Jeremy Youde is a political scientist with a focus on the politics of global health. The Dean of the College of Urban and Public Affairs (CUPA) at Portland State University, he is the author of five books, including Global Health Governance in International Society.
In its chaotic first few weeks, one of the new Trump administration's many targets has been global health. With a few strokes of a Sharpie, President Donald Trump halted nearly all U.S. foreign assistance programs, including those for global health, and started the process of pulling the United States out of the World Health Organization. Trump made a range of false claims about foreign aid to support his moves, including spreading the lie that the United States Agency for International Development (USAID) sent $50 million to Gaza for condoms that Hamas "used as a method of making bombs."
These actions, many of which defy Congress and are abuses of executive branch authority, have caused havoc for aid groups and other governments and undermined relationships built up over years of American foreign policy. While some foreign assistance programs have received waivers on an ad hoc basis to resume at least some of their work, the overwhelming confusion and uncertainty have thrown the global health community into tumult, dismantling decades of American leadership on global health and threatening remarkable progress in fighting infectious diseases around the world.
For decades, under Democratic and Republican administrations, the active involvement of the U.S. in funding and staffing global health programs has made the world healthier. The President's Malaria Initiative, launched under George W. Bush's administration in 2005, has saved at least 50,000 lives each year from the mosquito-borne disease. Guinea worm, a debilitating parasitic infection found in infected drinking water, has gone from afflicting more than 3.6 million people annually in 1986, including in parts of the Middle East, to being almost entirely eradicated thanks to a partnership between the Carter Center and the Centers for Disease Control and Prevention. The CDC has also been a leader in the Global Polio Eradication Campaign, preventing more than 20 million cases of paralysis and bringing the number of wild polio cases down from 350,000 in 1988 to 12 in 2023—yes, 12. The President's Emergency Plan for AIDS Relief, or PEPFAR, has channeled more than $120 billion since its launch in 2003 under President Bush toward stopping the spread of HIV and increasing access to life-prolonging medicines. It is credited with saving more than 26 million lives in the past 21 years, primarily in sub-Saharan Africa. PEPFAR has also enjoyed strong bipartisan support over four different presidential administrations, including Trump's first term.
When the Trump administration recently announced it was "temporarily" freezing all foreign aid (funds that Congress had approved and appropriated), including for global health programs, and then set about unilaterally dismantling USAID, an independent agency created by Congress, it undermined all of this progress.
Global health programs that have been the foundation of U.S. humanitarian assistance have made very real and tangible improvements in the lives of people around the world.
- Jeremy Youde
Take PEPFAR as an example. The abrupt aid cutoff meant that programs that provided HIV testing had to immediately cease activities and that PEPFAR-funded programs could no longer distribute anti-AIDS drugs. The aid freeze also shut off access to computer systems that oversee this work. Interrupting access to anti-AIDS drugs is particularly worrisome, as it can allow HIV to multiply and mutate. A few days later, Secretary of State Marco Rubio issued a waiver to allow PEPFAR recipients to distribute anti-AIDS drugs again—but it remains unclear whether that includes preventative treatments, testing or other vital services, part of a confounding waiver process for lifesaving humanitarian aid that has left programs shuttered. Trump's executive orders have also interrupted tuberculosis programs and other supportive services. Beyond the medical consequences of these delays, program leaders have expressed concern that the interruptions are undermining trust and increasing stigma in these health services.
Global health programs that have been the foundation of U.S. humanitarian assistance have made very real and tangible improvements in the lives of people around the world. But those gains must be sustained through ongoing actions and investments, which Trump has now put at permanent risk.
And the impacts will reach America. We may not know when or where it will start or what will cause it, but we do know that there will be more pandemics in the future. By its very definition, a pandemic is widespread and grows at an exponential rate. That means that it is crossing borders, putting everyone at risk unless and until it is stopped.
It might be tempting to assume that a country can simply close its borders and that will be enough to keep it safe. That assumption would be wrong. Even if a country could completely stop the movement of people and goods across its borders (and there is no evidence that any country could completely seal itself off), that wouldn't stop migratory birds from flying overhead or other animals getting in and spreading disease. With an estimated 60 percent of emergent infectious diseases being spread by animals, every country needs to be vigilant about monitoring outbreaks and sharing information with others. And the WHO's International Health Regulations, the only international treaty that defines a state's rights and obligations to address infectious disease outbreaks, do exactly that. By withdrawing from the WHO, the U.S. is not only cut off from this vital information, but it raises the risk of new disease outbreaks entering the country, while heightening the risk for other countries, too.
It is no exaggeration to say that the global health system itself would not exist without the U.S., which has been its backbone—and largest supporter and donor—over the past 30 years.
- Jeremy Youde
If U.S. government officials really want to keep Americans healthy and safe, then they need to work with the WHO and the global health community. During his first term, Trump even touted U.S. leadership in global health at the United Nations General Assembly and told a delegation of African heads of state that "we cannot have prosperity if we're not healthy." Interrupting these programs raises the risks that polio, which re-emerged in Gaza in 2024 when vaccination programs ended amid Israel's war, will spread further, or that Guinea worm, which had been endemic in the Middle East and North Africa, will return. Even if the Trump administration has no interest in humanitarianism or protecting others, America's economic and security interests are threatened if it ignores or undermines global health programs.
It is no exaggeration to say that the global health system itself would not exist without the U.S., which has been its backbone—and largest supporter and donor—over the past 30 years. It has consistently been the largest provider of development assistance for public health. It is the largest contributor to the WHO's budget. It was the first country to bring HIV/AIDS to the U.N. Security Council in 2000, galvanizing the international community's response. It created PEPFAR, the biggest investment ever in global health by any country to address a single disease, which has helped "to change the trajectory of the global HIV epidemic," according to the Kaiser Family Foundation. America's pharmaceutical research infrastructure made it possible to create effective COVID-19 vaccines in less than a year, something many thought impossible. This American leadership matters, and it has made the world—and the U.S. itself—a healthier and safer place.
This isn't to say that everything is perfect in global health, or that there isn't room for improvement. But you can't make improvements if you aren't at the table—and by withdrawing from the WHO and scaling back (or ending) global health programs entirely, the U.S. government loses its ability to reform these programs. How do you push for reforms in the WHO if you aren't a member, and why should any other country listen to you?
What's worse, from the Trump administration's perspective, is that these actions are creating the very circumstances they claim are the problem. If the U.S. is concerned that the WHO is too beholden to the Chinese government, then it makes little sense to create a leadership vacuum in global health that China could fill. China seems unlikely to replace U.S. funding for the WHO, but its extensive use of bilateral health diplomacy has proven to be an effective "soft power" tool—and building such positive relationships with other countries could allow China to assume even greater leadership in the current geopolitical climate. In other words, leaving the WHO because you think Beijing has too much influence could end up giving China even more influence and leadership around the world.
Even if the Trump administration decided to change its mind tomorrow and rejoin the WHO, restore all funding for foreign assistance and support not dissolve USAID, the confusion and uncertainty that Trump has introduced makes it hard for any country to trust U.S. foreign policy. What is preventing Trump from changing his mind yet again? How long can American allies trust that the U.S. will live up to its commitments? Abandoning this leadership position undermines trust in the U.S., on global health and many other issues, and those effects will linger long after Trump is out of office.
