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Trump pushing historic cuts in global health aid
Rollback presented as a trade-off for domestic initiatives
WASHINGTON — A half-century after the United States led a global expansion of international efforts to combat infectious disease and promote family planning, the Trump administration has embarked on a historic retrenchment that many fear threatens the health of millions and jeopardizes America’s standing in the world.
Since taking office, President Donald Trump has proposed dramatic cuts to the U.S. Agency for International Development, which has historically spearheaded U.S. efforts to improve women’s and children’s health.
The White House is urging reductions this year to major international health initiatives, including the President’s Emergency Plan for AIDS Relief, or PEPFAR, which provides life-saving medicines to millions of AIDS patients in developing nations.
The Trump administration has imposed tough new restrictions on U.S. support for aid organizations that provide family planning and other health services.
And last week, the White House announced it is cutting all U.S. contributions to the United Nations Population Fund, or UNFPA, the lead international agency dedicated to promoting family planning and child and maternal health.
Cuts on the scale proposed by the president could be devastating, warned former Republican Senate Majority Leader Bill Frist, a surgeon who has worked extensively on global health since retiring from Congress.
“If the U.S. chooses to drastically cut its foreign assistance, including for HIV/AIDS, nutrition and family planning, we risk reversing our strides over the past 25 years to reduce extreme poverty and disease worldwide,” Frist said. “That potentially creates a domino effect which could lead to nation destabilization, conflict and catastrophic loss of life.”
The U.S. is the largest funder of global health programs, including family planning.
The Trump administration has defended the rollback as necessary to address domestic needs, such as repairing aging bridges and airports, and constructing a new wall along the border with Mexico.
Conservatives also want to ensure the U.S. is not funding abortion services.
“These steps to reduce foreign assistance free up funding for critical priorities here at home and put America first,” the administration explained in its 2018 budget proposal released last month.
But across the world, there are growing fears the United States will no longer be a reliable ally in tackling major global health challenges, including combating HIV/AIDS, malaria and future pandemics such as Ebola, which killed thousands in Liberia.
Last month, more than 100 evangelical and Catholic leaders who work on international aid sent a letter to Trump, imploring him not to cut U.S. aid.
Several international aid groups, speaking on condition of anonymity to avoid being seen as criticizing the new administration, said they have already been told by U.S. government officials to expect a major shift away from health care assistance globally.
The stakes in this retrenchment are high.
Although maternal and child mortality rates have been falling globally, in 2015 more than 300,000 women died from complications during pregnancy and childbirth, and nearly 6 million children died before the age of five due to disease and malnutrition, according to World Health Organization estimates.
For decades, the U.S. played a critical role in addressing major global health challenges.
The last Bush administration’s campaign to address the AIDS epidemic in the developing world — spearheaded by PEPFAR — is widely credited with helping to turn the tide against the deadly disease.
“President Bush changed the face of Africa,” said Jennifer Kates, who oversees global health research for the nonpartisan Kaiser Family Foundation.
Total U.S. spending on global health topped $10 billion in 2016, more than half of which is committed to HIV/AIDS, according to a Kaiser analysis.
Support for global family planning has waxed and waned over the years, as Republican presidents, including Bush, have been less supportive.
But the Obama administration made family planning a major priority, seeing access to contraception as key to improving the health of mothers and children, empowering women and supporting economic development.
Although the White House said it would continue support for PEPFAR and other global health funds, the administration has proposed a series of substantial cuts this year to PEPFAR as well as programs targeting polio, tuberculosis and malnutrition, according to budget documents sent to lawmakers last month and first reported by Politico.