of health programmes initiated by USAID in mortality reduction and keeping off global pandemics.
Recent decisions by the US government to cut funds for international assistance have caused much consternation among the ranks of the world health community. The rationales vary—from an economic interest perspective to a changing-of-the-guard political agenda—but the impacts go far beyond national borders. Such actions are threatening to dislodge gains made so far against diseases, put particularly vulnerable populations in an extremely tenuous position, and further weaken global health security at the worst time.
As the world wrestles with emerging and re-emerging health threats, the reduction in US aid raises but one critical question: What happens when the world’s most powerful nation steps back from its leadership role in global health?
Traditionally, the US government has been on the front line in investments into global health, which sees billions of dollars every year going towards life-saving interventions. For example, PEPFAR has provided life-saving anti-retroviral treatment to more than 20 million people living with HIV/AIDS around the world. The Global Fund to Fight AIDS, Tuberculosis, and Malaria, to which the United States is the largest contributor, has saved an estimated 50 million lives. GAVI, the Vaccine Alliance, has immunised millions of children in low-income countries against deadly diseases that otherwise would have consumed immeasurable lives.
Beyond that, specific programmes have been enacted using US funding to strengthen health systems, better train health workers, and support the early identification of infectious disease outbreaks. The investment has paid dividends not only for developing nations but also for global stability in reductions in the spread of epidemics.
Malaria-related deaths have fallen drastically, HIV is no longer the death sentence it once was, and maternal and child mortality rates have dramatically declined. Yet these hard-won gains are now in jeopardy.
Similarly, cuts to tuberculosis and malaria programmes will result in fewer people being treated, meaning that drug-resistant TB will spread much more quickly than current rates, and cases of malaria will surge when control measures are weakened.
Equally alarming are the overlooked consequences of cuts on maternal and child health. In countries with extremely high maternal and neonatal mortality rates, these cuts can literally equate to a death sentence for many mothers and their children.
But perhaps most saliently, it will be the impact on global health security. The COVID-19 pandemic underlined the fact that diseases respect no borders. The US has been a major funder of pandemic preparedness, including programmes in disease surveillance and rapid response. A reduction in funding means many countries will be in a precarious situation against any outbreaks in the future.
While the short-term results of these funding cuts can already be predicted, the long-term impacts could be a whole lot worse: global health systems that are dependent on heavy external funding will not be able to continue with essential services.
Without US funding, developing nations will have to reallocate limited resources from other basic sectors, like education and infrastructure, to merely keep healthcare services functional. Weakened health infrastructures can only make dealing with future health crises so much more difficult.
Moreover, gains achieved over the past twenty years in the fight against diseases like polio could be rolled back. Weakened immunisation programs could result in outbreaks of vaccine-preventable diseases, which would not only affect developing countries but also the rest of the world.
Beyond the health ramifications, cuts in international aid also bear geopolitical and economic importance. For a long time, the US has used foreign aid as one tool for maintaining good relations and the cementing of alliances. The moment such funds are cut, the resultant vacuum will be filled instantaneously by other global powers, particularly China and Russia, that are increasingly flexing muscles of influence across Africa and other developing regions.
For example, China has aggressively increased its investments in the African continent through the Belt and Road Initiative, often linking infrastructure development with health diplomacy. The vacuum created by the US will continue to provide China and other countries with more elbow room to influence developing countries and, in the process, reshape global power dynamics.
Besides, US industries, especially the pharmaceutical and healthcare industries, benefit greatly from these global health investments. American companies are involved in vaccine production, medical research, and global health infrastructure projects. Reduction of aid hurts not only the economy and labour market of the recipient countries but also that of the United States.
Most times, health crises lead to economic downturns, food insecurity, and migration crises—all contributing to social unrest and political instability. Certainly, a weakened global health system is not only a problem for developing nations but has direct implications for global security and economic stability.
Confronted with such devastating consequences of the cuts, policymakers, global health advocates, and civil society organisations should make a case for a rethink of US foreign assistance priorities. Investment in global health is a moral imperative, but it is also one that is very strategic.
In order to mitigate the impact, some measures need to be considered:
Alternative funding mechanisms: Greater collaboration will be needed from governments, private sector partners, and philanthropic organisations in order to fill funding gaps.
Stronger advocacy: A greater rationale must be articulated by public health experts and advocates for the United States’ continued investment in global health, emphasising its humanitarian and national security benefits.
Increased domestic investment: As important as international aid is, developing countries must also work toward building more self-sufficient health systems through local investments and policy reforms.
This decision by the US to cut funding for international aid is ostensibly on account of domestic policy but should not be taken in isolation since its repercussions are global. This isn’t only about budget shift; it is the long-term implications of withdrawing from health diplomacy: millions of lives hang in the balance, hard-earned public health victories could be reversed, and geopolitical stability undermined.
The world has witnessed the benefits of strong and well-funded global health initiatives and the dangers of neglecting them. With new health threats continuing to emerge, the US should recognise that investment in global health is not a matter of charity but one of the essential pillars of global security and economic stability.
Today, more than ever, the world is in need of strong leadership for global health. The United States has the unique opportunity to reiterate its commitments toward international health initiatives not just for the sake of the developing countries but also for its own strategic and economic interests.
This isn’t a question about whether U.S. aid matters. The reality is—it does. It is more of a question of whether the U.S. is willing to step up and continue leading from the front in the fight for a healthier, more stable world. The answer to that question is what will define the future of global health for generations.