Global health experts have voiced strong concerns over the dismantling of the United States Agency for International Development (USAID), which provides tens of billions of dollars in overseas aid annually.
The Trump administration has announced drastic workforce reductions and an immediate suspension of nearly all USAID programs. A 90-day freeze on aid funding has been imposed as the government conducts a “review” to align projects with President Donald Trump’s policy priorities.
Trump has long criticized foreign aid spending, arguing that it must conform to his “America First” agenda. His administration has specifically targeted USAID, describing its spending as excessive and highlighting certain programs as examples of alleged waste of taxpayer money.
However, health experts have warned that these cuts could lead to the spread of diseases and significant delays in vaccine and treatment development.
In addition to directly managing numerous health programs, USAID funds other organizations to carry out health initiatives. The funding freeze has created uncertainty among these groups. While some humanitarian programs have received waivers, the announcement has already disrupted services.
Dr. Tom Wingfield, an expert in tuberculosis (TB) and social medicine at the Liverpool School of Tropical Medicine, emphasized the severity of the situation in an interview with the BBC.
“People don’t appreciate the extent and reach of USAID. It goes towards under-nutrition, hygiene, toilets, access to clean water, which all have a massive impact on TB and diarrhoeal diseases,” he explained.
He also stressed that infectious diseases do not recognize borders, a concern that is exacerbated by climate change and large-scale migration.
“TB kills 1.3 million people per year and makes a further 10 million people ill. But four out of 10 people never receive any care and can therefore transmit the disease,” he said.
According to Dr. Wingfield, any disruption to research projects or clinical care increases the risk of disease transmission.
“Whether it’s a research project or a clinic affected, then we run risk of further transmission. People will die directly because of cuts in US funding,” he warned.
The funding freeze threatens not just TB treatment programs but also those assisting people with HIV. Many HIV care and prevention services are run by non-governmental organizations (NGOs), which rely on USAID funding to provide life-saving anti-retroviral medications. These drugs can suppress HIV to undetectable levels, reducing the risk of transmission.
Dr. Wingfield cautioned that treatment interruptions could be disastrous.
“People with controlled HIV, if they miss meds, the virus in their blood increases and there’s a risk of onwards transmission. There is a risk of undoing all the progress to date,” he said.
Catastrophic Impact on Health Services
Frontline AIDS, a UK and South Africa-based organization working with 60 partners in 100 countries, has reported widespread distress caused by the aid freeze. More than 20 of its partners have already been affected.
According to the organization, confusion over the freeze and subsequent waivers has led to serious operational challenges. Many partners have had to suspend HIV treatment, prevention, and care services for vulnerable populations. Staff layoffs have also been reported.
“The majority remain in limbo and this is having a catastrophic impact on communities and organisations,” said John Plastow, Executive Director of Frontline AIDS.
One of its partner organizations in Uganda is expected to run out of HIV testing kits, TB medications, and condoms within a month. These supplies are largely funded through USAID’s President’s Emergency Plan for AIDS Relief (PEPFAR).
In South Africa, many HIV services have been halted. Some of these clinics provide aftercare and emergency contraception for women and girls who have been raped.
Beyond immediate service disruptions, the aid freeze has also shaken trust in US-backed programs.
Professor Peter Taylor, director of international development studies at Sussex University, warned that the abrupt cuts could have lasting consequences.
“Stopping things suddenly undermines people’s trust. People are bewildered and angry,” he said.
He argued that the damage extends beyond health services, affecting America’s standing in global development efforts.
“The undermining of basic trust is the real cost and that is being magnified in many situations around the world. This is so damaging to the US global reputation,” he added.
Research and Vaccine Development in Jeopardy
Experts are also worried about the future of international drug trials funded by USAID. Professor Thomas Jaki, who leads the MRC Biostatistics Unit at the University of Cambridge, fears that many ongoing and upcoming clinical trials may now be at risk.
“Unfortunately, there are quite a number of trials that are immediately affected by the USAID freeze—both in terms of running trials but also trials that are in set-up and are planned to start soon,” he said.
He expressed concern that the freeze would hinder medical advancements.
“I am convinced the US funding freeze will detrimentally impact treatment development, to an extent where exciting new treatments are delayed by years or even discarded,” he said.
The impact will be particularly severe in fields such as malaria and HIV, where USAID plays a major role in funding research.
Global Health at Risk
Professor Rosa Freedman, an expert in international law and global development at the University of Reading, pointed out that USAID provides up to 40% of the world’s development aid. This funding supports not only health initiatives but also education and economic development.
However, she warned that health programs would bear the brunt of a prolonged or permanent funding freeze.
“This will be partly due to the prevention of further vaccines being distributed or funded by USAID,” she said.
According to Prof. Freedman, diseases that were once under control could re-emerge if vaccine programs are disrupted.
“This could mean that preventable diseases, which we thought had been contained or even eradicated, could reappear or worsen, such as cholera and malaria,” she explained.
She also raised concerns about the wider global impact of the funding freeze.
“Given the globalized and interdependent nature of our planet, the concern will be that these diseases could spread quickly and far,” she said.
As the Trump administration moves forward with its aid review, the future of USAID remains uncertain. Experts warn that the consequences of these cuts could be felt for years, potentially reversing decades of progress in global health.