Extracts below. Full text: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00556-2/fulltext
The Trump Administration's dismantling of USAID is a catastrophe for global health, the consequences of which will be felt for generations...
USAID has been a key supporter of the World Bank Group, the World Food Programme, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, driving progress towards the UN Sustainable Development Goals. Without USAID, the future of many global health programmes hangs in the balance, putting countless lives at risk...
As countries such as the UK, France, and Germany also scale back their aid spending, the question now is: who or what can fill the void? The aid system is far from perfect... Is there, therefore, an opportunity to rethink the global aid architecture, rather than replace it?...
Aid is undoubtedly essential in some circumstances. The Global Health 2050 Lancet Commission argued that development assistance should focus on two broad purposes: first, direct support for basic services and disease control in countries with the least resources; and second, financing of global public goods to, for example, tackle antimicrobial resistance, prevent and respond to pandemics, and develop and deploy new health technologies... On Feb 14, the African Union's High-Level meeting on Domestic Financing in Africa took place in Addis Ababa, where Oluremi Tinubu, First Lady of Nigeria, declared that “Africa cannot continue to rely solely on donor funding and foreign aid, which, although helpful, are often unpredictable and unsustainable”.
That unpredictability is now painfully clear. The sweeping chaotic and ill-considered unilateral halt of global health programmes is no way to institute reforms. Change should be strategic, transparent, carefully implemented, and done in a spirit of support rather than imposition. Local expertise and resources should be centred in systems that empower nations to take charge of their development and health needs. The demise of USAID leaves no choice but to reconsider the broader landscape of foreign aid itself.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org