Policy Updates

On June 3, 2025, the US Congress received a US$9.4 billion rescission request to claw back previously approved funding, with US$8.3 billion to be cut from the State Department and USAID.

The request is the first of several expected before the end of the discal year. The package includes funds already targeted by DOGE. If Congress passes the package, which requires only a simply majority, the cuts will become law.

Assistance to Europe, Eurasia, and Central Asia would be eliminated entirely. Other notable cuts included:

• US$1.7 billion cut from the Economic Support Fund, nearly half of its approved funding for 2025;
• US$500 million cut from USAID programs for MCH, HIV/AIDS, and infectious diseases;
• US$437 million cut from voluntary contributions to UN agencies, including UNICEF, UNDP, and UN Population Fund;
• US$400 million cut from the State Department's global health programs for HIV/AIDS;
• US$496 million cut from USAID's international disaster assistance fund;
• US$200 million cut from assessed contributions to the Contributions to International Organizations account, impacting UN organizations;
• US$83 million cut from the Democracy Fund's appropriated budget of US$345 million;
• US$57 million cut from the Transition Initiatives account from its appropriated budget of US$75 million; and
• US$27 million cut from the Inter-American Foundation and US$22 million from the US African Development Foundation, both around half of their respective budgets.

Congress controls the federal budget, approving annual funding for government operations, with the president needing congressional consent to defer or withhold funds. The rescinded funds can then be redirected or returned to the Treasury. Congressional committees have 25 days to review the request. After committee approval, the package moves to the House and Senate for expedited votes, where Congress has 45 days to act on the request.

The Congressional Budget Office estimates the US government is on track to spend ~US$7 trillion in 2025, with the rescission request equivalent to 0.1% of government spending.

On May 30, 2025, officials from the US government announced the termination of a US$258 million program for HIV vaccine research at Duke University and the Scripps Research Institute.

A senior agency official stated that NIH leadership reviewed the consortia for HIV/AIDS vaccine development and immunology and decided not to support its continuation, stating that it will focus on using existing approaches to battle HIV/AIDS.

While ongoing clinical trials based on the work may continue, ending the programs indicates that no new candidates will enter trials in the future.

Public health experts have criticized that the cuts will hinder progress against HIV. Since 2010, new HIV infections have decreased steadily, but in 2023, the WHO still reported 1.3 million new cases, of which 120,000 were found in children.

On May 20, 2025, at the Qatar Economic Forum, US government advisor Elon Musk responded to estimates from UNAIDS predicting that the discontinuation of PEPFAR could result in 4 million additional AIDS-related deaths by stating he would ‘fix’ the crisis stemming from the withdrawal of US funding for HIV/AIDS services.

Musk, who implemented significant cuts to USAID under DOGE, previously stated when pressed that that useful parts of USAID had been transferred to the State Department. UNAIDS published a positive reaction to Musk's assertion and emphasized the urgent need to resume funding for global HIV/AIDS prevention and treatment services.

Many HIV/AIDS prevention programs supported by PEPFAR have not resumed operations, despite a limited waiver for some testing and treatment efforts focused on pregnant or breastfeeding women to continue.

On May 20, 2025, US Secretary of Health and Human Services Robert Kennedy Jr. criticized the WHO and asserted that it was unfit to lead global health cooperation in a video address shown at the 78^th WHA.

Kennedy asserted that the WHO has not addressed its COVID-19 failures or made significant reforms to its bureaucratic structure. He also criticized the agency's recently adopted pandemic agreement, reiterating the US will not participate. He acknowledged the WHO's historic role in smallpox eradication but claimed its priorities now reflect corporate medicine biases and political agendas, including promoting harmful ‘gender ideology.’

Kennedy urged national health ministers to join the US in a "new era of cooperation." The US did not send an official delegation to the WHA and withdrew from the WHO in January 2025.

On March 28, 2025, the US administration announced plans to merge USAID into the State Department, dissolving it as an independent agency and reducing staffing to a statutory minimum of 15 positions, and additionally detailed specific cuts to USAID grants and multilateral funding.

Congress must pass new legislation to officially eliminate the agency. The State Department will create an Office of Global Food Security to manage food security and humanitarian programs previously handled by USAID. The remaining global health programs will be supervised by the Bureau of Global Health Security and Diplomacy. Other programs will be managed by regional bureaus within the State Department.

Deputy administrator of policy and programs at USAID Jeremy Lewin informed staff that employment contracts would be severed by July 1 or September 2, 2025. By July 1, 2025, the State Department will fully take over USAID’s remaining programming. By September 2, 2025, USAID’s operations will transfer to State or shut down completely.

The administration also provided Congress with documents listing 5,341 terminated USAID programs and 898 active ones, detailing that 86% of programs have been terminated, slightly more than the 83% cut reported on March 10, 2025. The total value of terminated programs is US$75.9 billion, with US$48.2 billion already obligated and US$27.7 billion yet to be assigned.

UN institutions and other multilaterals saw steep cuts, with terminated awards totaling US$4.1 billion to 14 UN agencies, the IBRD, and Gavi.

On March 26, 2025, a spreadsheet detailing which USAID projects will continue and which will end indicated that the US administration plans to continue 898 USAID awards and end 5,341.

A spokesperson for the State Department, now overseeing USAID, confirmed the terminations. Some grants for HIV and tuberculosis medications, and food aid for countries in civil wars and natural disasters will continue. Spending on health programs like HIV vaccinations is congressionally allocated, and it is unclear if the administration has the unilateral legal power to end them.

USAID funding has mostly been eliminated, with only 869 of 6,000 employees remaining active. Remaining programs are, according to the administration, valued at up to US$78 billion, but only US$8.3 billion is unobligated funds intended for future disbursement. This suggests a massive reduction from the previous annual USAID spend of US$40 billion.

Programs terminated include funding for the FAO, which monitors diseases transmitted from animals to humans in 49 countries. Major programs to track and fight malaria have also ended.

On March 26, 2025, it was reported that the US plans to end financial support for Gavi, terminating a grant valued at US$2.6 billion through 2030, with US$1.8 billion yet to be disbursed.

Gavi is estimated to have saved the lives of 19 million children since its creation 25 years ago. The US contributes about 13% of its budget.

The loss of US funds will set back Gavi's ability to continue providing basic services, like immunizations for measles and polio. By Gavi’s estimate, the loss of US support may mean 75 million children do not receive routine vaccinations in the next five years, resulting in over 1.2 million child deaths.

The US became the largest donor to Gavi during the COVID-19 pandemic. While European countries have historically provided significant funding, many have announced plans to reduce development spending. Japan, another major Gavi donor, has also struggled with a depreciating currency.

On December 12, 2024, USAID announced an additional US$29 million in support for Somalia to support resilience and food security in Somalia, where 7 million people require assistance due to natural disasters, disease, insecurity, and poverty.

The funding is part of two 5-year programs aiming to assist 880,000 vulnerable households in South Central Somalia. USAID is partnering with World Vision and Save the Children to provide services including health, WASH, and nutrition, while also strengthening households' ability to cope with future challenges."

On December 3, 2023, US President Joe Biden pledged US$1 billion in assistance to address food insecurity and other needs of internally displaced persons and refugees across 31 countries in sub-Saharan Africa during his trip to Angola.

This announcement is part of Biden's 2022 commitment at the US-African Leaders Summit to help communities tackle food insecurity in sub-Saharan Africa.

The assistance, along with previous commitments by the US, offers a range of services, including emergency assistance, health, WASH, education, and shelter. This additional assistance brings the total humanitarian assistance in FY2024 to nearly US$6.6 billion.

During the same visit, Biden announced that USAID is elevating its presence in Angola to a USAID mission.

On November 21, 2024, the Lowy Institute published the annual Pacific Aid Map which confirmed Australia remains the largest donor to the Pacific region.

The 2024 Pacific Aid Map provided complete data from 2008-2022, the second major donor in the Pacific region is China, which overtook the US. Other Western donors reduced their ODA to the Pacific region largely due to overarching budget constraints and redirected funding to Ukraine.

In 2022, Australia provided AUD2.2 billion (US$1.5 billion) whilst China provided US$256 million. The publication indicated that China has continued to revise its approach, including shifting towards grants and away from lending programs.

In general, loans to the Pacific region have increased from 12% in 2009 to 40% in 2022, driven largely by an increased focus on infrastructure in the region.