The Trump Administration’s Foreign Aid Review: Status of U.S. Support for Gavi, the Vaccine Alliance

Background on the U.S. and Gavi

• Gavi, the Vaccine Alliance (Gavi), is an independent public-private, multilateral financing entity created in 2000. It raises and pools resources from multiple donors and in turn, disburses approximately $1.7 billion per year to support procurement and distribution of vaccines in low- and middle-income countries (LMICs).
• Gavi supports vaccines against 20 infectious diseases, and hosts the global emergency vaccine stockpiles against Ebola, yellow fever, meningitis, and cholera. By playing a market shaping role through pooled procurement, demand forecasting, support for regional manufacturing capacity, and other strategies, Gavi helps to drive down prices for vaccines in LMICs.
• Gavi reports that it has helped to immunize more than 1.2 billion children in 78 LMICs, preventing more than 20 million deaths, and generating economic benefits estimated at more than $280 billion, since 2000.
• The U.S. government was one of the original donors to Gavi and had been its third largest contributor in recent years, providing 13% of its funding since its inception. Gavi also had a donor liquidity partnership with the U.S. International Development Finance Corporation (DFC) allowing Gavi to quickly access up to $1 billion from a “Rapid Financing Facility” to support routine immunization and pandemic response, backed by forthcoming donor pledges. Additionally, the U.S. was the largest donor to COVAX, the international effort housed at Gavi that supported the development, procurement, and delivery of COVID-19 vaccines to LMICs (COVAX ended in 2023).
• Only LMICs whose most recent Gross National Income (GNI) per capita is below a certain threshold are eligible for Gavi assistance (56 countries in 2026). Countries are required to co-finance a portion of their vaccines on a sliding scale. To date, 19 countries have graduated from Gavi assistance.

• Gavi had been the primary mechanism by which the U.S. government supported the procurement of vaccines for LMICs. The USAID bilateral maternal and child health program had complemented Gavi by supporting in-country capacity building and immunization campaigns and, prior to its dissolution in 2025, USAID had managed the U.S. partnership with Gavi.
• Every five years, Gavi replenishes funding through “pledging conferences”. For the 2026-2030 period, Gavi secured more than $9 billion towards a target budget of $11.9 billion, which it estimates would save at least 8 million lives by 2030.
• Prior to the start of the Trump administration, U.S. funding provided to Gavi in FY 2024 was $300 million.

Current Status of U.S. Support for Gavi:

• Stop-work order: The foreign aid review’s stop-work order initially froze all U.S. bilateral programming but was not applied to Gavi or other multilateral institutions. The administration subsequently announced that it canceled 86% of all USAID awards. KFF analysis finds that of 770 global health awards identified, 80% are listed as terminated, including the main Gavi contract as well as the COVAX contract. Gavi reports that it has not received a termination notice for its main contract, although it did receive one for COVAX (all U.S. funding was already disbursed to COVAX in 2021).
• International organizations review: A second executive order, calling for a 180-day review of U.S. participation in all international intergovernmental organizations, was initiated. Per the order, the purpose of the review was to determine which are “contrary to the interests of the United States and whether such organizations, conventions, or treaties can be reformed”. Gavi was not on the list of 66 international organizations from which the U.S. withdrew, per a January 7, 2026, presidential memorandum.
• 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, including global health activities which would be integrated into its Bureau of Global Health Security and Diplomacy (GHSD). Delivery of lifesaving vaccines is listed among the USAID activities to be continued at GHSD, although currently the relationship with Gavi is being managed through the Office of Global Affairs at the Department of Health and Human Services. 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. Per the 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. While the strategy and country agreements include the importance of polio and malaria vaccination and metrics for measuring their delivery, Gavi is not mentioned, and the U.S. has not announced how it will procure these vaccines.
• Funding: The Trump administration has not included funding for Gavi in its budget requests, including its FY27 budget request that stated that any future funding for Gavi is “contingent on the organization making necessary reforms and meeting certain benchmarks on vaccine safety.” While Congress appropriated $300 million for U.S. contributions to Gavi in FY 2025 and FY 2026, the current administration has not provided funding to Gavi after citing concerns about vaccine safety, despite Gavi following globally-recognized scientific standards and evidence. Gavi has committed to working toward accelerating its transition to different vaccines, in partnership with its Board and countries, and based on manufacturers ability to expand production capacity, among other factors. On July 29, 2026, the administration announced it would “immediately release” $600 million in Congressionally-appropriated FY25 and FY26 funding to Gavi.
• U.S. representation on the Gavi Board: The U.S. historically played a role in Gavi’s governance, including as a Board and committee member, but with the suspension of U.S. funding by the Trump administration, the U.S. is no longer eligible to be part of the Board. In its recent announcement that it would resume funding, the administration stated that the U.S. “expects to resume its place on the Gavi Board.”   
• Potential impact on health outcomes: The loss of U.S. support for Gavi would affect procurement of vaccines for LMICs, with particular impact on children. Gavi estimates that loss of funding could result in 75 million children not receiving routine vaccinations over the next five years, leading to more than 1.2 million children dying as a result. Reductions in vaccine stockpiles could also impact outbreak control.

What to Watch

• Implementation of the America First Global Health Strategy
• Status of U.S. funding appropriated by Congress for Gavi and the U.S. role in Gavi governance
• Further results of the administration’s international organizations review
• Impact of U.S. changes to global health programs on health outcomes