US divestment in global health: disruption, uncertainty and response

The decisions of the US administration under Donald Trump in January 2025 to divest from many development activities have severely disrupted the state of affairs in global health. We analyse the extent of this disruption from two perspectives. First, we show that about 45 out of every 100 dollars spent on global health from 2019 to 2022 came from the US. Using data on bilateral official development assistance for health from the US, we identify recipient countries and health areas that will be most affected. We demonstrate differential sectoral impacts in more than a dozen countries-mainly within WHO's Africa region-which have been heavily reliant on US aid and other external sources to fund their health services. Severe fiscal constraints and/or ongoing conflicts and fragility in these countries further exacerbate potential impacts. Second, we analyse US contributions to UN organisations and other multilateral bodies most relevant to global health. This combined analysis provides a baseline for countries and organisations to understand the immediate financial fallout and the future risks within a changed global health financing system.