A narrative review

On 20 January 2025, the U.S. administration issued an Executive Order freezing all foreign assistance funds for 90 days, including funds distributed by the US President’s Emergency Fund for AIDS Relief (PEPFAR). The following months saw sweeping cuts, reversals, and mass firings (USAID’s staff were cut from 10,000 personnel to 15), and a series of lawsuits and appeals (see KFF’s helpful timeline for more on this). Researchers and advocates began immediately to document the impact and forecast future scenarios. This narrative review summarizes reports and analysis that I could find to date (August 2025).

The US cuts brought an abrupt end to what in hindsight appears to have been the “golden age” for Development Assistance for Health (DAH), which rose to historic levels during Covid-19 to $80.3 billion in 2021, and fell to $49.6 billion in 2024 (based on the OECD Creditor Reporting System).[1] It is currently forecast to drop to $38.4 billion in 2025.[2]

The U.S. cuts were followed by cuts across Europe. The UK announced a cut in aid spending from 0.5% of GNI to 0.3%, to begin in 2027.[3] This followed the UK’s merger of its international development department, DFID, with the Foreign and Commonwealth Office.[4] The Netherlands announced plans to cut aid by EUR2.4 billion starting in 2027, reducing Netherlands international development spending from 0.62% of GNI in 2024 to 0.44% in 2029.[5] In 2024, Switzerland reduced spending for ODA from 11.25bn to 11.12 for four years, and began winding down programmes in some countries, “chipping away at aid bit by bit” according to one NGO director.[6]

France also cut its aid budget by 35%, and launched a review of existing programmes.[7] Guillaume Bigot, a French far-right member of Parliament, said, “”In the beginning [development aid] was aimed at our former colonies and the poorest countries. It is now tinged with globalist ideology. We are helping…countries with which we have few links or that don’t need the aid – even hostile countries.” He went on to denounce funding for the Green Climate Fund and the Global Fund to Fight AIDS, TB and Malaria.[8]

Methods: This spontaneous narrative review is based on a search of PubMed in August 2025 using “funding cuts”, as well as other articles and reports shared among members of the Community Health and HIV Advocates Navigating Global Emergencies (CHANGE) Modelling and Data Analysis working group during January-August 2025. This resulted in a total of 33 relevant civil society reports, UN reports, commentaries, and peer-reviewed articles.

Below, I summarize the current reports and forecasts of the likely impact of the global health funding cuts of 2025. (Caveat: as events continue to unfold, and new evidence is gathered, the following may become dated quicky.)

HIV – The five countries providing over 90% of international HIV funding announced reductions of between 8-70% of international aid for 2025-26.[9]

The largest of these by far was PEPFAR, which invested more than $100 billion in HIV prevention, testing and treatment, providing 20.6M people with ART and reporting over 2 million babies born HIV-free. PEPFAR also trains healthcare workers, builds laboratories, and supports supply chains, among other interventions. PEPFAR programmes are implemented primarily by two agencies: the US Centers for Disease Control (CDC) and USAID; with over 450 prime implementing partners and 850 sub-recipients in 55 countries. 27 (or close to half) of the 55 PEPFAR-supported countries are in Africa. Nonetheless, as USAID’s former global health director noted, the actual amounts at stake are relatively small: “Foreign aid is a speck in the 6.75-trillion-dollar government budget. At about eight billion dollars last year, USAID’s global health budget is smaller than that of many hospital systems.”[10]

A PEPFAR emergency waiver to the stop-work order committed to continuing to provide diagnostics, treatment, management of opportunistic infections, supply chain support, and some human resources.[11] However, the waiver did not reinstate other services halted by the stop-work order, including HIV prevention, Post-Exposure Prophylaxis (PEP) for rape survivors, and Pre-Exposure Prophylaxis (PrEP) for HIV-negative partners in sero-discordant couples and key populations. The waiver also failed to stop the shutdowns of many services; this required formal notification and approvals from staff, but from 21 January, CDC staff were under orders not to communicate with external partners; on 8 February, USAID staff were put on administrative leave.[12]

An early survey of 153 PEPFAR partners in 27 countries by Lankiewicz and colleagues documented the sweeping impact of the executive order. In the first week after the freeze, the survey found widespread disruption of HIV services, with over 70% reporting disruption of either loss to follow-up services, gender-based violence services, monitoring and data collection, HIV testing, or HIV treatment.[13] 86% of respondents reported that their clients would lose access to HIV treatment services within the next month. Most respondents reported their organizations had already laid off staff, particularly community-based staff. Nearly one-third of respondents reported their organizations had already completely closed, either temporarily or permanently. 

Lankiewicz et al wrote, “These findings indicate that the stop-work order has had devastating consequences for PEPFAR beneficiaries. Although the waiver lifts portions of the funding freeze, these data highlight the inability of PEFPAR’s global implementer network to absorb a complete financial shutdown without causing major disruption to public health services.” The survey warned that “even short pauses in funding will be unsurvivable for many.”[14]

A number of researchers and experts have evaluated the expected impact of the funding cuts on HIV transmission and access to treatment, using different infectious disease models, and generating stark scenarios, including:

• amfAR predicted that on each day of the freeze, about 220,000 people (including over 7000 children) would be unable to access treatment;[15]
• Another estimate predicted that the 90-day stop-work order alone would lead to at least 100,000 lives lost over one year;[16] and
• UNAIDS estimated that the funding cuts would lead to an additional 6.6 million new HIV infections, an additional 4.2 million AIDS-related deaths, and 3 million additional children orphaned by HIV by 2029.[17]  

UNAIDS further published a table showing all the predictions generated by several different modelling groups.[18]

In a commentary, a group of African leaders forecast that “in the worst-case scenario, if PEPFAR funding were ceased entirely and no equivalent mechanism replaced it, surges in HIV incidence could potentially undo nearly all progress achieved since 2000. This suggests that even if funding were reinstated after between 12 months and 24 months of discontinuation, up to an additional 20–30 years of investment relative to the status quo could be required to end AIDS as a public health threat.”[19] They concluded, “Although PEPFAR is imperfect because of its rigid and self-serving priorities, its impact is undeniable.”[20]

In addition to the above predicted new infections and loss of life, experts noted the additional risk that the funding cuts could result in increased dolutegravir resistance, due to patients trying to stretch out ART treatment to fill gaps in access.[21]

The impact on HIV prevention was immediate and sweeping, and caused a major setback at a moment of optimism. Long-acting injectable lenacapavir had recently been found to be “potentially transformative”, a twice-yearly injectable that shows drastic reductions of HIV infection risk among women and key populations. Researchers say lenacapavir “could be the closest tool to an HIV vaccine that will be available before 2030”, but that past experience with access to prevention services shows that targeted interventions are needed to make it available in LMICs.[22] However, they noted, the impact of the funding cuts would be likely to force national HIV programmes to direct resources to HIV treatment at the cost of investing in prevention measures such as lenacapavir. HIV vaccine trials were also halted.[23]

Tuberculosis – While much attention justifiably focused on the HIV response, the impact on TB of US funding cuts was arguably even more severe, yet attracted less attention. 

The US is the largest bilateral contributor to global efforts to prevent and treat tuberculosis, historically contributing $200-250 million annually.[24] But even before the funding cuts, major shortfalls in funding were hampering the response. In 2023, only 26% of the total US$22 billion needed globally for TB was funded.[25]

The US funding halt caused widespread disruption to the TB response in high-burden countries across South Asia, Africa, Southeast Asia and Central Asia; including “substantial disruption in drugs and diagnostic logistics, and potential stock out in the next few months in many countries expected.”[26] All high-burden countries were hit at once, and low-income countries with high TB burdens lacked other resources to fill the gap. The greatest impact is expected in Africa, with Southeast Asia and Western Pacific close behind. “Community engagement efforts, including active case finding, contact tracing, and screening, are deteriorating rapidly,” and as of August 2025, experts reported that procurement systems and supply chains were already failing as a result of the US funding cuts.[27]

Thus, as a result of the funding cuts, modelling predicted that an additional 62,000 people will die of tuberculosis.[28]

South Africa was one of the high-burden countries to experience this impact. A South African TB Think Tank survey in March 2025 found significant instability faced by TB services and research due to the stop-work orders with 44% of activities suspended; inluding linkage to TB care, health systems strengthening, TB prevention, screening and testing, TB treatment and follow-up, community-based services, and technical support to government health agencies.[29] A further threat of the interruption of drug trials could jeopardize efforts to improve treatment for drug-susceptible and drug-resistant TB. At the same time, the risk of drug-resistant strains increases as a result of only partial drug availability.[30]

The current and former chairs of WHO’s Global Programme on Tuberculosis and Lung Health has called for urgent coordinated action and emergency funding.[31]

Malaria and insect-borne diseases – A leaked USAID memo published in the New York Times forecast that if malaria programs were halted, the world would see an additional 12.5 million to 17.9 million malaria cases, and 71,000 to 166,000 additional malaria deaths annually.[32] Additional threats were raised due to other mosquito-borne diseases: USAID had previously been working with donors to combat dengue, Zika and chikungunya in Latin America and the Caribbean by targeting mosquitoes.[33] Local cases of malaria transmission have spiked in the southern US in recent years.[34]

Neglected Tropical Diseases (NTDs) – Downs and colleagues noted that mass drug administrations have significantly reduced the risks of NTDs in recent years, with important progress made towards elimination; but the funding cuts introduced uncertainty.[35] Also, ongoing work to coordinate and deliver more than $1 billion of corporate drug donations for NTDs has been halted.[36]

Other outbreaks – Amon and Sharfstein warned that the global health funding cuts would directly impact the U.S., noting 15 travel health notices abroad to US citizens from the US CDC, and 250 notices of outbreaks in the first three weeks of March 2025.[37] Likewise, they note the risk of polio resurgence risk.[38]

Mpox is already a WHO Public Health Emergency of International Concern, given a rapid increase in deaths in 2024. As of 2025, 24 African countries have reported active mpox transmission, with high rates in Sierra Leone, Uganda and DRC (the epidemic epicentre).[39] The response to mpox is undermined by the cuts. 

USAID also worked with WHO on response to outbreaks of Marburg (related to Ebola, no treatment available, and a death rate of 99%); this work has also been halted.[40]

USAID spent $900m in 2023 to fund labs and emergency preparedness in response in more than 30 countries.[41] The US has limited sight of outbreaks in Russia and China, and to fill this gap, USAID funded experts in Kazakhstan to share info on bird flu and other diseases.[42] USAID also funded Demographic and Health Surveys in many countries, an important source of health trend insights. All this work has now apparently been interrupted. 

Overall impact –  USAID funding was associated with a 15% reduction in mortality, a 32% reduction in under-five mortality, a 65% reduction in mortality linked to HIV, and 50% from neglected tropical diseases.[43] Overall, the USAID funding cuts alone are predicted to result in more than 14 million deaths.[44]

The disproportionate impact on children has been highlighted by many predictions. USAID funding cuts could result in more than 4.5 million deaths in children under 5.[45] If PEPFAR is cut, models predict by 2030 that an additional 1 million children will contract HIV, 0.5M children will die of AIDS, and 2.8 M children will become orphaned by AIDS.[46] Funding cuts could also reverse progress on maternal mortality, an important indicator of public health.[47]

Several experts point to the lasting infrastructure damage that will be caused by the funding cuts, for instance for Malawi, which lost more than US$350 million, 13% of national budget.[48] For civil society organizations, rebuilding will take a long time, and is not assured, even if the funding is reinstated. Schiffer rightly notes, “To be clear, there is no such thing as a temporary pause. When an NGO, a small business, or an American company that receives U.S. government funding to implement U.S. foreign assistance is told to stop work, even for 90 days, that means people are fired, expertise is lost, and programs are shut down.”[49]

Alternative futures

The funding cuts surfaced a debate long bubbling away below the surface of global health, about the need to reimagine global health, decolonize systems and mechanisms put in place in the 20^th century, and to seize the opportunity to construct global health along more equitable and sustainable lines. These calls became even more urgent given the shortfalls in the replenishment conference for Gavi, the Vaccine Alliance (donor pledges of $9 billion fell short of the 11.9 billion target), and looming anxieties over the 2025 replenishment targets for the Global Fund.[50] However, no clear consensus has emerged yet. 

Emerging donors – Both critics and champions of funding by China, India and Gulf states noted the US cuts provide an opportunity for new global powers to fill the gap. Proponents called for the “global health community to engage constructively with emerging donors.”[51] Critics pointed out that China may invest through its Belt and Road Initiative, and could fund research into new technological solutions such as as AI and electric vehicles, but is unlikely to invest in keeping the US (or presumably other countries) safe from outbreaks.[52]

Domestic financing – Many have called for an increase in domestic financing for health in LMICs. In Vietnam, for example, proponents point to successful HIV integration into primary healthcare, health insurance coverage of HIV, centralised ART procurement, and a 20% increase in domestic financing for HIV from 2013-2022.[53] Domestic financing for health has steadily increased by 212% relative to the 2004 implementation of PEPFAR.[54]

Creative visions call for using the AIDS Trust Fund as a model for pooled funding; using alcohol and tobacco sin taxes; putting in place more transparent procurement systems and community oversight to combat corruption and waste; and local production of commodities, among other solutions; arguing that “Africa’s health security hinges on self-reliance, not foreign aid.” [55] There is some distance to go to realize this vision: to date in Africa, only South Africa and Cabo Verde have managed to meet the Abuja Declaration target of 15% of the national budget to health; most dedicate only 5-7%.[56] Advocates continue to champion greater domestic financing. 

Regional mechanisms have been proposed as offering a means to decentralize power and funds.[57] Other proposed approaches include pooled funds with flexible mechanisms for local organisations, and more cash disbursements to families.[58]

Some have called for an expansion of philanthropic support, but this raises issues of accountability, priority-setting and sustainability given donor whims.[59] To date, private philanthropies have not filled the gap.

The role of the private sector has also been debated: some argue private funders could be incentivized to support global health, but note that in some cases this could amplify conflicts of interest.[60] The private sector is also unlikely to fund politically sensitive health services for marginalized groups. 

Some scholars have also suggested that AI can help make health service delivery cheaper and more efficient, but note continuing issues with algorithmic bias, poor digital infrastructure, quality control, and the need for human oversight.[60]

Discussion

In the wake of the funding cuts, studies and reports understandably focused largely on modelled estimates of future impact, with empirical data largely documenting the immediate effects on existing systems, organizations and institutions. The actual human cost of the cuts will take years to tally, and debate may continue for years to come.

For those who spent years contributing to the HIV response, it is deeply discouraging to see the dismantling of significant parts of the system of prevention, treatment and response; and at a moment when highly effective PrEP had just become available, and something like the end was in sight. For TB, the funding cuts are arguably even more devastating, though they have received less attention. While HIV activists immediately mobilized, forming a new global network and launching dozens of webinars and guidance documents to support each other, the TB response has a less vocal activist community, fewer institutions, and comparatively less resources available to document or respond to the cuts. 

The likely increase of many other infectious diseases, from mpox to Zika to malaria, is deeply worrying, given that critical warning systems have had funding slashed, while prevention and treatment programmes are also impacted. 

For children in LMICs, in particular, the cumulative impact of all the funding cuts will be devastating. The result will be more drastic rationing, and less effective public health, especially for those most marginalized. The burden will fall largely on community volunteers and systems, as it always has, and as Sophie Harman notes, women will be left picking up the pieces of crumbling health systems.[61] The impact on women, children and key populations may be slow to emerge, but will radiate outwards and will be felt globally for many years to come.  

While many have called for the cuts to spark a reimagining of global health, the solutions proposed seem meagre in comparison with the size of the gap. The renewal of longstanding calls to move away from vertical programmes and similar aid conditionalities towards more resilient health systems do not address the fact that mainstream health programmes have historically failed to engage communities or to prioiritize the health needs of young women or socio-economically marginalized, stigmatised, and criminalised groups. Stigma, discrimination and taboos around sexual and reproductive health, HIV and TB in particular have yet to be eliminated, and continue to hamper access to services for many who need them most.

Development assistance for health was never purely a technical problem of funding and health systems. As the 2025 funding cuts show clearly, global health is (and will continue to be) political.

Updates:

31 August 2026 – Corrected number of people on ART via PEPFAR (20.6 million), with thanks to Simon (HIV i-Base).

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^[i] Apeagyei AE, Bisignano C, Elliott H, et al. Tracking development assistance for health, 1990-2030: historical trends, recent cuts, and outlook. Lancet. 2025;406(10501):337-348. doi:10.1016/S0140-6736(25)01240-1

^[ii] Apeagyei et al, Tracking development assistance, 26 July 2025. 

^[iii] Mwanje J, Blackett K, Corona S, et al. UK aid cuts threaten global child health: a call to rethink international assistance. BMJPO 2025;9(1). doi:10.1136/bmjpo-2025-003602. 

^[iv] Yach D, Ron A, Nitzan D. The Golden Age of Global Health is Over. What Follows? J Epidemiol Glob Health. 2025;15(1):98. doi:10.1007/s44197-025-00443-5. 

^[v] Government of the Netherlands, Policy on International Development. Letter to the Parliament, 21-02-2025. https://www.government.nl/documents/parliamentary-documents/2025/02/21/policy-letter-on-international-development. 

^[vi] Matthew Allan, Foreign aid cuts: Where does Switzerland stand? Swissinfo.ch, 7 February 2025. https://www.swissinfo.ch/eng/swiss-diplomacy/foreign-aid-cuts-where-does-switzerland-stand/88841450. 

^[vii] Alison Hird, France launches commission to evaluate overseas aid, amid far-right criticism. RFI, 2 March 2025. https://www.rfi.fr/en/france/20250302-france-launches-commission-to-evaluate-overseas-aid-amid-far-right-criticism. 

^[viii] Hird, France launches commission. 

^[ix] Ten Brink D, Martin-Hughes R, Bowring AL, et al. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries: a modelling study. The Lancet HIV. 2025;12(5):e346-e354. doi:10.1016/S2352-3018(25)00074-8. 

^[x] Gawande A, Behind the chaotic attempt to freeze federal assistance. The New Yorker, 29 January 2025. https://www.newyorker.com/news/the-lede/behind-the-chaotic-attempt-to-freeze-federal-assistance. 

^[xi] Kates J. The status of President Trump’s pause of foreign aid and implications for PEPFAR and other global health programs. Kaiser Family Foundation, 2025. https://www.kff.org/policy-watch/the-status-of-presidenttrumps- pause- of- foreign- aid- and- implications- for- pepfar- and- other- globalhealth- programs/. 

^[xii] Lankiewicz E, Sharp A, Drake P, et al. Early impacts of the PEPFAR stop-work order: a rapid assessment. Journal of the International AIDS Society. 2025;28(2):e26423. doi:10.1002/jia2.26423

^[xiii] Lankiewicz et al, Early impacts, 2025

^[xiv] Lankiewicz et al.

^[xv] Andelson Office of Public Policy. Impact of stop work orders for PEPFAR programs. amfAR, The Foundation for AIDS Research; 2025. https://www.amfar.org/wp-content/uploads/2025/ 01/Impact- of- Stop- Work- Orders- for- PEPFAR- Programs- 2.pdf

^[xvi] Tram KH, Ratevosian J, Beyrer C. By executive order: The likely deadly consequences associated with a 90-day pause in PEPFAR funding. Journal of the International AIDS Society. 2025;28(3):e26431. doi:10.1002/jia2.26431.

^[xvii] UNAIDS. About the impact of US funding cuts on the global HIV response, 2025. Web page. https://www.unaids.org/en/impact-US-funding-cuts/About. 

^[xviii] UNAIDS. Estimating the potential impact of HIV response disruptions, 2025. https://www.unaids.org/sites/default/files/2025-04/JC3144_Estimates_Funding_cuts_impact_En.pdf. 

^[xix] Ten Brink D, Martin-Hughes R, Bowring AL, et al. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries: a modelling study. The Lancet HIV. 2025;12(5):e346-e354. doi:10.1016/S2352-3018(25)00074-8.

^[xx] Adeyinka DA, Ologunagba B, Olakunde BO. US funding cuts as a catalyst for African-led HIV solutions. The Lancet HIV. 2025;12(4):e248-e249. doi:10.1016/S2352-3018(25)00049-9. 

^[xxi] McClure M, Gandhi M. Threat of HIV and tuberculosis drug resistance after US funding cuts. The Lancet Infectious Diseases. 2025;25(5):e256-e257. doi:10.1016/S1473-3099(25)00209-9.

^[xxii] Lynch S, Cohen RM, Kavanagh M, et al. Lessons for long-acting lenacapavir: catalysing equitable PrEP access in low-income and middle-income countries. The Lancet HIV. 2025;0(0). doi:10.1016/S2352-3018(25)00161-4. 

^[xxiii] Gawande A, Behind the chaotic attempt to freeze federal assistance. The New Yorker, 29 January 2025. https://www.newyorker.com/news/the-lede/behind-the-chaotic-attempt-to-freeze-federal-assistance. 

^[xxiv] Maciel et al, Undoing progress, 2025. 

^[xxv] Maciel EL, Pablos-Mendez A, Abubakar I. Undoing progress through sudden tuberculosis funding cuts. The Lancet. 2025;0(0). doi:10.1016/S0140-6736(25)01328-5. 

^[xxvi] Stop TB Partnership. Report on the impact of US government funding halt on TB response in high TB burden countries, 3 March 2025. https://www.stoptb.org/sites/default/files/documents/Disruption%20US%20FUNDING%20halt030325.pdf. 

^[xxvii] Maciel et al, Undoing progress, 2025. 

^[xxviii] Amon J, Sharfstein JM. The Domestic Consequences of Defunding Global Health. JAMA Health Forum. 2025;6(5):e252462. doi:10.1001/jamahealthforum.2025.2462. 

^[xxix] Ndjeka N, Kubjane M, Abdullah F, et al. Impact of US funding cuts and stop work orders on TB services and research in South Africa. IJTLD OPEN. 2025;2(4):241-243. doi:10.5588/ijtldopen.25.0168. 

^[xxx] McClure M, Gandhi M. Threat of HIV and tuberculosis drug resistance after US funding cuts. The Lancet Infectious Diseases. 2025;25(5):e256-e257. doi:10.1016/S1473-3099(25)00209-9. 

^[xxxi] Maciel et al, Undoing progress, 2025. 

^[xxxii] Amon and Sharfstein, The domestic consequences, 2025.

^[xxxiii] Ibid.

^[xxxiv] Amon and Sharfstein, 2025.

^[xxxv] Downs P, Tate A, Harvey D, Baker MC. The changing neglected tropical disease landscape in Africa: implications for policy, practice, and strengthening health systems. Health Aff Sch. 2025;3(7):qxaf136. doi:10.1093/haschl/qxaf136.

^[xxxvi] Gawande A, Behind the chaotic attempt to freeze federal assistance. The New Yorker, 29 January 2025. https://www.newyorker.com/news/the-lede/behind-the-chaotic-attempt-to-freeze-federal-assistance. 

^[xxxvii] Amon J, Sharfstein JM. The Domestic Consequences of Defunding Global Health. JAMA Health Forum. 2025;6(5):e252462. doi:10.1001/jamahealthforum.2025.2462.

^[xxxviii] Amon and Sharfstein, 2025.

^[xxxix] Mithi VS. Mpox in Africa: funding cuts and delayed global actions fuelling new epicentres. The Lancet Global Health. 2025;13(9):e1512-e1513.

^[xl] Gawande, Behind the chaotic attempt, 2025. 

^[xli] Amon and Sharfstein, 2025.

^[xlii] Gawande, Behind the chaotic attempt, 2025.

^[xliii] Cavalcanti DM, de Oliveira Ferreira de Sales L, da Silva AF, et al. Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis. Lancet. 2025;406(10500):283-294. doi:10.1016/S0140-6736(25)01186-9. 

^[xliv] Cavalcanti DM, et al, Evaluating the impact, 2025. 

^[xlv] Cavalcanti et al, 2025.

^[xlvi] Cluver L, Makangila G, Hillis S, et al. Protecting Africa’s children from extreme risk: a runway of sustainability for PEPFAR programmes. The Lancet. 2025;405(10490):1700-1712. doi:10.1016/S0140-6736(25)00401-5. 

^[xlvii] Taylor L. Maternal mortality falls 40% worldwide, but funding cuts could reverse progress, says UN. BMJ. 2025;389:r689. doi:10.1136/bmj.r689. 

^[xlviii] Mithi VS, Mpox in Africa, 2025. 

^[xlix] Schiffer M, Stop-work order on US foreign aid puts China first and America last. Just Security, 27 January 2025. file:///Users/u2272006/Zotero/storage/QGC3I6R3/us-foreign-aid-stop-work-order.html. 

^[l] Jerving S, Gavi pledges fall short about $2.9B as US pulls out. Devex, 25 June 2025. https://www.devex.com/news/gavi-pledges-fall-short-about-2-9b-as-us-pulls-out-110345.

^[li] Yach D, Ron A, Nitzan D. The Golden Age of Global Health is Over. What Follows? J Epidemiol Glob Health. 2025;15(1):98. doi:10.1007/s44197-025-00443-5.  

^[lii] Amon and Sharfstein, 2025.

^[liii] Ten Brink D, Martin-Hughes R, Bowring AL, et al. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries: a modelling study. The Lancet HIV. 2025;12(5):e346-e354. doi:10.1016/S2352-3018(25)00074-8.

^[liv] Sidibe M, Makgoba TC, Paul B, et al. Accelerating domestic investments to end AIDS in Africa. The Lancet. 2025;405(10487):1335-1336. doi:10.1016/S0140-6736(25)00685-3. 

^[lv] Adeyinka DA, Ologunagba B, Olakunde BO. US funding cuts as a catalyst for African-led HIV solutions. The Lancet HIV. 2025;12(4):e248-e249. doi:10.1016/S2352-3018(25)00049-9. 

^[lvi] Adeyinka et al, US funding cuts, 2025. 

^[lvii] Yach et al, The golden age, 2025. 

^[lviii] Mwanje J, Blackett K, Corona S, et al. UK aid cuts threaten global child health: a call to rethink international assistance. BMJPO 2025;9(1). doi:10.1136/bmjpo-2025-003602. 

^[lix] Yach et al, The golden age, 2025.

^[lx] Crew B. Can industry fill the gap left by US research funding cuts? Nature. 2025;642(8069):S1-S1. doi:10.1038/d41586-025-01925-z. 

^[lxi] Yach et al, 2025. 

^[lxii] Harman S, Sick of it: The global fight for women’s health. FSC, 2024.