US President Donald Trump has made a series of decisions that have hit the body to global management of health. He announced that the United States is leaving the World Health Organization. Additionally, a 90-day freeze was made on funds distributed by the US Agency for International Development (USAID) due to a pending review by the US Department of State. This includes funding for the President's Emergency Plan for AIDS Relief (PEPFAR). The decision sparked an alarm in the global health sector.
Katherine Kyobtungi, executive director of the African Population and Health Research Center, outlines which countries are at risk most and which health programs are at risk the most.
What does the US exit mean for Africa?
The US exit from Freeze, announced in USAID funding, is a catastrophic move that has dramatically impacted the health of millions of people in Africa.
The United States is the largest national donor in the WHO, and contributes approximately 18% of the institution's total funds.
US Development Aid is used to implement large-scale health programs on the continent. For example, Nigeria received approximately US$600 million in health support from the US, which is more than 21% of its 2023 health budget.
WHO is a global health organization that integrates scientific research and develops guidelines that African countries rely on to shape their own policies and practices.
The biggest loss in Africa under the USAID umbrella is funding from Pepfar. Pepfar is used for HIV-related programs such as prevention, testing and treatment. Through PEPFAR, the US government has invested more than US$110 billion in global HIV/AIDS response.
Read more: Who in Africa: Three Ways to Lose from Trump's Decided to Retreat
What will be lost?
Various functions.
First, technical guidance. The WHO provides technical guidance to countries on issues ranging from tuberculosis management to cost-effective malaria control.
Second, the ability to mobilize resources. WHO has the obligation and mechanism to bring together experts from around the world to evaluate new treatments, diagnoses and vaccines. They can assess new evidence regarding new patterns of new bugs, resistance to current treatments, and more.
Third, WHO has key tools and mechanisms for health policy decisions in African countries. These include:
WHO's list of essential medicines to inform decisions about important drugs
Similar mechanisms for evaluating new vaccines provide guidance that will make regulatory approval faster and easier in African countries that do not have a strong system.
Fourth, WHO also provides resources for emergency response, such as in the event of an outbreak of diseases such as Ebola or Covid-19. The WHO can quickly mobilize experts and funds and coordinate emergency responses.
Fifth, WHO provides evidence-based guidelines. This does this by collecting and sharing information such as the cause of an outbreak, monitoring signals of potential outbreaks, and coordinating efforts to develop new technologies such as vaccines and medical devices.
Sixth, the WHO's ability to support critical programs in tuberculosis prevention and emergency response will be reduced.
Seventh, the withdrawal of US citizens working at these global institutions, and the order to cease sharing of data, is excluded from the global information sharing mechanism that keeps us inherently safe. It means. It is difficult to share information about emerging health threats in the United States with other parts of the world. The same goes for the opposite.
Which countries are most affected?
Many African countries rely heavily on the support provided by Pepfer and USAID for health sector programs and humanitarian assistance.
The countries most affected are those with high burdens of HIV, tuberculosis and malaria, and countries with a large number of refugees and groups of people internally displaced.
Currently, the top eight USAID winners in Africa are Nigeria, Mozambique, Tanzania, Uganda, South Africa, Kenya, Zambia and the Democratic Republic of the Congo.
If funds are not mobilized rapidly to fill the gap left by the US withdrawal, the health impacts of millions of Africans are at stake. The inability to prevent new infections and the threat of drug resistance due to disruption in treatment has widespread consequences.
In Uganda, where around 1.4 million people live with HIV/AIDS, 60% of HIV/AIDS programs' spending came from Pepfar and about 20% from global funds (partially funded by Pepfar).
Dramatic cuts in funding are devastating for patients and the larger health system.
The Pepfar program, a lifeline for millions of Africans, is under threat even before the latest aid freezes. In 2024, the US Congress granted a one-year permit in place of a typical five-year funding certification.
The conservative backlash against the program has grown over the years, with concerns that some funds could be used to fund abortions. Current approval expires in March 2025 and is classified within the 90-day Aid Review period. The current approval for next month will expire and, in light of the current atmosphere, there is a very high chance that it will not be renewed.
Read more: How US policy on abortion affects women in Africa
What measures should African countries take?
There has been a lot of discussion about lost jobs and lives, but there is not much discussion about what will happen next. It is the way the African government plans to alleviate the short-term and foreseeable future.
Therefore, we need to ask the government what it means to us and how they plan to ensure that they do not reverse the profits they have made so far. This includes preventing millions of HIV infections, improving testing, and providing life-saving anti-retroviral treatments.
The sudden, dramatic decision made by the Trump administration has been welcomed by several commentators. That awakening relies on flawed “development assistance” systems, a tool of apparently geopolitical impact, to invoke the needs of the continent.
Read more: US health funding cuts: What Nigeria can lose
The mistrust and confusion in the global health sector should be rapidly mobilized to civic action to invest in key sectors that governments have long relied on foreign aid. Without sustainable investment, the health sector's profits could be lost, reversing decades of progress in global health.
Finally, Africans, especially scientists and scholars, need to confront the worrying anti-science trends underlying some of these dramatic policies. The growing distrust in science and institutions will not diminish unless it is challenged.
It's ridiculous that a continent of 1.3 billion depends on the whims of a man, many miles away. His signature in a single document.
The world needs to wake up. You need to wake up.
