What Does Dismantling USAID Mean For Global Health?
Mar 10, 2025
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Dr. Atul Gawande, a surgeon and former head of global health at USAID, and Dr. Salim Abdool Karim, an epidemiologist and director at the Centre for the AIDS Programme of Research in South Africa, delve into the fallout from the U.S. dismantling USAID. They discuss the devastating effects of funding cuts on vital health initiatives battling diseases like HIV, malaria, and tuberculosis. The conversation highlights the ethical dilemmas faced by clinical trial participants and the geopolitical ramifications of U.S. withdrawal from global health leadership, especially as rivals like China rise.
Recent cuts to USAID jeopardize vital global health initiatives, leaving millions without necessary treatments and exacerbating existing health crises.
The U.S. withdrawal from the World Health Organization significantly hinders global health leadership, allowing competing nations to strengthen their influence and endanger public health.
Deep dives
Impact of USAID Funding Cuts on Global Health
Recent funding cuts to the U.S. Agency for International Development (USAID) have severe implications for global health initiatives. The termination of critical programs includes the president's malaria initiative, tuberculosis control, and significant HIV efforts that support millions of lives, particularly children. The abrupt withdrawal from these initiatives leaves countless patients without necessary treatments, jeopardizing their health and survival. Additionally, the freeze on funding has affected humanitarian assistance, stunting progress in conflict areas and exacerbating global health crises.
Ethical Concerns and Abandonment of Research Participants
The abrupt cessation of funding has raised serious ethical concerns, notably regarding patients involved in clinical trials. Individuals in South Africa were left without care, and ongoing research programs were brought to a halt, endangering the health of participants who had already started treatment. For example, women involved in a phase one study for HIV prevention were left with devices inserted in their bodies without follow-up care, creating a risk of severe health repercussions. Despite the stop-work order, some organizations opted to use their resources to ensure that no patients were abandoned, highlighting the moral obligations that surpass administrative directives.
Consequences of U.S. Withdrawal from Global Health Leadership
The U.S. decision to withdraw from the World Health Organization (WHO) signals a significant shift in the country's role in global health leadership. With diminished communication and funding, the WHO risks losing its capacity to respond to health crises effectively, as U.S. contributions are vital for major health challenges worldwide. This withdrawal not only threatens global health systems but also allows other players like China and Russia to fill the void, undermining the U.S.'s influence and relationships in critical areas. Furthermore, it poses a public health risk, as reduced cooperation could lead to an increase in outbreaks of diseases such as polio and avian flu, which could return to U.S. borders.
On the very first day of Donald Trump’s second term, he signed an executive order targeting foreign aid programs, especially the U.S. Agency for International Development (USAID).
Comprising less than 0.1% of the federal budget, USAID provides international humanitarian and development aid for poverty eradication, education, disease prevention, and medical programs. The Trump administration has cut off funding for these programs and most of the USAID staff was placed on leave or laid off.
Since January, hospitals and clinics in places like Thailand, Syria, and India have shuttered; clinical trials on HIV and maternal health have been canceled; and projects on polio, malaria, and tuberculosis prevention have been stopped.
Then, this week, the Supreme Court rejected a bid to keep some aid funds frozen. But what does that mean in practice for USAID’s global health initiatives?
Host Flora Lichtman talks about the global health implications of dismantling USAID with Dr. Atul Gawande, surgeon and former head of global health at USAID; and Dr. Salim Abdool Karim, epidemiologist and director of the Centre for the AIDS Programme of Research in South Africa.
Transcripts for each segment will be available after the show airs on sciencefriday.com.