The rapid withdrawal of international health aid by the United States (US) constitutes a public health emergency of international concern (PHEIC), according to Professor Matthew Herder and colleagues writing in the BMJ this week.

According to the World Health Organization’s (WHO) International Health Regulations, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. 

“Multiple estimates predict reduced US funding will lead to millions of deaths by 2030,” argue Herder, from the Dalhousie University’s school of law in Canada, Professor Roojin Habibi from Ottawa University, Fatima Hassan, director of Health Justice Initiative in South Africa, and Andrew Hill, visiting research fellow at the University of Liverpool in the UK.

The Trump administration’s funding freeze on the US President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in “the sudden closure of treatment services for thousands of people with HIV/AIDS”, while the stop-work orders imposed on the US Agency for International Development (USAID) “immediately reduced HIV testing and treatment”.

If this aid is not resumed, UNAIDS estimates that there could be six million HIV-related deaths – a 10-fold increase on 2023 mortality – and nine million new HIV infections by 2030.

Meanwhile, cuts in funding for malaria, tuberculosis and other diseases are expected to “risk millions more deaths in the coming years”, they argue.

“If the Trump administration follows through on its threat to halt funding for Gavi, the Vaccine Alliance, alter the US childhood vaccination schedule, and fundamentally change its approach to pandemic preparedness as part of its America First global health strategy, vaccine preventable diseases and deaths are likely to resurge, both in the US and abroad,” they note.

Meanwhile, ceasing US funding for United Nations agencies, including UN Women and the UN Population Fund, “threatens to end services that support sexual rights and reproductive health in more than 150 countries.”

Mobilise resources

In response, they want the World Health Organization (WHO) to declare a PHEIC in order to galvanise resources to address the US actions.

They argue that the US actions amount to an “extraordinary event” within the definition of the IHR, and that an “event” is not limited to the “manifestation of disease” but extends to any “occurrence that creates a potential for disease.” 

“The main interpretive issue in this case is whether the political actions of the US amount to a public health risk through the ‘international spread of disease’,” they acknowledge.

While the “spread of disease” hasn’t fully materialised yet, “we are in a state of anticipation that numerous outbreaks of infectious diseases will occur as treatment and public health programmes reliant on US funding shut down around the globe”.

They argue that, while a PHEIC “has never been declared because of the political actions of a single country, risk is the paramount consideration, and the US’s recent decisions have greatly amplified the risk of multiple international outbreaks of disease”.

However, should the WHO declare a PHEIC, this can help to “mobilise collaboration, assistance, and financing across member states” and also enable countries to issue “compulsory licences, overriding the patent rights of pharmaceutical companies, to improve access to essential medicines to treat HIV, malaria, tuberculosis, and other diseases.”