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 has included the development of formal GHS partnerships with other countries, starting with 17 in 2014 and rising to more than 50 in 2024, with programs focused in particular in countries at risk for emerging diseases.
• 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.
• Multiple U.S. agencies, coordinated by the National Security Council (NSC), have been involved in these efforts including USAID (now dissolved), CDC, the Department of Defense (DoD), the State Department, HHS, and USDA. The first U.S. GHS Strategy, providing overall guidance across the government, was released by the first Trump administration. The Biden administration released an updated Strategy in 2024.
• The FY 2025 Continuing Resolution passed in March included level funding of $993 million for GHS programs at USAID and CDC. At times, Congress has provided additional, time-limited emergency funding when outbreaks occur, such as for Ebola in 2014-2015, Zika in 2016, and COVID-19 starting in 2020. The administration’s FY 2026 budget request includes $493.2 million for GHS, a decrease of $500 million (final appropriation levels are determined by Congress).
• 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.

Current Status of U.S. Global Health Security Programs

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

• Funding freeze/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 remain disrupted and implementers faced challenges in getting permission to resume programming and difficulties in getting paid.
• Dissolution of USAID: Earlier this year, USAID had about 50 staff supporting international outbreak response efforts, a number which dropped to six in the early weeks of the Trump administration (current levels are unknown). As a result, many GHS partners have 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.
• DoD GHS programs may also be targeted for cuts, with potentially up to 75% of staff to be let go.
• 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 remaining global health activities (including GHS work) 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 programs transitioned in July.
• GHS Strategy: The administration has withdrawn the GHS strategy, stating that it would be replaced, although no timeline has been provided. This has raised questions about coordination across the government, particularly in the event of a major threat and given the reorganization and reduction of global health programs already underway.
• New Global Health Strategy: In September 2025, the administration released the America First Global Health Strategy. It includes “making America safer” as one of its pillars, marking the first outline of its plans for GHS going forward. Per the new strategy, the U.S. will aim to:
  • Enable detection of an outbreak with epidemic potential within seven days, through strengthened surveillance, data sharing and laboratory capacity, and will assign U.S. health staff to U.S. missions;
  • Contain outbreaks originating outside the U.S. rapidly at their source, prioritizing mobilization within 72 hours of detection, support to field epidemiological staff, essential commodities, and, if needed, travel restrictions.

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 reported 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.

What to Watch

• Reorganization: The dissolution of USAID and integration of remaining USAID global health activities, including GHS, into GHSD raises questions about how activities will be integrated with existing GHSD functions and whether new capacities will be needed. GHSD has historically focused on coordination and diplomatic roles rather than the in-country implementation roles that USAID and CDC led on.
• Funding/Budget Request: The administration’s FY 2026 budget request includes significant reductions in funding for global health, including a $500 million reduction for GHS (final appropriation amounts will be determined by Congress). The administration also submitted its first rescission package to Congress, including proposed rescissions of more than $1 billion in FY 2025 funding for global health. Congress voted to amend the package, reducing that amount to $500 million and exempting some program areas from the rescission, although global health security was not listed among those program areas.
• New Global Health Strategy: Over the next few months, it is expected that the administration will develop more specific plans for its GHS work at the State Department, including with countries, which will provide more details on the future of this work.