Upon taking office in January, the Trump administration has begun a process of dismantling decades-old programmes aimed at supporting health and nutrition in low-income countries. The largest hit has been the United States Agency for International Development (USAID). Secretary of State Marco Rubio announced that about 5,200 of 6,200 USAID contracts, or 83%, are being cancelled. Even those projects that have not been cancelled have found that funding has dried up, at least for the time being, and they were being moved to the Department of State. Up until now, USAID, which began in 1961, was an independent federal agency.
The reason Secretary Rubio gave for the cancellations was that the projects did not serve “the core national interests of the United States”. This follows up on a statement by the White House issued shortly after President Trump’s inauguration, which stated that, “The United States foreign aid industry and bureaucracy are not aligned with American interests and in many cases antithetical to American values. They serve to destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations internal to and among countries. . . . It is the policy of United States that no further United States foreign assistance shall be disbursed in a manner that is not fully aligned with the foreign policy of the President of the United States.” It called for a 90-day moratorium on funding until all programmes could be evaluated. The cancellation of the 5,200 projects was the result of that evaluation.
It is too early to know the consequences of these actions, in part because it is not yet clear whether much of the funding shortfall can be met by enhanced contributions by other wealthy countries or through increased private charitable organizations. It is estimated that the United States has been responsible for 30% of the $28 billion in annual global health funding. Most vulnerable are programmes aimed at reducing HIV/AIDS, and in particular, funding HIV medications, as the USA directly supports 63% of worldwide funding in this area, and more when its contributions to global health cooperatives is included. The main funding programme, the President’s Emergency Plan for AIDS Relief (PEPFAR), has been credited with saving 26 million lives, mainly in Africa, through the provision of medications. At the time of writing, PEPFAR has not been reauthorized by the U.S. Congress, even though it had bipartisan support since its inception in 2003 under the administration of President George W. Bush. Since that time, it has spent an estimated $120 billion.
There are currently numerous lawsuits pending by both supporters of the USAID programmes as well as contractors who have not been paid. Furthermore, other lawsuits take aim at the Trump administration for not spending money that has been authorized by Congress. Ultimately these cases will be decided by the U.S. Supreme Court. Nevertheless, the administration’s intent to drastically reduce foreign aid is likely to be successful since President Trump’s party controls both houses of Congress.