As the reality sets the United States drastically reducing their foreign assistance to developing countries, an emergency conversation begins among governments, philanthropists and global organizations for health and development.
He focuses on one key question: Who will fill this gap?
Last year, the United States contributed about $ 12 billion to global health, the money financed by HIV treatment for new infections; Polio vaccine, measles and pneumonia; clean refugee water; and tests and drugs for malaria.
The next largest funds is the Gates Foundation, which pays a fraction of that amount: The global health department had a budget of $ 1.86 billion in 2023.
“The gap that has now been fulfilled can easily reconcile anyone,” said Dr. Ntobeko Ntusi, Executive Director of the South African Council for Medical Research.
US assistance is directed through the United States agency for international development or USAID, which the new Trump administration has largely dismantled, and other Government agencies, including the National Health Institutes, which are also facing a significant reduction in health research.
Many people suggest that other countries, especially China, could move to some of the areas that left the United States, said Dr. Ntusi. Other emergency appeals are large philanthropy, including the Gates Foundation and open philanthropy.
This conversation in Africa is the most serious. About 85 percent of US consumption on global health went to programs in or for African countries.
For countries like Somalia, where US assistance consisted of 25 percent of the entire Government budget, or Tanzania, where the US financed most public health care, the loss is catastrophic. And for the main global health agencies, the situation is similar to critical.
President Trump has already pulled out from the World Health Organization, which is now trying to reduce the $ 500 million budget by $ 2026-27 to cope with the withdrawal of US funds.
“Most of our neighbors on the continent, completely relied on the United States to get most of the rescue medicines for endemic infections, “said Dr. Ntusi.” And I do not see that most governments can have resources to wear overnight. And so I think there will be pernicious consequences on the lives lost from Africans who will die from infections that can be prevented “
The US is the largest donor of Gavi, an organization that supplies basic vaccines to the poorest countries in the world and the global fund for the fight against AIDS, tuberculosis and malaria. Congress requires American contribution. Asked about dedication to these and other multilateral agencies, including a pandemic fund, a spokesman for State Department said that the programs were examined to see if they would align with national interest, and that financing will only continue for those who have fulfilled this condition.
Who goes in?
There is no indication that additional funds will come from other G7 countries, European Union or other high -income countries. Britain, Germany, France, the Netherlands and Scandinavian countries have reduced their side help. Some new donors have supported the support of WHO, including Saudi Arabia and South Korea, but their consumption is dwarf because of the amount he once gave.
Of the non -governmental players, the World Bank is best placed for long -term support of health consumption. The bank has said a little so far. This could offer countries that are severely affected by American innovative financing, such as health debt replacements, so that the nations that struggle under a large long burden of some fiscal freedom to make up for lost health resources. However, the now is the largest shareholder of the bank, and Trump’s administration would have an impact on any such investment.
A large part of the public debate on the filling of the vacuums that left now focused on China, which built a significant presence with the funding of infrastructure projects in African countries, especially those with extensive mineral reserves or strategic ports.
“There is a good reason to do so,” said Ian Chong, an associate professor of political science at the National University of Singapore. Cinema foreign assistance considers a tool of soft forces in its superpower with the United States, as the United States did when setting up USAIDs during the height of the Cold War with the Soviet Union. China seeks to take advantage of help to collect more support from developing countries in the United Nations.
Although Chinese help was mainly coming in infrastructure construction loans, it includes support for more diverse projects. Chinese response to Western Development AID, program discovered in 2021 under the name Global Development Initiative, includes $ 2 billion For the upgrade of livestock production in Ethiopia, the fight against malaria in Gambia and for planting trees in Mongolia, among other projects.
Mr. Chong said that Chinese ability to fulfill the opening that USAID could limit to her own financial limitations. The Chinese economy has stagnated because of the property crisis and increasing state debt, and the country has already reduced major infrastructure loans.
To date, China has shown little interest in supporting global health programs or supporting on a scale anywhere near the USAID level. Aiddata, University Research Laboratory in William and Mary in Virginia, assessment This Beijing provides about $ 6.8 billion a year with grants and cheap loans.
Philanthropy
The philanthropy that have already worked in Global Health have been missed by panic calls with frozen funds.
“I talked to some of the foundations that all said we were overwhelmed by people who say, “Help us, help us, help us,” and I think they try to patch small holes, “said Sheila Davis, the executive director Local self -government cooperates that health care will bring communities in developing countries. They paid, what should a new donor save? Or which one is the best strategy? “
The main of the foundations that prayed for help is the Gates Foundation, which warned its Grants recipients that it could not compensate for the gap. In addition to financing global health programs, the Foundation also supports health research and is a major contribution to the Gavi.
“There is no foundation – or a group of foundations – which can provide funding, labor capacity, expertise or leadership that the United States historically secured to fight and control deadly diseases and solve hunger and poverty around the world,” Nabors, he said to the time.
Multiple recipients of the Gates Foundation, who refused to talk about records because they described confidential conversations, said that they were told by the members of the Foundation Staff that they would continue to finance the research and programs in areas that have already worked, but will not expand significantly and yes, yes, Although some support can be restructured to try to make up for a part of the lost US funds, the Foundation’s operation would continue to be “catalytic” and not supported large -scale programming as USAID did.
John-Arne Røttingen, Executive Director of the Wellcome TRUST, which is one of the biggest donors Global Health Research, said in the email that the Foundation “explored what options could exist” in the new landscape. But, he said, his help would be “a fall in the ocean compared to what governments around the world should provide.”
Several small organizations, such as the founders of the pledge, have launched “bridges” funds, ranging about $ 20 million to $ 200 million to try to help with the immediate gaps.
But the philanthropic sector was mostly silent about important changes in the landscape. The main players who have already put hundreds of millions of dollars in health care in Africa, such as the Susan T. Buffett Foundation, have not answered questions about their plans. The Delta Foundation (faced by Zimbabweic telecommunications billionaire Sourge Masiyiwa) refused to talk about the matter.
Two executives in smaller private foundations said there was a reluctance to say anything public about the fear of retaliation from Trump’s administration, including a potential loss of charity status.
African governments
The African governments are under tremendous pressure from frustrated citizens to take responsibility for health consumption that came from the US, the question led the agenda at a meeting of the Minister of Health of the Continent at the African Union’s summit last week.
In 24 years since the union adopted what is called Declaration in AbujiBy committing their 42 members to spend 15 percent of health budget, only a few countries have ever hit the goal and a maximum of a year or two. The average health consumption by African countries is less than half of that amount.
In Nigeria, the President convened an emergency committee to make a plan for the lack of budget, and Parliament awarded an additional $ 200 million to the state budget last week. But this extraordinary measure illustrates the scale of what is lost: it is less than half of $ 512 million that have now given Nigeria for health care in 2023.
Nigerian Health Minister, Dr. Muhammad Pate, said nearly 28,000 health care workers in the whole or part of the USAID, which also included three -quarters of drug law and test sets for 1.3 million Nigerians living with HIV living with HIV
Nigeria will quickly need to find new ways of working, he said, including the strengthening of the production of some of these items in the country. “It may not be so fantastic, but at least it will serve,” said Dr. Pate.
He also predicted that the end of American help would accelerate what he called “reconciliation” in Africa. “The world has moved in the last 20 years,” he said. “So we have other actors: we have China, India, Brazil, Mexico and others.”
Deisy Ventura, a professor of global health ethics at the University of São Paulo, said the change could open up the possibilities for other countries to perform a new influence.
“The withdrawal of the United States can now open space for new leaders,” she said. “It is important that in the global south we imagine an international coordination of willingness and response in emergencies without the United States.”
Berry Wang Contribution to Hong Kong reporting.
