A group of public health and legal experts has argued in The BMJ that the rapid withdrawal of international health aid by the United States should be treated as a public health emergency of international concern (PHEIC). They contend that the scale and speed of the funding cuts create a serious global health risk that could affect multiple countries and require a coordinated international response. Under the World Health Organization’s International Health Regulations, a PHEIC is defined as an extraordinary event that poses a public health risk to other states through the international spread of disease.
The authors warn that reduced US global health funding could lead to millions of deaths by 2030. They point specifically to the Trump administration’s funding freeze on PEPFAR, which reportedly caused the sudden closure of treatment services for many people living with HIV/AIDS, while stop-work orders affecting USAID disrupted HIV testing and treatment programs. If this aid is not restored, UNAIDS estimates there could be six million HIV-related deaths and nine million new HIV infections by 2030, marking a dramatic reversal in global HIV progress.
Beyond HIV, the experts say cuts to malaria, tuberculosis, and other disease programs could put millions more lives at risk in the coming years. They also caution that if the United States follows through on threats to halt support for Gavi, the Vaccine Alliance, alter its childhood vaccination strategy, and weaken pandemic preparedness under an America First global health approach, vaccine-preventable diseases could rise again both domestically and internationally. In addition, ending US support for UN agencies such as UN Women and the UN Population Fund could severely disrupt sexual and reproductive health services in over 150 countries.
The authors are calling on the World Health Organization to declare a PHEIC in order to mobilize urgent international action and resources. They argue that the US funding decisions qualify as an extraordinary event because the International Health Regulations do not limit an “event” solely to the presence of disease, but also include situations that create the potential for disease outbreaks. Although the outbreaks they fear have not fully materialized yet, they say the world is already in a period of heightened risk as treatment and prevention systems dependent on US funding begin to shut down.
They acknowledge that a PHEIC has never before been declared because of the political actions of a single country, but argue that the unprecedented level of risk should be the central consideration. In their view, the US decisions have significantly increased the likelihood of cross-border outbreaks and health system disruption. A formal WHO declaration, they say, could help rally financing, strengthen international cooperation, and even allow countries to use emergency legal measures such as compulsory licensing to improve access to essential medicines for HIV, malaria, tuberculosis, and other diseases.
