The USAID List of Terminated Global Health Awards – What Does it Tell Us?

It was recently reported that a list was sent to Congress of awards to be terminated at USAID, an agency already effectively shuttered as part of the administration’s foreign aid review and funding freeze. The list generally confirms what has been in administration court filings and other announcements – that most awards at the agency are slated to be terminated. Specifically, it indicates that of more than 6,200 awards, 5,341 or 86% will be terminated, representing $27.7 billion in unobligated funds. Of this, $7.4 billion in unobligated funds falls directly under USAID’s global health bureau and billions more are for global health activities funded through other bureaus or at the individual country mission level. While the situation does appear to be fluid, with Congress having yet to weigh in and with litigation ongoing, the list does raise several questions:

• Despite a waiver continuing “life-saving humanitarian assistance,” including core life-saving medicine and medical services, several such projects are on the USAID terminated list. Shortly after the foreign aid review and funding freeze were initiated, putting a stop to most bilateral foreign assistance activities, Secretary of State Rubio issued an emergency waiver stating that “Implementers of existing life-saving humanitarian assistance programs should continue or resume work if they have stopped.” This was followed by specific waivers for some PEPFAR services and a subset of other health services. Despite these waivers, however, several projects that seem to meet the definition of life-saving as indicated in the waiver language and are interventions that have been shown to reduce morbidity and mortality, are on the terminated list. These include, for example, efforts to strengthen and deliver malaria diagnosis and treatment services as part of the President’s Malaria Initiative (PMI) in Cambodia, Ethiopia, and The Gambia and TB projects focused on diagnosis and treatment in Nigeria and South Africa. Also on the terminated list is a contract for Gavi, the vaccine alliance, an international public-private partnership that provides routine vaccines to more than half of the world’s children helping to avert almost 19 million childhood deaths.
• Several awards on the terminated list are already spent in full. According to the list, there are several awards for which all funding has already been obligated and, per USASPENDING, the government’s funding database, fully spent. In global health, for example, these include funding for COVAX, the COVID-19 vaccine mechanism that was housed at Gavi (all funding was already disbursed in 2021), an award for CEPI, the Coalition for Epidemic Preparedness Innovations, and an award for the Pandemic Fund (housed at the World Bank). These may be on the list because their awards are technically still open.
• Other awards on the terminated list appear to be for broader contract arrangements, listing outstanding obligations for funding that has yet to be appropriated by Congress. This appears to be the case for Gavi, for example, which is listed as having $1.7 billion in unspent obligations through 2030. However, of this, only $300 million has been appropriated by Congress (for FY 2025) and the remaining amount appears to be a projection of future funding. This also seems to be the case for polio and immunization funding at the World Health Organization (WHO), for which $781 million is listed as unobligated but is likely an estimate of future appropriations.
• The list confirms other reports and administration statements about what is not being supported, including several projects related to HIV prevention and interventions for key populations, family planning projects, and support for WHO. This includes, for example, a project in Zambia focused on voluntary medical male circumcision to reduce the risk of HIV, one in Malawi focused on preventing new HIV infections among men and women including adolescent boys and young men, and one in Namibia focused HIV prevention and treatment among key populations; family planning projects in Ghana, Kenya, and Zimbabwe; and projects that sought to integrate family planning with maternal health and others services in several countries. Support for WHO is also on the terminated list.
• There are many awards on the terminated list that worked to strengthen host country government, civil society, and private sector capacity to deliver services. While these awards are not directly life-saving, they are designed to support country ownership and sustainability, to help reduce the reliance on the U.S. government, such as an HIV project in Uganda and a malaria project in Uganda. As such, canceling these projects could set back such efforts.
• Finally, it is unclear if this list is final, or just the most recent one circulating. There have been at least three other lists circulating thus far with different sets of terminated awards. Given that this list is reported to have just gone to Congress, it is possible some negotiation may still be underway. In particular, while the administration typically has the authority to choose which specific implementing organizations it will work with, in global health, Congress provides agencies with specific funding instructions including amounts for different program areas (e.g., HIV, TB, malaria, maternal health and others) and for certain international institutions (e.g., The Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi). As such, Congress may evaluate the list of terminations against these directives. Indeed, the FY 2025 funding bill that was just signed into law requires the administration to report to Congress within 45 days regarding its spending plans for foreign assistance.