by Kaymarlin Govender, Annamarie Bindenagel Šehović and Damian Naidoo
On January 20, 2025, U.S. President Trump’s second inauguration unleashed a dramatic global health and development policy shift.
Key executive orders included dismantling USAID and withdrawal from the WHO, alongside a broader review of U.S. participation in international organisations and funding for UN agencies like UNESCO, UNHRC, and UNRWA.
These actions have exposed the fragility of global health financing and international cooperation or multilateralism.
Fragility of Health Financing
Global health financing has long been precarious. For instance, only two African countries – Cabo Verde (15.75%) and South Africa (15.29%) – have met the Abuja Declaration (15% of national budgets allocated to healthcare) target in 2021. Most African nations allocated an average of just 7.35%, highlighting chronic underfunding.
The COVID-19 pandemic exacerbated these funding gaps.
The U.S. has historically been the largest global health funder, contributing $12.4 billion annually. The Trump administration’s foreign aid cuts have eliminated 83% of USAID programmes. These funding cuts jeopardise critical health services such as HIV treatment, tuberculosis (TB) care, and maternal health services in low- and middle-income countries.
- Nearly 20.6 million people have lost access to treatment, risking a sixfold increase in HIV cases by 2029.
- TB control is at risk in 18 high-burden countries reliant on international aid.
- Maternal and child health funding for emergency care for mothers and newborns exacerbates already dire conditions.
The abrupt termination of U.S. funding underscores vulnerabilities in reliance on single donors for global health initiatives. Diversified funding sources are urgently needed to ensure sustainable progress.
Another impact of this trend is the cut to research funded through entities such as the U.S. National Institutes of Health (NIH). These alone threaten to derail 600+ ongoing clinical trials. Further consequences include enrolment halts, staff layoffs, and abandoned critical infrastructure, such as lab maintenance.
All this jeopardises future evidence-based health programmes by stifling innovation in precision medicine and disease prevention while undermining workforce training and data collection systems essential for public health initiatives.
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Abrupt halts to research also raise ethical concerns, as patients in trials — often with life-threatening, treatment-resistant conditions — lose access to experimental therapies. This violates trust and exacerbates health inequities for marginalised groups reliant on NIH-funded studies.
Additionally, sudden terminations waste years of participant contributions and taxpayer investments. Institutions in the U.S. and partnering countries risk a “brain drain” of scientists to countries with stable funding, further weakening U.S. medical leadership.
International Cooperation
Trump’s administration has also retreated from multilateral bodies and agreements that have historically underpinned global cooperation.
On January 20, 2025, an executive order initiated U.S. withdrawal from the WHO, citing dissatisfaction with its handling of global health crises like COVID-19. This decision disrupts negotiations on the WHO Pandemic Agreement and amendments to the International Health Regulations.
Multilateralism emerged post-WWII through institutions like the IMF, World Bank, and WHO to foster collective action on trade, health, and development issues. While imperfect, these frameworks have been instrumental in addressing cross-border challenges like pandemics and climate change.
The reduction in U.S. financial support has far-reaching consequences for global health, multilateralism, and development security, most notably in the areas of climate finance and humanitarian aid.
Navigating the Funding Crisis: Alternative Approaches for low-resourced settings
The Trump administration’s retreat from multilateralism and drastic cuts to foreign aid pose significant threats to global health security and development progress. To mitigate the impact of reduced U.S. aid, we need to
- Diversify funding sources by encouraging additional donors (e.g., EU nations and BRICS partnership) to increase contributions (recent partnership between EU and South Africa), strengthen domestic resource mobilisation for healthcare and development, leverage private sector partnerships by engaging philanthropic organisations like the Bill & Melinda Gates Foundation while recognising their limitations.
- Develop a health research and development prioritisation and governance mechanism for Africa. Africa produces just 3% of global medicines, importing over 90% of drugs and 99% of vaccines. Capacity challenges—like limited R&D infrastructure, skilled researchers, and sustainable funding—hinder progress. Africa CDC is proposing a continental health R&D coordination and governance framework (table) to address this gap which will be crucial for improving health outcomes, maximising resources, and strengthening collaboration among African countries and researchers.
- Support low- and middle-income countries to build resilience against future crises by improving efficiencies in healthcare access and delivery through modern technologies offers a more sustainable approach to mitigating the loss of health personnel previously funded by USAID programmes. Strategies such as leveraging digital health solutions, telemedicine, artificial intelligence, and HIV self-testing can enhance responsiveness and resilience in health systems, ensuring continuity of care while reducing dependency on external funding.
By prioritising short-term national interests over long-term global welfare, both the U.S. and the world stand to lose—economically, socially, and politically. While it is unlikely that we can fully bridge the funding gap left by the U.S., we can begin to assert greater control over our situation by exploring alternative strategies and resources.
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Professor Kaymarlin Govender is the Research Director at HEARD, University of KwaZulu-Natal, and a member of the WHO Global Research Group on Knowledge Translation and Evidence-informed Policymaking.
Dr Annamarie Bindenagel Šehović is an Associate Fellow at the Potsdam Center for Policy and Management (PCPM) University of Potsdam, Germany.
Damian Naidoo is formerly from the Health Promotion Unit, KwaZulu-Natal Department of Health.
The views and opinions expressed in this opinion piece are those of the author, who is not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.
