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    • Devex CheckUp

    Devex CheckUp: How Trump’s first 100 days fractured global health

    A look at how President Trump's first 100 days in office have impacted global health. Plus, why the global fight against malaria is falling short, and a new fund targets maternal and newborn health in Africa.

    By Jenny Lei Ravelo // 01 May 2025
    Sign up to Devex CheckUp today.

    In his first 100 days back in the White House, U.S. President Donald Trump unleashed a series of decisions that are already having a harsh and potentially long-lasting impact on global health.

    After the administration froze and eventually axed thousands of USAID foreign aid awards, organizations were forced to shut down offices and furlough or lay off thousands of staff. That includes some of the biggest global contractors and NGOs, such as Chemonics International, which had to furlough around 63% of its American workforce. Local organizations were hit just as hard — Anova Health Institute in South Africa laid off nearly 3,000 workers, including HIV counselors, health workers, and data capturers. Thousands of USAID staffers, including many from the Bureau of Global Health, also lost their jobs.

    One WHO health official estimated the direct job losses in the health and care economy at over half a million — though others say that’s likely a low estimate.

    The ripple effects? Countless health facilities shuttered and services suspended — from HIV programs to sexual and reproductive health services. A new survey by the International Union Against Tuberculosis and Lung Disease found disruptions in tuberculosis care and prevention in at least 10 national TB programs in Africa. Lifesaving interventions such as providing clean water and medical care in Gaza have also been gutted “for the convenience of the U.S. government,” some termination letters stated.

    And it’s not just statistics — it’s lives. In South Sudan, at least five children and three adults died of cholera while trying to find treatment, according to The New York Times. They simply couldn’t access the care they needed in time.

    Some groups are calculating the human cost each day services aren’t restored. As of publication, a live tracker supported by Boston University estimates that more than 42,000 adults and over 4,400 children have died due to cuts to PEPFAR programs. Another tracker attributes over 18,000 additional TB deaths to the discontinuation of USAID funding.

    And sadly, this might just be the beginning.

    Layoffs are anticipated in multiple U.N. agencies and programs, including at the World Health Organization and UNAIDS, as the cuts leave a gaping hole in their budgets — which will no doubt have an impact on the assistance they’re providing in countries.

    Leaked budget recommendations from the White House’s Office of Management and Budget also propose further cuts to global health funding under the State Department, as well as cuts to programs in the U.S. Department of Health and Human Services that could have global implications.

    Read: How Trump's first 100 days have meant chaos for US foreign aid

    + To mark the first 100 days of Trump's second term, Devex journalists will discuss the impact on U.S. foreign aid, from the USAID freeze to upcoming global development initiatives. Join us on May 6 for this event. Save your spot now.

    One big number

    $3.3 billion

    —

    That’s how much 20 U.S.-based philanthropic foundations spent on health projects in 2022, with the Gates Foundation accounting for 83% of the total. Other foundations that made significant investments in health include the Bloomberg Family Foundation, the Good Ventures Foundation, and the Conrad N. Hilton Foundation, according to an analysis of the latest OECD data by my colleague Miguel Antonio Tamonan.

    Why does this matter? Because in the midst of declining foreign aid from governments, foundations are expected to fill some of the funding gaps. But if their tax-exempt status is revoked — as some rumors suggest — then available funding could shrink further.

    Read: How 20 US foundations spent more than $8 billion on development (Pro)

    ICYMI: Philanthropies fear Trump will target their tax-exempt status

    + Not yet a Devex Pro member? Start your 15-day free trial today to access all our expert analyses, insider insights, funding data, events, and more. Check out all the exclusive content available to you.

    Gates does it again

    Speaking of philanthropy, there’s a new fund dubbed the Beginnings Fund, which launched this week with the support of philanthropic heavyweights such as the Gates Foundation. It plans to deploy $500 million over the next five years to help save more than 300,000 lives and provide quality care for 34 million women and newborns across sub-Saharan Africa, which, sadly, still accounts for 70% of maternal deaths globally.

    What’s different about this fund? According to a news release, it will focus on “sustainability and local ownership” by partnering with African governments and national organizations and experts.

    Read: New Gates-backed fund targets maternal and newborn health in Africa

    A rare bit of good news

    Over the weekend, Uganda declared the end of its eighth Ebola outbreak (hurray!) less than three months after declaring it. Experts say the country’s experience managing outbreaks enabled it to control this latest health emergency relatively quickly. The country’s 2022 Ebola outbreak also lasted for about three months, so it does appear it is getting the hang of dealing with the disease.

    But what’s different this time? Uganda and its partners appear to have tackled most of the response with little help from the U.S. — at least early on.

    Devex reported that for more than a week after the outbreak declaration, U.S. support for the response was suspended, despite a waiver allowing U.S. funding for lifesaving humanitarian assistance. Elon Musk, who heads the Department of Government Efficiency Service, or DOGE, which led the charge on the dismantling of USAID, said the pause was a mistake and that funding was resumed in February.

    But Nicholas Enrich, who previously served as USAID acting assistant administrator for global health, told the U.S. House Committee on Foreign Affairs in late March that none of their activities were approved, and no funds had been made available for the Ebola response. On top of that were massive staffing cuts at USAID and communication restrictions with WHO that made it difficult for them to respond.

    “Day by day, my team and I raised the payment issues. However, none of our partners ever received access to funds for activities,” Enrich told the committee.

    As the outbreak ended, however, the U.S. embassy in Uganda published a fact sheet chronicling its contributions in combating the outbreak, including a commitment of $8 million to the response, and sending 10 treatment courses for Ebola that it said arrived at Uganda’s National Medical Stores on April 9 and 26.

    ICYMI: Ousted USAID health lead says US fumbled Uganda’s Ebola response

    Also: US delayed assistance to Uganda’s Ebola response

    The new 50

    People are living longer today than in decades past. WHO estimates that 1 in 6 people globally will be 60 years old or older by 2030, and data from the International Monetary Fund says that a 70-year-old in 2022 has similar cognitive abilities as someone aged 53 years old in 2000. That is worth celebrating, wrinkles and all.

    But during a World Bank-IMF Spring Meetings session on “Super Aging,” World Bank officials said aging comes with challenges. Some high-income countries are dealing with rising pension costs with increased retirement, while their labor forces are shrinking. Several low- and middle-income countries are also facing a rapidly aging population, with less mature social protection systems for older people.

    There are ways countries can turn the crisis into an opportunity. They can start upskilling older adults so they remain employable, and introduce savings schemes and social pension policies for those working informal jobs, so they have something to rely on when they get older. And if countries want to ensure more of their populations reach past the age of 60, they should hike taxes on health-harming products such as cigarettes, said Sir George Alleyne, director emeritus at the Pan American Health Organization.

    Hiking taxes for harmful products could generate an additional $3.7 trillion in government revenue globally over the next five years, while helping reduce consumption of these products, according to an opinion piece for Devex.

    Read: 70 is the new 50 — World Bank raises complexities of tackling aging

    Opinion: Financing health for all requires bold moves away from aid

    Getting … there?

    To mark World Malaria Day on April 25, WHO urged the global community to “re-energize efforts” toward eliminating malaria. The goal is a 90% reduction in cases and deaths by 2030, however, current trends suggest this is unachievable. In 2023 alone, malaria caused an estimated 260 million infections and 600,000 deaths across 83 countries.

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    Some experts remain hopeful, given the existence of two malaria vaccines that have been rolled out in several African countries. But they, too, are aware of other factors at play that could derail elimination. Climate change is increasing the risk of malaria transmission and is projected to lead to 550,000 additional malaria deaths between 2030 and 2049. They also fear that recent foreign aid cuts will significantly undermine malaria control efforts.

    Read: Is the world on track to eradicate malaria 

    What we’re reading

    The Phase 3 clinical trial for a highly anticipated TB vaccine candidate has completed the enrolment of participants months ahead of schedule. [STAT]

    There are now nearly 900 measles cases across the U.S., according to the CDC. [NBC News]

    Bill Gates, one of the biggest philanthropic donors, has met with White House officials and members of Congress to make the case for global health. [The New York Times]

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    About the author

    • Jenny Lei Ravelo

      Jenny Lei Ravelo@JennyLeiRavelo

      Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.

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