As US funding for global health collapses, rival powers are stepping in — and the world’s pandemic defenses are weakening.
When health systems sag, outbreaks spread, instability grows, and adversaries gain influence on the cheap. The question for Washington isn’t whether to revive yesterday’s aid model; it’s how to shape one for the future.
America must act as a catalyst: spurring public-private partnerships, unlocking innovation, and making us all safer in the long run.
Template for Leadership
The US President’s Emergency Plan for AIDS Relief (PEPFAR) shows how targeted funding and science — like its deployment of long-acting Lenacapavir — can bend epidemics.
Meanwhile, the Global Fund, a public-private partnership that finances programs to fight AIDS, tuberculosis, and malaria, illustrates how private-sector vehicles can crowd in risk-tolerant capital for digital health and delivery.
As Russia mulls a USAID-style development arm, the US can maintain influence by setting standards and match-funding with allies, philanthropies, and firms.
PEPFAR’s Legacy at Risk
PEPFAR alone saved over 25 million lives and built the backbone for broader disease response across Africa.
Programs like the African Cohort Study (AFRICOS) informed HIV policy across Tanzania, Kenya, and Nigeria.
PEPFAR labs and clinics became platforms for mass immunization and rapid COVID-19 response.
In short, US investments turned global health aid into ready-made assets for the next crisis. But this infrastructure is now at risk — not from external threats, but from self-inflicted cuts.
On the front lines of Tanzania’s HIV response this past summer, we saw the fallout up close. Our graduate research team, working with Muhimbili University and the national hospital, interviewed seven local NGOs — five of which were heavily reliant on US funding.
The results were stark: five terminated programs, four laid off staff, and two shut their doors entirely. Some lost up to 70 percent of their budgets overnight. Critical services disappeared. Skilled workers lost jobs. Stability cracked.
China and Russia Step In
In the vacuum, other actors are moving fast.
Some NGOs pivot to local fundraising, private deals, and non-US donors. Others are eyeing deeper partnerships with foreign governments willing to step in where the US has pulled back, including strategic rivals like China and Russia.
Russia plans to reform its aid focus toward humanitarian response, while China is expanding health-related assistance.
The China-Africa Health Cooperation Think Tank Dialogue, held in late September, aimed to “improve research and drive collaborative innovation” among global health institutions.
On its face, the forum meets the demands of African health experts. At its core, it represents a strategy to align Chinese and African leaders geopolitically, capitalizing on the void the US once held in foreign aid.
Foreign Aid as National Security
Foreign aid has long been a national security tool. Shifting away from aid as a method of influence doesn’t make America stronger — it weakens global stability and cedes ground to adversaries.
As the world becomes more autocratic, the influx of bad-faith actors will fuel societal instability, prolong conflicts, and raise tensions worldwide, directly affecting US foreign and domestic interests.
Instead, the US must lead as a catalyst, using its science, partnerships, and strategic funding to protect health systems, strengthen alliances, and secure its influence for decades to come.
Disclaimer: The views and opinions expressed here are those of the author and do not necessarily reflect the editorial position of The Globe Post.
