Health Aid Cuts in Secret Trump Deals Will Inflict 'Preventable' Death, Disease on Global South: Report
"It will be patients who will pay the ultimate price," said one global health advocate.
The US Congress has pushed back against President Donald Trump's efforts to slash foreign aid, which has long been supported by Democrats and Republicans alike—but a new report on more than a dozen Memoranda of Understanding that the White House has reached with countries that have long relied heavily on healthcare assistance shows that the administration is underspending "congressionally appropriated global health funds by potentially billions of dollars," as it pushes its "America First Global Health Strategy."
That's according to Public Citizen, which on Sunday joined Partners In Health in releasing an analysis of documents that the two nonprofits obtained after suing the Trump administration and filing a Freedom of Information Act (FOIA) request.
The groups reviewed the MOUs that have been signed for 18 out of 34 countries whose agreements have been negotiated by the US State Department, including Rwanda, Liberia, Burundi, and Madagascar.
Although Congress has voted to keep foreign aid levels relatively constant—rejecting a budget that called to slash global health spending by $6.2 billion before approving one that proposed a $615 million decrease in spending—the report finds that the MOUs cut foreign health aid by about $2 billion by 2030, compared to 2024 levels.
“These documents suggest that the Trump administration is on course to underspend on global health by billions of dollars compared to what Congress has ordered, risking lives and allowing diseases to spread,” said Peter Maybarduk, director of the Access to Medicines program at Public Citizen. “The administration must answer how and when it intends to invest the missing billions for health.”
Overall, funding for programs that aim to prevent the spread of diseases including HIV/AIDS, tuberculosis, and Ebola—which is currently spreading in the Democratic Republic of Congo's fastest-spreading outbreak on record—is set to be reduced by 59% from historical spending, according to the MOUs viewed by Public Citizen and Partners in Health.
Some countries would see their health assistance from the US plummet even more, with Rwanda's MOU stipulating a 97% reduction in US health aid. Liberia is set to receive 84% less funding for health initiatives by 2030, and Burundi is set to lose 78% of its aid.
"Partners In Health provides direct care in Rwanda, Liberia, and Sierra Leone, along with seven other countries, and expects under-spending of these funds to impact patients’ access to care," said Public Citizen.
The MOUs also demand that the countries meet strict co-financing requirements to make up for their lost funding, and governments in poor countries across Africa could face penalties "which could worsen funding cuts" if they miss the co-financing targets.
"The planned decreases in US funding are larger for several countries than the funding increases from partner governments," reads the report. "For more than half of countries (11 out of 18), co-financing commitments fall short of the US government’s cuts over five years compared to baseline US government funding."
Countries are likely to struggle to meet the co-financing requirements in the MOUs, warned Public Citizen and Partners In Health.
Malawi would be required to secure new healthcare funding equal to 56% of the country's total health expenditure, the report found. With Uganda also facing co-financing requirements from international health organizations including the Global Fund and Gavi, the East African country would be required to mobilize funds equal to 44% of its total health budget.
"These funding cuts will cause death and disease that is preventable,” said Vincent Lin, associate director of health policy and advocacy for Partners In Health. “The State Department is setting up other countries for failure with the co-financing requirements outlined in these agreements, but it will be patients who will pay the ultimate price.”
Maybarduk told The Washington Post that Sierra Leone will be required under its MOU to fill a 71% health funding gap by 2030.
“It’s going to be very difficult, and if a country like that falls behind, and then is punished for that, then of course the health problems compound," said Maybarduk.
The State Department denied to the Post that the Trump administration will not spend all the foreign health assistance funds appropriated by Congress; it suggested that more of the money than usual may go to religious organizations as well as an "innovation fund" to support US technology that aims to fight disease.
Last week, Public Citizen sued the Trump administration under FOIA to obtain the rest of the MOUs that remain hidden from the public.
The White House, said the group, "has kept the public in the dark about the full details of its plans for the future of US support for global health."
"The State Department has negotiated these bilateral agreements," the group said, "on rushed timelines with limited participation from civil society and affected communities."
