Devex CheckUp: The Trump administration puts Gavi support on the chopping block

It’s an aid bloodbath as the Trump administration said it has terminated 86% of USAID programs, including support for Gavi, the Vaccine Alliance. The organization provides vaccines for millions of children in some of the poorest settings around the world.

In total, USAID is slashing 5,341 programs, according to documents from the Trump administration my colleagues received. That leaves only 898 programs, which are focused on “strategic and life-saving aid, including emergency food assistance and life-saving global health activities,” according to an accompanying letter from a USAID official.

It is not clear that the Trump administration actually has the power to end these programs since funding is allocated by the U.S. Congress, but even an attempt to make such cuts would have seismic consequences across global health efforts.

But Dr. Sania Nishtar, the chief executive officer of Gavi, tells my colleague Sara Jerving that the organization has not received a termination notice from the U.S. government, and Congress has approved $300 million for the organization’s activities this year.

“A cut in Gavi’s funding from the US would have a disastrous impact on global health security, potentially resulting in the deaths of over a million children over five years, and endangering lives everywhere from dangerous disease outbreaks,” she says.

According to the documents, the USAID programs the administration is moving to cut total $75.9 billion, including some that started years ago and others with end dates far in the future. Of that total, $48.2 billion was already obligated, which means those funds were assigned or committed but not necessarily paid out to an implementing organization. This leaves some $27.7 billion from these terminated programs with money yet to be obligated.

The State Department is also set to lose 2,100 programs — about 40% of its overall aid commitments — totaling $4.6 billion.

The listed health cuts also include the World Health Organization’s polio and immunization program, two separate grants to the Anova Health Institute — a South African NGO that is the largest non-U.S.-based PEPFAR implementer — and UNAIDS (more on that below), among cuts to other organizations providing health services.

The spreadsheet also included programming that was spared — including a $13.4 billion award on the ledger from 2017 until 2027 for the Global Fund to Fight AIDS, Tuberculosis and Malaria — although all that funding has already been obligated.

Read: The USAID awards the Trump administration killed — and kept

What next?

UNAIDS has lost 40% of its total annual revenue as a result of USAID cuts.

The Trump administration terminated grants to the agency worth $50 million in core or flexible funding and an additional $40 million in non-core or earmarked funding.

UNAIDS hasn’t had to cut any jobs yet, but the agency is facing difficult decisions about its future, Executive Director Winnie Byanyima has acknowledged.

Read: UNAIDS faces dicey future as US slashes 40% of its budget

Outbreak breakdown

Nicholas Enrich, who served as acting assistant administrator for global health at USAID before being placed on administrative leave earlier this month, testified before the U.S. House Committee on Foreign Affairs on Tuesday about what he describes as the U.S.’s botched assistance to the Ebola response in Uganda.

He spoke about a series of unheeded warnings, unanswered emails, blocked payments, health supplies stranded in a warehouse, culling of staff, misrepresentations to the public, and an underplaying of the seriousness of the spread of one of the world’s deadliest diseases, my colleague Sara Jerving writes.

In a clip that went viral, billionaire Elon Musk said during a White House Cabinet meeting last month that the U.S.’s Ebola activities had been accidentally turned off but then quickly resumed.

However, this was false, according to Enrich, who told the committee: “None of the activities were approved, and no funds had been made available for any Ebola response activities.”

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

Read more: US delayed assistance to Uganda’s Ebola response

ICYMI: USAID official dismissed after detailing ‘failure’ to give lifesaving aid

Past due

The U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, is no longer authorized. The deadline for the U.S. Congress to re-up the program, which is responsible for saving 26 million lives since its launch in 2003, came and went on Tuesday. Hardly anyone in Washington seemed to notice.

It’s not as bad as it sounds, though. Some time-bound elements expired Tuesday, including guidance on how PEPFAR funds are spent. But the program is written into law, and it has funding, so it’s not just going to disappear.

However, while PEPFAR can exist without authorization, that does not mean it will. The program has been struggling ever since it was included in the Trump administration’s stop-work order on foreign aid two months ago. It has been further destabilized by the administration’s suspension and elimination of grants to USAID. The agency is the primary implementer of PEPFAR activities.

Key payment systems are shut down, slowing the distribution of critical funding. Services that facilitate the delivery of lifesaving medication had their contracts canceled. HIV counselors are not getting paid.

While some elements of PEPFAR have been allowed to continue under the waivers granted by the Trump administration, the reality is that the complex system is struggling.

Read: Why PEPFAR has bigger problems than reauthorization

Background reading: Some PEPFAR programs get waiver to restart operations

Taking stock

One of the challenges I keep hearing from the people considering the global impact of Washington’s program suspensions and cancellations is that they’re missing a comprehensive overview of everything that has been affected.

Thanks to a leaked memo from the Kenyan government, which my colleague Jenny Lei Ravelo and Sara gained access to, we now have some insight into the scale of the disruption in that country, at least.

U.S. support accounted for nearly a third of the funds needed to procure, store, and distribute essential commodities for a range of programs, including HIV, malaria, tuberculosis, and family planning. Now those stocks are in jeopardy.

The concerns stretch further, though, into health information data systems that the U.S. government was helping to support. Those systems are now facing critical vulnerabilities. American funds also helped pay for health workers, and it’s not clear where their salaries will come from now. There is a fear that health facilities could fall into disrepair. Even the rollout of the country’s Social Health Insurance Fund is in jeopardy.

The memo includes a call to reimagine health financing and reduce donor dependency, but it seems unlikely that this will happen quickly enough to mitigate some of these immediate threats.

Read: Kenyan govt internal memo warns of ‘domino effect’ of US health cuts

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Under scrutiny

It has not been a good year for Saima Wazed, the regional director of WHO Southeast Asia. Bangladesh’s Anti-Corruption Commission has been investigating her since January. Last week, the body officially filed two charges against her.

The first alleges that she provided false information in her application for the WHO position, including claiming a specialization that she does not possess. The more troubling claim, though, is that she colluded with a former bank executive to induce donations to a foundation that she founded and chaired.

This, of course, is the same Wazed whose mother was ousted as prime minister of Bangladesh last year.

Read: Bangladesh anti-corruption agency accuses WHO director of fraud

Shaping a revolution

Global health took center stage at the recent Mobile World Congress in Barcelona, Spain. That’s thanks to the growing convergence between global health and artificial intelligence, including AI’s potential to revolutionize health care delivery.

The emerging synthesis is raising some concerns, though, about how to regulate this potentially transformative technology and how to make sure that poorer parts of the world also get to benefit from it.

You can watch Devex journalists in conversation with experts at the Mobile World Congress about these and other critical issues.

Watch: How will AI change global health?

What we’re reading

After withdrawing his first nominee to head the U.S. Centers for Disease Control and Prevention, U.S. President Donald Trump has picked Susan Monarez, a microbiologist and immunologist, to head the agency. [Reuters]

Brooke Nichols, an associate professor of global health at Boston University, is tracking the number of additional adults and children who could die from AIDS-related illnesses in 2025 if the Trump administration doesn’t restore foreign aid. [BU School of Public Health]

India pledged to eliminate TB by 2025, but instead, the country is backsliding, with more than 2 million cases reported each year. What went wrong? [Deutsche Welle]

Sara Jerving contributed to this edition of Devex CheckUp.

Update, March 27, 2025: This article has been updated to include additional details about funding that was spared from aid cuts.