A new White House “pocket rescission package” threatens to throw the Pan American Health Organization (PAHO), the Americas branch of the World Health Organization, into a financial crisis – if it is not stopped by the US Congress before the end of September.   

The White House order, announced on the eve of the long US Labor Day weekend, cancels some $4.9 billion more in US international aid already allocated by Congress in its last funding bill – striking another deep blow at initiatives in fair trade, workers health and safety, and clean energy as well as global health.

The targets of the cuts in “woke, wasteful and weaponized spending” include shards of programmes previously administered by the now-defunct USAID,  along with the International Labor Organization, the World Trade Organization, the Organization for Economic Co-Operation and Development (OECD), the Green Climate Fund, and UN-backed peacekeeping operations – as well as PAHO. 

US Senator Susan Collins (Rep, Maine), described the White House maneuver as “unlawful” because it was announced within 45 days of the 30 September end of the fiscal year – giving Congress almost no time to respond. 

“Given that this package was sent to Congress very close to the end of the fiscal year when the funds are scheduled to expire, this is an apparent attempt to rescind appropriated funds without congressional approval,” Collins said in a statement. 

“Article I of the Constitution makes clear that Congress has the responsibility for the power of the purse.  Any effort to rescind appropriated funds without congressional approval is a clear violation of the law,” she said. 

The White House initiative also threatens to sabotage bipartisan efforts to negotiate a new funding bill that would avoid a federal government shutdown on 1 October.  Leading Democrats in Congress have already threatened to reject a compromise on a funding bill if the pocket rescissions package isn’t  somehow halted. 

In July, Trump successfully clawed back some $9 billion in previously allocated Congressional funding for foreign aid and public broadcasting, after Republicans in both chambers approved the cuts — but that package of cuts was submitted to Congress with sufficient time for them to react. 

US alleges PAHO complicity in “trafficking of Cuban doctors” 

Last week’s announcement targeting $45 million in Congressional appropriations to PAHO as part of the new “pocket rescissions” package, was based on White House allegations that the regional health body faces “credible allegations of forced labor and human trafficking of Cuban doctors.”

The White House reference is to a longstanding Brazilian programme known as Mais Medicos (More Doctors), which aimed to increase the number of doctors serving in remote and indigenous Brazilian regions. The programme relied heavily upon Cuban medical teams in its start-up phase beginning in 2013 – although by 2025 Cubans represented no more than about 10% of the Mais Medicos medical teams.

In that initial phase, from 2013-2018, PAHO helped facilitate the dispatch of thousands of Cuban doctors, who typically earned only about $40 a month in their home country, to work in Brazil – where they earned roughly $500 monthly, Brazilian sources told Health Policy Watch. 

Most doctors returned home from Brazil satisfied with the scheme, which yielded a far higher income than they could have otherwise earned. However, the pay was only about one-quarter of the salary Brazilian doctors typically receive – with most of the balance going to the Cuban government, and about 5% paid to PAHO, for its work in facilitating the exchange. 

In 2018, some Cuban medical team members who did not return home, began looking for ways to take legal action over their employment conditions in Brazil. They claimed that they were subject to human trafficking due to the salary differentials, and the fund collected by the Cuban government as well as PAHO from the arrangement.  

Last week, a prominent Cuban member of Congress, Rep. Carlos Gimenez,  sent a letter to US President Donald Trump urging him to revoke PAHO’s traditional UN immunity to allow the doctors to file suit against the health agency in US courts.  

He charged that PAHO received about $129 million for facilitating the programme between 2013-2018 while Cuba reaped more than $2.3 billion from the salaries of the roughly 10,000 Cuban doctors who participated in the programme during those years. 

“I am not calling for a blanket revocation of PAHO’s immunity,” Gimenez wrote in an X post,  “Rather I am urging a targeted executive order revoking PAHO’s immunity solely for its activities related to the Mais Medicos programme.”

PAHO’s role ended in 2018 

In 2018, the exchange programme was halted by Brazil’s new president, Jair Bolsonaro, who accused Cuba of using it for human trafficking. 

Since the return of  President Lula da Silva to power in 2022, Cuban doctors are again serving in the Mais Medicos programme, but under private contracts that give them salaries equivalent to Brazilian doctors – and without any PAHO involvement. In 2025, Cuban doctors only represented about 10% of Mais Medicos participants.  A much higher priority has meanwhile been placed on the recruitment of Brazilian doctors as well as doctors from other Latin American countries. 

Cuba has a long tradition of sending its doctors abroad to work – with various bilateral arrangements put in place. In 2024, Cuban doctors were sent to Rwanda with much fanfare to help the country jumpstart its 4×4 initiative that aims to quadruple its health workforce.  Meabwhile, citizens of some Caribbean countries can attend medical school in Cuba for free. 

So at the time, the Cuban-Brazilian arrangement was not seen as so exceptional, sources told Health Policy Watch.  

“Cuba exports doctors and has been exporting for ages to more than 100 countries, including, in some cases, high income countries such as Portugal, Spain, and the Ukraine,” one source said. 

“Today, there is something like 25,000 Cuban doctors working abroad…Cuba is also under a US  economic embargo.  And medical know-how is one of its few assets.  It’s true that in some cases, the Cuban government may earn income from these exchanges, while some goes to pay the doctors themselves. But if the US is angry with this business, they should probably talk to all of these other countries that engage Cuban doctors as well.”

US support for PAHO in jeopardy

Meanwhile, if the White House rescission order holds, at least $45 million in US payments already appropriate by Congress to PAHO is at risk.

In fact, the US government assessed payment to PAHO for the 2024-25 biennium was $55.6 million a year. And of that amount, it still has some $78.5 million oustanding. That represents the lion’s share of  $116.9 million in unpaid assessed contributions from member states for 2024-2025.

The US is the single larger donor to PAHO, so a sustained cutoff in US funds would have lasting consequences on the organization, which has already shrunk down its budget from over $1.14 billion for 2022-23 in the wake of the COVID pandemic to a planned budget of  $762 million for 2026-2027, including $662 million for base programs and $100 million for special programs and emergencies.

Since PAHO is 75% self-funded by WHO member states that belong to the Americas region, the agency had comparatively been less affected by the global budget crisis hitting WHO headquarters and its five other regional offices in Asia, Europe and Africa, due to the US withdrawal from WHO in January.

In fact, last week’s White House rescissions represent the first direct attack by the Trump administration on PAHO, a storied regional health organization that the United States helped found over a century ago, as the Pan American Sanitary Bureau.  

Due to the long US history of involvement with PAHO, whose headquarters is also based in Washington, DC, PAHO staff had been hoping that the Trump administration might avoid targeting the agency in the massive assault launched on US foreign health, development and climate aid since January. 

Now all of that has changed.

But with the White House announcement issued at the start of a long holiday weekend in the United States, neither PAHO nor the WHO office in Geneva have yet offered any kind of official reaction. 

Said one senior PAHO officer, who requested anonymity, “Of course we are worried and we planning with different scenarios but that’s all I know for now.”

Image Credits: PAHO/WHO, @MaisMedicos, @Maismedicos , Rwanda New Times , Andre Medici/LinkedIn.