On his first day in office, Jan. 20, 2025, President Donald Trump began a drastic reshaping of the United States’ role in global health as part of the first 26 executive orders of his new term.
He initiated the process of withdrawing the U.S. from the World Health Organization, which works to promote and advance global health, following through on his first attempt in 2020. He also ordered staff members of the Centers for Disease Control and Prevention to cut off all communications with WHO representatives.
In his first week, Trump also issued a stop-work order pending a 90-day review on nearly all programs of the United States Agency for International Development, or USAID.
Many experts view this as a first step in dismantling the organization, which facilitates global efforts to improve health and education and to alleviate poverty. The sweeping move left aid workers and the people who depend on them in a panic and interrupted dozens of clinical trials across the world.
President Trump’s executive order sparked legal action from international health care organizations, resulting in a federal judge ordering a temporary halt to the Trump administration’s freeze on foreign aid. Ultimately, that legal action was unsuccessful.
On Feb. 23, the Trump administration put nearly all of USAID’s 4,700 workers on paid administrative leave globally and stated that it would be terminating 1,600 of those positions.
Most recently, on Feb. 25, a federal judge ordered the Trump administration to allow some USAID funding to resume and required that it pay all of its invoices for work completed before the foreign aid freeze went into effect.
I am the executive director of the Global Health Impact project, an organization that aims to advance access to essential medicines in part by evaluating their health consequences around the world, and a researcher focusing on global health and development ethics and policy.
In my view and that of many other public health scholars, closing down USAID will imperil our national security and put millions of lives at risk.
20 million with HIV treated
USAID works with both nongovernmental organizations and private companies to help distribute medicines and vaccines around the world. The agency also helps improve government policies and invest in research and development to contain and address epidemics and pandemics.
Starting in the late 1960s, for instance, USAID helped lead the effort to eliminate smallpox and has also helped fight polio and other devastating diseases over the past six decades.
The smallpox pandemic was one of the worst of all time – it killed one-third of the people infected, causing an estimated 300 million to 500 million deaths worldwide in the 20th century. By contrast, COVID-19 killed less than 1% of those infected.
These efforts have brought immense financial as well as health benefits to the U.S. and the rest of the world. Some economists estimate that the Global Polio Eradication Initiative, created in 1988, alone saved the world more than US$27 billion as of 2017, and that it will save a total of $40 billion to $50 billion by 2035.
USAID also plays an important role in promoting global health equity. The agency works to increase access to primary health care, combat hunger and strengthen health systems – ultimately saving lives. In addition, USAID has provided a great deal of funding to fight infectious diseases such as malaria, tuberculosis and HIV.
For instance, the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, provides treatment for 20 million people living with HIV in Africa. Trump’s federal aid freeze has halted funding for PEPFAR projects.
While the limited waiver under which the agency must now operate means some PEPFAR activities may eventually resume, many are now left without federal funding indefinitely. Unless another organization fills the gap, millions will die without USAID assistance.
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Mistakes made
This is not to deny that USAID has made some grave errors in its history.
For instance, USAID provided significant funding to the Democratic Republic of Congo (formerly Zaire) during the murderous regime of Mobutu Sese Seko, who was in power from 1965 to 1997.
But USAID also has done an immense amount of good. For instance, it has helped contain the Ebola epidemic in the Democratic Republic of Congo since 2018. USAID’s work in preventing epidemics from spreading helps people everywhere, including in the U.S.
If anything, there is a strong argument for increasing USAID funding. China has invested heavily in Asia and Africa through its Belt and Road Initiative, which is an attempt to recreate ancient trade routes by investing in roads, trains and ports. Some researchers argue that this has shifted diplomatic relations in favor of China. They believe that if the U.S. does not make similar investments and instead cuts foreign aid, it will affect the United States’ ability to achieve its foreign policy objectives.
Similarly, there is a strong argument for increasing U.S. support for the WHO rather than withdrawing from the organization.
Trump’s withdrawal order cites what he sees as the organization’s failures in addressing the COVID-19 pandemic as the rationale. But the WHO helped lead efforts to accelerate vaccine development and distribution, and retrospective reports claim that even more deaths could have been avoided with greater international cooperation.
While dismantling USAID will cause irreparable harm to global health, these actions taken together are likely to deal a devastating blow to efforts to protect Americans and everyone else in the world from sickness and death.
Alyssa Figueroa, an undergraduate student at Binghamton University, contributed to this article.
