Health
As the U.S. Exits Foreign Aid, Who Will Fill the Gap?
As the reality sets in that the United States is drastically diminishing its foreign assistance to developing countries, an urgent conversation is starting among governments, philanthropists, and global health and development organizations.
It is centered on one crucial question: Who will fill this gap?
Last year, the United States contributed about $12 billion to global health, money that has funded treatment of H.I.V. and prevention of new infections; children’s vaccines against polio, measles and pneumonia; clean water for refugees; and tests and medications for malaria.
The next largest funder is the Gates Foundation, which disburses a fraction of that amount: its global health division had a budget of $1.86 billion in 2023.
“The gap that has been filled by the U.S. cannot be easily matched by anybody,” said Dr. Ntobeko Ntusi, the chief executive of the South African Medical Research Council.
U.S. assistance has been channeled through the United States Agency for International Development, or U.S.A.I.D., which the new Trump administration has largely dismantled, and other government agencies, including the National Institutes of Health, which is also facing substantial cuts in health research grants.
Many people are suggesting that other countries, particularly China, could move into some of the areas vacated by the United States, Dr. Ntusi said. Others are making urgent appeals to big philanthropies including the Gates Foundation and Open Philanthropy.
This conversation is most consequential in Africa. About 85 percent of U.S. spending on global health went to programs in or for African countries.
For countries such as Somalia, where U.S. aid made up 25 percent of the government’s whole budget, or Tanzania, where the U.S. funded a majority of public health care, the loss is catastrophic. And for the major global health agencies, the situation is similarly critical.
President Trump has already pulled the U.S. out of the World Health Organization, which is now trying to make an initial budget cut of $500 million for 2026-27 to cope with the withdrawal of American funds.
“Most of our neighbors on the continent, they’ve been completely reliant on the U.S. to procure most of the lifesaving medications for endemic infections,” Dr. Ntusi said. “And I don’t see most of the governments overnight being able to have the resources to cope. And so I think there’s going to be devastating consequences on lives lost from Africans who will die of preventable infections”
The U.S. is the largest donor to Gavi, an organization that supplies essential vaccines to the world’s poorest countries, and to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The U.S. contribution is required by Congress. Asked about the commitment to these and other multilateral agencies including the Pandemic Fund, a State Department spokesperson said that the programs were being reviewed to see if they aligned with the national interest, and that funding would continue only for those that met this condition.
Who Steps In?
There is no indication that additional funding will come from the other G7 countries, the European Union or other high-income nations. Britain, Germany, France, the Netherlands and Scandinavian countries have all reduced their foreign aid. Some new donor countries have come forward to support the W.H.O., including Saudi Arabia and South Korea, but their spending is dwarfed by the amount the U.S. once gave.
Of nongovernmental players, the World Bank is best placed to provide long-term support for health spending. The bank has said little so far. It could offer countries hit hard by the U.S. cutoff innovative financing such as debt-for-health-care swaps to give nations struggling under heavy debt burdens some fiscal freedom to make up lost health care funding. However, the U.S. is the largest shareholder of the bank, and the Trump administration would have influence over any such investment.
Much of the public discussion about filling the vacuum left by the U.S. has focused on China, which has built a significant presence by financing infrastructure projects in African countries, particularly those with extensive mineral reserves or strategic ports.
“There is good reason for them to do so,” said Ja Ian Chong, an associate professor of political science at the National University of Singapore. China regards foreign aid as a soft-power tool in its superpower rivalry with the United States, much as the United States did when setting up U.S.A.I.D. during the height of the Cold War with the Soviet Union. China seeks to use aid to garner more support from developing countries in the United Nations.
While Chinese aid has largely come in loans to build infrastructure, it includes support for more varied projects. China’s answer to Western development aid, a program unveiled in 2021 called the Global Development Initiative, includes $2 billion for upgrading livestock production in Ethiopia, fighting malaria in Gambia and planting trees in Mongolia, among other projects.
Mr. Chong said China’s ability to fill the opening left by U.S.A.I.D. could be constrained by its own financial limitations. China’s economy has stagnated because of a property crisis and rising government debt, and the country has already scaled back on big infrastructure loans.
To date, China has shown little interest in supporting global health programs, or in providing grants on a scale anywhere near U.S.A.I.D. levels. AidData, a university research lab at William & Mary in Virginia, estimates that Beijing provides about $6.8 billion a year in grants and low-cost loans.
Philanthropies
Philanthropies that were already working in global health have been deluged with panicked calls from organizations with frozen funds.
“I have talked to some foundations who have all said we’re being inundated with people saying, ‘Help us, help us, help us,’ and I think they’re trying to patch little holes,” said Sheila Davis, the chief executive of the nonprofit Partners in Health, which works with local governments to bring health care to communities in developing countries. But if a patchwork bailout can cover just 20 percent of what the U.S. was paying for, what should a new donor save? she asked. “Do you choose to save one program fully and then let others go? Or what is the best strategy?”
Chief among the foundations fielding pleas for help is the Gates Foundation, which has been warning its grant recipients that it cannot make up the gap. In addition to funding global health programs, the foundation also supports health research and is a major contributor to Gavi.
“There is no foundation — or group of foundations — that can provide the funding, work force capacity, expertise, or leadership that the United States has historically provided to combat and control deadly diseases and address hunger and poverty around the world,” the foundation’s North America director, Rob Nabors, said by email.
Multiple recipients of Gates Foundation funding, who declined to speak on the record because they were describing confidential conversations, said they had been told by foundation staff members that it would continue to fund research and programs in the areas it already worked, but wouldn’t expand significantly, and that while some grants might be restructured to try to compensate for part of the lost U.S. funding, the foundation’s work would continue to be “catalytic” rather than support large-scale programming like U.S.A.I.D. did.
John-Arne Røttingen, the chief executive of the Wellcome Trust, which is among the largest donors to global health research, said in an email that the foundation was “exploring what options might exist” in the new landscape. But, he said, its help would be “a drop in the ocean compared to what governments across the world need to provide.”
A couple of small organizations, such as Founders Pledge, have started “bridge funds,” ranging from about $20 million to $200 million, to try to help plug immediate gaps.
But the philanthropic sector has largely been silent about the momentous change in the landscape. Major players that have already put hundreds of millions of dollars into health care in Africa, such as the Susan T. Buffett Foundation, did not respond to questions about their plans. The Delta Foundation (co-founded by the Zimbabwean telecom billionaire Strive Masiyiwa) declined to discuss the issue.
Two executives at smaller private foundations said there was a reluctance to say anything publicly because of fear of retribution from the Trump administration, including a potential loss of charitable status.
African Governments
African governments are under tremendous pressure from frustrated citizens to assume responsibility for the health spending that was coming from the U.S. The issue led the agenda at a meeting of the continent’s health ministers at an African Union summit last week.
In the 24 years since the Union adopted what’s called the Abuja Declaration, committing its 42 members to spending 15 percent of their budgets on health, only a couple of states have ever hit that target, and for a year or two at most. Average health spending by African countries is less than half that amount.
In Nigeria, the president convened an emergency cabinet committee to make a plan for the budget shortfall, and Parliament allotted an extra $200 million to the national budget last week. But that extraordinary measure illustrates the scale of what’s been lost: it’s less than half of the $512 million that the U.S. gave Nigeria for health care in 2023.
Nigeria’s health minister, Dr. Muhammad Pate, said that nearly 28,000 health care workers in the country had been paid in whole or part by U.S.A.I.D., which also covered three-quarters of the bill for drugs and test kits for the 1.3 million Nigerians who live with H.I.V.
Nigeria will quickly need to find new ways of operating, he said, including boosting manufacturing of some of those items domestically. “It may not be as fancy, but at least it will serve,” Dr. Pate said.
He also predicted that the end of U.S. aid would accelerate what he called a “realignment” in Africa. “The world has shifted in the last 20 years,” he said. “So we have other actors: We have China, India, Brazil, Mexico and others.”
Deisy Ventura, a professor of global health ethics at the University of São Paulo, said the change could open opportunities for other countries to exert newfound influence.
“The retreat of the United States may open space for new leaders now,” she said. “It’s important for us in the global south to imagine an international coordination of emergency preparedness and response without the United States.”
Berry Wang contributed reporting from Hong Kong.
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Students at the University of Kent in the U.K. are calling for a shutdown in light of an active meningitis outbreak.
The demands follow multiple alerts from the UK Health Security Agency (UKHSA) about the outbreak.
As of March 18, the agency had announced a total of 15 confirmed cases of meningococcal disease, 12 additional potential cases and two deaths in Kent, a county in the southeast of England. The University of Kent is located in Canterbury, a historic city within Kent.
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Meningococcal disease is a serious bacterial infection caused by Neisseria meningitidis, according to the Centers for Disease Control and Prevention.
It can cause two life-threatening conditions: meningitis (infection of the brain and spinal cord lining) and a bloodstream infection called septicemia, which can lead to sepsis, per the above source.
Two people have died amid an outbreak of meningitis at the University of Kent in Canterbury. (Carl Court/Getty Images)
Even with prompt treatment, meningococcal disease can become fatal within hours. Health agencies report a typical fatality rate of about 10% to 15%.
In response to the outbreak, students at the University of Kent launched an online petition calling for campus to be closed.
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“Students at the University of Kent are increasingly concerned about reports of meningitis and sepsis cases affecting members of the campus community,” the petition states, as posted on Change.org. “The confirmation of two deaths, along with reports of hospitalizations, has caused understandable concern among students and staff.”
The petition expressed concern that in-person exams, lectures and other campus activities are continuing amid the outbreak.
As of March 18, health officials had announced a total of 15 confirmed cases of meningococcal disease, 12 additional potential cases and two deaths in Kent, a county in the southeast of England. (Carl Court/Getty Images)
“Many students feel that they are being placed in a difficult position: attend exams and in-person activities during a period of heightened concern or prioritize their health and well-being while risking potential academic consequences,” the petition states. “Students should not feel forced to choose between protecting their well-being and continuing their education.”
“Students deserve to feel safe on campus,” the petition concluded. “We are therefore calling on the University of Kent to consider precautionary steps to prioritize the well-being of students and staff during this situation.
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Preventative antibiotic treatment is being distributed to University of Kent students, according to UKHSA, as well as to those who visited Club Chemistry, a nightclub in Canterbury, between March 5 and March 7.
“A vaccination program has started for students and staff who live in or work in the halls at the University of Kent Canterbury Campus — approximately 5,000 students,” the agency noted.
Fox News Digital reached out to the university requesting comment.
Symptoms of meningococcal disease
Described by the CDC as a “rare but severe illness,” meningococcal disease most commonly causes symptoms of meningitis, including fever, stiff neck, headache, nausea, vomiting, sensitivity to light or altered mental status.
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It can also cause meningococcal bloodstream infection, which is marked by fever and chills, vomiting, fatigue, vomiting, cold hands and feet, severe aches and pains, diarrhea, rapid breathing or a dark purple rash, the CDC notes.
Transmission and treatment
Meningitis infections can spread through close contact with someone who has meningococcal disease, “generally, through things like coughing or kissing, but it can also spread by being in the same household or room for extended periods of time with an individual who is infected,” Dr. Barbara Bawer, a primary care physician at The Ohio State University Wexner Medical Center, previously told Fox News Digital.
The UK Health Security Agency (UKHSA) is contacting 30,000 students and staff of the university to notify them of the outbreak. (Carl Court/Getty Images)
Those who have symptoms of the disease should see their primary care physician immediately, according to the doctor.
As symptoms tend to progress quickly and can be life-threatening, it is essential that the patient receives antibiotics immediately.
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“It can become fatal or dangerous very quickly — within hours — for any individual, especially if antibiotics are not initiated in a timely manner,” Bawer warned. “Even with antibiotics, meningitis can be fatal.”
She added, “This is often due to misdiagnosis, because meningitis can mimic many other illnesses.”
Infection prevention
Most cases of meningococcal disease worldwide are caused by six variations of the Neisseria meningitidis bacteria — A, B, C, W, X and Y.
In the U.S., the most common variations are B, C, W and Y. There are vaccines available to protect against types A, C, W and Y (the MenACWY vaccine) and type B (MenB vaccine), according to the CDC.
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“MenACWY vaccines are routinely recommended for adolescents and for people with other risk factors or underlying medical conditions, including HIV,” the agency previously stated.
“Students should not feel forced to choose between protecting their well-being and continuing their education.”
To reduce risk, Bawer recommends that people get vaccinated with the current meningitis vaccine as recommended by the CDC and avoid being in very closed-in spaces with others as much as possible.
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“If you know of someone who has meningitis in your household or you’ve come in contact with their oral secretions (i.e., you kissed them), then you should get preventative antibiotics,” the doctor told Fox News Digital.
This is even more important for those who are immune-compromised or who are on medications that decrease the immune system, Bawer added.
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The practice of combining cold exposure and breathwork — known as the Wim Hof Method — has gained popularity as a wellness practice, with some research suggesting benefits for stress, energy and mental clarity, though evidence for treating chronic disease remains limited.
And now, a recent study published in the journal Nature appears to support the technique’s potential health benefits.
The research included more than 400 healthy adults averaging 37 years of age, who practiced either the Wim Hof Method (WHM) or mindfulness meditation daily for about one month.
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The WHM practitioners were split into in-person and at-home groups, where one did ice baths and the other took cold showers.
The participants reported their energy, mental clarity, and stress and anxiety levels. The researchers also measured heart rate, breathing and sleep.
Wim Hof, creator of the Wim Hof Method that combines cold exposure and breathwork, is pictured among icebergs on Iceland’s Diamond Beach. (Wim Hof Method)
Participants in the breathwork and cold group had greater improvements in energy, mental clarity and ability to handle stress, benefits that were most noticeable right after their daily practice.
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The study also found that meditation reduced stress early on, but the WHM showed gradual improvements in stress levels over a longer time period. Differences in sleep, cognition and heart health measures were more subtle.
The short 29-day study period could pose a limitation in measuring long-term impacts, the researchers acknowledged.
Wim Hof is pictured meditating in the snow in Switzerland. “I felt that this was going to make a huge difference in people,” he said of his method. (Wim Hof Method)
The participants also knew which group they were placed in, which could have influenced the self-reported results.
“I felt that this was going to make a huge difference in people,” Wim Hof told Fox News Digital. “I had a lot of anecdotal evidence, but that doesn’t make it scientific.”
What is the Wim Hof Method?
The Wim Hof Method is comprised of three pillars: cold, breathing and mindset.
“It is a combination of the three … and when they come together, they reinforce each other and become stronger,” he said. “Use the cold well, and you bring the immune system, the energy system and your cardiovascular system to an optimum [state].”
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Breathing has been shown to lower inflammation, which is the main driver of disease, according to Wim Hof. Research has also shown that a change in mindset can re-circuit the brain to handle stress more efficiently.
Lowering stress levels is crucial to improving health, he noted, as high cortisol (the body’s stress hormone) and inflammation are drivers of chronic disease.
Sunday Swim, a group practicing the Wim Hof Method, does a cold plunge on a Long Island beach. (Sunday Swim)
Lead study author Dr. Jemma King, of the University of Queensland School of Psychology in Australia, said she entered the world’s largest Wim Hof study with a “healthy dose of scientific skepticism.”
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“People are really anxious, people are really burnt out, and the world is very destabilized at the moment,” she told Fox News Digital. “People are increasingly dependent on healthcare systems, and profits keep growing and people keep getting sicker.”
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“We’re glued to screens; we’re reaching for pills every time life feels hard. And so we really wanted to [find out] — is there a better way?”
Sunday Swim founder Brendan Cooke assists participants with breathwork on a Long Island beach. (Sunday Swim)
Although meditation is an important tool for some, an alternative method that involves more activity may be a better option for those with “busy brains,” according to the researcher.
“You’re not sitting there just accepting energy,” she said. “You can actually face it head on, and you can overcome your aversion to the cold, which is very invigorating.”
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“If you choose to do small doses of the right kind of stress, it doesn’t break you down. It actually makes you stronger,” King added.
Scientifically, breathwork can help flush the brain of toxins, clearing mental fog while increasing levels of the beneficial chemicals adrenaline and dopamine, she noted.
Cold exposure may not be safe for everyone, especially those with certain cardiovascular conditions. (iStock)
“We also found something really shocking and unexpected: The people doing the Wim Hof Method became more willing to speak up at work,” King shared. “They were more likely to raise hard issues or have a voice or take interpersonal risks.”
“If you train yourself to step into the cold water every morning, you kind of override that voice that says, ‘Don’t do that,’” she added. “This bravery, this toughness that you train every morning, starts to show up everywhere else in your life.”
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Starting safely
For beginners, Hof recommends simply stepping into a cold shower at home, which activates the cardiovascular system and boosts energy.
“Take the cold shower, go into that breathing, and suddenly you’ll feel an innate power awakening,” he said. “That is the nervous system, and you have control over that.”
Cold exposure may not be safe for everyone, especially those with certain cardiovascular conditions, such as abnormal heart rhythms, heart disease or Raynaud’s syndrome, according to Harvard Health.
Those with underlying conditions should get a physician’s approval before embarking on a cold plunge or another mode of cold exposure therapy, experts advise.
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“[For those who] have conditions, I say start with breathing alone,” Hof recommended. “Breathing trains the nervous system like weightlifting trains the muscles.”
“Know that you are built to have willful control over your health, happiness and strength,” he added.
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A Los Angeles mother of three says she’s lucky to be alive after an uncommon procedure left her cancer-free.
Amy Piccioli, a busy CPA, was just 39 when she visited the ER last year for what she thought was dehydration due to a stomach bug.
Instead, a CT scan revealed a mass in her colon and multiple lesions in her liver, which led to a colorectal cancer diagnosis — despite having “zero signs.”
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“I had no symptoms,” Piccioli told Fox News Digital. “I’m one of those people who’s very diligent about my health and very cognizant about changes in my body. So for this to have happened without any signs or symptoms was just shocking to me.”
Because the cancer had already spread, it was automatically a stage 4 diagnosis.
Amy Piccioli, a Los Angeles mother of three, says she’s lucky to be alive after an uncommon procedure left her cancer-free. (Amy Piccioli)
“I just went numb — I couldn’t believe it,” Piccioli said. “Immediately, you have those feelings of panic and fear.”
In June 2024, Piccioli began undergoing chemotherapy, along with an immunotherapy drug. Just three months later, scans showed that the chemo had shrunk the tumors. Next, she underwent surgery to remove a tumor from her colon.
An unlikely path
After completing the traditional courses of treatment, Piccioli found herself embarking on a path to liver transplantation.
“The cancer was all over my liver,” she shared. “In cases where the cancer is confined to one side of the liver, they can basically cut that portion out … but in my case, a resection was not a possibility because the cancer was everywhere.”
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Although the chemotherapy was successful, she said, “it was always going to be a ‘whack-a-mole’ situation, where I would be on systemic chemo for an extended period of time, new stuff would pop up, and it would just be this cycle over and over and again.”
“The chances of eradicating the cancer entirely from my liver with chemo alone was very slim. In cases like mine, liver transplantation is really the only long-term solution.”
Piccioli (right) is pictured with Dr. Zachary C. Dietch, a transplant surgeon at Northwestern Medicine. (Northwestern Medicine)
Liver transplantation as part of a colorectal cancer treatment is more prevalent in Europe, but not common in the U.S.
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“We just didn’t think it would be an option here,” Piccioli said. “It seemed like something that was going to require a lot of effort to get.”
Her California care team soon discovered, however, that Northwestern Medicine in Chicago offers a liver transplantation program specifically for metastatic colorectal cancer patients.
“I have no evidence of disease currently,” shared Piccioli, pictured on the beach with her husband and three kids. (Amy Piccioli)
“When liver metastasis is noted, our medical oncologists, along with our transplant surgeons begin to make care pathways tailored to the patient,” Satish Nadig, MD, PhD, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center, told Fox News Digital.
The chances of a successful transplant depend largely on how the patient responds to treatment, according to doctors. In “carefully selected” patients, the five-year survival rate can be 60% to 80%.
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“Response to chemotherapy is a critical gatekeeper for liver transplantation in colorectal liver metastases,” Nadig said.
“Demonstrated disease control or response is usually required, as it identifies patients whose tumor biology (less aggressive and not spreading quickly) is favorable enough to justify a transplant.”
“You have to be the captain of your own ship.”
Piccioli, who was in search of a living donor, shared the need with family and friends. A lifetime childhood friend, Lauren Prior, underwent screening and was deemed a match.
The transplant was performed in December 2025, making Piccioli the first person at Northwestern to receive a living donor transplantation for metastatic colon cancer.
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Today, she and the donor are recovering well.
“The first week or two were difficult, but by week four, I was up and around, getting back to doing normal life things,” she said. “About two months out, I started working out again. I’m now three months out and feel completely normal. It’s amazing what the body can do.”
Piccioli, who was in search of a living donor, shared the need with family and friends. A lifetime childhood friend, Lauren Prior (right), underwent screening and was deemed a match. (Amy Piccioli)
Piccioli recently had her first post-transplant blood screening for tumor molecules within the body, and none were detected. “So I have no evidence of disease currently,” she shared.
She will remain in Chicago for ongoing monitoring and screening until the end of March, when she will return home to Los Angeles.
On the lookout
Early-onset colorectal cancer is often “silent,” according to Nadig.
“That’s because screening is absent before age 45 and symptoms (such as slow bleeding) are usually subtle,” he cautioned. Tumors can also grow in hard-to-detect locations, like the right side of the colon, or with biology that “delays obvious warning signs.”
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Although Piccioli experienced no warning signs, she encourages others to pay attention to any changes in the body that may signal cancer.
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“Do the screenings at the recommended ages, follow up and just be diligent about your health,” she advised.
“I think a lot of the reason that I got to Northwestern and was able to receive this transplant was because I was so diligent about calling the doctors, scheduling the appointments … I think that is really the most important thing: You have to be the captain of your own ship.”
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