The Cost to Global Health

Since its inception in 2003, PEPFAR (the President’s Emergency Program for AIDS Relief) has distributed $120 billion in funding to prevent and treat HIV in 55 different countries, saving 26 million lives. When the U.S. halted most foreign aid grants in January, PEPFAR’s survival was in jeopardy, leading to international concern and outcry. A limited waiver to allow PEPFAR to resume “urgent life-saving HIV treatment services” was provided on February 1. However, with most USAID employees laid off, “there is no one left to process waiver applications,” according to The 19th. Although Congress appropriated funding to PEPFAR through September in a continuing resolution in March 2025, they were not able to authorize continuing PEPFAR itself, adding to the confusion.

Asked to explain how these cuts align with the new administration’s vision for global health, a State Department spokesperson shared a statement from a February 10 interview with Secretary Marco Rubio: “Any time you have a pause or some hiccups about how to restart the payment programs, but all that’s going to get taken care of here very quickly, and those programs will continue. We’re not walking away from foreign aid. We are walking away from foreign aid that’s dumb, that’s stupid, that wastes American taxpayer money.”

A post-September freeze in PEPFAR funding could trigger a resurgence in HIV infections, especially if people are unable to obtain antiretroviral medication. This, in turn, could lead to 1 million new cases of HIV in children and an additional 2.8 million children orphaned by AIDS in the next 5 years alone, according to an April Lancet article . Cutting funding to PEPFAR also impacts testing and treatment for tuberculosis, which is the leading cause of death among individuals with HIV.

The modern world has never faced infectious disease with such a public health vacuum, especially in the U.S.

“It’s a program we want to continue,” Secretary Rubio said. “Ideally, it’s a program that over time shrinks, not expands, because less and less people are getting HIV or are transmitting it to their children.”

The U.S. isn’t alone in pulling back from supporting global health, says Josh Michaud, associate director for global health policy at KFF, a nonpartisan, nonprofit health policy research institute, pointing out that the U.K. and other countries are also cutting foreign aid.

“What that means is there’s a lot less money going to support global health programs and a lot fewer services provided to the people who are in dire need of them. It just equals more death, illness, and suffering around the world. That’s the bottom line,” he says.

The impacts of lost food and health aid will have the most immediate effects, Michaud says. Whether the subsequent impacts will be a dramatic increase in outbreaks of novel diseases like H5N1 bird flu or a steady uptick in more familiar pathogens such as malaria, mpox, and measles, isn’t yet clear. The modern world has never faced infectious disease with such a public health vacuum, especially in the U.S.

“At the end of the day, health is a national security issue,” Sorrell says. “Health is an individual security issue—if we don’t have access to clean water, to nutritious food, to safe shelters and safe places to live, our physical and mental health are at risk. When we don’t have healthy people, we don’t have prosperity, we don’t have peace, and we don’t have security.”