While reality is located as the United States are drastically decreasing its foreign assistance to developing countries, an urgent conversation is starting between governments, philanthropists and global health and development organizations.
It focuses on a crucial question: who will fill this gap?
Last year, the United States contributed to about 12 billion dollars to global health, the money that financed the treatment of HIV and the prevention of new infections; Children’s vaccines against polio, measles and pneumonia; Clean water for refugees; and tests and drugs for malaria.
The next largest funding is the Gates Foundation, which provides a fraction of this amount: his Global Health Division had an $ 1.86 billion budget in 2023.
“The gap that has been filled by the United States cannot be easily combined with anyone,” said dr. Ntobeko Ntousi, CEO of South African Medical Research Council.
The assistance of the United States has been channeled through the United States Agency for International Development, or USAID, that the new Trump administration has widely dismantled, and other government agencies, including the National Institutes of Health, which is also facing substantial cuts to the subsidies for health research.
Many people are suggesting that other countries, in particular China, could move to some areas freed from the United States, said dr. Ntusi. Others are making urgent appeals to the large philanthropies including the Gates Foundation and the open philanthropy.
This conversation is more consequential in Africa. About 85 percent of US expenditure for global health went to programs in African countries.
For countries such as Somalia, where US aid constituted 25 percent of the entire government budget, or Tanzania, where the United States financed the majority of public health care, the loss is catastrophic. And for the main global health agencies, the situation is equally critical.
President Trump has already pulled the United States out of the World Health Organization, which is now trying to make an initial cut of $ 500 million for 2026-27 to cope with the withdrawal of American funds.
“Most of our neighbors on the continent have completely relied on the United States to get most of the life -saving drugs for endemic infections, “said Dr. Ntusi.” And I don’t see most of the governments during the night of have the resources to cope.
The United States are the largest Gavi donor, an organization that provides essential vaccines for the poorest countries in the world and the global fund to combat aid, tuberculosis and malaria. The contribution of the United States is requested by the congress. When asked about the commitment to these and other multilateral agencies including the pandemic fund, a spokesman for the State Department said that the programs were revised to see if they had aligned themselves with national interest and that the funding would continue only for those who satisfied this condition.
Who enters?
There is no indication that further funding will come from the other G7 countries, from the European Union or from other high -income nations. Great Britain, Germany, France, Netherlands and Scandinavian countries have all reduced their foreign aid. Some new donor countries have come forward to support WHO, including Saudi Arabia and South Korea, but their expense is diminished by the amount that the United States once have given.
Of non -government players, the World Bank is in the best position to provide long -term support for health expenditure. The bank has said little so far. It could offer countries affected hard by innovative United States cutting funding as a health debt swap to give the nations that fight under heavy debt charges a certain tax freedom to invent lost health funding. However, the United States are the largest shareholder of the bank and the Trump administration would have influence on these investments.
Much of the public discussion on filling the void left by the United States focused on China, which built a significant presence by financing infrastructure projects in African countries, in particular those with large mineral reserves or strategic ports.
“There is a good reason for them to do it,” said Ja Ian Chong, associate professor of Political Science at the National University of Singapore. China considers foreign aid as a soft power tool in its rivalry of superpower with the United States, just as the United States did when Usaid installed during the apice of the Cold War with the Soviet Union. China tries to use aid to obtain greater support from developing countries in the United Nations.
While Chinese aids are largely in loans to build infrastructure, it includes support for more varied projects. China’s response to aid for western development, a program presented in 2021 called Global Development Initiative, includes $ 2 billion for the updating of cattle production in Ethiopia, fighting malaria in Gambia and planting trees in Mongolia, among others projects.
Chong said that China’s ability to fill the opening left by Usaid could be limited by its financial limitations. The Chinese economy has stagnated due to a real estate crisis and increasing government debt and the country has already reduced large infrastructure loans.
To date, China has shown little interest in supporting global health programs or in providing subsidies on a staircase everywhere near the USAID levels. Aiddata, a university research laboratory in William & Mary in Virginia, estimate that Beijing provides around 6.8 billion dollars a year in subsidies and low -cost loans.
Philanthropies
The philanthropies that were already working in Global Health have been flooded by calling to panic by organizations with frozen funds.
“I talked to some bases that all said we are flooded with people who say: “Help us, help, help” and I think they are trying to bother small holes, “said Sheila Davis, managing director of the non -profit partners in health , who works with local governments to bring health care to communities in developing countries. Paying, what should a new donor save?
The main one of the bases that lift to ask for help is the Gates Foundation, which warned its recipients of the subsidy that cannot create the gap. In addition to financing global health programs, the Foundation also supports health research and is an important contribution to Gavi.
“There is no basis – or group of foundations – capable of providing funding, workforce, competence or leadership force that the United States have historically provided to combat and control fatal diseases and face hunger and poverty all over the world “, The foundations” The director of North America, Rob Nabors, said via E -mail.
Multiple recipients of the Gates Foundation financing, who refused to speak on the record because they were describing confidential conversations, said they had been said by the members of the foundation staff who would continue to finance research and programs in the areas that already worked, but not it it would make expand significantly and that while some subsidies could be renovated to try to compensate for part of the lost US financing, the work of the Foundation would continue to be “catalytic” rather than support large -scale programming as Usaid did.
John-Arne Røttingen, CEO of The WellCome Trust, who is among the major donors of global health research, said in an e-mail that the Foundation was “exploring what options could exist” in the new landscape. But, he said, his help would be “a drop in the ocean compared to what governments around the world must provide”.
A couple of small organizations, such as the founders, started “Bridge Funds”, ranging from about $ 20 million to $ 200 million, to try to help fill the immediate gaps.
But the philanthropic sector was largely silent about the important change in the landscape. The main actors who have already put hundreds of millions of dollars in health care in Africa, such as the Susan T. Buffett Foundation, did not answer questions about their plans. The Delta Foundation (co-founded by the billionaire of the Zimbabwe Strive Masiyiwa) refused to discuss the matter.
Two managers in the smallest private bases said that there was a reluctance to say something publicly due to the fear of punishment by the Trump administration, including a potential loss of charity status.
African governments
African governments have enormous pressure from frustrated citizens to take responsibility for the health expenditure that came from the United States, the problem brought the agenda to a meeting of the health ministers of the continent during a summit of the African Union last week.
In the 24 years since the union has adopted what is called the Abuja declaration, committing its 42 members to spend 15 percent of their health budgets, only a couple of states have never achieved this goal and for a year or Two at most. Average health expenditure by African countries is less than half of this amount.
In Nigeria, the president convened an emergency cabinet committee to make a plan for the budget deficit and Parliament assigned an extra $ 200 million to the national budget last week. But that extraordinary measure illustrates the scope of what has been lost: it is less than half of the $ 512 million that the United States gave to Nigeria for health care in 2023.
The Minister of Health of Nigeria, dr. Muhammad Pate said that almost 28,000 health workers in the country had been paid in whole or in part by Usaid, who also covered three quarters of the account for drugs and tests for 1.3 million Nigerians who live with HIV
Nigeria will have to quickly find new ways of operating, he said, including the strengthening of the production of some of these articles at national level. “It may not be so elegant, but at least it will serve,” said dr. Pate.
He also predicted that the end of US aid would accelerate what he called a “realignment” in Africa. “The world has moved in the last 20 years,” he said. “So we have other actors: we have China, India, Brazil, Mexico and others.”
Deisy Ventura, professor of global health ethics at the University of San Paolo, said that change could open opportunities to other countries to exercise a new influence.
“The withdrawal of the United States can open space for the new leaders now,” he said. “It is important for us in the global south to imagine an international coordination of preparation and emergency response without the United States.”
Berry Wang Reports contributed by Hong Kong.