Physician’s guide to healthcare reform

THE TRUMP ADMINISTRATION HAS CUT more than 80% of government spending on global health services. On his first day in office, Donald Trump issued an executive order withdrawing the United States from the World Health Organization (WHO).

On the same day, he issued an executive order freezing foreign aid for a 90-day review. In the months that followed, the administration cut approximately 92% of foreign aid contracts under the U.S. Agency for International Development (USAID), with much of the reductions made for health care.

Rationale for cuts 

The cancellation of programs and reduction in payments is part of Trump’s “America First” agenda, which reduces allocation of resources that benefit other countries and focuses more on programs with direct benefits to the U.S. The formal notice of withdrawal from WHO criticized the organization for “mishandling of the COVID-19 pandemic,” “failure to adopt urgently needed reforms,” “unfairly onerous payments from the United States,” and excessive influence of WHO by China. Among the specific criticisms of WHO was its delay in determining that COVID’s transmission was aerosolized.

Prominent public health experts in the u.S. acknowledged Who has problems but strongly opposed the withdrawal. Stefano M. Bertozzi, former dean and current professor of health policy and management at UC Berkeley School of Public Health, said, “[Y]ou don’t pull out of an organization because it makes a mistake. What you do is figure out why the mistake was made and try to improve the organization so that it is better prepared for next time.”

What it affects 

A January 2025 editorial in Science magazine titled “A world less safe and secure” noted: “Withdrawing from WHO now will forfeit U.S. voting power and political leadership. …The U.S. will be on the outside looking in while the most consequential decisions are taken, including the adoption of a new Pandemic Agreement and the election of the next director-general in 2027.”

WHO is a United Nations agency founded in 1948. Prior to withdrawal of the U.S. (and perhaps withdrawal of some other countries), it had 194 member states. It employs more than 8,000 professionals, including public health experts and physicians.

The headquarters of WHO is in Geneva, and it has six semi- autonomous regional offices. The current biennial budget is $6.8 billion. Until the withdrawal, the US paid approximately 22% of that, with extra amounts going to special projects.

Abolishing USAID 

Earlier this year, President Trump and Secretary of State Marco Rubio formally announced plans to dismantle the uSAID as an independent agency. Their rationale was that much of U.S. foreign aid was wasteful and part of a liberal agenda.

The shutdown of USAID included funding freezes and stop-work orders. The Trump administration plans to have a limited number of USAID’s function absorbed by the State Department, and to issue a “limited waiver” to allow “life-saving services” to continue.

The scope of “life-saving services” is uncertain. Programs that have been terminated include malaria diagnosis and distribution of drugs for treatment of HIV/AIDS.

USAID was established by Congress in 1961 as part of the Foreign Assistance Act. Multiple legal challenges are underway regarding the power of the president to abolish the agency created by Congress and to cut funding that Congress already allocated.

Although USAID has been a major source of federal funds devoted to global health, other federal entities have funded global health, including the State Department, the Department of Defense, the Centers for Disease Control and Prevention and the National Institutes of Health.

The total amount the U.S. spent on global health in 2024 was approximately $12 billion, which is less than 1% of the federal budget.

Impact of cuts 

Among the organizations challenging the actions against USAID is Oxfam America. In a statement, Oxfam said: “The effect of these cuts on people is dire: At least 23 million children stand to lose access to education, and as many as 95 million people would lose access to basic health care, potentially leading to more than 3 million preventable deaths per year.” An internal memo from USAID said that cuts to programs for maternal and child health would affect services for 16.8 million pregnant women annually and eliminate postnatal care for 11.3 million newborns within the first two days of life.

The ultimate effects of the cuts may be difficult to determine. Harvard’s T.H. Chan School of Public Health noted that the executive orders cutting international aid eliminated data collection systems, including the famine early warning system, that would track the effect of withdrawal of aid. •