“the American government remains the single-most important entity in global health. The US spent nearly $13 billion on global health programs in its 2023 fiscal year. It provides one-third of the funding to and has a permanent seat on the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an organization also started during the George W. Bush administration, which supports prevention and treatment for some of the world’s most deadly diseases in 130 countries.
The US iso the single largest contributor to the World Bank’s newly established Pandemic Fund. And along with the United Kingdom and the Bill and Melinda Gates Foundation, the United States underwrites much of the budget for Gavi, the Vaccine Alliance, which largely supports vaccine programs in developing countries and has contributed to the vaccination of nearly 1 billion children since its founding in 2000.
But the failure to reauthorize PEPFAR signals growing ambivalence among some US political leaders about funding health programs around the world. The internationalist “compassionate conservatives” of yesteryear, perhaps best embodied in George W. Bush’s presidency, have been pushed out of the Republican Party, replaced by Trump acolytes less interested in public health domestically or abroad. Donald Trump’s “America First” nationalism and the ferocious conservative backlash against public health authorities during Covid have unmoored a field that long viewed itself as above politics.”