The recent decision by the U.S. government to relax federal vaccine requirements and cut funding for vaccine research and development at home has raised alarm among public health advocates globally.
In a significant move, the Trump administration ceased funding for Gavi, an international initiative that has been pivotal in vaccinating millions of children in low-income and medium-income countries against deadly diseases like measles and cholera.
Gavi, known as the Vaccine Alliance, has played a crucial role since its inception, collecting contributions from government and private entities to fund vaccine purchases and distribution. Annually, Gavi allocates around $1.7 billion to its mission.
Since the year 2000, Gavi has successfully vaccinated over 1.1 billion children across 78 countries, preventing more than 18 million deaths from diseases such as meningitis, diphtheria, and polio, which has saved more than $250 billion in health and economic costs.
In 2024, the United States ranked as Gavi’s third-largest funder, following the United Kingdom and the Gates Foundation, having contributed $3.7 billion from 2000 to early 2025.
The Biden administration had expressed intentions to contribute $1.6 billion over five years starting in 2026, in addition to another $300 million for the remainder of 2025.
However, this commitment was overturned when Health and Human Services Secretary Robert F. Kennedy Jr. announced on June 26, 2025, that the previous administration would not fulfill its financial obligations to Gavi, resulting in a substantial funding deficit for the organization.
Kennedy’s remarks focused on what he considered to be Gavi’s inadequate track record on vaccine safety, a stance that many scientists and pediatricians have contested, particularly since it drew on a single, controversial study based on outdated data.
As of now, Gavi has yet to find enough alternative funding sources, as other major donors, including nations, foundations, and corporations like Cisco, Mastercard, and Shell, have not committed enough support to cover the $3 billion gap in Gavi’s five-year plan.
Nonetheless, significant contributors such as the United Kingdom and the Gates Foundation have reiterated their commitments, pledging $1.7 billion and $1.6 billion, respectively, to be allocated from 2026 to 2030.
In response to the diminished funding, Gavi is seeking to cut costs and expand its donor base, increasing its reliance on philanthropy as it navigates the current financial landscape.
This shift in funding dynamics is particularly concerning given the increased proportion of Gavi’s financial backing that comes from corporate and foundation donations, which surpassed 20% in 2024.
While philanthropy has bolstered Gavi’s vaccination programs and raised overall childhood vaccination rates, questions remain about the sustainability and autonomy of health systems in low-income and medium-income countries.
In my research alongside collaborators focused on vaccine hesitancy and clinical observations in South Africa and Tanzania, I have witnessed both the advantages and challenges posed by Gavi’s increasing dependence on philanthropic funding.
The increasing reliance on large donors like the Gates Foundation, which has invested over $30.6 billion since Gavi’s inception, raises concerns about the potential for diminishing autonomy among recipient nations.
Despite the Gates Foundation’s impactful contributions—which include approximately $7.7 billion dedicated to Gavi—the concentrated influence of a single donor can lead to tensions among health officials in recipient countries.
In various clinics across South Africa, Tanzania, and other regions of sub-Saharan Africa, healthcare professionals expressed apprehensions regarding the lack of control over vaccine selection and prioritization of vaccination efforts.
One doctor in Dar es Salaam remarked, “That’s all decided by donor offices—not by our own health ministry,” indicating a perception of external control over local health initiatives.
While Gavi maintains that its board makes vaccine investment decisions based on comprehensive research, some health workers have observed instances in which donors advocate for specific vaccine brands tied to their own investments.
Moreover, healthcare workers reported that compliance with the Gates Foundation’s reporting requirements often led to administrative burdens that detracted from genuine patient care.
A district health official in rural Tanzania voiced his frustration, stating, “We’re spending more time filling out reports for the donor than talking to patients,” underscoring the inefficiencies introduced by stringent expectations.
The pattern of prioritizing quantifiable targets over sustainable health system development was echoed by multiple health officials: “It’s all about hitting numbers, not building systems,” stated one official in Cape Town.
While foreign governmental aid can also influence local health priorities, it tends to be less direct than philanthropic funding, as governments typically engage in bilateral agreements subject to diplomatic protocols and public accountability.
Conversely, large foundations like the Gates Foundation operate with significant autonomy, often imposing their own strategic objectives onto public health initiatives, leading to perceptions of overriding local priorities.
The Gates Foundation itself concedes that philanthropy cannot substitute for U.S. government contributions. Rob Nabors, director of the North America Program at the Gates Foundation, highlighted the impossibility of foundations replicating the scale of government aid and expertise historically provided by the U.S.
Without the extensive diplomatic investments and infrastructure support traditionally offered by the U.S., Gavi’s potential for long-term impact in public health may be compromised.
While the Gates Foundation has made strides toward leveraging its resources for manufacturing capabilities in developing countries, philanthropic initiatives alone cannot replace comprehensive governmental support.
The foundation reported expenditures of $1 billion by 2018 to bolster vaccine manufacturers in developing regions, as well as announcing $15 million in 2022 to enhance a South African company’s capacity to produce vaccines.
Regardless of funding sources, Gavi remains a critical entity, not only for international public health but also for Americans, as outbreaks of vaccine-preventable diseases can rapidly cross borders given the interconnected nature of global travel.
Consequently, U.S. support for Gavi transcends mere international goodwill; it is a preventive measure for safeguarding public health domestically as well.
image source from：theconversation
