US President Donald Trump wants to eliminate $4.3 billion from the US government’s global health budget, including all funding for the Pan-American Health Organization (PAHO), the World Health Organization’s (WHO) regional organisation for the Americas.

His proposed budget for 2027, which needs to be approved by the US Congress, includes a 42% increase – some $445 billion – for defence, including “$1.1 trillion in base discretionary budget authority” for the Department of War.

In contrast to the lavish military budget, deep cuts are proposed to domestic health programmes, with an overall 12,5% reduction in the Department of Health and Human Services (HHS) budget.

Domestic cuts include $923 million less for HIV/AIDS, $561 million less for maternal and child health, a $576 million cut to mental health (including suicide prevention, substance use prevention and treatment) and a $872 million cut to health workforce programs.

The Centers for Disease Control and Prevention (CDC) is allocated $663.8 million, the same amount as previously and the budget claims that CDC “will play a key role in implementing an America First approach to global health to replace the functions of the World Health Organization.”

Driving these cuts is Russell Vought, head of the White House Office of Management and Budget. Vought, former vice-president of the right-wing think tank Heritage Foundation, co-authored Project 2025, the conservative blueprint for governance being followed by the Trump administration.

No money for ‘corrupt’ PAHO

When Trump announced that the US would leave the WHO on his first day in office in January 2025, he made no mention of PAHO, and US officials have continued to interact with the other 34 member states in the regional body.

However, the US has not paid its membership fees (called assessed contributions) to PAHO since 2024, and owes the body over $134 million.

In his latest budget ask, Trump describes the WHO and PAHO as “corrupt organizations [that] have shown no independence from inappropriate political influences, such as when the WHO aided in the COVID-19 coverup.”

In February, PAHO projected a 19% reduction in its 2026/27 budget, and is cutting 17% of staff. Its 2024/24 budget was $820 million, which means a $155 million cut. Measles and dengue are surging in the region, while health services in the Caribbean have been badly affected by extreme weather events.

No more disease-specific aid

In a death knell for the US President’s Emergency Plan for AIDS Relief (PEPFAR), the proposed budget for the US State Department will “eliminate disease-specific accounts”.

The reason given is that this will “provide the Department crucial agility to address the actual needs of each recipient country—across HIV/AIDS and other infectious diseases such as malaria, tuberculosis, and polio—to strengthen global health security and protect Americans from disease.

PEPFAR, started by Republican President George W Bush, is the US government’s most successful aid programme, credited with saving 25 million lives and preventing millions of new HIV infections.

However, the Trump budget claims 60% of its funds were “wasted”. It also makes the misleading claim that “PEPFAR funded health workers who performed over 21 abortions in Mozambique”. 

The US has not allowed its foreign aid to be used to fund or lobby for abortions since it enacted the Helms Amendment in 1974.

Four Mozambican nurses, whose salaries were partly covered by PEPFAR, did not know that they could not provide abortions (which are legal in Mozambique) if they received PEPFAR funding, as previously reported by Health Policy Watch.

PEPFAR’s own compliance mechanisms identified the violation, and it took “immediate corrective action with the partner”, including ensuring that Mozambique repaid PEPFAR for the nurses’ salaries, the plan said in a statement. 

Anti-contraception bias

There is no funding ask for contraception or reproductive health. The budget also contains several disparaging references to contraception, something that Project 2025 also takes issue with, preferring “natural contraception”.

The proposed budget disparages PEPFAR for “promoting reproductive health education and access to birth control and other harmful programs couched under ‘family planning’ in Ghana.”

“The Budget would ensure no funding supports abortion, unfettered access to birth control, and also eliminates funding for circumcision and Lesbian, Gay, Bisexual, Transgender, and Queer services to better focus funds on life-saving assistance.” according to proposal.

“The United States should not pay for the world’s birth control and therapy.”

New ‘America First Global Health Strategy’ bilaterals

Included in the State Department Budget is $5.1 billion to “execute” its America First Global Health Strategy (AFGHS), the bilateral Memorandums of Understanding (MOUs) with individual countries.

“The President’s new vision of bilateral health assistance eliminates bloated Beltway Bandit contracts, does more with fewer dollars, and transitions recipient countries to self-reliance,” according to the budget. 

By 10 April, the State Department had signed 30 bilateral global health agreements. The latest is with the Philippines, signed on 9 April (no details available, including the amount involved). 

It follows an MOU with Cambodia, the first in Asia, signed on 6 April. The US will provide $30.8 million over five years for infectious disease prevention and response capabilities, including “accurately identify pathogens of epidemic and pandemic potential before they spread internationally” and “a robust network of laboratories” aimed at eliminating malaria in Cambodia.

A day before this, a bilateral was signed with Tajikistan, the first in the South and Central Asia region, involving $38 million in US aid over the next five years to “support Tajikistan’s efforts to combat HIV/AIDS and tuberculosis, while bolstering disease surveillance and outbreak response.”

Way forward

The US Congress still needs to approve the budget and may well authorise more money, particularly for domestic health. 

In February, Congress approved a $50 billion Foreign Affairs Bill, including $9.4 billion for global health for the fiscal year 2026, almost three times larger than Trump’s request for $3.8 billion.

White House budget head Vought will testify before the House budget committee on Trump’s request next Wednesday.

Image Credits: Gage Skidmore, International AIDS Society, PAHO/WHO.