The Cost to Global Health
Cuts to U.S. aid funding will have ramifications abroad—and at home.
The WHO’s declaration of smallpox eradication in 1980 was a high-water mark for public health.
Bullish on their success, the global public health enterprise turned to another threat: polio. Eliminating polio would require not only widespread vaccination but also widespread laboratory capacity so countries could monitor the health of their populations. Throughout the 1990s and 2000s, funding from the U.S. and international partners like the WHO helped to build testing facilities around the world and train scientists to run them, including in Nigeria, Africa’s most populous country.
These labs didn’t just test for polio. They could perform surveillance and testing for other infectious diseases, too. The $20 billion invested by WHO and UNICEF (which included funding from U.S. coffers) began paying dividends in the fight against infectious diseases like Lassa fever and bacterial meningitis.
Then the Ebola virus began circulating in west Africa’s urban centers in 2014. The outbreak sickened over 28,000 and killed 11,000, with nearly all cases concentrated in Sierra Leone, Guinea, and Liberia. Neighboring Nigeria logged 20 cases but never had any sustained transmission, even in the megalopolis of Lagos, where disease spread could have sparked a worldwide outbreak.
A major reason Nigeria dodged the worst of Ebola was because of the country's emergency operations center, which was originally established to support polio eradication, says Joseph Amon, PhD, MSPH, director of the Center for Public Health and Human Rights and distinguished professor of the practice in Epidemiology. Researchers could perform the intensive testing and surveillance needed to identify potential cases before they had a chance to spread. Infrastructure investments meant local hospitals had access to adequate PPE and other supplies to reduce transmission at health care facilities, too.
America’s withdrawal from the WHO and retreat from investing in the global health enterprise this year put these capabilities at risk. Cuts to global health programs at USAID and in other countries will not only directly and quickly impact the transmission of diseases like TB and malaria, but ripple effects of the loss of global public health infrastructure will persist for decades, says Judd Walson, MD, MPH, the inaugural Robert E. Black Chair of International Health. The next explosive virus outbreak may be harder for many countries to dodge—and these impacts will also be felt right here in the U.S., he says.
“In the interest of our own security, we need to know what’s happening, and then we need to be able to mount an effective response if something occurs,” says Walson. “And that, of course, requires careful surveillance, monitoring, and having the ability to know what’s happening in very remote parts of the world and in countries with whom we don’t have great diplomatic relations.”
Much of U.S. global health funding comes from the country’s broader foreign aid budget. In fiscal year 2024, this budget totaled $12.4 billion, less than 1% of the total federal budget of $1.6 trillion. Though a small portion of total government spending, American global health efforts play a key role in the country’s health security, says Erin Sorrell, PhD, MSc, a senior scholar at the Johns Hopkins Center for Health Security and an associate professor in Environmental Health and Engineering. By cutting this funding, “we have essentially dismantled over half a century of partnerships, programs, and investments in a variety of public health forums and initiatives,” she says.
The security implications for the world and the U.S. are vast. USAID distributed three-quarters of all U.S. global health aid, and the abrupt termination of funding from the organization has halted critical emergency distributions of food and medical aid in Yemen, Afghanistan, and other conflict zones. Starvation and disease in crisis areas are likely to increase and affect the most vulnerable populations. Some severely malnourished children will die, Walson says, and survivors will remain more vulnerable to infections in the future. The lack of food will also exacerbate the world’s refugee and migration crisis.
Yet the full impact of the loss of U.S. aid will be hard to measure, as the cuts have also crippled data collection systems. The Famine Early Warning Systems Network, which for 40 years has combined climate data from NASA and NOAA with other information on food prices and agriculture, was shut down—meaning that the U.S. and other countries will no longer know which parts of the world are most in need of food, according to reports from CNN, NPR, and The Guardian. USAID-funded Demographic and Health Surveys collecting data on maternal and pediatric health for half the world also folded, according to the New York Times. The shuttering of frontline programs to monitor a host of infectious diseases—including Ebola, mpox, measles, and H5N1 bird flu—means these pathogens can circulate unnoticed. Increased disease transmission abroad makes it more likely not only that a disease will be imported into the U.S., but that a microbe will mutate and spread further, Sorrell says. Personnel reductions at the CDC and NIH further weaken the country’s ability to respond to pathogens arriving on our shores.
Many of these cuts have come abruptly, according to Science magazine. A single email from federal officials at USAID halted the $100 million STOP Spillover research project, which has developed a point-of-care test for Lassa fever in Liberia, created an app to identify influenza-like illnesses in wild bird markets in Bangladesh, and built a surveillance team in Cambodia to test for bat-associated viruses. The goal of the initiative is to monitor virus transmission in livestock and wildlife and identify novel disease threats before they start circulating in humans.
“We have all benefited from the investment that the U.S. has made in ensuring the well-being and security of people all over the world,” Walson says. “We are not going back to the way that things were before January 20. There have been real, lasting, and permanent impacts and disruptions to the public health architecture.”
What no one yet knows is what the brave new world will look like.
Since its inception in 2003, PEPFAR (the President’s Emergency Program for AIDS Relief) has distributed $120 billion in funding to prevent and treat HIV in 55 different countries, saving 26 million lives. When the U.S. halted most foreign aid grants in January, PEPFAR’s survival was in jeopardy, leading to international concern and outcry. A limited waiver to allow PEPFAR to resume “urgent life-saving HIV treatment services” was provided on February 1. However, with most USAID employees laid off, “there is no one left to process waiver applications,” according to The 19th. Although Congress appropriated funding to PEPFAR through September in a continuing resolution in March 2025, they were not able to authorize continuing PEPFAR itself, adding to the confusion.
Asked to explain how these cuts align with the new administration’s vision for global health, a State Department spokesperson shared a statement from a February 10 interview with Secretary Marco Rubio: “Any time you have a pause or some hiccups about how to restart the payment programs, but all that’s going to get taken care of here very quickly, and those programs will continue. We’re not walking away from foreign aid. We are walking away from foreign aid that’s dumb, that’s stupid, that wastes American taxpayer money.”
A post-September freeze in PEPFAR funding could trigger a resurgence in HIV infections, especially if people are unable to obtain antiretroviral medication. This, in turn, could lead to 1 million new cases of HIV in children and an additional 2.8 million children orphaned by AIDS in the next 5 years alone, according to an April Lancet article . Cutting funding to PEPFAR also impacts testing and treatment for tuberculosis, which is the leading cause of death among individuals with HIV.
The modern world has never faced infectious disease with such a public health vacuum, especially in the U.S.
“It’s a program we want to continue,” Secretary Rubio said. “Ideally, it’s a program that over time shrinks, not expands, because less and less people are getting HIV or are transmitting it to their children.”
The U.S. isn’t alone in pulling back from supporting global health, says Josh Michaud, associate director for global health policy at KFF, a nonpartisan, nonprofit health policy research institute, pointing out that the U.K. and other countries are also cutting foreign aid.
“What that means is there’s a lot less money going to support global health programs and a lot fewer services provided to the people who are in dire need of them. It just equals more death, illness, and suffering around the world. That’s the bottom line,” he says.
The impacts of lost food and health aid will have the most immediate effects, Michaud says. Whether the subsequent impacts will be a dramatic increase in outbreaks of novel diseases like H5N1 bird flu or a steady uptick in more familiar pathogens such as malaria, mpox, and measles, isn’t yet clear. The modern world has never faced infectious disease with such a public health vacuum, especially in the U.S.
“At the end of the day, health is a national security issue,” Sorrell says. “Health is an individual security issue—if we don’t have access to clean water, to nutritious food, to safe shelters and safe places to live, our physical and mental health are at risk. When we don’t have healthy people, we don’t have prosperity, we don’t have peace, and we don’t have security.”