Losing the Fight Against Global Infectious Disease

March 31st, 2025

Lindsey Zhao

Since the Trump administration re-entered the US White House in January, President Trump has signed a series of executive orders aimed at cutting down wasteful government spending. One of the government agencies that has garnered most of President Trump’s ire is the US Agency for International Development, or USAID for short. It is the primary agency that distributes foreign aid, including, importantly, to humanitarian programs that combat infectious disease across the world. The US is the world’s largest dispenser of foreign aid; and 60% of that is funneled through USAID. Almost immediately after he had taken office, a ruthless battle began against USAID, which Secretary of State Marco Rubio has repeatedly deemed “extremely fiscally irresponsible”. While their initial efforts to instantly freeze all USAID funding to international programs and fire thousands of federal employees have been challenged by Democrats, activist organizations, and courts alike, President Trump has forged ahead, recently sending a 281-page document to Congress that details his decision to continue 898 USAID funding awards and to end 5,341. He has now abolished over 80% of USAID’s humanitarian aid contracts.

While this has widespread implications for various aid sectors, this article will primarily focus on what the shutdown of USAID could mean for the fight against infectious disease. It is hard to understate how crucial USAID has been for programs that combat infectious diseases like HIV, tuberculosis, mpox, measles, malaria, etc. Let’s go through some of these efforts.

Since the early 2000’s, USAID has provided 60% of the funding for the $6.5B program PEPFAR—President’s Emergency Plan for AIDS Relief—that provides over 20 million people (mostly in Africa) with antiretroviral drugs to combat HIV/AIDS, and it has saved over 25 million lives. Stopping treatment causes virus levels to dramatically increase, helping the virus evolve resistance to drugs and become transmissible. Eliminating PEPFAR could result in roughly 600,000 additional HIV deaths over the next decade in South Africa alone, which has struggled with huge HIV/AIDS outbreaks for years. Already, clinics across the world have been forced to close their doors, fire their staff, and deny patients the care and drugs they need to survive because they are running out of medicine to give. The 55 countries supported by the program, including Zimbabwe, Kenya, and Haiti, are likely to see devastating impacts on their population. Worldwide, these disruptions to HIV programs could lead to 10 million more cases of HIV and 3 million deaths.

USAID also formerly implemented the $1B initiative called the President’s Malaria Initiative, which funds malaria prevention and research. Now, for example, a company using funding from the initiative has “more than one million insecticide-treated bed nets in a warehouse in Ethiopia that, along with antimalarial drugs and diagnostics, it now can’t deploy.” While the programs that fund the purchase of anti-malaria efforts remain mostly intact, all of the programs to distribute them have been slashed. Health officials estimate up to 166,000 more people could die preventable deaths from malaria now that these programs have been cut.

Tuberculosis is considered the world’s most deadly disease, despite being perfectly curable. Since 2000, USAID and its partners have saved the lives of more than 58 million tuberculosis (TB) patients. Similar to the situation facing malaria and HIV/AIDS patients and health providers, funding halts have crippled efforts to fight TB: USAID singularly accounts for 1/3 of the world’s donor funding for TB. If foreign aid does not resume to tuberculosis programs by the end of the year, experts worry it could lead to 62,000 additional deaths. In Cambodia, halts have resulted in 100,000 people missing screening.

Most recently, President Trump announced he would end grants to Gavi, a public-private global health partnership that gives money to developing countries to provide critical vaccines to their children. The US makes up 13% of its budget, and over the past 25 years Gavi is estimated to have saved 17 million childrens’ lives. An end to funds means approximately 75 million children will miss routine vaccinations over the next five years, resulting in 1.2 million deaths.

USAID has served as a method of projecting US soft power abroad for decades, and funding vaccination and disease programs internationally prevents the risk of large outbreaks from occurring and reaching the United States and their citizens. Yet, critics argue the agency is too bloated, corruption is widespread in aid distribution, and that countries should be responsible for their own health programs.

Brooke Nichols, an infectious disease mathematical modeller and health economist and Associate Professor of Global Health at Boston University, created a tracker to estimate anticipated deaths from USAID funding cuts to health programs. Every hour, one hundred and three people are likely to die. If the Trump administration does not reverse course, that number will only climb higher and higher.