How USAID's dismantling could impact noncommunicable diseases

The Trump administration’s dismantling of the U.S. Agency for International Development has had an immediate effect on the global health areas the agency has prioritized such as HIV, nutrition, reproductive health, infectious diseases, maternal and child health care, and neglected tropical diseases. However, the damage won’t stop there. It’s also expected to have an impact on the management of noncommunicable diseases, or NCDs, Katie Dain, chief executive officer of the NCD Alliance, told journalists at the organization’s conference in Kigali this week. While USAID hasn’t played a significant role in funding the response to these diseases, the major halt in funding is expected to have “a ripple effect on all different health issues,” she said. “It's going to have a huge impact,” she added. The U.S. provides over 40% of overall donor government assistance for global health, with health funding totaling $12.4 billion in fiscal year 2024. When government ministers of health in low- and middle-income countries look at the new holes in their budgets, they will likely prioritize areas where investments have been made in recent years, such as HIV, maternal health, and infectious diseases, pushing NCDs further down the list, Dain said. “NCDs have already been under-prioritized. Anything on the bottom of the list is going to get even further de-prioritized,” she said. It could also set back efforts to integrate health care, she said. Global health efforts have long been criticized for existing in siloes —- where funding is targeted toward one specific disease vertically, as opposed to broader health system strengthening. “If you've got less cooperation at the international level, countries are going to be at more risk in terms of these different health threats that they're facing.” --— Katie Dain, CEO, NCD Alliance She said the NCD Alliance has engaged in a lot of advocacy work around health care integration, such as ensuring the Global Fund to Fight AIDS, Tuberculosis and Malaria, PEPFAR, and vaccine alliance Gavi integrate services such as those for hypertension, dialysis, and cancer into their country-level investments. And there's been progress, for example, PEPFAR has started integrating hypertension screening into HIV treatment programs in five African countries. “That's the direction of travel that we've seen across sub-Saharan Africa in recent years, which I think is really positive — and I think that's all potentially in jeopardy,” Dain said. “There's going to be a shift, potentially, back to the vertical.” This could be done in order to safeguard that programming, she added. PEPFAR has also done a lot of health system strengthening across the board, such as strengthening the health workforce, improving surveillance, and providing access to essential medicines — which is all in jeopardy, Dain said. Additionally, the Trump administration signed an executive order to pull out of the World Health Organization. The United States is the organization’s top donor and while U.S. funding to WHO didn’t necessarily go to NCDs, a weaker WHO means all of the organization's departments have less capacity to respond to public health issues, Dain said. WHO provides normative guidance and sets standards for countries on diseases — and then countries tailor those strategies and policies to their own country context. It also provides technical assistance to countries, as well as data and statistics. In the wake of Trump’s WHO pullout, Argentina’s government also said it would withdraw from WHO. “The risk is this gradual, kind of eroding, of multilateralism,” Dain said. “If you've got less cooperation at the international level, countries are going to be at more risk in terms of these different health threats that they're facing.”