The United States spent roughly US$12 billion on global health in 2024. Without that yearly spending, roughly 25 million people could die in the next 15 years, according to models that have estimated the impact of such cuts on programmes for tuberculosis, HIV, family planning, and maternal and child health.
The United States has long been the largest donor for health initiatives in poor countries, accounting for almost one-quarter of all global health assistance from donors. These investments have contributed to consistent public-health gains for more than a decade. HIV deaths, for example, dropped by 51% globally between 2010 and 2023, and deaths owing to tuberculosis dropped by 23% between 2015 and 2023.
However, the administration of US President Donald Trump has cut billions of dollars of spending for global health, including dismantling the US Agency for International Development (USAID) and freezing foreign-aid contributions—some of which has been temporarily restored.
Researchers are actively studying the potential impact of these funding cuts. John Stover, an infectious-diseases modeller at Avenir Health, a global-health organization in Glastonbury, Connecticut, and his colleagues used mathematical models to estimate health outcomes should all US funding for global health be cut and not replaced. The results, posted on the preprint server SSRN earlier this month, have not yet been peer-reviewed.
The researchers “use a combination of robust, well-established and proven mathematical models and analytical approaches to estimate the impact,” says Andrew Vallely, a clinical epidemiologist at the Kirby Institute at the University of New South Wales in Sydney, Australia. “Their findings are devastating to read,” he adds, calling it “a wake-up call for all of us working in global health.”
James Trauer, an infectious-disease modeller at Monash University in Melbourne, Australia, emphasizes the models’ reliability, stating, “These models are probably as good as we have available at the moment for predicting the direct effects of the funding cuts on these various programmes.”
On 28 March, Marco Rubio, the US secretary of state, mentioned that the government was reorienting its foreign-assistance programmes to align with the country’s priorities. “We are continuing essential life-saving programmes and making strategic investments that strengthen our partners and our own country,” he said.
In relation to HIV and AIDS, the researchers modelled the effects of cutting the US President’s Emergency Plan for AIDS Relief (PEPFAR) in the 55 countries it supports, which includes stopping the delivery of treatments, tests, and interventions that prevent transmission. The programme has already been impacted by funding freezes.
Should PEPFAR be discontinued, there would be 15 million more deaths from AIDS by 2040 than if the programme continued, significantly impacting six African countries, including Mozambique, Nigeria, and Uganda. Roughly 14 million extra children would become orphans as a direct result of those AIDS deaths—a trend that had been anticipated to decline over the next 15 years. Moreover, 26 million more people could become infected with HIV without the continued support of PEPFAR.
The funding impact varies significantly based on a country’s reliance on US government support. In Uganda, for example, about 65% of funding for HIV research comes from the United States. Some models suggest that in a partial-funding scenario, maintaining funding for treatment alone could avert 97% of the additional deaths and 90% of the extra new HIV infections.
The situation is similarly dire regarding tuberculosis. The global number of infections of Mycobacterium tuberculosis—the bacterium responsible for the world’s deadliest infectious disease—is expected to surge without US aid funding. Researchers examined the potential effects of cuts to USAID and US contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria across 79 low- and middle-income countries, although the extent of US contribution reductions in upcoming years remains unclear.
These reductions could contribute to an additional 69 million M. tuberculosis infections and 2 million extra deaths by 2040.
These estimates align broadly with other assessments regarding the potential impact of funding cuts. “There’s been tremendous progress made in global health over the last couple of decades, and we’re at risk of losing a lot of that,” says Katherine Horton, an epidemiologist at the London School of Hygiene & Tropical Medicine, who has contributed to the modelling on tuberculosis.
image source from：https://www.nature.com/articles/d41586-025-01191-z
