Trump administration’s decisions threaten global health

The recent decisions of the Trump administration, notably the withdrawal of the United States from the World Health Organization (WHO) and the suspension of funding for vital HIV, Tuberculosis and Malara prevention and treatment programs in Africa, raise serious concerns about the future of public health on the continent. These measures, with both immediate and long-term implications, threaten to undermine decades of progress in the fight against infectious diseases.

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Immediate impact on HIV Programs?

Upon taking office, President Donald Trump signed an executive order initiating the U.S. withdrawal from the WHO, justifying this move by citing an alleged imbalance between American and Chinese financial contributions. This decision was followed by a broader suspension of U.S. foreign aid, which included essential HIV programs in Africa. Secretary of State Marco Rubio announced a 90-day pause to review U.S. foreign aid, with limited exceptions for emergency food assistance and military aid to selected countries.

?This funding freeze led to the cessation of antiretroviral drug distribution in numerous African clinics funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and President’s Malaria Initiative. As a result, patients have been forced to cancel appointments, and efforts to screen for and prevent malaria, tuberculosis and HIV have been interrupted, increasing the risk of transmission and progression of diseases that know no borders.?

Medium-term consequences?

In the medium term, the suspension of U.S. funding threatens the continuity of treatment for millions of people living with HIV, Tuberculosis and Malaria in Africa. With prevention, testing, and treatment programs disrupted, efforts to control the epidemic could be completely undone. In Africa, the fight against the three major infectious diseases relies heavily on funding from international programs such as PEPFAR, PMI, and the Global Fund. In several countries, the implementation of these initiatives has been divided into sub-regions, each receiving distinct funding. As a result, at the time of writing, some provinces—particularly those supported by the Global Fund—continue to operate normally. In contrast, other regions, where programs are primarily funded by PEPFAR and PMI, have come to a complete standstill, paralyzed by the suspension of funds. This situation once again highlights the ripple effects of the U.S. administration’s decision, plunging millions of beneficiaries and frontline workers into a state of deep uncertainty.?

According to an internal memo from the U.S. Agency for International Development (USAID), this decision could disrupt the supply of essential medicines for HIV, malaria, and tuberculosis, endangering millions of lives and risking the emergence of drug-resistant strains. In September 2023, AIDSPAN had already sounded the alarm in an article about the severe health risks posed by the suspension of PEPFAR for global HIV/AIDS efforts.?

In the long run, the U.S. withdrawal, which accounts for nearly 20% of the WHO’s budget, could weaken African health systems by reducing available resources for medical personnel training, epidemiological surveillance, and emergency health responses. The Africa Centres for Disease Control and Prevention (Africa CDC) has expressed deep concern, emphasizing that many African countries rely on U.S. funding through the WHO for their public health programs.?

Here is a graph (Figure 1) showing the number of people losing access to ARV treatment every day in the worst-affected countries.

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Figure 1: Impact of Stop Work Orders for PEPFAR Programs

Source: The Andelson Office of Policy public

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This other graph (Figure 2) highlights the alarming increase in the number of HIV infections among infants every day as a result of the cessation of PEPFAR-funded services.

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Figure 2: Impact of Stop Work Orders for PEPFAR Programs

Source: The Andelson Office of Policy public

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For an exhaustive overview of the impact of the suspension of PEPFAR, I invite you to look at the statistical data document prepared for this purpose by The Andelson Office of Public Policy.

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A shaken trust and a threat to the future?

Donald Trump made a momentous decision by announcing the U.S. withdrawal from international health security negotiations. He declared that his country would not recognize the binding nature of the global treaty designed to prevent, prepare for, and respond to pandemics. As highlighted by Stéphanie Tchiombiano, a professor and global health specialist, behind this uncompromising stance lies a cynical political calculation: catering to a segment of his electorate that is fiercely opposed to multilateral institutions and embraces blind isolationism, regardless of global health realities.?

This rupture is far from being a mere symbolic gesture; it significantly weakens collective mechanisms for the prevention and coordination of emerging health threats. By voluntarily excluding itself from these strategic discussions, the United States forfeits privileged access to critical data on future epidemics, thus jeopardizing its own ability to anticipate and respond to health crises.?

Worse still, by undermining the credibility of international efforts, this decision erodes the very concept of a global response to health crises, leaving the world more vulnerable and each nation to fend for itself in the face of impending disasters. The United States, which was severely affected by the COVID-19 pandemic, appears to have learned nothing from past lessons, opting instead for a perilous ideological stance of self-isolation. This nationalist retreat, disguised as health protectionism, will protect neither Americans nor the rest of the world; rather, it will create an even deeper divide in the fight against future pandemics.?

Ultimately, the actions of the Trump administration risk compromising the trust of international partners and local beneficiaries in the reliability of U.S. funding, making it increasingly difficult to establish sustainable health programs.

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Conclusion: A window of opportunity??

On the eve of the 8th replenishment of the Global Fund, in which the United States contributes about 30% of the funding, concerns are more urgent than ever about our ability to eliminate HIV, tuberculosis, and malaria as major public health threats by 2030, as initially envisioned under the Millennium Development Goals (MDGs). The potential U.S. disengagement threatens decades of progress and jeopardizes access to vital treatments for millions of people.?

However, as concerning and regrettable as this decision may be, it brings to the forefront an unavoidable urgency: the need for African states to strengthen domestic financing for health. It is imperative that governments across the continent increase their investments in public health by allocating a larger portion of their national budgets to programs aimed at combating HIV and other infectious diseases. Beyond financial support, this crisis must also spur closer regional cooperation: pooling resources, sharing expertise, and implementing coordinated strategies are crucial levers to ensure the continuity of care, improve prevention efforts, and reinforce the resilience of health systems. Rather than being at the mercy of international political decisions, Africa must seize this opportunity to establish its health autonomy and affirm its capacity to sustainably protect the health of its populations.