The reality sets the US is significantly reducing foreign aid to developing countries, and has led to urgent conversations between governments, philanthropists and global health and development organizations.
It focuses on one important question: who fills this gap?
Last year, the US donated around $12 billion to fund global health, HIV treatment and prevent new infectious diseases. Children's vaccine against polio, measles and pneumonia. Clean water for refugees. Malaria testing and medication.
The next biggest funder is the Gates Foundation. The global health sector budget was $1.86 billion in 2023.
“The gaps filled by the US cannot easily match anyone,” said Dr. Ntobeko Ntusi, CEO of the South African Medical Research Council.
US aid is channelled through the United States International Development Agency, or through the USAID, which was largely dismantled by the new Trump administration, and other government agencies, including the National Institutes of Health.
Many people suggest that other countries, particularly China, can move to some of the regions vacated by the US, Dr. Ntusi said. Others are urgently appealing to large charities, such as the Gates Foundation and open charities.
This conversation is the most consequential in Africa. Approximately 85% of the US global health spending was involved in programs in African countries.
Losses are devastating in countries such as Tanzania, where the US funds most of public healthcare, such as Somalia, where US aid accounts for 25% of the government's total budget. The situation is also equally important for major global health agencies.
President Trump has already separated the United States from the World Health Organization and is currently trying to deal with the withdrawal of US funds by attempting to cut the first budget by $500 million for 2026-27.
“Most of our neighbors on the continent rely entirely on the US to source most life-saving drugs for endemic infectious diseases,” Dr. Ntusi said. “And I don't think most governments can have the resources to deal with overnight, and I am devastating to the lost lives of Africans dying from preventable infectious diseases. I think there will be a consequence.”
The United States is the largest donor to Gavi, the world's poorest country and the organisation that supplies vaccines essential to the World Fund to combat AIDS, tuberculosis and malaria. The US contribution is necessary in Congress. A State Department spokesperson said he was asked about his commitment to these and other multilateral agencies, including the Pandemic Fund. The program is being reviewed to see if it is in line with national interests, and said funding will only be continued to be made by those who meet this condition.
Who will intervene?
There is no indication that additional funding will be available from other G7 countries, the European Union or other high-income countries. The UK, Germany, France, the Netherlands and Scandinavian countries all reduced foreign aid. Some new donor countries are moving forward to support the WHO, including Saudi Arabia and South Korea, but their spending has been extended by the amount once given by the US.
Among non-government players, the World Bank is perfect for providing long-term support for health spending. Banks have hardly said anything so far. It gives countries that are taking a hard hit on US cutoff innovative funding, financial freedom to those struggling under the burden of debt debt, to fill financial freedom. Countries could be hit hard by innovative fundraising. However, the US is the largest shareholder in the bank, and the Trump administration will have an impact on such investments.
Much of the public debate about filling the vacuum left by the US focuses on African countries, particularly China, which has built a major presence by funding infrastructure projects with large mineral reserves or strategic ports. I'm guessing it.
Ja Ian Chong, an associate professor of political science at the National University of Singapore, said: China sees foreign aid in the competition of the US superpower as a soft power tool, similar to when it established USAID during the Cold War with the Soviet Union. China is trying to use aid to gather more support from the United Nations' developing countries.
China's aid is primarily financed to build infrastructure, but includes support for more diverse projects. China's response to Western Development Assistance, a programme released in 2021 called the World Development Initiative, includes upgrading livestock production in Ethiopia, fighting malaria in Gambia, and 2 billion for planting trees in Mongolia Includes dollars.
Chong said China's ability to fill the openings left behind by USAID could be constrained by its own financial constraints. China's economy has stagnated due to the property crisis and increased government debt, and the country is already shrinking with large infrastructure loans.
To date, China has shown little interest in supporting global health programs or providing grants close to the USAID level. Eidota, the university lab of William & Mary in Virginia, estimates that Beijing offers around $6.8 billion a year in grants and low-cost loans.
charity
The charity, which already worked in global health, was discontinued after panicked calls from organizations with frozen funds.
“We've all talked to some foundations who said they're flooded with people who say, 'Help us, help us, help us, help us, help us.' did. We work with local governments to bring healthcare to communities in developing countries. But what should new donors save if patchwork relief only cover 20% of what the US was paying for? she asked. “Do you choose to save one program completely and then let go of the other program? Or what's the best strategy?”
Among the Foundation's Fielding Plays for Help is the Gates Foundation. This warns that Grant's winners cannot fill the gap. In addition to funding the Global Health Program, the foundation also supports health research and is a leading contributor to Gavi.
“There is no foundation or foundation group that can provide funding, workforce capabilities, expertise or leadership,” North American director Rob Nabors said in an email.
Several recipients of the Gates Foundation Funding refused to talk about the records because they described the confidential conversation. It has expanded significantly, and some grants may be restructured to try to compensate for some of the lost US funds, but it supports large-scale programming like USAID. Instead, the foundation's work will continue to be “catalysts.”
John Arnlottingen, CEO of Welcome Trust, one of Global Health Research's biggest donors, said the foundation is “exploring which options may exist” in the new landscape. He said in an email. But he said the help was “a reduction in the ocean compared to what governments around the world need to provide.”
Several small organizations, such as the Founder's Pledge, have launched “bridge funds” ranging from around $20 million to $200 million, trying to cram in immediate gaps.
However, the charity sector has been largely silent about significant changes in the landscape. Key players, such as the Susan T. Buffett Foundation, who have already put hundreds of millions of dollars into healthcare in Africa, did not answer questions about their plans. The Delta Foundation (with a Zimbabwean telecom billionaire in charge of Mashiiwa) refused to discuss the issue.
Two executives from a small private foundation said they were reluctant to say anything publicly, including the potential loss of the charity situation, due to fear of retaliation from the charity administration.
African government
The African government is under great pressure from frustrated citizens to assume responsibility for health spending that came from the United States. The issue led the agenda at a meeting of the continental health ministers at the African Union Summit last week.
In the 24 years since the union adopted what is called the Abuja Declaration, 42 members have pledged to spend 15% of their budget on health. This has achieved that goal. The average health spending by African countries is less than half that.
In Nigeria, the president convened the Emergency Cabinet Committee to plan for budget shortages, and Congress allocated an additional $200 million to the national budget last week. But that extraordinary measure shows the scale of what has been lost. That's less than half of the $512 million the US gave to Nigeria to healthcare in 2023.
Nigeria's Minister of Health Dr. Muhammad Patee said that nearly 28,000 health workers in the country were paid in full or part of the USAID. With HIV
Nigeria needs to find a new way to run it soon, he said. “It may not be that flashy, but at least that would help,” Dr. Putty said.
He also predicted that the end of US aid would accelerate what he called a “reorganization” in Africa. “The world has changed over the last 20 years,” he said. “So we have other actors. We have China, India, Brazil, Mexico, etc.”
Deisy Ventura, a global health ethics professor at the University of Sao Paulo, said the change could open up opportunities for other countries to exert new influence.
“The retreat of the United States may now expand the space for new leaders,” she said. “For us at the Global South, it's important to imagine international coordination of emergency preparation and response without the United States.”
Berry Wang contributed to the report from Hong Kong.
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