Devex CheckUp: Trump admin proposes sweeping cuts to global health

The Trump administration has put U.S. global health spending firmly on the chopping block.

In the wake of the Department of Government Efficiency’s dismantling of the U.S. Agency for International Development, the administration is now looking to rescind $900 million allocated for global health during the 2024 and 2025 fiscal years. That includes a $400 million cut to the President’s Emergency Plan for AIDS Relief, or PEPFAR, according to my colleague Sara Jerving.

This would codify — and extend — the cuts DOGE has enacted. And it is part of a broader $9.4 billion in previously enacted funding that the administration is asking Congress to wipe away.

But that’s not all.

In the budget request for fiscal year 2026, the administration wants to slash PEPFAR spending by $1.8 billion and allocate only $424 million to the President’s Malaria Initiative. That’s a 47% cut to a program that offers malaria treatment and prevention services in some of the hardest-hit countries.

It also excluded funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, though the request said there might be room for a contribution. But the maximum the administration wants to contribute is one-fifth of the organization’s total funding, a dramatic reduction from the one-third of previous years.

The request omits funding for Gavi, the Vaccine Alliance entirely. This comes just after Gavi’s board welcomed Trump administration official Mark Kevin Lloyd, the assistant administrator for the U.S. Bureau of Conflict Prevention and Stabilization and the assistant to the administrator for global health at USAID.

His appointment was seen as a potential opportunity to reverse the administration’s indifference toward the organization, which has helped vaccinate more than half of the world’s children against infectious diseases. The U.S. had been the organization’s third-largest contributor, responsible for 13% of its funding.

The Biden administration had pledged to continue in this tradition, setting aside $1.58 billion for Gavi’s current replenishment cycle that will pay for its work from 2026 to 2030.

The current White House justified its exclusion of Gavi in the funding request because the organization “reports a reserve of over $7.0 billion in its most recent statutory financial statements.”

A Gavi spokesperson told Sara the organization is mandated to keep a nine-month operational buffer. Any additional funding held in reserve is already accounted for.

And those are not even all the programs at stake. The administration wants to completely cut funding for family planning and reproductive health, neglected tropical diseases, and nonemergency nutrition because they “do not make Americans safer.”

It’s safe to say that if the requests are enacted, they would drastically reshape the global health funding landscape.

Read: Trump budget request and rescission plan slashes global health funding

Also: Trump administration official Mark Kevin Lloyd joins Gavi board

Unforced error

The threats to PEPFAR extend beyond funding cuts, Mitchell Warren, AVAC’s executive director, writes in an opinion piece for Devex.

U.S. Secretary of State Marco Rubio’s plans to restructure his department would result in PEPFAR’s marginalization, burying it under authorities with little health expertise. That “means the intellectual capital of hundreds, if not thousands, of global health experts has been lost,” Warren writes.

Rather than a realignment, Warren calls for the U.S. Congress to recommit to PEPFAR so that it can maintain a focus on data-driven, evidence-based programs that are the best opportunity to reach ambitious HIV targets, including ending AIDS as a public health threat by 2030.

Opinion: The US legacy in HIV is unraveling

Show us the money

With traditional bilateral donors such as the United States clearly in retreat, who is going to pay for an expanding list of global health priorities?

Priya Basu, the head of the Pandemic Fund, has some ideas. Her fund is pioneering a model of leveraging its grants to draw additional money from both multilateral development banks and the low- and middle-income countries that are attempting to shore up their pandemic preparedness and response.

Speaking at a Devex event on the sidelines of last month’s World Health Assembly, Basu said that the model seems to be working. In its first two funding rounds, the Pandemic Fund awarded $885 million, which she said leveraged an additional $6 billion from both external and domestic resources.

By drawing on domestic funding, it helps to ensure that governments are determining which among the many health priorities gets funded.

Representatives from Gavi and the Global Fund, who spoke after Basu, agreed that funding models have to shift. But the Global Fund’s Françoise Vanni cautioned that change can’t come too quickly.

She said it is important for remaining funders to consider, “How do we address the current crisis without putting people at risk, while at the same time engaging on these long-term, medium-term pathways toward transition and sustainability and fully funded and owned health systems?”

Read: A new model for funding global health takes shape

Related reading: Can MDBs step up to meet the moment? (Pro)

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An alternative approach

It was a victory for traditional, complementary, and integrative medicine when World Health Organization member states agreed to a new strategy for the field at the recent WHA. That should translate into stronger collaboration and more opportunities to integrate TCIM into modern health care.

But that does not mean everyone is on board. While the strategy got a lot of support from Asian, African, and Latin American countries, other parts of the world had questions about maintaining rigorous scientific research to ensure TCIM meets the same standards as any other form of care.

That tension comes through in the final strategy, which emphasizes respect for TCIM and for patients’ rights to choose their own treatment, while also underscoring the importance of strict regulation.

Read: WHO adopts new global strategy on traditional medicine

The birth of an agency

Delese Mimi Darko has been appointed as the inaugural director-general of the African Medicines Agency. She is currently the chief executive of Ghana’s Food and Drugs Authority.

This is a long-awaited appointment to the new specialized health agency of the African Union that is tasked with improving regulatory harmonization of medicines across the continent, including in pharmaceutical manufacturing.

“Her appointment marks the operational birth of a continental agency with the power to reshape Africa’s pharmaceutical landscape,” Michel Sidibé, African Union special envoy for AMA, wrote on X.

Read: Ghana's Delese Mimi Darko appointed to lead African Medicines Agency

What we’re reading

Nearly 11 million Americans could lose health insurance under the tax bill that has been approved by the U.S. House of Representatives. [Stat]

Amid broader cuts to HIV research, the U.S. eliminates a $258 million program to search for vaccines against the disease. [The New York Times]

The Trump administration has also pulled the plug on a contract with Moderna to develop vaccines against flu viruses, including bird flu. [NPR]

Sara Jerving contributed to this edition of Devex CheckUp.