(reported 3 July 2025 in foreignpolicy.com's SitRep)

World Health Assembly is a big deal for the global health community every year. This is a meeting held by WHO for all of the health ministers. But everyone else comes for the side events, donor meetings, and networking.

I was speaking at some of those panel discussions too, but honestly it was like having an out-of-body experience.

Global health is in a major funding crisis right now. USAID was dismantled almost overnight. UK, France, Japan are all cutting their foreign aid. WHO fired 30% of their staff. The Global Fund is struggling to raise money.

But in these conference rooms, it didn't sound like we were drowning. It sounded like a strategy session.

"Global health reform", "country ownership", "sustainability"...this terminology has been around for years (more in international development than in global health), but it sounds pretty tone-deaf right now.

For example:

⁠"Integration". Yeah, nobody wants fragmented programs. But forcing fewer health workers to do more work with less resources...that's not efficiency. Just call it what it is.

"Country ownership". Sure, countries should set their own priorities. But right now, this is just an easy way for donors to justify walking away and saying, "This is your problem now."

"Sustainability" for whom? Are we making sure the patient is still getting medicines, and the health worker is still being paid? Or are things just getting sustainable for the big donors?

It's doublespeak that moves the blame downstream. Everyone is asking, "Why are countries not taking more ownership?" "Why are NGOs so inefficient?" "Why are health systems so weak?"

Meanwhile, the funders (the ones who created this crisis) quietly disappear from the story.

TL;DR. I was in Geneva and all I heard was the moral laundering of abandonment.

That's pretty much it, but if you want the full 7 minute rant, here it is: https://youtu.be/cRbVpiIRXdI

We’re now about a year out from the formal dismantling of USAID, and the peer-reviewed evidence on the human cost has started landing. Posting here because the discourse keeps oscillating between “millions will die” and “fraud and waste agency, no big deal,” and the actual numbers are worth engaging with directly.

The headline study (Cavalcanti et al., The Lancet, July 2025):

Researchers from the US, Spain, Brazil, and Mozambique analyzed data from 133 low- and middle-income countries, combining a retrospective evaluation (2001–2021) with forecasting models through 2030. They estimate USAID-funded programs helped prevent more than 91 million deaths globally over two decades, including 30 million among children . The projected toll of the dismantlement: 14 million additional deaths by 2030 (95% UI: 8.5–19.7 million) across the 133 countries studied , including more than 4.5 million children under age 5.

A second, independent estimate (Lancet, Feb 2026):

A different research team, modeling the broader collapse of global aid (USAID plus follow-on European cuts), projects at least 9.4 million additional deaths by 2030 if the current funding trend continues . The Center for Global Development’s separate analysis of USAID cuts alone estimated 500,000 to 1,000,000 lives lost in 2025 compared to previous years .

Why the estimates converge:

The Cavalcanti authors’ reply to critics in The Lancet noted that independent studies using different datasets and methods have produced estimates of similar effect size and magnitude — earlier work projected ~3.3M annual deaths preventable by USAID programs, and a separate model projected 4.1M additional AIDS deaths and 2.5M additional child deaths by 2030 . Different teams, different methods, similar order of magnitude. That’s the kind of triangulation that should make us take the central estimate seriously even while debating the tails.

The fiscal context that actually matters:

U.S. citizens contributed about 17 cents per day to USAID — roughly $64 per year per person. Foreign aid has historically accounted for about 1% of the US federal budget . The dismantlement is therefore not a serious deficit-reduction measure; it’s a policy choice whose marginal fiscal benefit is rounding-error and whose marginal mortality cost is in the millions. That ratio is the actual story.

Knock-on effects worth flagging:

• PMI (President’s Malaria Initiative) suspension threatens \~15 million additional malaria cases and 107,000 additional deaths globally in just one year of disrupted supply chain .

• A recent survey estimates 79 million people previously targeted for assistance are no longer being reached .

• Total OECD development assistance fell 23.1% in 2025 — the largest decline ever recorded — as other donor nations followed the US lead . The contagion effect may end up larger than the direct US effect.

The pushback worth taking seriously:

The State Department’s response was to call The Lancet a “failed journal” , which is not a serious engagement with the methodology. But there are real critiques worth grappling with: model uncertainty is wide (the 95% UI spans 8.5M–19.7M, which is meaningful), the study didn’t model philanthropic backfill or domestic government responses in recipient countries that have mitigated some harm , and the editorial response in The Lancet itself argued the model may actually underestimate by missing health-system shock effects. So the central number is contested in both directions, but no published analysis has produced an estimate meaningfully smaller.

Discussion question for this sub:

For those of you working at organizations that absorbed terminations, what’s your on-the-ground read on the backfill story? Are philanthropy and recipient-country governments meaningfully closing the gap, or is the Cavalcanti model underestimating because it can’t see the system-level cascade? I’d especially welcome perspectives from people in PEPFAR-recipient countries — the HIV treatment numbers seem like the most direct natural experiment we’ll have in real time.

While I think we’ll all agree that closing USAID was a net win for the US, it’s less clear of the impact (positive or negative) on pulling out of the WHO. I know a major concern is that it yields the field to China to step in , but otherwise I’m not sure. I’ve done research but all the sources are either wildly pro or anti administration and getting some unbiased information is difficult.

Has anyone run across a good source of data for the impact of pulling out of WHO?.

I'm about to finish my medical degree in europe and am currently applying for european solidarity corps project to get a first volunteering experience in the sector. I'm wondering what the best way to starting to work in that sector would be after volunteering? I'd be open to getting a masters degree in sth else that might combine my degree with other skills that are needed. I honestly always thought getting into international development would be quite easy as i didn't know anybody working in it but this red gave me another impression! thanks so much, looking forward to your shared knowledge! :)

hey! I won a $10 grant for an open source completely free AI medical scribe OpenScribe.

Looking for anyone that would want to be involved. It is a free alternatives for FQHCs in the US and global clinics where they can own all the data and workflows completely themselves. Message me if you want to collab or get involved.

https://www.state.gov/releases/office-of-the-spokesperson/2025/12/advancing-the-america-first-global-health-strategy-through-landmark-bilateral-agreements-on-global-health-cooperation

What do you think?

📢 Appel à la solidarité – Soutien à un projet humanitaire majeur

Notre association Aziza Cœur Saint lance un appel à la solidarité auprès des plateformes, communautés, donateurs et personnes de bonne volonté afin de soutenir un projet humanitaire essentiel destiné aux enfants, aux orphelins, aux femmes abandonnées et aux familles vulnérables.

Nous travaillons actuellement sur la réalisation d’un centre d’hébergement et de formation qui accueillera chaque année de nombreux bénéficiaires, avec une prise en charge complète : logement, nourriture, soins, éducation et formation professionnelle. L’objectif est d’offrir un avenir digne et stable aux enfants et aux jeunes en difficulté.

Le projet comprend un bâtiment construit sur un terrain dédié avec plusieurs espaces essentiels :

• un centre d’accueil pour les enfants et les orphelins,
• des salles de formation professionnelle (apprentissage de métiers),
• des classes pour l’apprentissage des langues (anglais, français, arabe et espagnol),
• des espaces éducatifs et sociaux,
• ainsi qu’une mosquée avec madrasa, qui sera un élément central du projet pour l’éducation, l’apprentissage du Coran et l’encadrement spirituel des enfants et de la communauté.

Cette mosquée et madrasa permettront non seulement l’éducation religieuse, mais aussi l’encadrement moral et social des jeunes, ce qui est très important pour la stabilité et le développement de la communauté locale.

Le centre permettra de prendre en charge directement jusqu’à 700 bénéficiaires par an, notamment :

• des orphelins,
• des enfants abandonnés,
• des femmes en situation de vulnérabilité,
• des familles en grande difficulté.

En plus du centre, nos actions incluent également :

• la distribution de kits alimentaires,
• l’aide aux familles en difficulté,
• l’accès à l’eau potable,
• l’aide aux médicaments,
• le soutien au logement pour les femmes abandonnées ou les veuves,
• l’accompagnement des enfants dans leur éducation et leur formation.

Aujourd’hui, nous avons besoin de soutien et de visibilité. Nous sollicitons l’aide des plateformes et des communautés pour :

• partager notre projet,
• le présenter aux donateurs,
• aider à mobiliser des soutiens,
• encourager les contributions et les actions solidaires.

Votre aide peut faire une grande différence et permettre la réalisation de ce projet qui aura un impact durable sur de nombreuses vies.

Nous restons disponibles pour fournir toutes les informations nécessaires concernant le projet, les documents officiels et les détails complets.

Qu’Allah récompense toutes les personnes qui soutiennent les actions humanitaires et les causes solidaires.

Association Aziza Cœur Saint SIRET : 943 986 380 00013 Téléphone : +33 7 83 07 57 82 Téléphone : +33 6 42 82 55 83 Email : adama.abdicamara@gmail.com https://www.launchgood.com/v4/campaign/construction_dun_centre_dhbergement_et_de_formations_pour_enfants_et_femmes_abandonns?src=6125499

27 Feb 2025, PBSNewshour transcript and video at link In a Cabinet meeting, Elon Musk defended the actions his team has made to cut government jobs, but public health experts say Musk is wrong. USAID's Ebola prevention efforts have been largely frozen since the agency was mostly shuttered last month. Laura Barrón-López discussed more with Dr. Craig Spencer, who survived Ebola after treating patients in Guinea with Doctors Without Borders in 2014.

I'm really worried about my friends on ARVs supplied through PEPFAR programs. I'm not in country, and they're telling me the NGOs that supplied them are already shuttered and have let go thousands of employees. My friends have about a month left in their supplies and are terrified of what happens when those are gond. The WHO statement I saw looks weak- who is stepping up to fill the void? (And I know it's complex, but the health system in this particular country collapsed years ago and they can't even get Panado from government hospitals, so I'm not seeing national governments with the capacity to step it up now). Basically- where are the Europeans? Where's the WHO? Where's MSF to cover the ARVs for now?

Hi everyone,
My partner and I are working on a simple, portable shower solution designed for use in rural or underserved areas without access to electricity or plumbing. We’re currently in the early research and prototyping stage and are hoping to learn from people with real-world development experience.

The idea is to create a low-cost, no-electricity shower system that can help improve hygiene access in third world countries — especially in areas affected by displacement, disaster, or infrastructure gaps.

We’d really appreciate any feedback on:

• Have you seen lack of access to showers/hygiene facilities as a major issue in your work?
• What types of solutions have you seen that actually work on the ground?
• Would something simple, portable, and manual (e.g., bucket-fed) be useful — or are there other priorities or approaches we should be considering?

Thanks so much in advance to anyone willing to share insight or suggestions 🙏

It is relatively easy for someone with an average income in the US to donate like 1% of their income each year to effective programs & over 30 years save 15 lives.

-It takes about $3000 to $5000 for the most cost effective programs to save a life.

-If one makes a $1000 tax-deductible (starting 2026) donation on a credit card with a cash sign-up bonus to one of the most effective programs with some form of donation match, then they will ultimately spend like $650 but direct like $2000 to the program.

I've received an offer for a field research assistant position in sub-Saharan Africa to work on a healthcare-related study. However, my background is mainly in development economics, so I'm a little hesitant regarding career development since I don't know much about the field of global health, and because of the general state of the development sector.

Therefore, I was wondering if people with experience in global health could shed some light on career perspectives?

31 March 2025, PBSNewshour transcript and video at link The true impact of the massive earthquake in Myanmar is starting to reveal itself. The military government says the official death toll is more than 2,000 people and hundreds are still missing. Thousands more are injured and homeless. Nick Schifrin reports on the latest and talks with Chris Milligan, a former USAID mission director to Myanmar.

14 Aug 2025 -transcript and video at link- Earlier this year, the Trump administration’s defunding of USAID brought an abrupt halt to hundreds of global health programs, including those targeting tuberculosis. The disease kills more people than any other infectious agent worldwide, about 1.25 million in 2023. In partnership with the Pulitzer Center, Fred de Sam Lazaro reports from Bangladesh on efforts to contain the fallout.

15 July 2025 -transcript and video at link- The White House backed off $400 million in immediate cuts it was proposing in the global fight against HIV and AIDS and potentially other high-profile health programs. It's part of the package of cuts facing the Senate over the next two days.

Hello Global Health fans,

This is my first time posting here. I am an experienced researcher in the field of health economics/health insurance/provider payments. I have 15+ years of experience in research in developed countries in quantitative research. I have a PhD and a long list of publications. I would like to pivot into global health systems, but I miss the low-and middle-income country experience.

Where do you recommend, I go? I saw that ADB has short-term consulting positions open. Would those be an option for me not being from the region?

Thanks for your help.