How US Health and Human Services budget cuts could impact global health

In recent weeks, the U.S. Department of Health and Human Services, or HHS, terminated thousands of employees and consolidated divisions and functions across the department. The cuts triggered concerns among health experts, who fear they may reduce U.S. capacities to respond to public health threats and make Americans less safe. But the impact could also go beyond U.S. borders. A document outlining the White House’s Office of Management and Budget proposal for the HHS seen by Devex also shows funding for programs such as the Centers for Disease Control and Prevention’s Global Health Center — which helps investigate outbreaks globally — and the National Institutes of Health’s Fogarty International Center — which provides research training to U.S. and foreign scientists working in low- and middle-income countries — are also being eliminated. “These cuts will be a tragic step backwards. The only winners here are Big Tobacco and cancer cells.” --— Tom Frieden, president and CEO of Resolve to Save Lives and a former CDC director Jirair Ratevosian, a global health security expert and currently an associate research scientist at Yale University, told Devex it’s unclear what policy direction the U.S. administration is trying to propose based on this document alone, although it raises several questions and concerns. One key concern is the impact of the proposed funding cut for the Global Health Center and the lack of clarity on how some of its functions, particularly its work implementing the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, activities, will continue. He said about 30% of PEPFAR implementation, which translates to over $1 billion, happens through HHS, and the center plays a majority role in it. “It's very concerning, because the offices are eliminated, and there’s nothing described that would replace or reorganize them in any other way,” he said. This adds to uncertainties surrounding the future of PEPFAR, the biggest bilateral assistance program for the HIV response, whose future is currently being debated by lawmakers. An internal memo highlighting recommendations from the OMB on foreign aid also recommends slashing PEPFAR’s funding by more than half for 2026. “To me, it spells trouble. I think if you try to put all these pieces together, it really means a global HIV response that is going to be unrecognizable,” Ratevosian said. The budget proposal for HHS eliminates funding for the Office of Global Affairs, which leads on global health diplomacy and policy. But the proposal also suggests moving the office under the Assistant Secretary for External Affairs, although it’s unclear how much of its functions will be maintained. None of this is final. As a budget passback document, HHS can still request modifications to the proposal. Then it will be part of the U.S. president’s budget request, which then has to go to Congress, which could question the legality of some of the proposed changes in the HHS. “We have seen that the Trump administration is willing to test the limits of its authority. We have seen areas where Congress has pushed back, and we’ve seen areas where Congress has not pushed back,” Ratevosian said. “I think as it relates to spending for global health programs, that’s going to be a key question to watch.” Some organizations are already calling on U.S. Health and Human Services Secretary Robert F. Kennedy Jr. to reverse the cuts. The Coalition for Global Hepatitis Elimination along with other organizations recently issued a letter asking Kennedy to reinstate CDC’s national reference laboratory for viral hepatitis, which has the expertise and the technologies to help diagnose patients with liver diseases of unknown cause and plays a vital role in detecting and responding to hepatitis outbreaks in the U.S.. While much of the letter focuses on the U.S. impact of shuttering the lab, Dr. John Ward, director of the Coalition for Global Hepatitis Elimination, told Devex the work of the lab extends to the detection and response to hepatitis outbreaks in other countries. It has assisted countries such as Georgia and Uzbekistan with tests to help them assess their hepatitis burden. He said, “No other lab in the world has the capabilities of the recently shuttered viral hepatitis lab at CDC.” Meanwhile, some fear HHS funding cuts for the CDC Office on Smoking and Health would lead not only to more addiction and disease among kids in the U.S. but could have an impact on global tobacco control efforts. The office serves as a World Health Organization Collaborating Centre for Tobacco Surveillance and plays a role in the Global Tobacco Surveillance System, which monitors tobacco use in countries representing 70% of the world’s smokers, according to Tom Frieden, president and CEO of Resolve to Save Lives and a former CDC director. He said that data is essential to help governments implement lifesaving interventions and protect kids from the tobacco industry. “These cuts will be a tragic step backwards. The only winners here are Big Tobacco and cancer cells,” he told Devex.