Trump orders sow chaos in global public health
“It's basically a declaration of war on public health,” says one expert
A U.S.-funded public health program called PEPFAR supplies medications to people living with HIV, including this sixteen-year-old girl in Kenya.
Brian Inganga/AP Photo
By Meghan Rosen
U.S. global health programs are in crisis.
A recent flurry of executive orders and surprise actions by the Trump administration have roiled the international public health community, leaving healthcare workers scrambling and aid programs in peril.
On January 20, President Donald Trump issued an executive order pausing U.S. foreign development assistance for 90 days to assess “programmatic efficiencies and consistency.” The ripple effects spread immediately. On January 24, the State Department put out a stop-work order halting foreign aid work. And on January 27, the Trump administration placed dozens of officials at the U.S. Agency for International Development on leave.
USAID is a global health–focused agency that works with countries around the world on programs to improve maternal health, deliver vaccines and provide access to HIV treatment, among other efforts. One such program, the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, has already suffered the fallout from Trump’s actions. The administration ordered organizations in other countries to stop giving out HIV drugs purchased with U.S. aid. And according to amfAR, the Foundation for AIDS Research, healthcare workers with PEPFAR have been instructed to stop all clinical services.
The PEPFAR program, which is active in over 50 countries, currently provides HIV treatment for more than 20 million people around the world, according to the World Health Organization. In 2024, the United States put nearly $5 billion toward PEPFAR.
On January 28, Secretary of State Marco Rubio seemed to backtrack on the administration’s foreign aid freeze in a memo that offered waivers for lifesaving humanitarian assistance, including HIV treatment. But it’s unclear exactly which programs are exempt.
In 2024, the United States spent about $12.4 billion on global health funding. About 40 percent went to PEPFAR and other HIV programs, but “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,” says Michael Merson, a global and environmental health researcher at the New York University School of Global Public Health. “We are, as a nation, the leading provider of global health assistance.”
In a January 26 statement, a spokesperson for the State Department said, “The United States is no longer going to blindly dole out money with no return for the American people.”
The total money the United States gives to global public health programs is a tiny droplet in the total U.S. budget, says Lawrence Gostin, a public health policy expert at Georgetown Law in Washington, D.C. In fiscal year 2024, the country spent roughly $6.8 trillion in total. “I think the average American doesn’t understand how much good the United States does in the world,” he says — and how relatively little it costs.
Spending breakdown
In 2024, the United States spent $12.4 billion on global health programs. More than 40 percent of this funding went to support global HIV efforts, which include distributing antiretroviral medications to people with HIV. This chart shows how that total funding is split amongst different program areas.
Global health expert Michael Cappello notes that the funding pause will have “an immediate chilling effect” on international-based work, and “it will ultimately erode trust in the United States.” The pause will “damage our credibility as partners in protecting lives, conducting research and providing essential services to people all over the world.”
Though the funding pause is set for 90 days, even short breaks can disrupt aid programs. “It’s not as though you can just flip a light switch and turn them back on,” says Cappello, of Yale University.
Trump’s foreign aid fracas comes amid upheaval at the World Health Organization and the U.S. Centers for Disease Control and Prevention. The President has ordered the United States to withdraw from WHO and has instructed CDC employees to immediately halt communications with that organization.
All together, “it’s basically a declaration of war on public health,” Gostin says. “The level of alarm could not be higher.”
Despite the challenges of the past week and a half, Cappello says that the global health community in the United States remains committed to doing their work and finding ways to improve the lives of people around the world. “We are resilient and undeterred.”
