As reality determines that the United States drastically reduces its external help in developing countries, an urgent debate begins between governments, philanthropists and world health and development organizations.
It is focused on a critical question: Who will fill this gap?
Last year, the United States contributed about $ 12 billion to global health, the money that funded HIV treatment and the prevention of new infections. Child vaccines against polio, measles and pneumonia. clean water for refugees. and tests and medicines for malaria.
The next largest funder is the Gates Foundation, which disburses a fraction of this amount: its The World Department of Health had a budget of $ 1.86 billion in 2023.
“The US -filled gap cannot easily match anyone,” said Dr. Ntobeko Ntusi, CEO of South African Medical Research Council.
US aid was channeled through the United States or USAid International Development Service, which the new Trump administration has largely disassembled other government services, including the National Institutes of Health, which also face significant cuts in grants for research for health.
Many people suggest that other countries, especially China, could move to some of the areas evacuated by the United States, Dr. Ntusi said. Others make emergency appeals to large charities, including the Gates Foundation and Open Philanthropy.
This discussion is more consequent in Africa. About 85 percent of US spending on global health went to programs inside or for African countries.
For countries such as Somalia, where US aid made up 25 % of the total budget of the government or Tanzania, where the US funded the majority of public health care, loss is devastating. And for the big world health services, the situation is just as critical.
President Trump has already pulled the US from the World Health Organization, which is now trying to make an initial budget cut of $ 500 million for 2026-27 to face US capital withdrawal.
“Most of our neighbors in Epirus have been completely dependent on the US to supply most of the rescue medicines for endemic infections, “Dr. Ntusi said.” And I don’t see most of the governments being able to have resources to deal with. And so I think there will be catastrophic consequences for lives lost by Africans who will die from infections that can be prevented “
The US is the largest donor in Gavi, an organization that supplies basic vaccines to the poorest countries in the world and the World Fund for the Fighting of AIDS, Tuberculosis and malaria. US contribution is required by Congress. Asked about their commitment to them and other multilateral organizations, including the Pandemic Fund, a Foreign Ministry spokesman said the programs were reviewed to determine whether they were in line with the national interest and that funding would continue only for those who met.
Who comes in?
There is no indication that additional funding will come from other G7 countries, the European Union or other high -income nations. Britain, Germany, France, the Netherlands and the Scandinavian countries have reduced all their external assistance. Some new donor countries have come forward to support where, including Saudi Arabia and South Korea, but their costs are earnings from the amount once the US gave.
Of the non -governmental players, the World Bank is better positioned to provide long -term support for health costs. The bank has said little so far. It could offer countries that have been hit hard by US cut off innovative funding, such as debt-for healthcare exchanges to give nations struggling under heavy debt burdens some fiscal freedom to offset lost funding. However, the US is the largest shareholder of the bank and the Trump administration would have an influence on any such investment.
Much of the public debate on the filling of the vacuum left by the US has focused on China, which has created a significant presence of infrastructure funding in African countries, especially those with extensive mineral stocks or strategic ports.
“There is a good reason to do so,” said Ja Ian Chong, Associate Professor of Political Science at Singapore National University. China considers external assistance as a soft power tool in superpower rivalry with the United States, as well as the United States when creating USAID during the Cold War with the Soviet Union. China seeks to use help to gather more support than developing countries in the United Nations.
While Chinese aid is largely on loans to build infrastructure, it includes support for more varied projects. China’s response to Western Development Aid, a program presented in 2021 called the World Development Initiative, includes $ 2 billion to upgrade animal production in Ethiopia, fighting malaria in Gambia and planting trees in Mongolia, .
Mr Chong said China’s ability to fill the opening left by USAID could be limited by its own financial restrictions. China’s economy has stopped due to the crisis of ownership and growing government debt and the country has already declined in large infrastructure loans.
To date, China has shown little interest in supporting global health programs or in scale grants anywhere close to USAID levels. Aiddata, a university research lab at William & Mary in Virginia, estimates that Beijing provides about $ 6.8 billion a year to low cost grants and loans.
Charity
Charities already working on global health have been excluded with panicked calls from frozen funds.
“I have talked to some institutions that everyone has said that we are flooding with people who say, “Help us, help us, help us” and I think they are trying to correct small holes, “said Sheila Davis, CEO of non -profit health partners , who work with local governments to bring health care to communities in developing countries. But if a patchwork rescue can only cover 20 percent of what the US is paying, what should a new donor save? he asked. “Do you choose to save a program fully and then let others go? Or what is the best strategy?”
The leader among the foundations that make reasons for help is the Gates Foundation, which warns recipients of grants that it cannot compose the gap. In addition to funding global health programs, the Foundation also supports health research and contributes significantly to GAVI.
“There are no foundations – or a group of foundations – that can provide funding, labor force capacity, expertise or leadership that the United States has historically been provided to combat and control fatal illnesses and address hunger and poverty Around the world “, the Foundation, North America’s director, Rob Nabors, said by email.
Many recipients of Foundation Fund funding, who refused to speak in the archive because they describe confidential conversations, said they had told the staff of the Foundation that it would continue to fund research and programs in the areas already worked, but you would not significantly expand and that while some grants could be restructured to try to compensate for part of the funding of Lost US, the Foundation’s work will continue to be “catalytic” instead of supporting large -scale planning such as USAID.
John-Arne Røtingen, the Managing Director of Wellcome Trust, who is one of the biggest donors of Global Health Research, told an email that the Foundation “explores which options may be” in the new landscape. But, he said, his help would be “a fall in the ocean compared to governments around the world to provide”.
Two small organizations, such as the founders’ commitment, have launched “bridge funds”, ranging from about $ 20 million to $ 200 million, to try to help connect directly gaps.
But the charity has a large extent silent about the significant change in the landscape. Important players who have already put hundreds of millions of dollars in health care in Africa, such as the Susan T. Buffett Foundation, did not answer questions about their plans. The Delta Foundation (founded by billionaire Zimbabwe’s telecommunications billionaire, Strive Masiyiwa) refused to discuss the issue.
Two executives in smaller private institutions said there was a reluctance to say anything publicly because of the fear of punishment by Trump’s administration, including a possible loss of charity.
African governments
The African governments are exerting tremendous pressure from frustrated citizens to take responsibility for the US health costs, the issue led the agenda to a meeting of the Epirus Ministers of Health at a summit of the African Union last week.
In the 24 years since the Union adopted what is called Abuja’s Declaration, committing its 42 members to spend 15 % of their health budgets, only a few states have ever hit this target and for a maximum of one or two years . Average health spending from African countries are less than half of this amount.
In Nigeria, the President convened an emergency committee to make a plan for budget deficit and parliament gave an additional $ 200 million to the national budget last week. But this excellent measure depicts the scale of what was lost: it is less than half of $ 512 million that the US gave Nigeria to health care in 2023.
Nigerian Health Minister Dr. Muhammad Pate said that about 28,000 health care workers in the country had been paid in whole or part of USAID, who also covered three -quarters of the drug and testing bill and test kits for them 1.3 million Nigerians living with HIV virus
Nigeria should quickly find new ways of operation, he said, including the enhancement of the construction of some of these items in the domestic market. “It may not be so fancy, but at least it will serve,” Dr. Pate said.
He also predicted that the end of US aid would accelerate what he called “re -election” in Africa. “People have been shifted for the last 20 years,” he said. “So we have other actors: We have China, India, Brazil, Mexico and others.”
Deisy Ventura, a professor of global ethics at the University of Sao Paulo, said the change could open opportunities for other countries to exert a new influence.
“The decline of the United States can open space for new leaders now,” he said. “It is important for us in Global South to imagine an international coordination of readiness and emergency reaction without the United States.”
Berry wang He contributed a report from Hong Kong.
