Devex CheckUp: US aid cuts spark tough reforms at UN agencies

Global health programs were left scrambling when the U.S. government announced it would pull out of the World Health Organization and slashed thousands of funding awards. Now, major U.N. agencies are making some tough — and urgent — calls to stay afloat.

I learned that UNAIDS has kicked off a restructuring plan in response to donor aid cuts. Switzerland gutted its entire funding for the program, and in recent weeks, the U.S. also terminated its awards.

It’s unclear how many UNAIDS programs are affected, but any funding loss from the U.S. government will be a major blow. The United States is UNAIDS’ biggest donor, accounting for more than 40% of its resources. No blueprint has been presented yet on the restructuring, but staff are already bracing for job losses, with some anticipating up to 40% of staff will be let go.

WHO is also tightening its belt. It froze hiring, reduced travel, and offered early retirement to staff. Senior leaders are also racking their brains about how to keep programs running on a much smaller budget.

Dr. Mike Ryan, who wears three hats as WHO deputy director general, executive director of the WHO health emergencies program, and now chair of the group leading the work on the reprioritization of WHO’s activities, gives a glimpse of what’s at stake.

He says they’re shrinking the two-year budget of the health emergencies program from $1.2 billion to $872 million, a decline of about 27%. And with that comes some “terrible” choices.

“The question is, what do you want to stop doing? You want to stop doing Ebola? You want to stop doing emergency medical teams responding to major disasters in the world? Would you like to stop intelligence gathering so that we know what the next epidemic or pandemic will be?” he says.

Exclusive: UNAIDS staff anxious as restructuring looms amid aid cuts

Plus: With US funding loss, WHO forced to make 'terrible' programmatic choices

Wake me up when September ends

By Sept. 30, whatever’s left of the current U.S Agency for International Development may be dissolved and replaced by a new bureau embedded in the State Department — or at least that’s the idea shared by Tim Meisburger, head of USAID’s Bureau for Humanitarian Assistance, in a closed-door meeting last week that Devex first reported on. The bureau will have four offices, including one focused on global health emergencies.

Is this the final version of USAID’s future? No one seems entirely sure and the details remain murky. But one staffer told my colleague Elissa Miolene: “On one level, people are finally happy to have a vision. … But if this is really what the vision was, couldn’t he have started there?”

Exclusive: Inside the closed-door meeting on USAID’s future

+ Two months after the U.S. aid freeze: What's the fallout? Join us on March 25 for a discussion on what's next for USAID, Congress’ foreign aid budget, updates on the lawsuits, and how globaldev orgs can navigate the changes. Save your spot now. This event is for Devex Pro members. If you aren’t one yet, start your 15-day free trial today.

Rise of the superbugs

Antimicrobial resistance, or AMR, could cause the deaths of 169 million people by 2050 if urgent action isn’t taken to curtail its spread. But with the U.S. funding cuts, experts fear the world may be heading into a crisis.

Here’s why:

• Treatment disruptions for infectious diseases such as tuberculosis and malaria can lead to drug resistance, and the gutting of surveillance systems would allow drug-resistant strains to spread undetected. Before Nicholas Enrich, the USAID acting assistant administrator for global health, was dismissed from his post, he calculated that the U.S. aid freeze would lead to an increase of up to 32% in multidrug-resistant TB.

• What’s worrying for malaria is that all WHO-recommended treatments for uncomplicated malaria rely on the antimalarial drug artemisinin, which is under threat due to emerging parasite resistance. Several new drugs are currently in development, but the reality is they’re not yet available.

• Cutting funding for diagnostics would also lead to misuse and overuse of antimicrobials, especially in places where anyone can just buy antimicrobials without a prescription. On top of that, USAID shuttered programs that were strengthening stewardship of antimicrobial use in humans and agrifood systems. One of those was a $250 million Global Health Security Programme at the Food and Agriculture Organization.

• Drug-resistant pathogens not only pose a threat to human health but also to the global food supply. Projection shows it could jeopardize food security for over $2 billion people and drive health care costs to $159 billion annually by 2050.

• Ending support for infection control, safe water, and sanitation in hospitals creates the perfect breeding ground for the spread of drug-resistant pathogens. “AMR is not a vertical disease — it's a sign of a poor health system,” Ramanan Laxminarayan, an epidemiologist and founder of the One Health Trust, tells Devex contributor Catherine Davison.

Read: Could US foreign aid cuts fuel a superbug crisis?

Seth says

Berkley says the U.S. funding cuts have some immediate impacts, such as on access to treatment and care for people living with HIV. But it’s too early to understand the full ramifications. For one, there will be shifts in donor funding. Some funders might decide to support a terminated program. However, that could also mean funding is taken away from other critical programs.

Read more: Seth Berkley warns of an era of ‘polyepidemics’ as cooperation crumbles

Take two

The race for the next WHO regional director for Africa is back on. Just three months after Tanzanian politician Dr. Faustine Ndugulile won the last election, he unexpectedly died while receiving medical treatment in India, triggering a new election.

Despite criticism in the last race, there are still no women in the lineup.

Two familiar names are back: Niger’s Dr. Boureima Hama Sambo and Côte d'Ivoire’s Dr. N’da Konan Michel Yao. They were part of last year’s race and are trying their luck again this year. Joining them this time around are Mohamed Yakub Janabi from Tanzania, Moustafa Mijiyawa from Togo, and Dr. Mohamed Lamine Dramé from Guinea.

So, what do they bring to the table? My colleague Sara Jerving put together a brief profile for each candidate and their vision for the continent. A virtual candidates’ forum will be held on April 2, after which African ministers of health and their representatives will put it to a vote on May 18 in Geneva.

Read: WHO releases candidates for its top job in Africa; none are women, again

One big number

That’s how many preschool-aged children are at risk of getting schistosomiasis or bilharzia, a parasitic disease that can affect a child’s cognitive development and cause malnutrition, anemia, and even organ damage or death. Yet, until now, there was no pediatric treatment designed for this age group. That’s changing with the introduction this month of the first preventative treatment for schistosomiasis tailored for preschoolers. A consortium of partners piloted the drug in Uganda and more pilot programs are expected in other countries soon.

Read: Uganda receives first pediatric drug for schistosomiasis. What's next?

What we’re reading

Bill Gates is lobbying Trump officials to keep funding global health programs. [Reuters]

The number of WHO’s top-ranked directors has doubled since Tedros took office, from 39 in 2017 to 75 in 2024. Most of the new positions are at WHO’s headquarters in Geneva. [Health Policy Watch]

Gaza’s health ministry says at least 404 people were killed in a surprise Israel airstrike, upending a ceasefire agreement. [Associated Press]