The Decision-Making Behind Recent Funding Cuts
At the start of his second administration, President Trump empowered a new government advisory body called the Department of Government Efficiency (DOGE) to design and implement funding cuts aimed at reducing government spending. The group, founded on January 20th, 2025, was led by South African billionaire Elon Musk and was staffed by IT and finance professionals, few of whom have worked for the government, in scientific research, or for international aid organizations. After several DOGE-initiated funding cuts faced public scrutiny and were deemed unconstitutional by several United States courts, Elon Musk stepped down from the organization in late May 2025.
One of the main funding cuts related to public health that was deemed unconstitutional was the dismantling of the U.S. Agency for International Development (USAID). The reason this cut was considered unconstitutional, according to Judge Theodore Chuang, who presided over the case, is that DOGE deprived Congress of its constitutional right to determine when to shut down an agency of its creation. However, this decision was not finalized until March 2025 and set no requirements for rebuilding the organization, which gave DOGE more than enough time to dismantle USAID. Other cuts did not see the same success as in the USAID case, such as cuts to the National Institutes of Health (NIH), but were still significant. Given the wide-reaching impacts of public health programs through USAID and other targeted agencies, it is crucial to understand how funding cuts will affect public health campaigns in the United States and globally.
Which Programs Had Funding Cut?
United States Agency for International Development (USAID)
USAID was a governmental agency dedicated to helping other countries recover from disasters, alleviate poverty, and create democratic reforms. Additionally, the organization was responsible for international HIV/AIDS relief efforts. Throughout its history, USAID was responsible for numerous global health campaigns, such as assisting in the international effort to eradicate smallpox in the 1960s. Recently, USAID was responsible for distributing vaccines, offering humanitarian aid, and supporting health workers internationally during the COVID-19 pandemic. Outside of short-term campaigns to alleviate threats to public health during major events like the COVID-19 pandemic, USAID was largely responsible for implementing the President’s Emergency Plan for AIDS Relief (PEPFAR), which was established by President George W. Bush in 2003.
On January 24th, 2025, DOGE instituted a halt on all USAID efforts worldwide, and, by the 27th, they started placing all of USAID’s highest-ranking officials on leave and offboarding hundreds of other employees. Due to these actions, people with HIV/AIDS may be forced to go without care for years to come, as it is unlikely that private corporations or other nations will supply the funding that the United States no longer provides. This process was not deemed unlawful until March 10, 2025, and, even then, the condemnation of these actions did not reverse the impacts. Many researchers, academics, and experts warn that the sudden removal of this agency is a detriment to global health initiatives. Some experts even claim that up to 14 million people could die in the coming years because of the removal of USAID’s aid efforts. With no reinstatement in sight, further harm caused by the complete removal of the United States’ foreign aid, including a lack of access to crucial HIV/AIDS treatments, is anticipated in the coming years.
National Institutes of Health (NIH)
The National Institutes of Health (NIH) is the primary United States federal agency for biomedical and health-related research, responsible for supplying grants for medical research and public health activities. Many of the recent funding cuts have targeted current NIH grants dedicated to cancer and HIV/AIDS research, and have blocked future applicants from receiving grants that include any mention of diversity, equity, and inclusion (DEI), even though diversity statements were once a standard requirement for most NIH grants.
In the past, the NIH was responsible for funding research focused on advancing immunotherapy, precision technologies, and early detection technologies to reduce the impacts of cancer on the American population. These research projects and other public health programs have lost funding that analysts say will not be supplemented by the private sector in the future. Another sector of public health facing an uncertain future is infectious disease programming. By July 2025, nine pandemic response centers were closed due to NIH funding cuts. These centers were responsible for developing vaccines and cures for new and emerging infectious diseases, like new strains of highly pathogenic bird flu that spread to humans through direct contact with poultry.
Future Details and Implications
In March, efforts to halt and reverse these funding cuts began. So far, courts have ruled that the dismantling of USAID was unconstitutional, that all DOGE documents and materials must be made public through the Freedom of Information Act, and that hundreds of NIH grant terminations are illegal. However, many of these judicial decisions were threatened when Congress passed a bill in July that legally solidified DOGE’s funding cuts to USAID. This new legislation sets a precedent that might allow for judicial decisions against funding cuts to be overridden by Congress.
Conclusion
Altogether, the futures of USAID and NIH public health programs remain unclear. Whether the aforementioned funding cuts will gain legislative legitimacy is unknown. The long-term effects will depend on how Congress and future administrations handle public health funding. In the meantime, reduced support for research and international aid could affect both global health programs and scientific progress in the U.S.