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Navigating US global health aid cuts: What can past donor exits teach us?
Brookings
2025.03.26
On January 20, 2025, President Donald Trump signed an executive order imposing a 90-day freeze on foreign development assistance while launching a top-to-bottom review of all aid programs. The order was followed by a stop-work directive that paused most U.S. aid-supported projects worldwide, with only a few exceptions.

The consequences for global health were profound since the United States is the largest provider of health aid. An analysis by the Kaiser Family Foundation of official development assistance (ODA) recorded by donors in the Creditor Reporting System database estimated that in 2023, the U.S. contributed about $12.9 billion toward global health activities, which was 42% of the total ODA for health. The stop-work directive had major public health consequences in countries that receive U.S. aid for health, including the sudden closure of clinics, hospitals, and clinical trials and disruptions in HIV, tuberculosis, and malaria programs that risk resurgence of these three diseases.

Before the executive order, 73% of U.S. bilateral assistance for health was channeled through the United States Agency for International Development (USAID), which has now been largely dismantled. The Trump administration has terminated over 90% of all USAID programs, and over 5,600 USAID workers have been fired or placed on leave. The dismantling of USAID has also shuttered much of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), a program launched by George W. Bush that has saved more than 25 million lives, as 60% of PEPFAR assistance is implemented by USAID. Tracking efforts, such as the PEPFAR Impact Tracker, are already estimating significant increases in HIV transmission and HIV-related deaths as a direct result of the funding freeze.

The sudden withdrawal of U.S. funding for global health marks one of the fastest and largest donor exits in history. The Center of Policy Impact in Global Health at Duke University has studied the transition of countries out of