Disease, Donations, and Democracy: The Impacts of USAID Funding Cuts on Infectious Disease Outcomes
- Antara Varma
- 5 hours ago
- 7 min read
By: Antara Varma
Photo by Mark Schiefelbein/The AP 2025
INTRODUCTION
In 1961, President John F. Kennedy established the United States Agency for International Development to bridge the gap between domestic abundance and global poverty (Office of the Historian). Beyond its humanitarian aims, however, the USAID was a form of soft power designed to strengthen ties with developing nations and curb Soviet influence. Since 1961, the agency has become integral to both US foreign policy and international efforts against poverty, disease, hunger, and political upheaval.
However, within hours of President Trump’s 2025 inauguration, all USAID funding and operations were suspended for 90 days, pending a review of all foreign aid expenditures— around 1% of the annual budget (The White House; Desilver). A subsequent memo from the State Department announced the termination of 5,800 of 6,200 USAID awards—slashing $54 billion in aid, $4.4 billion in State Department grants, and thousands of jobs (Knickmeyer et al.) Global health was especially affected, with 80%- $12.7 billion worth- of its awards being terminated (Kates et al.).
This elimination of medical aid is not merely a political or fiscal decision: it directly compromises global health security and infectious disease prevention, endangering millions.
INFECTIOUS DISEASE
Historically, the USAID has been a key actor in the elimination of infectious disease. Just five years after its founding, the agency’s partnership with the Center for Disease Control and Prevention, the World Health Organization (WHO), and the Soviet Union successfully eradicated smallpox, which killed 300 million people in the 20th century alone (Norris).
Since then, the USAID has played a significant role in the fight against HIV/AIDS, tuberculosis, and malaria. According to WHO, international aid towards TB treatment has saved 79 million lives since 2000, preventing 3.65 million deaths in 2023 alone (WHO, “Tuberculosis”).The USAID was the largest bilateral donor to low and middle-income countries, contributing roughly 25% of all international donations (WHO, “Funding Cuts”). HIV/AIDs and malaria have also declined considerably, with HIV-related mortality rates dropping 69% globally since 2004 and malaria mortality rates decreasing 36% from 2010 to 2020 (HIV.gov; CDC).
This progress, however, does not mean infectious disease is a thing of the past. Disease still rages on, with 1.25 million tuberculosis deaths in 2023; 630,000 HIV/AIDs deaths in 2023; and 600,000 malaria deaths in 2024 (WHO, “Tuberculosis”;WHO, “Funding Cuts”). What this progress does indicate is that malaria, AIDs/HIV, and tuberculosis mortalities are extremely preventable through treatment. In other words, this is a war we can win.
However, given the inherently adaptive nature of infectious disease, controlling death rates globally depends entirely on the ability to provide preventative services, treat patients promptly, and conduct research that responds to newly emerging needs. Should this ability be compromised, the decreasing mortality rates of the past 10 years can easily be reversed. As Nicholas Enrich of the USAID warned in his open letter, even a one-year disruption of global aid could lead to: 71,000-161,000 additional malaria deaths, a 28-32% rise in tuberculosis cases, up to 200,000 new cases of paralytic polio, and up to 28,000 new cases of emerging infectious diseases (Mandavili).
LONG-TERM CONSIDERATIONS
Some argue that Secretary of State Marc Rubio’s “Emergency Humanitarian Waiver” which reinstates “life saving humanitarian assistance” during the review process, indicates the administration’s understanding of these risks. However, the waiver, which reinstated PEPFAR HIV protection, TB screening, and some malaria services, is merely a 90 day lifeline: it does not provide permanent protection nor does it indicate any intention to safeguard infectious disease treatment in the future (The White House, “Emergency Humanitarian”).
In fact, several programs were terminated during the waiver, including the President’s Malaria Initiative in Cambodia, Ethiopia, and Gambia; tuberculosis treatment in Nigeria and South Africa; and Senegal’s largest malaria supply program. Most notably, the USAID ended its contract with Gavi, an international public-private vaccine alliance that has saved the lives 19 million children globally (Mednick et al.)”
This is only the beginning: dozens of “life-saving grants” are terminating by 2028, including an HIV research project by the International Aids Vaccine Initiative, an Infectious Disease Detection System by Family Health International, and a resistant tuberculosis early detection program by the Aurum Institute (US Department of State). Cumulatively, more than 71% of HIV, 79% of tuberculosis, and 80% of malaria awards have been terminated (Kates et al.).
RISK FACTORS
When the USAID was suspended, at least thirty of its ongoing clinical studies, including an experimental malaria treatment for children under 5 in Mozambique, a cholera treatment in Bangladesh, and pediatric tuberculosis trial in Peru and South Africa, were disrupted mid-trial (Nolen). In the short run, these subjects, by virtue of being partially exposed to their vaccines and medications, are at an extreme risk of developing resistant strains that will no longer respond to existing treatments. Thus, pausing infectious disease prevention for even a mere 90 days can drastically worsen global health outcomes.
Meanwhile, as human-wildlife interaction increases and extreme heat becomes more frequent, experts predict that infectious (specifically zoonotic) disease outbreaks will increase in frequency and transmission speed, dramatically increasing the prevalence of pandemics similar to Covid-19 (Lian et al., Marani et al.). This prevalence, along with making reactive containment less effective, also makes it economically unsustainable. In 2014, for instance, it cost $4.3 million dollars to contain a single American ebola case (CDC, “Ebola Virus”). Today, the US healthcare system spends $4.6 billion dollars annually on treating antimicrobial resistance (CDC, “CDC Partners”).
Furthermore, according to the National Institute of Health, the Covid-19 pandemic cost 16 trillion dollars in lost productivity and health reduction, indicating that continually investing in infectious disease prevention abroad will likely cost much less than t reactive containment or a pandemic (Cutler and Summers). Overall, for better health outcomes and a more fiscally sustainable disease response, global preparedness and prevention is key: this is the time to strengthen treatment networks and international partnerships, not fracture them.
POLICY CONSIDERATIONS
To reduce inefficiencies while preserving life-saving aid, the U.S. should:
Prioritize NGOs over foreign governments for fund distribution, as they are generally more transparent and accountable.
Deliver in-kind aid, including vaccines, antibiotics, bed nets, and masks, rather than unrestricted grants that are vulnerable to misuse or delay.
Support American manufacturing by subsidizing U.S.-based medical companies to supply aid materials directly. This keeps jobs within the U.S. while maintaining a steady aid flow abroad.
Include “Buy American” conditions on aid grants: Often, American aid tends to be spent on Indian or Chinese manufactured vaccines and materials, causing aid money to “drain” out of the economy. Including “Buy American conditions” in grant agreements would combat this “sunk cost” by encouraging aid recipients to purchase goods like medicine, testing materials, vaccines, and hospital supplies from American companies. While this may pose logistical hurdles for NGOs, it ensures that aid dollars circulate back into the domestic economy, boosting domestic production and employment, and perceptions of waste.
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