News and Insights

Aid Cuts: A Shot in the Foot for Global Health?

May 1, 2025

In light of the recent tariffs and cuts to global aid announced by the U.S. government, the world is creeping towards an ever more nationalistic, even isolationist state. Nowhere will this be felt more prominently than in global health.

At the onset of the Trump administration, much of the current U.S. foreign aid was frozen for a period of 90 days. Since then, many foreign aid contracts have simply been cancelled, leaving many charities and organizations worldwide unable to finance their own workforce and provide vital medical supplies. This has left many individuals, particularly those most vulnerable in low-income countries, without healthcare, and at the mercy of medical conditions which could be a death sentence. 

The logic of the cuts is that reducing government spending will reduce taxes. This is an appealing notion for many, and the sentiment has been present not just in the U.S. but has been echoed in Europe, with countries such as the UK also reducing their foreign aid spending.

As scientific communicators, it is our role to highlight the flaws in this line of thinking. Such a political maneuver results from a lack of long-term perspective. Defunding global health programs may recuperate finances in the short term; however, as non-communicable conditions worsen and infectious diseases spread, their impacts will increase costs many-fold.

From a long-term perspective, health programs stand next to investment in clean water in their capacity to improve overall quality of life. In particular, vaccination has been shown time and again to improve lives and to save money in the long term. 

A recent study conducted by the Office of Health Economics (OHE) found that investment in adult vaccination had a return on investment of up to 19 times the initial costs. This return is due to factors such as reductions in hospital admissions and treatment, and fewer hours spent on sick leave, resulting in a far more productive population. Removing access to life-saving interventions such as vaccinations will have a knock-on effect for generations to come. Many countries that were previously beneficiaries of these aid programs will feel the impact of the cuts not just in the immediate aftermath, but in long-term reductions in overall health and productivity.

The Situation in Africa

Nowhere is this more evident than in Africa. Experts have already weighed in on the impacts of the cuts, and the figures presented are staggering. According to models featured in a study published in The Lancet, the removal of stable funding from PEPFAR (President’s Emergency Plan for AIDS Relief) will result in an additional 1 million children infected with HIV, 500,000 additional children will die of AIDS, and 2.8 million children will be orphaned by AIDS in just the next five years. Another article published in Nature suggested that models indicate around 25 million additional deaths within the next 15 years.

The cuts are sector-wide, massively impacting or even grinding to a halt key health programs for diseases such as HIV, malaria, tuberculosis, and polio. Due to the sudden announcement of the cuts, many countries have been caught entirely unprepared. The WHO announced that Kenya, Lesotho, South Sudan, Burkina Faso, and Nigeria have only a few months until they deplete their supplies of antiretroviral medicine for HIV. “Instead of a careful handover, we’re being pushed off a cliff,” said Kate Rees from the Anova Health Institute in South Africa, which was faced with finding an alternative means of providing HIV antiretrovirals for around 900,000 people in the space of a day.

Government expenditure may be lowered across the U.S. and countries in Europe; however, the key point that needs to be communicated is that these reductions in expenditure will be weighed against lives lost.

The funding cuts have not just stifled medication supplies. They have also resulted in the mass layoff of healthcare workers across much of the continent. This abrupt loss of not only facilities but also medical expertise and community care is likely to impair domestic efforts to bolster healthcare services for years to come. While some countries have resorted to requesting healthcare staff to continue working on a voluntary basis, this is unsustainable.

Recovery from the cuts may be a severely drawn-out process. Few countries are prepared for it. Currently, around 30% of Africa’s health budget comes from official development assistance, which has been reduced by roughly 70% this year, from $81 billion to $25 billion. In 2001, African Union members made a commitment during the Abuja Declaration that they would aim to allocate at least 15% of government budgets to health. Currently, just two of the 55 member states – Botswana and Rwanda – have achieved this commitment. 

Without domestic funding in place, governments are faced with a short window of time to allocate funds before lives are lost. While some news outlets have opted to phrase this as a “wake-up call” for Africa, this mindset undermines the lives that will be lost in the process. WHO Director-General Dr Tedros Adhanom Gebreyesus commented on the matter, noting that while the aid withdrawal was the right of the U.S. administration it “has a responsibility to ensure that, if it withdraws direct funding for countries, it is done in an orderly and humane way to allow them to find alternative sources of funding.”

What We Can Achieve, and What is Now Being Lost

As Dr Tedros states, it is within the rights of the U.S. Government to withdraw aid. However, the question remains – and one that is echoed by many citing the necessity of these cuts – why is this America’s responsibility?

The moral implications are self-evident; the removal of the funding will result in potentially millions of lives lost. However, beyond the immediate fallout resulting from the cuts, lies a loss of reputation that is deeply demoralizing. The U.S., especially in the region of global health aid, has fostered a reputation that has been decades in the making, cementing their role as a global leader and an example of what can be accomplished.

This has been no small undertaking, amounting to billions of dollars a year, however, the impacts have been exceptional, with potentially millions of lives saved, disease cases across a number of conditions notably reduced, and even, the eradication of a disease in its entirety. This reputation as a global leader in health aid has been tarnished through a singular decision to abandon this position.

The cuts are made even more tragic by what we’ve shown can be accomplished through global collaboration and through the very aid programs being cut. Smallpox, a disease with a mortality rate ranging from 20% to 50%, and one that had ravaged human populations potentially for millennia, has been consigned to the history books through such global efforts. The combined efforts of pharmaceutical companies, government aid, communication and awareness efforts and grassroots activists resulted in a previously lethal disease becoming nothing more than a topic learned about in school for future generations.

This is almost the case for polio. However, what would otherwise be a cause for celebration the world over with the declaration of eradication for yet another disease, is now looking to be a potential resurgence with the recent cuts to aid. Billions have been spent to achieve eradication, and, according to the WHO, more than a million lives have been saved due to polio vaccinations. In a matter of months, decades of progress are being undone through cuts to vaccination budgets, allowing the disease to once again begin spreading.

In this regard, the short-term thinking of aid cuts falls apart. A cut to healthcare spending, and, in particular, vaccination programs, in one region is not an isolated event. Populations will eventually become reservoirs of disease, making any attempts at eradication impossible. 

The reality of modern-day travel is that we are never more than 24 hours away from any other destination. Via air travel, a person—and so, any pathogen that may also be present—can be in almost any other part of the world in the space of a day. The COVID-19 pandemic serves as the perfect example of how a virus initially detected in a single city in China took no more than a few weeks to become an issue faced by the entire world. 

In today’s interconnected world, isolationism is simply not an option when it comes to health. Pathogens do not recognize borders. Efforts to communicate this rationale must be made, and the science must be conveyed clearly, that a pathogen proliferating in one area of the world is not just a problem for other people; it is an issue that can very rapidly become a global matter. 

Through these aid programs, much has been achieved. As scientific communicators, we need to constantly remind the world of these achievements or age-old threats to global health will simply be forgotten, as is often the case with smallpox. Without prompting, history may be doomed to repeat itself.