‘It is chaos’: US funding freezes are endangering global health

Franklin Wanyama’s world was thrown into turmoil last month, when US President Donald Trump abruptly announced a freeze on foreign aid. Wanyama, a 29-year-old in Nairobi who was born HIV-positive, is one of millions of people worldwide whose life-saving treatment is funded by a US foreign aid programme.

The HIV clinic Wanyama visits has managed to continue delivering medications to its patients — although many clinics aren’t, say researchers. But drug supplies are being rationed.

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“We patients who are HIV positive, we are really panicked,” says Wanyama, whose two children do not carry the virus. He’s lost his job mentoring other HIV-positive people at a US-funded facility and is worried about continued access to medication. “The way things are going, I feel like I have worked so much for nothing.”

As the Trump administration announces drastic policy changes, nowhere is the shock more palpable than in the field of global health. Scientists, medics and health officials say the outsize US influence on battling disease globally will be difficult to quickly replace.

US actions such as the foreign-aid freeze and its pull-out from the World Health Organization in Geneva, Switzerland, will affect billions of dollars in annual funding to battle HIV, malaria and other areas in global health. That will cost lives and threaten global security, say researchers. “It will make the world a less safe place,” says Peter Horby, an infectious-disease researcher at the University of Oxford, UK.

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Funding freeze

After the Trump administration announced a three-month freeze on foreign aid last month, effects have rippled through the global-health community. Programmes supported by the US Agency for International Development (USAID) — where many employees have been furloughed, according to news reports — fund research, prevention and care for diseases such as HIV and malaria, and work on other global health priorities.

“People haven’t had a chance to get alternative funding because of the abrupt nature of this,” says Salim Abdool Karim, director of the Centre for the AIDS Programme of Research in South Africa, in Durban. The centre was due this week to enrol the first patient in a USAID-funded trial of HIV vaccines, which is now on hold. It is using its reserve funds to continue a trial testing whether a vaginal insertion can prevent HIV transmission.

“It is chaos,” says an HIV researcher in Africa, who runs a clinic that treats thousands of patients and is supported by a US programme called the President’s Emergency Plan for AIDS Relief (PEPFAR), and asked not to be named because of fears of reprisal. More than 20 million people mostly in Africa, including more than a million children and pregnant people, receive antiretroviral drugs through the US$6.5-billion programme.

The clinic has had to suspend staff, which were funded by PEPFAR, and its patients are continuing to receive drugs only because of volunteer efforts. Last night, the clinic received a waiver from the US government that appears to allow them to resume HIV treatment, but uncertainty abounds.

HIV treatments threatened

In South Africa, where the government provides the bulk of HIV care using some PEPFAR funding, the impact of the aid freeze will be minimal, says Abdool Karim. But in many other African countries, “if PEPFAR services stop, the effect will be catastrophic. The governments can’t just step in to meet the shortfall”.

Stopping antiretroviral treatment causes virus levels to rebound, making it possible for a person to transmit HIV — including through pregnancy to unborn children — and facilitating the evolution of drug resistance. “I’m hoping that someone somewhere sees sense and does not continue this abrupt ending of AIDS treatment programmes,” says Abdool Karim.

The President’s Malaria Initiative, a US$1-billion government programme that funds malaria prevention and research, has also seen funding dry up. Taylor Williamson, an employee at a company that helps to implement the malaria programme and other global health projects, says the aid freeze will have catastrophic effects.

His firm has more than one million insecticide-treated bed nets in a warehouse in Ethiopia that, along with antimalarial drugs and diagnostics, it now can’t deploy, and at time when malaria transmission spikes in many countries. “Without those services — especially now that it’s the rainy season in a lot of the world — people will die,” Williamson says. “We’re putting kids’ lives at risk by stopping this.”

WHO withdrawal

In Geneva this week, the WHO’s executive board grappled with how to handle the looming US withdrawal from the organization (this week, Argentina announced that it will also seek to leave the agency). Last year, the United States contributed nearly £1 billion to the organization, whose 2-year budget for 2024 and 2025 was $6.8 billion. In response, the agency has implemented cost-cutting measures.

Much of that money is earmarked for specific projects, such as polio eradication, and other governments and organizations will now need to fill gaps, says David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine and a former assistant director-general at the WHO. “Somebody’s going to have step in and fill that void if polio eradication is to continue.”

A US pullout from WHO, as well as a communication freeze announced by Trump between officials at the US Centre for Disease Control and Prevention (CDC) in Atlanta, Georgia, and the agency, will also affect the exchange of vital information and technical expertise, say scientists. The CDC had operated more than a dozen ‘WHO collaborating centres’ and many employees had been seconded to the organization. The WHO also provides a daily threat assessment to member states, and it’s unclear whether the United States continues to receive this, says Heymann.

Horby worries about how a diminished US role in global health will affect preparedness for pandemic threats such as H5N1 influenza and outbreak responses — including to one ongoing Ebola virus outbreak in Uganda, another possible one in the Democratic Republic of Congo and a Marburg virus outbreak in Tanzania. “It’s a big concern that there will be a huge loss of money and expertise on these global health threats,” says Horby.