Trump Administration Redirects Global-Health Funding to Cover USAID Closeout Costs

The administration plans to move roughly $2 billion earmarked for malaria, tuberculosis, maternal-child health, nutrition, global-health security and HIV/AIDS, plus about $1.2 billion originally designated for foreign-development assistance, to finance the shutdown of the U.S. Agency for International Development (USAID). A notification to Congress dated April 20 indicated that more than $19.1 billion has been set aside for USAID close-out expenses, including legal fees, pending invoices and asset sales.

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In 2025 the administration froze most foreign-aid programs and terminated thousands of contracts as it began dismantling USAID, transferring remaining activities to the State Department. The move follows a year of deep cuts to global humanitarian assistance by the United States and other donor nations.

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• The $2 billion cut could cause an estimated 121,000 preventable tuberculosis deaths and 47,600 malaria deaths (Health Security Policy Academy).

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• Nutrition program reductions may deprive 22.9 million children under-5 of lifesaving nutrition and 5.7 million women of safe childbirth facilities.

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• Approximately $1.7 billion of approved President’s Emergency Plan for AIDS Relief (PEPFAR) funds remain unspent, with $976.5 million carried over from FY 2024 and $700 million yet to be transferred to the CDC.

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• HIV testing fell by 14 million tests (-17 %) in 2025, and about 70,000 community health workers were laid off.

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Seventeen Senate Democrats wrote to Secretary of State Marco Rubio, OMB Director Russell Vought and acting USAID Administrator Eric Ueland urging an immediate reversal, arguing that the funds should be used “to deliver results for the American people.” A State Department spokesperson confirmed receipt of CNN’s inquiries but offered no comment. Senior State Department official Jeremy Lewin described the current level of people on antiretroviral treatment as “very, very good,” while noting a decline in testing and new enrollments.

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Health-policy analysts warn that diverting the money could lead to tens of thousands of deaths and undermine pandemic preparedness. Experts highlight the risk of lost trust among hard-to-reach populations, including men who have sex with men, adolescent girls, pregnant women and drug users. Advocacy groups argue that the lack of transparency around PEPFAR spending hampers accountability.

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Two members of Uganda Young Positives, an NGO supporting young people living with HIV/AIDS, continue volunteering without pay after U.S. aid cuts. In South Africa, the LGBTQ+ organization OUT reports hundreds of patients dropping out of care following the closure of a USAID-backed clinic.

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Analysts note that while budget documents show large unspent PEPFAR balances, the administration has not released official Q1-Q3 data for the program, creating uncertainty about actual disbursements. Some observers fear the administration may rescind or hold the remaining funds until the end of its term.

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• “The Administration should immediately begin using these foreign assistance funds to deliver results for the American people. There is no reason for this FY25 funding to be withheld to cover the wasteful costs this Administration has incurred because it chose to dismantle USAID,” — 17 Senate Democrats, letter to Rubio, Vought, Ueland

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• “When you see the number of people being tested going down… it suggests that people are being missed. They’re not being diagnosed,” — Jennifer Kates, director of global and public health policy, KFF

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• “All the evidence we have points to serious drop-offs in coverage in sort of January through the middle of the last year, and that will have made people sick,” — Charles Kenny, senior fellow, Center for Global Development

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• “Funding from PEPFAR being taken away will kill people,” — Asia Russell, executive director, Health Gap

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• “You can see it in the numbers that we can’t get back into care, that trust is already lost,” — Dawie Nel, director, OUT (South Africa)

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The Senate Democrats plan to introduce legislation to block the reallocation and restore the original health-program budgets. Congressional hearings on USAID’s closure and the impact on global health are expected later this year, and advocacy groups have pledged further legal challenges if the redirection proceeds.

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