The domestic consequences of defunding global health (15 May 2025)

Summary

On the 28 March 2025, the Trump administration notified Congress that it planned to shut down USAID (United States Agency for International Development) by 1 July 2025. The State Department would assume responsibility for “certain USAID functions” that align with the administration’s priorities and discontinue the rest. Two weeks earlier, in a post on X, Secretary of State Marco Rubio said that the programmes being cut (including efforts to address emerging infectious diseases, famines, natural disasters, maternal and child mortality, HIV, and tuberculosis) “spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States.”

To date, however, neither Rubio nor the State Department has elaborated on how these cuts and the reduction of USAID’s staff (from about 10 000 employees to 15) will affect the health of people around the world—or in the US itself.

Initial reports on the direct effects of the cuts have come from different sources. A leaked USAID document projected that if programmes were permanently halted, the world would see an additional 12.5 million to 17.9 million malaria cases and 71 000 to 166 000 additional malaria deaths annually. If US foreign aid is not restored before the end of 2025, it is estimated that at least 62 000 additional people would die of tuberculosis. Enormous harms to children are also expected because USAID spending has played a pivotal role cutting child mortality rates in half since 2000.