Global Health Funding—Where the Moral Rubber Hit the Road

“If we are serious about ending preventable deaths, both at home and abroad, we must protect the full ecosystem of global health programs. Anything less is short-sighted and unjust.”

Elisha Dunn-Georgiou, President and CEO, Global Health Council

“America’s leaders are increasingly casting aside empathy and compassionate care as dangerous liabilities. Elon Musk has called empathy ‘the fundamental weakness of Western civilization’.”

Craig Spencer, MD, emergency medicine physician, associate professor, Brown University School of Public Health

Historically, the U.S. has supported individuals and organizations engaged in global health. It is the morally right thing to do. Nonetheless, upon taking office on January 20, 2025, Mr. Trump immediately severed ties with the World Health Organization (WHO). On “Day One,” he also issued an executive order requiring a 90-day pause in foreign assistance, including funds for the Presidents Emergency Plan for AIDS Relief (PEPFAR). Then he scuttled the United States Agency for International Development (USAID) (officially shut down on July 1, 2025) and soon thereafter, announced the intention to curtail financial support of Gavi, the Vaccine Alliance. These decisions will have horrendous impacts on global health.

In this week’s Germ Gems post, I put these morally outrageous developments in perspective and discuss PEPFAR, the only global health program to survive the U.S. Congress’s $9 billion recissions package.

The foundation of a meaningful life. No one involved in healthcare is surprised by the profoundly negative impact Mr. Trump’s presidency is already having on the inherently interdisciplinary field of global health. (After all, in his first term of office, he did give plenty of warning of what would happen and ramped this up throughout his last campaign.) But I’m not sure anyone was quite prepared for the speed by which his administration dismantled vital global and public health alliances.

Before its recent and rapid dismantling, U.S. global health support saved approximately 3.3 million lives per year. Now we are faced with articles like these: “USAID defunding could lead to 14 million deaths worldwide from infectious diseases by 2030,” CIDRAP News, July 1, 2025; “Withdrawal of the United States from the WHO—How President Trump Is Weakening Public Health,” New England Journal of Medicine, April 17, 2025; and “Moral Injury and Brain Drain Are Destroying Our Public Health Workforce,” MedPage Today, July 12, 2025. Every American should be outraged by what is happening. Most are—and it is not just those of us who, out of a desire to help sick people, pursued a career in healthcare.

Continuing the funding for global health is a moral argument that still resonates with the majority of Americans. According to a recent New York Times article, “[E]ight in 10 Americans still believe the United States ‘should provide medicine and medical supplies, as well as food’ to people in developing countries.” (Spenser, C., “You Don’t Have to Be a Doctor to Understand This,” New York Times, July 7, 2025).

“[C]aring for others is a moral obligation, not a partisan position.” As Dr. Spenser said,  “If we allow the Trump administration’s assault on empathy to define our global health agenda, or ourselves, we won’t be turning away from the world—we’ll be turning away from who we are. The belief that we have a moral responsibility to others…is the moral foundation of a meaningful life.”

Sparing defunding of PEPFAR.  In 2003, President George W. Bush launched PEPFAR. As of August 2024, this flagship global HIV/AIDS relief program has provided cumulative funding of $120 billion for HIV/AIDS treatment, prevention, and research, making it the largest commitment by any nation focused on a single disease in history. PEPFAR is credited with saving 26 million lives and enabling 7.8 billion babies to be born without HIV infection. Focused initially on Sub-Saharan Africa, PEPFAR has expanded to provide funding to over 50 countries.

In January when I last reviewed the status of the HIV/AIDS pandemic, some experts were optimistic that the WHO’s goal of ending the pandemic by 2030 was actually achievable. (See “Can the HIV Pandemic Be Stopped by 2030? All Eyes Are on Lenacapavir,” Germ Gems, January 8, 2025).This optimism was due in no small part to the ongoing success of PEPFAR and the development of lenacapavir, a long-acting HIV-1 capsid inhibitor to treat and prevent HIV-1 infection.  But that was then and this is now—the era of brutal cutbacks in federal funding of global health programs.

PEPFAR is a bipartisan program that has long enjoyed support across party lines. Even so, PEPFAR was on the global health chopping block. It was initially a part of the rescissions package, a Trump administration initiative to cancel (claw back) previously appropriated but unspent federal funds for global projects.

Fortunately, the $400 million in funding for PEPFAR was ultimately preserved. (On July 17, 2025, the U.S. House of Representatives clawed back $9 billion instead of $9.4 billion in funding federal projects.)

There was intense political wrangling and lobbying to save global health programs—especially PEPFAR—from the claw backs of Mr. Trump’s “Big, Beautiful Bill.” Given the importance of global health to many of its members, I am sure that the Infectious Diseases Society of America (IDSA), a professional society for physicians, scientists, and other healthcare professionals specializing in infectious diseases lobbied long and hard for PEPFAR’s continued funding.  (See, “Planting seeds in uncertain times: Holding the line on health equity in HIV,” IDSA July 15, 2025). The HIV/AIDS activist community also protested this claw back. (See, “HIV Activists Organize to Save Lives as Trump Cuts Funding,” KKF Health News, June 24, 2025). But, it is my guess that Mr. Trump’s ultimate support for PEPFAR was due in some part to PEPFAR’s originator, a fellow Republican president, and in large part to avoiding a revolt from members of his party and getting his bill passed.    

PEPFAR’s reprieve from defunding is certainly welcome. But PEPFAR relies on other agency programs to be fully effective. And, USAID, PEPFAR’s main implementing agency, was gutted. It therefore remains unclear how PEPFAR will function with this administration’s cuts to other foreign aid programs. (See, “What are the Health Impacts of the $9 Billion Rescissions Package?,” MedPage Today, July 18, 2025). Nonetheless, PEPFAR’s defunding reprieve is a step in the right direction and I am celebrating it as a victory for global and public health.