Trump budget request and rescission plan slashes global health funding

The Trump administration is making sweeping cuts to global health funding in both its rescission package and its fiscal year 2026 budget request. This includes zeroing out funding for Gavi, and cuts to U.S. global AIDS initiative PEPFAR and the President’s Malaria Initiative. It also slashes support for family planning, reproductive health, neglected tropical diseases, and nonemergency nutrition. This comes in the wake of a months-long dismantling of the U.S. Agency for International Development, mass layoff of global health staff, and slashing of the majority of programs. Overall, the White House is asking the U.S. Congress to rescind $9.4 billion in previously enacted funding. This includes $900 million for global health programs, including $400 million for the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, according to Sen. Patty Murray, a Democrat from Washington. The package would claw back funds previously approved by Congress for fiscal years 2024 and 2025. This would include aid money already cut by the Department of Government Efficiency. If Congress passes the package, those cuts would be codified into law. Global health and advocacy organizations are calling on Congress to step in. “We urge Congress to reject rushed attempts to override their previous decisions and to continue supporting smart, effective international assistance programs,” wrote the ONE Campaign, the global advocacy organization. Separately, the Trump administration also has a fiscal year 2026 budget request that excludes funding for Gavi, the Vaccine Alliance — the leading international organization tasked with providing vaccines to lower-income countries that has helped vaccinate more than half the world’s children against infectious diseases. The White House noted in its justification for its exclusion that Gavi “reports a reserve of over $7.0 billion in its most recent statutory financial statements.” “Per organizational best practice, and as mandated by our Board, Gavi always keeps 9 months operational buffer as cash to ensure we are stable financially and able to fulfill commitments we have made to countries. Any other amounts held in Gavi accounts are spoken for,” a Gavi spokesperson told Devex. “Given high demand for Gavi programmes, expenditure for our current strategic period – Gavi 5.0 – will fully utilise all available funding allocated for this period. Fully delivering Gavi 6.0 will require US$ 9 billion in new donor funding.” Gavi is in the midst of its replenishment cycle for its work from 2026 through 2030. Last year, the Biden administration pledged at least $1.58 billion for this new funding cycle. Typically, when the U.S. pledges money to the organization, the U.S. Congress must then appropriate funds each year in the budget. Gavi received a $300 million payment from the U.S. government in December. This year, Congress also approved $300 million for Gavi in the fiscal year 2025 funding bill. The U.S. government accounts for 13% of Gavi's funding, making it the organization's third-largest contributor. The White House’s requested budget allocated $424 million to the President’s Malaria Initiative, or PMI, for funding to go toward prevention and treatment in places with high malaria burdens. This includes funding for surveillance systems, improving supply chains, increasing availability of products, and mitigating insecticide resistance. But this is a 47% cut to PMI, according to Malaria No More, which noted “this level of reduction would be catastrophic for malaria-affected countries across Africa, and make us less safe, secure, and prosperous here at home.” The White House’s request doesn’t include an allocation for The Global Fund to Fight AIDS, Tuberculosis and Malaria, but it wrote there’s still flexibility for the Trump administration to contribute. “Should the Administration decide to provide contributions to the Global Fund in FY 2026, it would ensure the United States is only contributing its fair share by leveraging $1 from the United States for every $4 from other donors, doubling the current 1:2 matching pledge,” it wrote. This would mean that the U.S. could only cover a maximum of one-fifth of the agency’s total funding as opposed to one-third in previous years. This change from the previous matching requirement is an “unprecedented” move that would “drastically diminish America’s leadership role in one of the most successful global health partnerships in history,” Malaria No More wrote. The White House added that it intends to increase the burden on foreign governments to “take their fair share of responsibility for global health programs.” For the $2.9 billion listed for HIV, for example, it said it's working to “off-ramp” the U.S. government’s role and working with countries on hand-off plans and to begin “drawing down direct HIV assistance in some PEPFAR-supported countries.” The administration is proposing a $1.8 billion reduction in funding to PEPFAR in the budget, according to ONE. The White House wrote that PEPFAR will focus on the “most cost-efficient, life-saving” HIV treatment, testing, and prevention models, such as prevention of mother-to-child transmission. “PEPFAR will also adjust its programming to increase cost-effectiveness, including shifting to lower-cost implementers; reducing overlapping functions across implementing partners and agencies; leveraging Artificial Intelligence and other digital technologies; and deploying targeted campaigns to reduce new HIV infections through introduction of high cost-efficiency biomedical tools, such as a twice-a-year HIV prevention injection,” it wrote. The White House also noted it’s completely cutting funding for programs that “do not make Americans safer, such as family planning and reproductive health, neglected tropical diseases, and non-emergency nutrition.” The U.S. has been the largest donor to family planning globally. In 2023, it accounted for 40% — or $582.5 million — of total funding from governments, according to KFF, a health think tank. The United Nations Population Fund, or UNFPA, put out a statement last month saying that U.S. funding cuts “will add further strain to the already-stretched global public health system.” In 2023, the U.S. contributed over $160 million to UNFPA, which accounted for about 11% of its $1.45 billion budget. “Over the past four years alone, with the US Government’s life-saving investments, we prevented more than 17,000 maternal deaths, 9 million unintended pregnancies and nearly 3 million unsafe abortions by expanding access to voluntary family planning,” the organization wrote. For neglected tropical diseases, U.S. funding increased from $15 million in fiscal year 2006 to about $115 million in fiscal year 2024, according to KFF. What the White House considers as a benefit to American citizens is funneling funding toward preventing infectious diseases, such as Ebola, from reaching American shores. The budget request allocates $200 million to global health security, in areas around helping countries detect and respond to outbreaks; $85 million for polio programs, including for vaccines, active case finding, referrals, and environmental surveillance; and $178 million for tuberculosis treatment programs. TB is “among the most lethal infectious diseases in the world and the United States is experiencing one of its worst outbreaks,” the White House wrote. Update, June 5, 2025: This piece has been updated to reflect that the budget request puts $85 million for polio programs.