Trump’s aid cuts have broken global health – but we can fight back

This story is part of “Pills, Perils, Profits”, a Himal investigative series on Southasian pharmaceutical manufacturing and exports. The series was supported by the Pulitzer Center.

THERE IS A commonly held belief in global health, an inside joke among veterans of the sector: the making of sausages and health policy are two things best left unseen. This has never been more true than right now as the US government under Donald Trump, with one executive order after another, accelerates the collapse of the global health order as we know it. 

This is not hyperbole. 

With Trump’s cuts to US funding, key initiatives like the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR) are faced with drastic reductions of resources, threatening health security especially in poor countries.

The supply chains that ensured access to reliable medicines for HIV, tuberculosis and malaria are up in flames. Numerous active clinical trials have been stopped, leaving study participants in limbo – a breach of medical ethics as well as human decency. A pioneering transgender health clinic in Hyderabad was shut down after USAID, the United States’ international development agency, pulled funding to it – part of an effort to align US foreign assistance with “America First” values. HIV patients in Botswana are staring at the possibility of running out of life-saving medicines. Funding cuts have also halted health screenings at airports and other transit points meant to control the spread of infectious diseases such as SARS, Ebola, Nipah and MRSA.

As per the World Health Organisation (WHO) – itself reeling after the United States withdrew its membership of and funding for the body – millions of people most vulnerable to tuberculosis, the world’s deadliest infectious disease, are now at “grave risk”. Tens of millions of them are in Southasia. The region is among the worst affected by the US funding cuts, with health programmes in Nepal, Sri Lanka, Pakistan, Bangladesh and Myanmar being slashed.

A tuberculosis researcher at Harvard’s T H Chan School of Public Health told me the Trump administration’s decisions could undo two decades of progress, leading to millions of deaths. “It feels like being dragged by my hair back into the Stone Age,” was this scientist’s apposite phrase.

As things fall apart, the WHO is mulling “terrible choices” such as trimming 21 percent of its budget for 2026–27. It has already frozen hiring, significantly cut back on travel, laid off temporary staff and offered early retirement packages. In April, at a meeting of WHO staff, senior officials reportedly revealed a funding shortfall of over USD 1.8 billion even to meet the organisation’s already slashed budget, and a looming deficit of USD 600 million this year. The organisation’s health emergencies budget, key to responding to emergencies particularly in low- and middle-income countries, is to be severely reduced.

But as easy as it is to blame Trump for everything, the truth is that his executive orders have simply pushed ineffective and failed structures of global health off the proverbial cliff. As patients run out of medicines, doctors lose jobs and researchers lose grants, the question is this: How could decades of what the powers of global health insisted on calling “sustainable” progress be so swiftly undone?