The United States Supreme Court has declined to intervene in the Trump administration’s freeze on foreign aid, referring the matter back to a District Court Judge who had earlier issued a temporary restraining order against the freeze.

Judge Amir Ali issued the order on 13 February ordering the US administration to resume payments for work already done on Congress-approved contracts that were in place before Trump took office. 

Ali ruled that Trump and his officials were “temporarily enjoined” from “suspending, pausing, or otherwise preventing the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025”.

He also prevented them from “issuing, implementing, enforcing, or otherwise giving effect to terminations, suspensions, or stop-work orders” related to these financial awards.

However, hours before the order was due to go into effect on 26 February, Trump’s legal team turned to the Supreme Court, claiming that Ali lacked the authority to make such a ruling.

Chief Justice John Roberts then issued an administrative stay of the order to enable the Supreme Court to consider the matter. 

Wednesday’s Supreme Court ruling – with five judges in favour and four against – simply directs Ali to “clarify what obligations the government must fulfill to ensure compliance with the temporary restraining order, with due regard for the feasibility of any compliance timelines”.

Ali’s ruling was made in response to court action by three civil society organisations – the AIDS Vaccine Advocacy Coalition (AVAC), Journalism Development Network and the Global Health Council – challenging Trump’s Executive Order (14169), which immediately stopped all congressionally appropriated foreign assistance funding pending future review.

Return to court

The plaintiffs return to court on Thursday (6 March) ​​where they will argue for a temporary injunction against the aid freeze.

The plaintiffs’ lead counsel, Lauren Bateman, an attorney with Public Citizen Litigation Group, stated on Wednesday that the Supreme Court ruling “confirms that the administration cannot ignore the law. To stop needless suffering and death, the government must now comply with the order issued three weeks ago to lift its unlawful termination of federal assistance.”

During the earlier court hearing, the plaintiffs detailed some of the effects of the freeze on foreign aid dispensed by the US Agency for International Development (USAID) and the State Department.

It has disrupted critical health programmes including maternal and child health programs; infectious disease prevention including against malaria and HIV, and clinical trials.

Plaintiffs were also forced to lay off staff in response to the freeze.

In its defence, Trump’s legal team claimed that life-saving health programmes had been given waivers. But this is no longer the case as the majority of USAID has been dismantled and life-saving projects were issued with permanent termination letters last week.

AVAC executive director Mitchell Warren appealed for support for the case: “These are immensely challenging times for all of us, and it is easy to be paralysed, overwhelmed and depressed. But we’ve all come too far for that to be the new normal. Lives, economies and democracies depend on our collective ability to stand up and fight back.”

Earlier, Warren described the funding freeze as harmful to global health and security: “In the name of economic efficiency, they are destabilizing public health, diplomatic relationships, communities, and economies.”

Devastating setback for tuberculosis 

The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. 

The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, approximately one-quarter of international donor funding for TB, according to the WHO.

“These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.”

Dr Tereza Kasaeva, WHO’s Director of Global Programme on TB and Lung Healt, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”.

This was proven during the COVID-19 pandemic, she added,  when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”. 

Image Credits: USAID Press Office.