The State of Global Health Following US Withdrawal of Funding: Impacts on USAID-Funded Projects

The landscape of global health has long been influenced by the contributions of international donors, with the United States standing as one of the most significant benefactors through agencies such as the United States Agency for International Development (USAID). However, recent shifts in U.S. foreign policy, including the withdrawal or redirection of funding from critical global health programs, have created ripple effects across low- and middle-income countries (LMICs). This shift is altering the trajectory of public health initiatives, particularly those reliant on USAID support, leading to disruptions in healthcare delivery, weakened epidemic preparedness, and increased vulnerabilities among marginalized populations.

The Role of the U.S. in Global Health Funding

Historically, the U.S. has played a crucial role in financing global health programs, investing billions of dollars annually to combat diseases such as HIV/AIDS, malaria, and tuberculosis, and to support maternal and child health. USAID, alongside other agencies like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Centers for Disease Control and Prevention (CDC), has been instrumental in advancing healthcare access, strengthening health systems, and fostering innovations in disease prevention and treatment.

The U.S. withdrawal or reallocation of funding, particularly under changing political administrations, has caused disruptions in many of these initiatives. The redirection of funds away from multilateral organizations such as the World Health Organization (WHO) or non-governmental organizations (NGOs) supporting reproductive health, for example, has left critical gaps in healthcare delivery worldwide.

Immediate Impacts on USAID-Funded Projects

1. Disruptions in HIV/AIDS and Malaria Programs

USAID-funded initiatives such as PEPFAR have been pivotal in providing antiretroviral therapy (ART) to millions of people living with HIV/AIDS. The withdrawal or reduction of U.S. funding has placed several ART programs at risk, leading to drug shortages and treatment interruptions, which can increase the likelihood of viral resistance and disease transmission. Similarly, funding cuts to malaria programs have affected the distribution of insecticide-treated nets and access to antimalarial medications, reversing gains made in malaria control in Africa and Asia.

2. Weakening of Reproductive Health Services

One of the most affected sectors is reproductive health. Policies such as the reinstatement of the Mexico City Policy (also known as the “Global Gag Rule”) have led to funding restrictions on NGOs that provide or even advocate for safe abortion services, even if they use non-U.S. funds for such activities. This has severely impacted family planning programs, particularly in sub-Saharan Africa, where USAID has historically been a major supporter of contraceptive access and maternal health services.

3. Reduced Emergency Response Capacity

USAID has played a major role in funding emergency response efforts for outbreaks such as Ebola, Zika, and, most recently, COVID-19. However, U.S. funding cuts to WHO and pandemic preparedness programs have left many LMICs struggling to maintain adequate surveillance and response mechanisms. The reduction in financial support has weakened early warning systems and laboratory networks, increasing the risk of localized outbreaks turning into global health crises.

4. Health Workforce and Infrastructure Challenges

The sustainability of healthcare workforce programs is also at risk due to funding uncertainties. Many USAID-supported initiatives train healthcare workers, provide scholarships for medical education, and improve healthcare infrastructure. The withdrawal of funds has led to the closure of training centres and fewer healthcare workers available to serve in rural and underserved communities. Additionally, supply chain disruptions for essential medicines and vaccines have become more pronounced due to the lack of financial support.

Broader Implications for Global Health Governance

The retraction of U.S. funding has not only affected USAID-supported projects but also altered the power dynamics in global health governance. Traditionally, the U.S. has been a leading advocate for global health security, but its withdrawal from funding and decision-making roles has left a leadership vacuum that other countries, such as China and the European Union, have attempted to fill. While these actors are increasing their contributions, their funding strategies may not align with USAID’s previous focus areas, leaving some health priorities underfunded.

Furthermore, the unpredictability of U.S. financial commitments has led to uncertainty among global health stakeholders, making it difficult for organizations to plan long-term interventions. Countries that once relied heavily on U.S. funding are now forced to seek alternative sources of financial support, which may not be readily available.

Potential Strategies for Mitigation

Given the substantial impact of U.S. funding shifts, various stakeholders—including governments, NGOs, and international organizations—must explore alternative strategies to mitigate the fallout:

1. Diversification of Funding Sources – Countries and organizations that have historically depended on USAID should seek diversified funding from multilateral agencies (e.g., the Global Fund, WHO, and World Bank) and private sector investments to maintain critical health services.
2. Regional and Local Ownership of Health Programs – Strengthening regional and national health financing mechanisms can reduce dependence on external donors. Initiatives such as the African Union’s commitment to increase domestic health spending can play a crucial role in sustaining essential services.
3. Strengthening South-South Cooperation – Collaborations between LMICs can facilitate the sharing of resources, technology, and expertise to bridge funding gaps. Countries with successful health interventions can assist others in adopting cost-effective and sustainable health models.
4. Advocacy for Sustainable U.S. Commitments – Global health advocates and policymakers must engage with U.S. legislators and stakeholders to emphasize the long-term benefits of sustained global health funding. Highlighting how global health investments contribute to international stability, economic growth, and national security can help maintain bipartisan support for continued engagement.
5. Innovation and Digital Health Solutions – Leveraging technology to optimize resource allocation can help mitigate funding gaps. Telemedicine, digital health records, and AI-driven disease surveillance can provide cost-effective solutions to healthcare delivery challenges in resource-limited settings.

Conclusion

The U.S. withdrawal of funding from global health initiatives has presented significant challenges to the sustainability of USAID-supported projects, particularly in LMICs. The immediate consequences include disrupted HIV/AIDS, malaria, and reproductive health programs, weakened pandemic preparedness, and diminished healthcare workforce capacity. Beyond the direct impacts, the shift in funding priorities has altered global health governance structures, creating uncertainties in long-term planning and international health security.

As the global health community navigates this new landscape, resilience, innovation, and diversified funding sources will be key to sustaining progress. Strengthening regional health financing, fostering new partnerships, and advocating for sustained U.S. involvement in global health will be critical steps toward ensuring that gains made over the past decades are not lost. The future of global health depends on collective action, strategic investments, and unwavering commitment to equity and access for all.

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