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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South Carolina is facing a major measles outbreak, resulting in the quarantine of hundreds of residents.
The South Carolina Department of Health (DPH) reported in a media briefing on Wednesday that the current number of measles cases has reached 111 as part of the current Spartanburg County outbreak.
DPH first reported a measles outbreak in the Upstate region on Oct. 2.
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The health department confirmed that 254 people are currently in quarantine and 16 are in isolation to prevent further spread.
The health department confirmed that 254 people are currently in quarantine in the upstate region. (Getty Images)
“This significant jump in cases is unfortunate,” a DPH spokesperson commented on the outbreak.
Public exposure was identified at Inman Intermediate School, with 43 of their students in quarantine.
“This significant jump in cases is unfortunate.”
Eight other intermediate and middle schools in the area are also reportedly undergoing quarantine. The DPH said multiple students have had to quarantine twice due to repeat exposure.
“Vaccination continues to be the best way to prevent the disruption that measles is causing to people’s education, to employment and other factors in people’s lives and our communities,” the spokesperson said.
“This significant jump in cases is unfortunate,” a DPH spokesperson commented on the current outbreak. (iStock)
Out of the 111 confirmed cases, 105 were unvaccinated. Receiving a vaccination within 72 hours has been shown to prevent measles infection, the DPH spokesperson noted.
Some cases are related to travel exposure, while others are from an unknown source, suggesting that measles is circulating in the community, the DPH noted.
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Connecticut has also reported its first measles case in four years, according to the Connecticut Department of Public Health.
The department confirmed on Thursday that an unvaccinated child in Fairfield County, under the age of 10, was diagnosed with measles after recently traveling internationally.
“Vaccination continues to be the best way to prevent the disruption that measles is causing,” a DPH spokesperson said. (iStock)
The child began to show symptoms several days later, including a runny nose, cough, congestion, fever and a rash starting at the head and spreading to the rest of the body.
The Connecticut DPH noted that measles is “highly contagious” and can spread quickly through the air via coughing or sneezing. The CDC has estimated that nine out of 10 unvaccinated individuals who encounter an infected person will develop the measles virus.
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According to the International Vaccine Access Center, more than 1,800 cases of measles have been reported in 2025, which is the most since the U.S. declared the virus eliminated in 2000. It is also the most cases recorded in three decades.
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“The single best way to protect your children and yourself from measles is to be vaccinated,” DPH Commissioner Manisha Juthani, M.D., wrote in a statement. “One dose of measles vaccine is about 93% effective, while two doses are about 97% effective.”
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A sperm donor whose samples helped conceive nearly 200 children across Europe unknowingly carried a cancer-causing genetic mutation — a hidden risk now tied to multiple childhood illnesses and early deaths.
An investigation led by the BBC and many other public service broadcasters revealed that the donations were made to Denmark’s European Sperm Bank (ESB). Those donations were then used by 67 fertility clinics in 14 countries over a 17-year span.
The donor, who was not identified, was paid to donate as a student beginning in 2005, according to the report.
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Although the donor passed the initial health screenings, he had hidden genetic mutations that damaged the TP53 gene, which helps to prevent cancer by repairing DNA damage or trigger the death of cancer cells.
When TP53 is mutated, those protective functions are lost, which can lead to uncontrolled cell division, accumulation of mutations and tumor growth, research has shown.
A sperm donor whose samples helped conceive nearly 200 children across Europe (not pictured) unknowingly carried a cancer-causing genetic mutation — a hidden risk now tied to multiple childhood illnesses and early deaths. (Getty Images)
Up to 20% of the man’s sperm would contain that mutated gene, and any children conceived from that affected sperm would have the mutation in every cell of their body, the BBC report stated.
As a result, these children would have a 90% risk of developing some type of cancer in their lifetime, including breast cancer, bone cancers, brain tumors and leukemia. This heightened risk is known as Li Fraumeni syndrome.
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Doctors raised these concerns at the annual congress of the European Society of Human Genetics (ESHG), which was held in Milan in May 2025.
At that conference, Edwige Kasper — a specialist in cancer genetics at Rouen University Hospital in France — presented the case of the sperm donor whose genetic material carried the harmful variant.
“This is the abnormal dissemination of genetic disease. Not every man has 75 children across Europe.”
It was reported that 23 children had been confirmed to have the variant at that time, 10 of which had already been diagnosed with cancer.
The actual number is likely much higher, the report surmised, as at least 197 children were born from the donated sperm — but not all data has been collected.
Kasper called for a limit on the number of births or families for a single donor in Europe.
“We can’t do whole-genome sequencing for all sperm donors — I’m not arguing for that,” she said. “But this is the abnormal dissemination of genetic disease. Not every man has 75 children across Europe.”
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She also recommended that children born from this donor’s sperm undergo genetic counseling.
“We have some children that have already developed two different cancers, and some of them have already died at a very early age,” Kasper recently told the investigators.
Up to 20% of the man’s sperm would contain that mutated gene, and any children conceived from that affected sperm would have the mutation in every cell of their body, the BBC report stated. (iStock)
There is no worldwide law that limits how many times a donor’s sperm can be used or how many children may be born from a single donor, according to the European Society of Human Reproduction and Embryology (ESHRE).
However, individual countries may have their own rules or guidelines surrounding sperm donor usage. The ESHRE recently proposed a cap of 50 families per donor as an international limit.
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Dr. Marc Siegel, Fox News senior medical analyst, commented on these developments to Fox News Digital.
“This awful story emphasizes the growing need for up-to-date genetic screening for all donors,” he said. “It also provides context for the idea that knowing the donor provides an advantage.”
“This awful story emphasizes the growing need for up-to-date genetic screening for all donors,” Dr. Marc Siegel said. (iStock)
“Genetic screening, including for oncogenes (genes that have the potential to cause cancer) is improving dramatically, and all use of sperm donations must include it,” Siegel went on.
He also called for AI to be used to improve and speed up the process.
“When a propensity for disease is suspected, the sperm must be discarded,” the doctor added.
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In a statement sent to Fox News Digital, the European Sperm Bank expressed “deepest sympathy” for the families involved.
“We are deeply affected by the case and the impact that the rare TP53 mutation has on a number of families, children and the donor. They have our deepest sympathy,” the ESP said.
The American Society of Reproductive Medicine provided its guidance on embryo and gamete donation, which stated in part that all prospective donors should undergo “appropriate genetic evaluation.” (iStock)
“ESB tests and performs an individual medical assessment of all donors in full compliance with recognized and scientific practice and legislation.”
In the case of this particular sperm donor with the TP53 mutation, the ESB noted that it occurs only in a small part of the donor’s sperm cells and not in the rest of the body.
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“In such cases, the donor himself and his family members are not ill, and a mutation of this type is not detected preventively by genetic screening,” the agency said.
When the ESB later confirmed the mutation in 2023, the donor was “immediately blocked” and authorities and clinics were notified.
“Donors should be healthy and have no history to suggest hereditary disease.”
“The clinics are responsible for informing the patients, partly because we as a sperm bank do not necessarily know the patients, and because the patients’ own treating physicians are best equipped to advise them in the specific situation,” the agency stated.
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When contacted by Fox News Digital, the American Society of Reproductive Medicine (ASRM) provided its guidance on embryo and gamete donation, which stated in part that all prospective donors should undergo “appropriate genetic evaluation.”
“Donors should be healthy and have no history to suggest hereditary disease,” the ASRM continued.
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Parents with concerns are encouraged to contact both their treating clinic and the relevant fertility authority in that country.
GLP-1 weight loss pill in development
Fox News senior medical analyst Dr. Marc Siegel discusses advancements in weight loss drugs, safety concerns surrounding nicotine patches and his interview with FDA Commissioner Dr. Marty Makary on vaccine protocol.
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Scientists in Sweden have created a new pill designed to help the body burn fat and control blood sugar in a different way than popular GLP-1 drugs, like Ozempic.
While injectable GLP-1s work by suppressing appetite, this new treatment boosts metabolism in the muscles.
A study led by researchers at Karolinska Institutet and Stockholm University included both an early animal study and a human clinical trial with 48 healthy adults and 25 people with type 2 diabetes, according to a press release.
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The new oral medication was found to successfully control blood glucose, boost fat burning and retain muscle mass in animals, while getting high marks for tolerability and safety in humans.
It was also found to have fewer side effects than GLP-1s like semaglutides and tirzepatides, which are known to cause appetite loss, gastrointestinal distress and muscle wasting, the researchers noted.
While injectable GLP-1s work by suppressing appetite, this new treatment boosts metabolism in the muscles. (iStock)
The experimental medication uses a new form of beta-2 agonist that benefits muscle function while also avoiding overstimulation of the heart, which has been identified as a potential safety concern of older versions.
The findings were published this week in the journal Cell.
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Because the new oral drug acts via a different mechanism than appetite-suppressing medications, it could be used alone or in combination with GLP-1s, the researchers noted.
“Our results point to a future where we can improve metabolic health without losing muscle mass,” said Tore Bengtsson, professor at the Department of Molecular Bioscience at Wenner-Gren Institute, Stockholm University, in the release. “Muscles are important in both type 2 diabetes and obesity, and muscle mass is also directly correlated with life expectancy.”
“Muscles are important in both type 2 diabetes and obesity, and muscle mass is also directly correlated with life expectancy.” (iStock)
This medication has the potential to be of “great importance” for patients with type 2 diabetes and obesity, according to Shane C. Wright, assistant professor at the Department of Physiology and Pharmacology at Karolinska Institutet.
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“Our substance appears to promote healthy weight loss and, in addition, patients do not have to take injections,” he added.
Dr. Trey Wickham, interim chief of the Division of Endocrinology, Diabetes & Metabolism at VCU Health in Richmond, Virginia, was not involved in the study but shared his reaction to the publication in the journal Cell.
“Our results point to a future where we can improve metabolic health without losing muscle mass.”
“This compound’s mechanism of action could address some specific metabolic concerns with previous weight reduction therapies, such as the loss of both muscle and fat tissue,” Wickham told Fox News Digital.
“Although the reported preliminary results are interesting, rigorous testing involving larger longitudinal trials are necessary to ensure human long-term safety and understand the potential role of this compound in the comprehensive, evidence-based treatment of obesity and diabetes.”
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The study had some limitations, the researchers noted, chiefly that the preclinical studies in mice fail to capture the “complex nature of these diseases” in humans.
Structural studies are needed to understand exactly how the drug works.
“This compound’s mechanism of action could address some specific metabolic concerns with previous weight reduction therapies, such as the loss of both muscle and fat tissue,” a doctor said. (iStock)
“Our phase 1 data show that compound 15 is well-tolerated; however, conclusive clinical efficacy data (on how the drug controls glucose metabolism) are currently still lacking.”
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Looking ahead, the company that developed the drug, Atrogi AB, plans to conduct a larger phase 2 clinical trial with a larger, more diverse population, including people with obesity.
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The study was supported in part by the Swedish Research Council, the Swedish Society for Medical Research and the Novo Nordisk Foundation.
Uppsala University, University of Copenhagen, Monash University and University of Queensland all collaborated with the lead researchers.
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