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Another change in U.S. foreign assistance is underway with the Trump administration’s expansion of the Mexico City Policy, aka the “global gag rule,” which during Republican-led administrations gets reinstated to block U.S. federal funding to international NGOs U.S. federal funding to international NGOs that provide or inform about abortion services, even when those activities are funded by other donors.
Last week, the White House decided to expand that policy to include all State Department foreign assistance. It will also now apply to United Nations agencies, U.S. NGOs, and foreign governments.
The new restrictions on what organizations can do also go far beyond abortion. It prohibits the use of nonmilitary foreign aid to promote “gender ideology,” “sex-rejecting procedures,” “discriminatory equity ideology,” and “unlawful DEI-related discrimination.”
Sexual reproductive health and rights advocates describe the new rules — which take effect in 30 days — as “harmful and destructive,” and say they will no doubt create chaos and confusion in aid programs. It can also create fear and force organizations to implement it excessively. It remains to be seen how organizations will comply with these new restrictions while implementing other donor-funded grants and agreements, such as programs specifically targeted for women, and whether that’s even possible.
There’s also the cost that complying with the rules would entail. Based on the documents, the U.S. government estimates implementing the new policy will cost service providers at least $340 million annually in administrative burdens, as it will require training and compliance monitoring, in addition to roughly $48 million for “one-time familiarization costs,” writes Devex Senior Reporter Adva Saldinger.
Adva’s reporting indicates that organizations may scale back or alter their programs to avoid risk, or they may decide to walk away from U.S. money — if they can — to avoid the headache.
Is your organization receiving U.S. funding? How do you plan to comply with this new set of rules? Email us at checkup@devex.com.
Read: New US funding rules restrict abortion, gender ideology, DEI (Pro)
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Strange bedfellows
In recent weeks, we’ve brought you updates about the U.S. foreign assistance funding bill that contains more than $9 billion in global health funds. While it looked to be on a path to passage before funding expires on Saturday, it is now unlikely.
The U.S. House of Representatives passed the legislation, and it awaits a vote in the Senate (and a signature from U.S. President Donald Trump). But it was bundled with other funding bills, including one for the Department of Homeland Security. Following the fatal shooting of Alex Pretti by a border patrol agent in Minneapolis, Senate Democrats said they would not approve funding for DHS without reforms to the agency.
This means delays for the foreign assistance funding bill, and it sets the stage for a partial government shutdown — which could last only a couple of days and have minimal impact, or could stretch longer as lawmakers try to find a compromise.
Senators could potentially vote separately to approve the foreign assistance funds, but it would require the House to approve the bill again, which wouldn’t happen before it is back in session on Monday. Adva tells me it’s unclear exactly how the rapidly evolving situation will play out. Stay tuned for updates.
ICYMI: Unexpected global health wins in the US foreign aid bill
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Human cost
One year on from the Trump administration’s actions to pause foreign aid and eliminate funding for several global health programs, many countries in Africa still don’t have a firm grasp on the severity of the impact of the cuts.
But initial estimates and anecdotal evidence from people living with HIV reveal the consequences of those actions.
The U.S. government’s decision to pause and then eliminate funding for several community-based outreach programs has led to a spike in the number of people who stopped collecting their HIV treatments from a health center in Malawi. In central Uganda, my colleague Andrew Green met Juma Bwanika, whose tests revealed detectable, rising levels of the virus in his blood, after he rationed his own HIV medicines during the U.S. government’s 90-day funding pause. Bwanika told Andrew that “ever since this order from Trump, I am seeing death near me.”
Many African governments are trying to shore up the response, including by integrating HIV services into general outpatient clinics — although community advocates warn that many people struggle to access health services in these facilities.
Read: One year after US aid freeze, HIV care in Africa is in retreat
+ To learn more about The Aid Report, visit www.theaidreport.us. This project is funded by the Gates Foundation and is an editorially independent initiative by Devex. If your organization has data or examples of how programs and people are being affected, whether positively or negatively, please email editor Kelli Rogers at kelli.rogers@devex.com. You can also reach Kelli securely on Signal or fill out this short survey.
More than words
African leaders aren’t just trying to keep health programs afloat. They are now rallying support to reduce the continent’s aid dependency through the “Accra Reset,” an ambitious initiative to redefine development cooperation.
To prove that it’s not just empty rhetoric, Ghanaian President John Dramani Mahama announced at this year’s World Economic Forum the launch of a global secretariat, a high-level panel on global health reform, and a “Guardians’ Circle” of former prime ministers and presidents to support the initiative.
He also outlined ways the initiative could get financial backing — including skimming a percentage from Africa’s sovereign wealth funds to invest in areas such as regional manufacturing for health products.
Read: Next steps for the Accra Reset announced at Davos
Canceled or not?
Here’s another confusing development — the status of a controversial hepatitis B vaccine trial funded by the U.S. Centers for Disease Control and Prevention.
The trial aims to study the health effects of the hepatitis B vaccine in newborns in Guinea-Bissau. But researchers questioned the motives for the study, especially since the vaccine has already been proven to be safe and efficacious. They’re also concerned that under the proposed protocol, only half of the babies will receive the vaccine at birth, leaving half unprotected.
The U.S. CDC, currently operating under the leadership of U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. — a vocal vaccine skeptic — no longer recommends hepatitis B vaccinations for U.S. newborns.
On Jan. 15, Africa CDC’s Dr. Yap Boum said, “The study has been canceled.” But digital news website Futurism reported on Jan. 20 that a spokesperson for the HHS said that “the trial will proceed as planned.”
And it seems Guinea-Bissau is still undecided. During a press briefing on Jan. 22, Dr. Armando Sifna, the country’s director-general of public health, said, “We have not yet held a meeting for the approval at the level of the country.”
Read: Guinea-Bissau still debating controversial US hepatitis B vaccine trial
Pony up
While the U.S. government is investing money in vaccine studies, it is not as willing to give money to Gavi, the Vaccine Alliance, an organization working to advance access to vaccines proven safe and effective.
HHS chief RFK Jr. said the U.S. won’t be contributing money to Gavi until it’s able to “reearn the public trust” and take “vaccine safety seriously.”
Reuters reports that the Trump administration has also asked Gavi to phase out shots containing the preservative thimerosal — used to keep vaccines in multidose vials stable — as a condition of resuming funding to the organization.
A Gavi spokesperson tells Devex that, “as the United States government has not yet pledged to Gavi it is currently not on the Gavi Board.”
The U.S. also doesn’t have plans to pay its dues to the World Health Organization, even if U.S. law requires it to fulfill its financial obligations to exit the agency.
Scoop: US loses Gavi board seat after withholding funding
ICYMI: The Trump administration says it won't pay what it owes WHO
Related: Can the US formally withdraw from WHO without paying its debts? (Pro)
No small feat
If Dr. William H. Foege, the pioneering epidemiologist who helped eradicate smallpox, knew the U.S. was withholding funding for Gavi, he might be very upset.
Foege, known as a “giant in global public health,” died on Jan. 24 at age 89 in Atlanta. He’s known for revolutionizing disease control in the 1960s by implementing ring vaccination in Nigeria — targeting only those exposed to the virus rather than entire populations. This strategy proved crucial to making smallpox the first infectious disease globally eradicated in 1980.
Beyond smallpox, Foege led the U.S. CDC, cofounded The Task Force for Global Health, and played a vital role in helping to establish both The Carter Center and Gavi. Bill Gates, calling him a friend and mentor, credited Foege with saving “hundreds of millions” of lives.
His final book "Change Is Possible," which was coauthored with students, emphasized global collaboration — a lesson colleagues say remains vital as funding for disease eradication diminishes and global health becomes increasingly politicized.
Read the obituary: ‘We continue to follow his light’ — world mourns health giant William Foege
What we’re reading
WHO says the U.K. is no longer classified as a measles-free country after a rise in measles cases and deaths. [The Guardian]
A few Asian countries have tightened airport health screenings amid an outbreak of the deadly Nipah virus in India's West Bengal state. [BBC]
Ethiopia declares the end of its Marburg outbreak. [Outbreak News Today]
About the author
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.
