US withdrawal from WHO and freeze on foreign aid means other governments must step up

In his first week as President of the United States (US), Donald Trump has made drastic decisions with far-reaching consequences. On the first day of his term, he announced plans to withdraw from the World Health Organization (WHO). Days later, the US State Department reinstated the global gag rule and issued a freeze on foreign aid, leading, among other things, to a devastating halt in the distribution of life-saving HIV drugs by PEPFAR. Although it is difficult to keep up with rapidly changing developments, it is clear that these decisions by one of the largest donors in global health directly impacts the health of millions of people in the world. Governments around the world must step up to sustain current funding in the short term, while working towards a more sustainable global health system in the future.

The withdrawal from the World Health Organization

Let’s first look at the WHO. The organization plays a critical role in global health by sharing knowledge, setting healthcare guidelines, advising governments, and combating infectious diseases. As the only organization in global health where (almost) all countries have a seat at the table, it facilitates rapid information sharing on outbreaks. This enhances fast development of diagnostics and medicines and adequate responses to local outbreaks, preventing them to become a pandemic.

The US decision to withdraw from the WHO is deeply concerning. As a founding member and its largest funder, contributing around one fifth of the budget, this move jeopardizes an already underfunded organization. Reduced funding will severely compromise its ability to detect and respond to outbreaks like mpox and the Marburg virus, eradicate polio, and support essential health programmes, including maternal care and mental . The instructions for staff at the US Centres for Disease Control to stop all communications with WHO will also have a direct effect. It severely hampers sharing of critical information, for instance on the bird flu outbreak in the US itself, thus posing a serious global health risk.

The impact of the US foreign aid freeze

The US has been a corner stone in global health for decades, contributing to improved health outcomes through its foreign aid programmes, including many health programmes. In 2023, the US spent 0,27% of GNI on official development assistance, including health programmes. Even though other countries spent more in relative terms – Germany spent 0.8% of GNI in 2023 – the size of the US economy makes it the largest donor in absolute terms. Some global health initiatives rely heavily on US funding. For example, the 2023-2025 replenishment round for the Global Fund secured 14.4 billion USD, of which 6 billion USD was pledged by the US.

The sudden freeze on official development assistance and the accompanying stop-work order for existing grants and programmes will have devastating consequences. In low-income countries many people depend on US supported programmes for access to health services and life-saving medications. PEPFAR, for example, has provided 20.6 million people with access to HIV-medication in 2023 alone. Trumps decision shocked the world: clinics stopped issuing HIV medications, even though they were laying on the shelf. Then, on Wednesday 29 January, a waiver was anounced, allowing for the distribution of HIV medications, but leaving uncertainty about preventive drugs and other PEPFAR services.

If the freeze continues or results in significant budget cuts, the implications will not be limited to low-income countries. Fragile regions could destabilize, disease outbreaks may increase, and limited surveillance capacity could allow epidemics to rebound, threatening global health security – including in the US.

Working towards a more sustainable system

While the current system of official development assistance has its flaws, it remains a lifeline for millions of people. Reforms are necessary but must be gradual to avoid catastrophic disruptions. It will take years for low- and middle-income countries to reduce their dependency on official development assistance and increase their capacity to raise public resources domestically.

Importantly, to achieve this, international cooperation is key. Governments must agree on reforms to the international tax rules and debt resolution mechanisms that hinder many counties from raising sufficient national budgets for healthcare and other public services. As an example, 33% of Zambia’s public budget in 2024 was allocated to domestic and external debt servicing. The health sector received less than 12%.

For now, the current system, with all its imperfections, is still saving lives. We should not throw away the baby with the bathwater. Reform is far less costly – both in terms of human lives and money – than dismantling what we have and rebuilding from scratch. People in need of healthcare cannot be put on hold.

Governments must step up

In this new reality, governments cannot afford to stand by. They should aim to fill the funding gap and use diplomacy to get other governments on board. This is an opportunity for all governments to adopt a long-term vision that recognizes the value of international cooperation and assistance.

Some of these investments will have tangible and measurable results within a short time span, others will be more difficult to capture or slower to emerge but not less valuable. After all, the epidemics prevented through coordinated international detection and response may never make it into history books, but the impact of these efforts is invaluable. By continuing to work together to strengthen global investments in development, we can make the world a healthier and safer place for everyone, no matter where they live.

No country can safeguard our health alone. By working together, we can protect the health and lives of millions worldwide.

Photo by Es Sarawuth on Canva