Introduction

In the latest addition to a series of recent changes to the Department of Health and Human Services, the Trump Administration has released a 281-page document announcing foreign aid cuts to global vaccination programs. These cuts have hit global NGOs the hardest, including the international organization Gavi, The Vaccine Alliance. 

The agency that oversees a majority of U.S foreign aid is the U.S Agency for International Development (USAID), with roughly one percent of the federal budget on foreign development assistance. USAID’s work expands across several global regions and helps to provide essential access to healthcare.

Termination of these programs will disrupt vital distribution of healthcare, specifically vaccines, leaving millions of people vulnerable. Most critically, immunization centers across Africa and Latin America, specifically in countries like Burkina Faso, Nigeria, and Afghanistan are at the brink of closure. With over 21 million children around the world currently under-immunized, cutting vital front-line immunization programs, the IRC states, could allow diseases to spread unchecked as threats to global health security. 

NGO Responses to Policy Shifts

Global NGOs working in regions across Africa and Latin America have expressed their disdain for the recent administration policies. Abby Maxman, CEO of a confederation of 21 NGOs called Oxfam, points out that the decision to shut down the USAID means that the U.S. government is “severely impaired in its ability to respond to the humanitarian crisis in Myanmar.” 

In situations where time is of the utmost importance, these aid cuts will most severely affect people enduring poverty, conflict, and life-threatening emergencies around the globe. More specifically, these NGOs will face difficulties in every step of their efforts: from vaccine supply and procurement to hiring of a local workforce for awareness and surveillance. Women and children will also be at a significantly higher risk of preventable disease and due to limited funding, experts expect to see seasonal upticks of malaria and measles cases in the following years.

Maxman further emphasized the heavy dependence of African countries on American aid. He stated that “in Côte d’Ivoire, 70 percent of antiretroviral medication in the country, on which people living with HIV and AIDS depend, is provided through PEPFAR (the U.S. President’s Emergency Plan for AIDS Relief).”

The cuts additionally outline the termination of more than 10,000 foreign aid grants and contracts, including clients of the International Rescue Committee (IRC). The IRC provides about 4.3 million services for communicable diseases around the world, including children under the age of 5. 

One of the IRC’s most impactful projects, Reaching Every Child in Humanitarian Settings (REACH) was conducted in partnership with Gavi, and leveraged flexible methods (including mobile clinics, mapping tools, local teams) to administer over 13 million vaccine doses to children across multiple regions of Africa. In South Sudan, REACH collaborated with local community health workers to raise vaccine awareness and combat misinformation. 

Economic Losses

These recent policy shifts have further caused ripple effects in the funding of NGOs across the world, led by Gavi. They predict that American aid withdrawal could leave over 75 million children without access to routine immunizations and cause over 1.2 million preventable deaths. Paired with facility closures and health worker layoffs, this shortfall compounds to an estimated economic loss of around $25 billion. 

Also, while the State Department has responded with the fact that “critical USAID awards remain active,” the slashed funds have heavily jeopardized childhood vaccine programs. And while the policy cuts may reduce upfront investment, NGOs report every dollar invested in early vaccination has the potential to save much more money in comparison to future disease treatment. Vaccines, in particular, can serve multiple epidemiological roles as either primary prevention (stopping the disease before it starts) or secondary prevention (preventing further progression for the disease). 

According to UNICEF, immunization is one of the most cost-effective public health interventions, preventing an estimated 4.4 million deaths yearly. Adaptable, low-resource interventions such as the ones used in REACH allow for the delivery of polio, measles, and diphtheria vaccines to children while maintaining the maximum impact per dollar.

A Historical Look into Global Vaccination

Since the early 20th-century, compulsory campaigns for disease like smallpox or yellow fever were often carried out coercively by colonizers in subject countries. However, the formal entry of the United States into global health aid was in 1948, when the U.S. helped found the World Health Organization in an effort to focus on humanitarian relief post-WWII.

In the 1980s, the U.S was instrumental in funding the eradication of smallpox and polio. This further spurred development of large-scale programs such as the Expanded Programme on Immunization (EPI) that covered childhood vaccination against several major preventable diseases. During the Cold War tensions, the motivations for global health aid shifted, as they were seen as a tool for international diplomacy to counteract communism in several regions. 

American leadership promoted a revolution of global vaccination through Gavi starting in the early 2000s, consisting of structural reforms to strengthen national health systems and help the most vulnerable communities. 

Disease prevention through vaccination and routine immunization through frontline efforts have proven to be highly effective. The direct promotion of malaria immunization through USAID and the Presidential Malaria Initiative helped cut malaria deaths by over 60%. 

Until recently, U.S global health funding had continued to increase with the creation of PEPFAR, emergency regulations following COVID-19, and donor contributions to multilateral organizations.

Geopolitical & Regional Consequences

In Africa, Malawi, Kenya, Nigeria, the Democratic Republic of Congo and South Africa are among the countries most reliant on U.S fundings, receiving major support for routine immunization, polio, and HIV/HPV programs. Immunization shortfalls not only result in millions of children missing critical vaccines, but also risk undermining long-term research into vaccine research for the region. Several HPV vaccine campaigns that were scheduled for rollout are being scaled back, which could have major effects on future cancer rates. In particularly conflicted countries like Sudan and Burkina Faso, closing of clinics and layoff of health workers have left refugees and displaced people particularly exposed to outbreaks, according to Doctors Without Borders. 

The Pan America Health Organization (PAHO) leads immunization programs in Latin America countries like Haiti, Honduras and Nicaragua, but the cuts might cause children to go without routine vaccination for an estimated five years. Due to a spike in measles cases in Venezuela in 2024, experts predict a rapid resurgence without sustained vaccination efforts as well. Similar to Africa, HPV vaccinations are facing cancellations and the population hardest hit are the migrant and displaced populations along the Venezuela-Colombia border or in Central America. 

While both of these regions face severe crises due to their vulnerable populations, infectious diseases know no borders. It will only be a matter of time that these global outbreaks could cause the emergence of these preventable infections within the United States. It has already been reported that cases of measles have reached a high in the past 20 years as domestic vaccine policy under Secretary Robert F. Kennedy has significantly lessened over the past year. 

Conclusion

Overall, the U.S foreign aid cuts have the potential to endanger not only global but American interest by threatening the prevalence of infectious disease control, economic efficiency and geopolitical relations. 

In just a few budget cycles, this is evident that the recent wave of foreign aid retrenchment have reversed decades of bipartisan investment and progress into the global health sector, signaling the Trump administration’s narrower focus on national interest. The United States has shown the implications of prioritizing self-interest over collective global efforts, but is that an ethical way to approach humanitarian aid policy?

And while private philanthropists and other countries have pushed for emergency funds, these schemes are largely unable to quickly replace the scale and reach of American aid, which was one of the largest in the world. It is worth watching out for changes in the global health environment, as unstable sources funding could shift the importance of nation-affiliated donors to cultivating private and local resources. 

Since the exact cut amounts are yet to be determined by Congress, only time will tell the complete extent to which global vaccination campaigns will be affected.