The Trump Administration’s Dismantling of Global Health: What’s Next

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This week marked what may be the final death knell for USAID and for much of the U.S. government’s decades-long investment in global health and development, an unparalleled effort that has helped to save millions of lives around the world. In a back and forth in federal court between a coalition of U.S. organizations and the government over the Trump administration’s foreign aid freeze, and after the judge repeatedly ordered the government to unfreeze the freeze and pay its bills, it was revealed in court documents and news reports that the administration canceled almost all USAID and State Department foreign aid grants and contracts. The cancellation includes many life-saving projects, even those that had received waivers from the Secretary of State Rubio to allow them to continue (though most were unable to do so due to the inability to get paid and an already depleted federal workforce). These cancellations include the main contract that provided life-saving commodities to low-income countries, such as bed nets to help prevent and medicines to treat malaria; oral rehydration salt and zinc co-packs to address severe diarrhea among kids; all TB projects and many HIV projects; and efforts to address maternal health. In addition, the administration had already said that certain global health areas were not eligible for waivers, including HIV prevention (other than for pregnant and breastfeeding women) and family planning, meaning that those services were ended last month.

This outcome is the result of several things that have collided at once: a combination of mis- and disinformation about USAID, foreign aid, and federal workers; the Trump administration’s campaign to get rid of federal workers and agencies, with USAID and foreign aid one of its first victims; increasing partisanship even in areas that had once seen broad, bipartisan consensus (such as PEPFAR); a lack of awareness among the U.S. public about what foreign aid is (and a propensity to think that it accounts for way more of the federal budget than its 1%); and genuine, more measured conversations about foreign aid reform, though those have been superseded by these events for now.

Ultimately, much of what happens will be decided by the courts and the administration’s response to court rulings, as well as by Congress which, thus far, has not stepped in to address the administration’s cancellation of funding it has appropriated and dismantling of a major agency it created. Whether there will be an opportunity to discuss real reforms for global health and development remains to be seen. And it will take time to see how the remaining, and likely much smaller U.S. global health and larger aid infrastructure, can best continue to make a difference, as well as whether other countries, including those in Africa, can fill some of the gap for the most urgent needs. Still, it is unlikely that the full extent of the damage already done to vulnerable people around the world is easily repairable.