America’s Abandonment of Global Health

“For he who has health, has hope, and he who has hope, has everything.”

Thomas Carlyle, 19^th century Scottish philosopher

“Global cooperation is not a luxury; it is a biological necessity.”

Ronald Nahass, MD, president of the Infectious Diseases Society of America

For much of the past century, the U.S. stood as the undisputed architect of the global health order. It helped found the World Health Organization (WHO), launched the President’s Emergency Plan for AIDS relief (PEPFAR), built the Centers for Disease Control and Prevention (CDC) into an institution whose expertise was sought worldwide, and channeled billions annually into vaccines, disease surveillance, and epidemic preparedness. That architecture—painstakingly constructed over decades—has been dismantled with remarkable speed and indifference to consequence by the Trump administration and the result is a global health emergency. In today’s Germ Gems post, I review some of the evidence supporting the opinion that this country’s policies toward global health constitute a self-inflicted public health emergency.

What is global health? The terms global health refer to a field focused on improving health and achieving equality for people worldwide. It is not a “soft” or peripheral field. It bridges medicine, epidemiology, public health, environmental science, economics, sociology, and international development. Its practitioners are the people who contain Ebola outbreaks before they reach airports, who ensure that a child in sub-Saharan Africa receives the same protection from measles as a child in Minnesota, who track the emergence of novel pathogens—hantavirus, avian influenza, the next unknown—before they become the world’s problem.

What is being lost? On January 7, 2026, President Donald Trump issued a presidential memorandum announcing the country’s withdrawal from 66 international organizations, conventions and treaties deemed contrary to American interests—among them dozens with direct bearing on global health governance. (McClellan, F., “Trump announces withdrawal from 66 global organizations,” The Lancet, January 17, 2026). The breadth of the disengagement is staggering in its specificity and its sweep.

The U.S. has withdrawn from the WHO, the central coordinating body for pandemic preparedness and international disease response. It has dismantled USAID, the agency responsible for delivering American development and humanitarian assistance across more than a hundred countries. It has frozen PEPFAR, the program credited with saving more than 25 million lives since its founding by President George W. Bush. It has made massive cuts to the Global Fund to Fight AIDS, Tuberculosis and Malaria—an institution that has disbursed over $60 billion and enabled the treatment of tens of millions of patients. It has cut the CDC’s critical role in global HIV programs, blocked $600 million in global vaccine funding, and slashed support for the Coalition of Epidemic Preparedness Innovations, the body created specifically to develop vaccines against the pathogens most likely to trigger the next pandemic.

Taken individually, any one of these decisions would constitute a serious blow to global health. Taken together, they represent a systematic deconstruction of the very infrastructure designed to prevent catastrophic infectious disease outbreaks.

Recently, the Lancet’s editor Richard Horton congratulated French president Emmanuel Macron and his government for convening an “Action Summit” to re-energized the One Health movement. (Horton, R., “Offline: Reinvigorating, One-Health—merci!,” The Lancet, April 18, 2026). Capturing the mood of the global health community, Dr. Horton then, however, described America’s posture as producing a “froideur”—a coldness—around global health.

“Froideur” is a diplomatically restrained word for what many practitioners would characterize far more harshly. When a country that possesses the scientific expertise, institutional knowledge, and financial capacity to lead chooses instead to withdraw, and when that withdrawal is accompanied by the active dismantling of programs that are keeping people alive today, the characterization of moral reprehensibility is not rhetorical excess. It is an accurate description of the consequences.

Is it too late? In April, Dr. Horton addressed President Trump directly making both a moral and strategic argument for the reengagement of the U.S. in global health. (Horton, R., “Offline: President Trump—it’s not too late,” The Lancet, April 25, 2026). Morally, a country of America’s wealth and capability has obligations that do not evaporate when an administration changes. The suffering being caused—that will continue to accumulate—in communities that depend on PEPFAR, on CDC surveillance support, and on Global Fund grants—is real and traceable directly to policy choices.

Strategically, the U.S. has an interest in a world with a robust disease surveillance and response capacity. Pandemics are not respecters of political borders or ideological commitments. The investment in global health infrastructure is also an investment in American security—a point that has been made persuasively by military and intelligence leaders for decades. A world with weaker health systems is a world from which the next pandemic emerges faster, spreads more widely, and arrives in American cities with less warning.

The global health community is resilient, and it will adapt. New coalitions will form; other nations will step forward; the architecture will be rebuilt in some form. But the window in which the U.S. can reclaim its role as a constructive and trusted partner in global health is not permanently open. Every month of disengagement erodes relationships, allows infrastructure to decay, and cedes influence that is difficult to recover.

The words of Thomas Carlyle quoted at the beginning of this post offer a fitting close. Health is a precondition of hope. Our nation once understood this. It used its power to extend the possibility of health to millions beyond our borders. It has an obligation to remember what it once knew, and to act on it before the cost of forgetting becomes irreversible.