President Donald Trump has taken an axe to global health funding and cooperation since returning to the White House in January – and what worries public health advocates is that he isn’t the only one chipping away.

In Europe, nine countries, including the biggest donors, are slashing foreign aid and no one is stepping up to fill the void. While the Covid pandemic underscored the world’s vulnerability to contagions, it hasn’t yielded new investments many global health advocates say are needed to do better next time. In fact, the opposite: Overall global health funding has dropped precipitously — to a 15-year low in 2025 — as nations focus on other priorities. That’s leading to fears that there will be an eventual repeat of the disorderly response to the coronavirus.

“There’s not a lot one can see geopolitically that would give people confidence that this is a great moment for cooperation or significant reinvestment in global health, leaving aside the polarization that emerged around public health” during the pandemic, said Thomas Bollyky, the director of the global health program at the Council on Foreign Relations, a Washington think tank.

The Trump administration’s distrust of the U.N. and its World Health Organization is more pronounced than other nations’, but many of them, particularly in Europe, have pulled back funding to focus on defense, as Trump has demanded.

Solidarity is also lacking, the advocates who fear a repeat of the Covid calamity said. For example, after four years of negotiations, WHO member countries are still negotiating a deal on sharing vaccines, drugs and information about pathogens spreading in their populations during future pandemics as part of an agreement they adopted in May. Trump pulled out of the talks earlier this year.

“We’re just seeing vulnerabilities in every direction, with no optimism in sight,” said Larry Gostin, a global health law professor who favors more robust cooperation and directs Georgetown University’s O’Neill Institute, which supports the WHO.

Bollyky said it might have been naive to expect different after Covid, considering the increased geopolitical competition — including wars in Europe and the Middle East — it gave way to, as well as the massive debts it left behind.

At last month’s U.N. General Assembly, countries considered a pact to combat chronic disease by promoting better diets and physical activity, protecting children from junk food marketing, and taking on excessive screen time and social disconnection.

Even though Trump’s health secretary, Robert F. Kennedy Jr., has made combating chronic disease the centerpiece of his “make America healthy again” agenda, he traveled to New York to reject the deal.

“It exceeds the U.N.’s proper role while ignoring the most pressing health issues,” he said.

The cuts and their impact

Kennedy’s objection denied the plan consensus. Less noted was that the U.N. had already agreed to drop from the chronic disease pact the most far-reaching recommendations, to increase taxes on alcohol, tobacco and sweetened beverages, after other member states balked.

Meanwhile, the donations undergirding the world’s efforts to contain diseases are falling. After a Covid spike that saw funding rise to $80 billion in 2021, overall global health funding has plummeted to just under $40 billion, according to a July report by the Seattle-based Institute for Health Metrics and Evaluation. Just in the last year, America cut 67 percent of its funding, or more than $9 billion; followed by the U.K., which cut nearly 40 percent; and France, with a 33 percent cut, the same report shows.

Trump on his first day in office said he was pulling out of the WHO and taking America’s annual contributions with him, which totalled some $640 million in 2023 according to the WHO’s most recent tally.

WHO Director-General Tedros Adhanom Ghebreyesus told POLITICO he has offset some of the losses because other countries paid more, as part of an agreement to do so that predated Trump’s return to the presidency. But Trump’s decision to withdraw still left a hole big enough to trigger the biggest downsizing in the WHO’s history.

Trump’s shift away from global health funding was too sudden, leading to deaths, according to Tedros. “They should have allowed an exit strategy,” he said.

The WHO isn’t the only global health funder Trump has left hanging. He also cut $300 million in annual funding to Gavi, the vaccine alliance, which helps poor countries buy and deploy vaccines, and he hasn’t made a commitment to donate money to the Global Fund to Fight AIDS, Tuberculosis and Malaria, of which the U.S. has been the biggest donor. A House appropriations bill, which includes funding for the two organizations, is stuck amid the ongoing government shutdown.

Global health advocates are worried about the impact. For the first time in 25 years, the number of children dying each year is expected to go up, billionaire philanthropist Bill Gates, whose foundation is the top private founder of global health initiatives, said during an event timed to the U.N. General Assembly where Kennedy spoke in September.

Anecdotal reports are bleak. Malaria killed babies in Cameroon when community health workers America previously supported were no longer paid, Reuters reported, and a 5-year-old in the Democratic Republic of the Congo died when the drug she needed was stuck in a warehouse, according to a Washington Post report.

Trump administration officials have pushed back vigorously against such reports, with Secretary of State Marco Rubio saying several times that no one has died due to U.S. aid cuts.

He and Trump administration allies have accused nonprofits and companies that have helped implement U.S. global health programs of creating a culture of dependency.

It’s the main reason Trump’s America First Global Health Strategy, released last month, says the U.S. will no longer fund intermediaries and instead will work directly with foreign governments, with the understanding that aid will not continue forever.

Those who see a silver lining in the upheaval believe it’s the incentive for those nations to focus on becoming self-reliant.

“It’s a good thing for the long term because countries are now waking up and saying: ‘OK, I have to mobilize domestic resources,’” Tedros said.

A downsizing at the WHO

The WHO is straining under the financial burden of the U.S. withdrawal, which is expected to become official in January.

It has cut its budget for the next two years by a fifth, halved the number of assistant directors-general and department directors and is letting go of some 600 employees at its headquarters in Geneva, Switzerland, out of its 10,000 employees globally. It’s making additional staffing cuts in regional and country offices.

The cuts have led to discontent among some WHO employees in Geneva, who last month expressed no confidence in the downsizing. Tedros defended the layoffs in a press conference earlier this month, saying a committee on fairness and transparency was set up to address employee concerns and that the no-confidence vote didn’t reflect the “real feeling of our staff” because only 100 employees participated.

Two global health insiders in Washington granted anonymity to discuss the WHO’s relationship with the Trump administration candidly said they hadn’t seen evidence that the WHO was trying to convince Trump to stay in the organization.

Tedros said he’s doing his best.

The WHO has asked for meetings with Trump administration officials, he said, “but for reasons they don’t tell us, it hasn’t happened yet.”

Tedros said he has worked for months with Kennedy to evacuate Palestinian children with cancer from the Gaza Strip during the recently ended war there. He said he hoped to build on it.

In addition, the WHO has shared information with the U.S. about disease surveillance, flu vaccines and the WHO’s medicines-licensing process, the organization said in a statement.

Tedros told POLITICO he agreed with Trump that the U.S. should bear less of the burden for funding the WHO and that he’d convinced member states to agree three years ago to increase their dues to cover 50 percent of the WHO budget by 2031. Most of the budget now comes from voluntary contributions.

This will also ensure the WHO is not unduly influenced by any member, Tedros said.

Trump, in announcing the U.S. withdrawal, cited those issues, as well as what he described as the WHO’s “mishandling of the COVID-19 pandemic.” Trump has said he believes the organization covered up China’s responsibility.

Tedros has in the past defended the WHO’s Covid response while acknowledging challenges and weaknesses.

The White House didn’t respond to a request for comment about whether it was still talking to the WHO.

Gostin said he tried to act as an intermediary between the WHO and Trump, laying out a proposal for reforms the U.S. could ask of the WHO. In response, Gostin said the administration said it wanted the WHO led by an American director-general and inspector general.

That was a nonstarter, Gostin said, because it would violate the rules for selecting leaders established by WHO members.

The White House didn’t immediately respond to a request for comment on Gostin’s account, with an automatic email pointing to the government shutdown as a reason for delayed responses.

Tedros has also had to navigate congressional politics in his outreach to U.S. officials.

Two months after Trump took office, Tedros met with a fierce critic of the president, Sen. Bernie Sanders (I-Vt.), on Capitol Hill. Tedros posed for a photo that Sanders then posted on X with the line: “Trump’s withdrawal from the WHO puts us, and people around the world, at greater risk of preventable deaths.”

Tedros said that besides Sanders, he’d also met that week with the other leader of the Senate’s health committee, Republican Bill Cassidy of Louisiana, as well as Lindsey Graham of South Carolina, the Republican who leads the Senate appropriations subcommittee on foreign operations, among other lawmakers.

Despite the collaboration in Gaza, Kennedy has lambasted the WHO, most recently telling health ministers meeting at the U.N. that the organization needed “radical reform.”

He has also encouraged other countries to work with the U.S. on global health outside the WHO. He has talked to Argentina’s health minister, Mario Lugones, about working together after the South American country announced that it too would withdraw from the WHO. Lugones also rejected the U.N. declaration on chronic diseases in September, backing Kennedy’s reasoning.

Officials from several other countries have followed Trump in calling for withdrawal from the WHO, including Italy’s deputy prime minister, Matteo Salvini, Hungarian minister Gergely Gulyás and the deputy speaker of the Russian parliament, Pyotr Tolstoy.

In the U.K., Action for World Health, a group chaired by right-wing opposition party leader Nigel Farage, has commissioned a report on reforming or replacing the WHO. David Bell, a senior scholar at the Brownstone Institute, an American think tank that started to oppose Covid lockdowns and now supports Kennedy, said he’s working on it.

The Israeli parliament’s health panel has also debated withdrawing from the global health body over what some members saw as WHO criticism of Israel during its war with Hamas.

The WHO had called for an end to the fighting long before the recent peace deal, and had said Israel should not bomb medical facilities, and that it should permit the flow of humanitarian supplies. Israel said Hamas was using hospitals for military purposes. It also said it was not impeding aid deliveries.

Tedros pointed to the willingness of member states to make larger financial contributions to the WHO as evidence that it still enjoyed widespread support.

The Department of Health and Human Services didn’t respond to repeated requests for comment on Kennedy’s plans for global health cooperation.

Seeking synergies

Foreign aid from donor countries that Gavi uses to provide vaccines to low-income nations was already shrinking.

“We have reduced our workforce by 24 percent — that means 155 full-time roles, and overall secretariat cost has gone down by 30 percent,” she said. The plans to do so started before the Trump administration’s funding cut.

During the pandemic, when Gavi managed COVAX, a global program to provide Covid vaccines to poor countries, its staff expanded, Nishtar said, adding that after the pandemic a rightsizing made sense.

Over the summer, Gavi raised $9 billion in pledges to cover its expenses for the next five years, well shy of its nearly $12 billion target. Still, Nishtar said that was “a very good outcome” given the austerity around global health. She still hopes more countries will pledge money so Gavi can reach the target. Meanwhile, Gavi is planning more staff and budget cuts.

To cope with the fundraising drought, Nishtar is exploring synergies with other organizations that rely on donors to help combat disease in the developing world, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Polio Eradication Initiative.

“We are having joint board meetings, there are joint action plans, and we are making tangible changes, at the last mile, in the secretariat, in the back offices, in the back offices in the countries on the programmatic side, to exploit synergy to the maximum,” Nishtar said.

The Global Fund, which, like Gavi, Bill Gates helped start more than two decades ago, is seeking $18 billion for its next three years of work. It says that would help save 23 million lives. Its previous attempt to raise the same amount, during the Biden administration, failed. The group declined an interview request.

The upheaval created by Trump’s cuts is prompting a hunt for redundancies among global health groups, whose efforts have often overlapped, said Lucica Ditiu, the executive director of the STOP TB Partnership, a U.N-hosted organization working to end tuberculosis.

She expects organizations like hers will need to be more creative since the Trump administration has told her it will continue to finance only the procurement of drugs and tests for tuberculosis, for example, but not advocacy and communications.

The new global health architecture that emerges must prominently address health security and be able to respond quickly and effectively to pandemics that might be around the corner, said Bärbel Kofler, Germany’s economic cooperation and development minister.

“We need more donor countries, larger foundations and also private companies to be part of an international health financing system,” she said at the World Health Summit in Berlin earlier this month.

Countries that have benefited from aid are already working to become more self-reliant. African leaders met at an Africa Health Sovereignty Summit in Ghana in August, where they set up several initiatives to help governments on the continent invest more in health and come up with new sources of financing.

Through its America First Global Health Strategy, the Trump administration has said it wants to transition most of the 71 countries it supports toward self-reliance and to focus on a smaller number of countries with the most strategic importance to the U.S.

“Communities on the ground love the United States and what we’ve done, but that is not translated into the leadership of those countries caring about the United States and what we’ve done,” said a former senior global health official in the first Trump administration granted anonymity to speak candidly on the issue.

That reflects a view shared by some Republicans in Congress, too — that America’s global health generosity hasn’t yielded the “soft power” dividends that were promised by politicians who made the case for being generous.

Georgetown’s Gostin said the new strategy is likely to mean U.S. support is concentrated more on Latin America and Asia, and less on Africa.

The Trump administration last month announced plans to give the Philippines, which it sees as a strategic ally against China, $250 million in new funding for acute public health challenges. The funding “demonstrates the efficient, time-limited, and narrowly targeted approach of this new era of America First foreign assistance,” the State Department said.