The Trump Administration’s Foreign Aid Review: Status of Global Health Security/Pandemic Preparedness

Background on U.S. Global Health Security Efforts

• The U.S. has supported global health security (GHS) and pandemic preparedness efforts for decades through funding and technical support provided to low- and middle-income countries (as well as support for multilateral efforts). This had included the development of formal GHS partnerships with other countries, starting with 17 in 2014 and rising to more than 50 in 2024.
• GHS efforts are designed to help countries and regions build capacities needed to prevent avoidable outbreaks, detect infectious disease threats early, and reduce the impacts of epidemics and pandemics through rapid and effective responses.
• Specific activities include: improving surveillance and laboratory systems, reducing the risks of animal to human disease exposures, training epidemiologists, and fostering better biosafety and biosecurity practices.
• U.S. investments in GHS have led to measurable increases in capacity, including improvement in 9 of 15 technical areas between 2018 and 2023 in GHS partnership countries and reductions in average outbreak response times.
• Prior to 2025, multiple U.S. agencies, coordinated by the National Security Council (NSC), were involved in these efforts including USAID (now dissolved), the Centers for Disease Control and Prevention (CDC), the Department of Defense (DoD), the State Department, HHS, and USDA. The first U.S. GHS Strategy was released in 2019 by the first Trump administration and an updated strategy was released by the Biden administration in 2024.
• Prior to the start of the Trump administration, U.S. funding provided to bilateral GHS activities in FY 2024 was $1.25 billion; $100 million was provided to the Coalition for Epidemic Preparedness Innovations (CEPI) and $250 million to the Pandemic Fund.

Current Status of U.S. Global Health Security Programs

The following administration actions have had a significant impact on U.S. GHS programs:

• Stop-work order: The stop-work order initially froze all USAID-based GHS programming and services. As a result, many GHS implementing partners let staff go and some USAID-supported GHS activities in progress were interrupted, such as funding for transport of samples and phone plans for contact tracers.
• Limited waiver: Some GHS activities were included in a limited waiver issued by the State Department on February 4 allowing “life-saving services” to continue, including: rapid emergency response to immediate infectious disease outbreaks, focused on pathogens with pandemic potential and those that pose a national security risk to U.S. citizens (e.g., mpox and H5N1), including detection, prevention, and containment and supply of medical countermeasures. Even with the waiver, services remained disrupted and implementers faced challenges in getting permission to resume programming and difficulties in getting paid.
• Dissolution of USAID: Before its dissolution, USAID had about 50 staff supporting international outbreak response efforts, a number which dropped to six in the early weeks of the Trump administration. As a result, many GHS partners lost points of contact and technical support, in addition to the loss of funding. Announcements of reductions at the CDC could further affect GHS capacity.
• Reorganization: The administration notified Congress on March 28, 2025, of its intent to permanently dissolve USAID and that any remaining USAID operations would be absorbed by the State Department with global health activities (including for GHS) to be integrated into its Bureau of Global Health Security and Diplomacy (GHSD). On May 29, 2025, the State Department further notified Congress of its proposed reorganization plan, and with the dissolution of USAID, programs moved in July 2025.
• America First Global Health Strategy: In September 2025, the administration released the America First Global Health Strategy, its roadmap for future U.S. government global health engagement (the Trump administration withdrew the 2024 Global Health Security Strategy and has not released an updated strategy). Per the America First strategy, the U.S. is negotiating bilateral, multi-year agreements with countries receiving U.S. global health assistance with an aim to transition the majority of countries to full self-reliance by the end of the agreement period. Global health security figures prominently in the new strategy and is part of all of the agreements signed to date. Goals include enabling detection of outbreaks with epidemic potential within seven days and containing outbreaks originating outside the U.S. rapidly at their source, prioritizing mobilization within 72 hours of detection.
• Withdrawal from WHO: In January 2025, President Trump announced that the U.S. would withdraw from the World Health Organization (WHO) and halted its funding (the formal withdrawal was completed in January 2026). The administration also said that the U.S. would not be bound by the recently revised International Health Regulations or the new pandemic agreement being negotiated by WHO, two international instruments that outline roles and responsibilities for countries to prepare for and respond to outbreaks.
• Funding: The Trump administration has requested significantly less funding for GHS in its budget requests and canceled or suspended funding for GHS-related projects and awards, including for contributions to CEPI and the Pandemic Fund. Despite this, Congress has continued to appropriate funding for bilateral GHS efforts at close to prior year levels, including $1.1 billion in FY 2026, and called for funding consistent with prior amounts for contributions to CEPI and the Pandemic Fund.

Impact on GHS Services and Outcomes

• The combination of administration actions described above has reduced capacity and may challenge communication and coordination across U.S. agencies and with partners, contributing to slower responses to emerging health threats, greater impacts, and increased risk of importation of diseases into the U.S.
• Experts estimate that there is a 50% chance of another pandemic emerging in the next 25 years, with the risk greatest in the least prepared countries. 
• The health impacts of poorly controlled outbreaks can be severe. An internal USAID memo from 2025 estimated that the risk of losing USAID GHS programs alone could result in more than 28,000 new cases of dangerous infectious diseases, such as Ebola and Marburg, every year.
• Emerging diseases can result in major economic and social costs, even with small-scale outbreaks.
  • The SARS 2003 outbreak led to an estimated $30 billion in economic losses (over $3 million per case) from reduced commerce, travel and trade.
  • The 2014-2015 West Africa Ebola epidemic led to an estimated $53 billion in economic losses. A single Ebola patient in New York cost the city’s $4.3 million in response measures.
  • Measles outbreaks in the U.S., often initiated through importation from other countries, can lead to significant costs; a recent study from Washington state found that a 71-case measles outbreak led to societal costs of $3.4 million, or almost $50,000 per case.
• Pandemics have even more massive economic costs, as experienced with COVID-19, which cost the U.S. alone an estimated at $16 trillion – a number four times the lost economic output from the 2008 financial crisis.
• News broke in mid-May of the ongoing Ebola outbreak in the Democratic Republic of the Congo, and given all of the changes made by the U.S. to its foreign assistance and global health response, U.S. support is taking shape under very different circumstances and through different organizational mechanisms than in the past, but a recent KFF analysis found that the speed of the U.S. government’s response to the current outbreak is on par with the prior two outbreaks, and initial U.S. funding amounts are already surpassing the prior two outbreaks.

What to Watch

• Implementation of the America First Global Health Strategy multi-year agreements with countries
• Status of U.S. funding appropriated by Congress for bilateral GHS efforts and contributions to CEPI and the Pandemic Fund
• U.S. international engagement in pandemic preparedness and response