Devex CheckUp: There was no way for global health to prepare for Trump

The new U.S. administration under President Donald Trump continues to cause seismic shifts in global health and aid. The U.S. Agency for International Development is all but shuttered and a freeze on foreign aid spending is still causing confusion.

The thing is, though, the leaders of the United Nations Population Fund, or UNFPA, thought they were prepared for whatever chaos was coming. It turns out, like most people, they were wrong.

You see, UNFPA was ready to have its U.S. funding ended. That’s happened every time a Republican president has taken office since Ronald Reagan. In 2023, U.S. funding added up to nearly 30% of the agency’s $443 million humanitarian operations. UNFPA leaders were already looking elsewhere for money.

But like virtually all of the programs that benefit from U.S. foreign aid, the agency was not prepared for the three-month freeze on funding that Trump put in place hours after taking office. That executive order was followed by a memo forcing all organizations to stop work on activities reliant on U.S. funding.

The first Trump administration allowed UNFPA to at least spend the money that was already in the pipeline. But this time, U.S.-funded projects have had to screech to a halt. This includes a female health worker project in Afghanistan, mobile health teams providing support to pregnant women in Gaza, and sexual and reproductive health services around the world.

It's not clear this work will ever resume. It also raises questions both legal — some countries don’t allow employees to just be laid off at the whim of the U.S. government — and logistical.

Meanwhile, the U.S. government has not actually said, yet, whether it intends to defund UNFPA.

Read: UN Population Fund thought it prepared for the worst — it didn’t

Out of focus

Speaking of the stop-work order, it seemed like the President’s Emergency Plan for AIDS Relief, or PEPFAR, might have avoided the full brunt of its impact.

PEPFAR recipients around the world complied with the initial order suspending spending, resulting in the shutdown of lifesaving treatment programs and efforts to prevent transmission of HIV.

Days later, Secretary of State Marco Rubio seemed to offer PEPFAR a lifeline, issuing “a limited waiver to implement urgent life-saving HIV treatment services.” That seemed to allow HIV treatment services and programs that work to prevent mother-to-child HIV transmission to resume.

Except — and this has become a theme in the early days of the administration — there are a lot more questions than answers. It’s still not clear to implementers just how broad the waiver is. As a result, many programs have been cautious about restarting activities out of fear that they might unknowingly violate the stop-work order.

The chaos this has caused, “whether it’s intentional or not, has effects on actual people’s lives and livelihoods and survival,” Jen Kates, a senior officer at KFF, tells my colleague Adva Saldinger.

Read: Some PEPFAR programs get waiver to restart operations

In focus

What does seem increasingly clear is that USAID will not survive even the first month of the new Trump administration.

In an announcement Tuesday, nearly all USAID staff members were put on administrative leave amid efforts to bring most personnel based outside of the country back to the United States. The institutional support contractors and personal service contractors that were essential to the agency’s operations have already been fired.

It looks like Rubio plans to try to fold USAID into his State Department. That will likely look far different from the agency that, until two weeks ago, employed more than 10,000 people across the world and channeled $40 billion into efforts in more than 130 countries.

A significant amount of those funds were earmarked for health: $3.3 billion went to HIV/AIDS, basic health received $2.8 billion, and maternal and child health and family planning received $1.37 billion.

Read: Most USAID staff cut from the agency, marking end of world’s largest donor

Plus: USAID funding explained — what’s at risk under Trump? (Pro)

+ At a moment when U.S. foreign aid undergoes its most significant restructuring in decades, what does this mean for the future of global HIV/AIDS programs and the communities they serve? Join us on Feb. 11 for a conversation with Chip Lyons, who brings unique insights from his tenure as president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation and his years at UNICEF. Save your spot now.

This event is exclusively for Devex Pro members. Not a Pro member yet? We offer a 15-day free trial.

Hoping for a U-turn

While USAID’s future seems dire, efforts are underway to reverse Trump’s executive order withdrawing the U.S. from the World Health Organization.

A team of U.S. legislators wrote to Trump encouraging him to stick with the agency, and they took a tack they hoped would appeal to the businessman-turned-politician. In the letter, the lawmakers argued that withdrawing from WHO would incur job losses within the United States, both because procurement services would be lost and WHO support for 72 health research and innovation centers would likely end.

Meanwhile, WHO Director-General Tedros Adhanom Ghebreyesus went on the offensive with a point-by-point refutation of the arguments Trump made in his executive order justifying the WHO withdrawal.

That included pointing out that America’s assessed financial contribution to WHO is calculated the same way as everyone else’s: based on a country’s gross domestic product. The reason U.S. contributions are so much higher than a country such as, say, China’s, is because of voluntary funds added on top of the assessed contribution.

Tedros also pointed to ongoing changes within the agency to refute Trump’s claims that WHO has failed to reform, even as he underscored that he was open to additional suggestions.

There’s no word from the administration yet on whether any of these efforts have changed Trump’s mind. However, Trump’s decision to withdraw appears to have emboldened other countries to follow suit.

Argentina President Javier Milei also wants to withdraw the country from WHO, his presidential spokesperson announced at a news conference Wednesday.

The spokesperson said the decision is due to the country’s “deep differences” with the agency on health management, particularly during the COVID-19 pandemic. Milei has criticized the lockdowns during the pandemic. The spokesperson added that WHO “lacked the independence from the political influence of other states,” echoing Trump’s accusations against the agency.

Read: Members of US Congress urge Trump to reconsider WHO withdrawal

Read more: The Trump effect? Argentina says it will withdraw from WHO too

ICYMI: Tedros refutes Trump’s claims of WHO’s lack of independence

Show me the money

Funding is almost certainly front of mind for Tedros and other WHO officials, with the loss of the agency’s biggest donor. And now, member states are questioning increases in assessed funding that were meant to help buoy the global health organization.

WHO member states had pledged to increase assessed contributions, which are desirable because they are fully flexible. And members had agreed to a 20% increase in their dues in 2023. However, a proposal to up those contributions by another 20% starting in 2026-2027 has hit a snag.

China, currently paying the second-largest membership dues to WHO, does not appear to be so open to the increase. WHO has already had to slash its base budget by $400 million for 2026-2027. Tedros is now pleading with member states to increase their contributions so the agency doesn’t have to make further cuts.

Read: WHO pleads for 20% funding increase as some countries push back

Temporary assignment

WHO officials have tapped Dr. Chikwe Ihekweazu to take over as acting regional director for Africa, following the death of Dr. Faustine Ndugulile in November. Ndugulile had been selected just months before his death to replace Dr. Matshidiso Moeti, who had led the regional office for 10 years.

Ihekweazu is the assistant director-general for the division of health emergency intelligence and surveillance systems in WHO’s emergencies department. He had not vied for the regional director opening.

Countries are currently in the process of nominating candidates, and a permanent regional director could be selected as early as May.

Read: Dr. Chikwe Ihekweazu appointed as WHO Africa acting director

Wait and see

Robert F. Kennedy, Jr. could be named U.S. secretary of health and human services as early as next week, after a key U.S. Senate committee advanced his nomination.

Kennedy has been dogged by his persistent — and misguided — questioning of the effectiveness of vaccines and by his claims linking vaccines to autism. In a Senate hearing, Kennedy stopped short of refuting those positions, instead saying, “I just want to follow the science, and if the science says I am wrong about what I’ve said in the past, as I said, I will publicly apologize.”

He has reportedly committed to protecting existing vaccine services if he is approved.

Kennedy has also questioned the link between HIV and AIDS, a form of AIDS denialism that has been roundly debunked.

Nevertheless, he could soon be in charge of a department responsible for securing the health of American citizens. All that remains is for the full Senate, which is controlled by Trump’s Republican Party, to take a final vote on his nomination.

Read: I will publicly apologize if science proves me wrong, says RFK Jr.

What we’re reading

Researchers have launched a trial of a vaccine against the Sudan strain of Ebola virus, amid an ongoing outbreak of the disease in Uganda. [BBC]

Officials suspect that compounds found in fertilizer might be responsible for the 17 deaths that have occurred in a small Indian village since December. [The Guardian]

When confronted with the U.S. order to stop work, staff members at medical facilities in Sudan that are propped up by American funds chose to continue to work rather than risk the lives of up to 100 babies and toddlers. [ProPublica]