Devex offices are closed this week for an August break. Instead of our regular Newswire, we’re taking deep dives into some of this year’s key development topics. Today, we dig into the impact of donor funding cuts to global health programs and organizations.
It’s been a grueling six months for global health organizations, as U.S. aid cuts have led to sharp funding losses across the sector. Thousands of jobs have been lost, including at some of the sector’s largest institutions. UNAIDS is cutting 55% of its staff, while Gavi, the Vaccine Alliance is eliminating 155 full-time positions — about a quarter of its workforce.
Organizations are also being forced to restructure. On the one hand, the World Health Organization has undertaken yet another major reorganization of its leadership chart — we’ve lost track of how many reshuffles WHO chief Tedros Adhanom Ghebreyesus has carried out during his tenure. On the other hand, the Stop TB Partnership is losing its diversity, equity, and inclusion officer amid broader staff cuts and shifts in U.S. funding policies that no longer support related activities.
Truth be told, calls for reform of the aid sector were there long before these big cuts hit. Funding was shrinking even before the U.S. took a wrecking ball to the sector, and there was growing criticism about the power imbalances that shape global health. One global health leader has even argued that major multilateral funders such as Gavi and the Global Fund to Fight AIDS, Tuberculosis and Malaria should sunset to end countries’ dependency on their assistance.
But what exactly should the future of global health look like? And how can these changes — which are all happening rapidly — be more carefully thought out?
Let us know what you think via checkup@devex.com.
Read: Stop TB cuts over a quarter of staff amid shift in US priorities
Plus: Stop TB Partnership retains US funds but must revise scope, cut staff
The World Health Organization was the first agency to feel the sting of the Trump administration’s U.N. retreat.
You all know the story. As soon as Trump took office, he issued an executive order to withdraw the U.S. from WHO, again. And in the weeks that followed, seconded U.S. officials were ordered to pack their bags and cut all contact with the U.N. agency. Then the U.S. decided to freeze its aid, with a few exceptions.
Under U.S. law, the government needs to pay its dues in full before it can separate from WHO. However, the Trump administration hasn’t done that. It still owes the agency money for 2024 and 2025.
The funding crisis created by the U.S. withdrawal, coupled with other donor cuts, forced WHO to implement cost-saving measures, such as introducing a hiring freeze and cutting down on travel. But this wasn’t enough to fill the giant U.S.-shaped hole in its budget.
So Tedros cut his senior management team in half and merged several departments. It looks like those who are left will probably have to do a lot more with a lot less, with some taking on massive portfolios. Kalipso Chalkidou, for example, is now director of governance, financing, economics, primary health care, and universal health coverage.
Some staff aren’t happy with how things are playing out with the restructuring, which WHO expects to finalize by the end of this month.
Experts, too, are skeptical about whether the restructuring will actually make the agency more agile or better aligned with its core strengths. Analysts at the Center for Global Development argue that WHO should focus on its global leadership role, rather than honing in on its country-level work.
Read: Tedros reveals new WHO leadership without deputy Mike Ryan
Read more: WHO names new directors in ongoing restructure
Deep dive: Inside WHO's reforms — progress, failures, and unfinished business
Funding insight: Who’s funding the World Health Organization? (Pro)
One organization deeply wounded by donor cuts is UNAIDS, which will significantly shrink its presence in countries and deprioritize many of its current activities, with the hope that other U.N. agencies can take over.
It will also be relocating a lot of functions in the coming months. One place where that loss of staff will be hugely felt is its headquarters in Geneva, where only 20 people will be left once the restructuring is completed.
But that may not be the end of it. In 2027, it could further reduce its presence and integrate with U.N. country teams, possibly leading to the closure of the secretariat by 2030.
All of that is still up for debate in the coming years. But one thing’s for sure — funding is pretty dire at the moment, so much so that UNAIDS asked to use a portion of its operating reserves to implement its activities, including the secretariat's restructuring in 2026.
Read: Will UNAIDS sunset by 2030?
Exclusive: UNAIDS will lose more than 50% of staff in restructuring
Amid the chaos and heartbreak, those working on HIV and AIDS found a ray of hope in recent weeks, when the U.S. Senate voted to preserve $400 million in funding for the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, that had already been approved by Congress but was on the chopping block as part of a White House rescissions package.
It’s a small win for HIV and AIDS advocates, who’ve spent months fighting to keep funding flowing from the world’s largest bilateral supporter of the HIV response.
But their battle is far from over. The White House 2026 budget request proposes a $1.9 billion slash in funding for PEPFAR, and there’s always the possibility of the administration sending another rescissions package asking to claw back more funding.
PEPFAR is currently operating under a waiver that limits the provision of HIV prevention drugs to pregnant and breastfeeding women and excludes high-risk groups such as men who have sex with men. And more dramatic changes may be on the horizon. A State Department plan, reported by The New York Times, talks about phasing out PEPFAR in its current form and transforming it into a platform for detecting and responding to global disease outbreaks.
Experts say any transition must be responsible — with a gradual handover, not an abrupt exit.
But the consequences of missteps are already being felt. In Uganda, 28-year-old Lydia Nabirye was one of the victims of the cuts. A local organization that helped coax Nabirye to take her HIV treatments was suddenly defunded by the Trump administration early in the year, forcing the organization to shut down its services. The result? Nabirye died after failing to take her meds.
Read: Senate blocks $400M cut to PEPFAR, but it’s a shell of its former self
Read more: Following PEPFAR cuts, vulnerable Ugandans are dying, providers say
Plus: What should a responsible PEPFAR transition look like? (Pro)
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The dramatic cuts in U.S. funding have led the Global Fund to make the ultimate decision to slice $1.4 billion out of the grants that it had already allocated for 2024-2026.
The U.S. owes the multilateral organization billions in pledged funds, but it’s unclear if it will ever make good on that promise.
The cuts vary across countries. South Africa, which is among the countries with the highest burden of HIV, faces a 16% reduction in its allocations, while South Sudan is set for only a 5% cut. But the vast majority of more than 100 countries are slated for cuts of 10% or more.
The Global Fund stated that funding for lifesaving commodities would be preserved. However, since cuts must occur elsewhere, organizations are concerned this could cripple their service delivery. Grants are undergoing revision now and are expected to be finalized in September. That means the full impact of this decision will only be known in October.
The future, however, is even more uncertain. The White House budget request for 2026 does not include any explicit allocation for the Global Fund, and in the case of any future funding, it’s only willing to pay for one-fifth instead of the usual one-third of the fund’s activities.
Still, that’s more generous than what’s planned for Gavi, which could be left with no U.S. funding at all if Congress backs the White House’s plan. U.S. Health Secretary Robert Kennedy Jr., a known vaccine skeptic, announced during Gavi’s replenishment summit that the U.S. isn’t putting another dollar into Gavi until it works to “re-earn the public trust,” and accused it of neglecting vaccine safety.
Read: Global Fund plans to cut $1.4 billion from grants it has already awarded
More: Gavi pledges fall short about $2.9B as US pulls out
ICYMI: Robert F. Kennedy Jr. says the US is cutting funding for Gavi
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