Since the reality in which the United States defines greatly reduces its external aid to developing countries, the urgent conversation begins between governments and charitable events and global health and development organizations.
It focuses on one decisive question: Who will fill this gap?
Last year, the United States contributed about $ 12 billion in global health, funds that have funded HIV and the prevention of new infections; Children’s vaccines against polio, measles and pneumonia; Clean water for refugees; And tests and medicines for malaria.
Next is the largest financier is the Gates Foundation, which spends a small part of this amount: The World Health Department had a budget of $ 1.86 billion in 2023.
“No person can fill the gap that the United States occupied easily,” said Dr. Natopico Netosi, CEO of the Medical Research Council in South Africa.
American assistance was directed by the United States Agency for International Development, or the US Development Agency, which has been largely dismantled by the Trump administration, and other government agencies, including national health institutes, which also face significant discounts in grants of health research.
Dr. Netosi said that many people suggest that other countries, especially China, can move to some of the areas that the United States has evacuated. Others make urgent calls to large charitable works, including the Gates Foundation and the open charitable work.
This conversation is the most dependent in Africa. About 85 percent of the United States went to global health to programs in African or African countries.
For countries like Somalia, where American aid constitutes 25 percent of the full budget of the government, or Tanzania, where the United States funded the majority of public health care, the loss is disastrous. For major global health agencies, the situation is very important.
President Trump has already removed the United States from the World Health Organization, which is now trying to make an initial reduction of $ 500 million for the period 2026-27 to deal with withdrawing American funds.
““Most of our neighbors on the continent were completely dependent on the United States to purchase most of the life -saving drugs for endemic infection,” said Dr. Netosi. “And I do not see that most governments during the night can obtain the resources needed to adapt. Therefore, I think there are severe consequences for missing lives from Africans who will die because of the preventive infections.”
The United States is the largest donor of Joy, an organization that provides basic vaccines for the poorest countries in the world, and for the global fuse to fight AIDS, tuberculosis and malaria. The United States’ contribution is required by Congress. In response to a question about adhering to these and other multilateral agencies, including the epidemic fund, a spokesman for the Ministry of Foreign Affairs said that the programs were reviewed to see if they were in line with the national interest, and that funding will only continue for those who faced this situation.
Who takes?
There is no indication that additional financing will come from other G7 countries, the European Union, or other high income countries. Britain, Germany, France, the Netherlands and the Scandinavian countries all reduced their external aid. Some new donor countries have advanced to support the World Health Organization, including Saudi Arabia and South Korea, but their spending is getting a dwarf with the amount provided by the United States once.
Among the non -governmental players, the World Bank is the best position to provide long -term support for health spending. The bank said a little so far. Countries can strongly provide countries with innovative financing in the United States, such as health care bodies for debt, to give countries that are fighting under heavy debt burdens some financial freedom to compensate for the financing of lost health care. However, the United States is the largest contributor to the bank, and the Trump administration will have an impact on any such investment.
A large part of the general debate focused on filling the United States’s void on China, which has built a great presence by financing infrastructure projects in African countries, especially those that have wide metal reserves or strategic ports.
“There is a good reason for them to do this,” said JA Ian Chung, Associate Professor of Political Science at Singapore National University at the University of Singapore. China considers foreign aid as a soft power tool in its extraordinary competition with the United States, as the United States did when establishing the United States Agency for International Development during the height of the Cold War with the Soviet Union. China seeks to use aid to gain more support from developing countries at the United Nations.
While Chinese aid has largely came in loans to build infrastructure, it includes support for more varied projects. China’s answer to Aid Western Development Aid includes a program that was unveiled in 2021 called the Global Development Initiative, 2 billion dollars To upgrade livestock production in Ethiopia, fighting malaria in Gambia and planting trees in Mongolia, among other projects.
Mr. Chung said that China’s ability to fill the left opening by the United States Agency for International Development could be bound through its financial limits. The Chinese economy has stolen due to the property crisis and the high government debt, and the country has already fell to large infrastructure loans.
So far, China has not shown great interest in supporting global health programs, or in providing grants anywhere near the level of the United States Agency for International Development. Auddata, University Research Laboratory in William and Mary in Virginia, Estimates Beijing provides about $ 6.8 billion annually as grants and low -cost loans.
Charitable works
Charitable works that were already working in global health have been reduced through injured calls from frozen boxes.
“I have spoken to some of the institutions that they all said we are drowning with people who say: “Help, help us, help us,” and I think they are trying to correct small holes, “said Sheila Davis, CEO of non -profit partners, who works with local governments to bring care Health for societies in developing countries. But if a patching plan can cover only 20 percent of what the states were paying United, what should the new donor provide? Or what is the best strategy? “
Among the institutions that are considered auxiliary appeals for assistance are the Gates Foundation, whose recipient warns against granting that they cannot compensate for this gap. In addition to financing global health programs, the Foundation also supports health research and is a major shareholder in Gavi.
“There is no basis – or a group of institutions – can provide financing, workforce, expertise, or leadership that the United States has historically provided to combat and control deadly diseases and treat hunger and poverty all over the world,” said Rob Napoors, the director of North America. , Via email.
Many beneficiaries of the financing of the Gates Foundation, who refused to talk about the record because they were describing secret talks, said that they had told them the employees of the Foundation that he would continue to finance research and programs in the areas that have already succeeded, but they will not have also expanded, and that although it is that Some grants may be restructured to try to compensate a portion of the lost American financing, the Foundation’s work will remain a “joke” instead of supporting Wide -range programming as did the United States Agency for International Development.
John Arn Roning, CEO of Wellcome Trust, who is among the largest international health research donors, said in an email message that the Foundation “explores the options” in the new scene. But he said that her assistance would be “a decrease in the ocean compared to what governments around the world need to provide.”
Two small organizations, such as the founders of the pledge, “Bridge Boxes”, which ranged between about 20 million dollars to 200 million dollars, started to try to help immediate gaps.
But the charitable sector was largely silent about the important change in the scene. The main players who have already placed hundreds of millions of dollars in the field of health care in Africa, such as the Susan T -Buffett Foundation, have not responded to questions about their plans. The Delta Foundation (which is involved in its founding by billionaires in Zimbabwe, struggling Masonica), refused to discuss the case.
Two executives said at a smaller private foundation that there is hesitation to say anything publicly due to the fear of revenge on the Trump administration, including the possible loss of the charitable situation.
African governments
African governments are subjected to tremendous pressure from frustrated citizens to take responsibility for the health spending that came from the United States, as the issue led the agenda at a meeting of health ministers on the continent at the African Union summit last week.
Within 24 years since the union adopted the so -called Abuja DeclarationAnd its 42 members committed to spending 15 percent of their budgets on health, only a few states reached this goal, for a period of one or two years at most. The average health spending by African countries is less than half of this amount.
In Nigeria, the President held a cabinet committee in emergency cases to develop a budget lack, and parliament allocated an additional $ 200 million to the national budget last week. But this extraordinary procedure shows the size of what was lost: It is less than half the amount of $ 512 million that the United States gave Nigeria Healthcare in 2023.
The Nigerian Minister of Health, Dr. Mohamed Bat, said that nearly 28,000 health care workers in the country have been entirely paid or part by the United States Agency for International Development, which also covered three quarters of the draft pharmaceutical law and test the 1.3 million test groups Nigerians who live with HIV
He said that Nigeria will quickly need to find new ways to work, including enhancing the manufacture of some of these elements locally. “This may not be a fantasy, but at least it will serve,” said Dr. Pat.
It also foretold that the end of the aid will speed up what he called “reorganization” in Africa. “The world has turned in the past twenty years,” he said. “So we have other actors: We have China, India, Brazil, Mexico and others.”
Daisy Ventura, a professor of global health ethics at the University of Sao Paulo, said change may open opportunities for other countries to practice new influence.
“The US decline may open an area for new leaders now,” she said. “It is important for us in the global south to imagine international coordination of emergency preparedness and response to it without the United States.”
Perry Wang Hong Kong reports contributed to the reports.
