Trump budget eliminates funding for crucial global vaccination programs

Protesters lay mock coffins outside the State Department to demonstrate against cuts to the U.S. President’s Emergency Plan for AIDS Relief, which supplies HIV treatments in developing countries, in Washington, April 17, 2025. The Trump administration’s proposed budget for the coming fiscal year eliminates funding for programs that provide lifesaving vaccines around the world, including immunizations for polio. (Allison Robbert/The New York Times)

By Apoorva Mandavilli

The Trump administration’s proposed budget for the coming fiscal year eliminates funding for programs that provide lifesaving vaccines around the world, including immunizations for polio.

The budget proposal, which cleared the House of Representatives last week, proposes to eliminate the Centers for Disease Control and Prevention’s global health unit, effectively shutting down its $230 million immunization program: $180 million for polio eradication and the rest for measles and other vaccine-preventable diseases. The budget plan also withdraws financial support for Gavi, the international vaccine alliance that purchases vaccines for children in developing countries.

Overall, the budget request explicitly follows President Donald Trump’s “America First” policy, slashing funds for global health programs that fight HIV and malaria, and cutting support altogether to fight diseases that affect only poorer countries.

“The request eliminates funding for programs that do not make Americans safer, such as family planning and reproductive health, neglected tropical diseases, and nonemergency nutrition,” the proposal said.

Many public health experts said that such thinking is flawed because infectious diseases routinely breach borders. The United States is battling multiple measles outbreaks, prompting the CDC last week to warn travelers about the risks of contracting measles. Each of those outbreaks began with a case of measles contracted by an international traveler.

Ultimately, it is up to Congress to determine the budget, and, as in previous years, many of the president’s proposals could be changed or discarded. Lawmakers are only starting to embark on the annual process. The current fiscal year expires at the end of September.

Gavi is in talks with administration officials and members of Congress to try to restore the organization’s funding, according to a spokesperson for the organization.

“I think the world has forgotten those days when graveyards used to be full of graves of children that died of measles, that died of diphtheria, that died of simple infectious diseases,” Dr. Sania Nishtar, Gavi’s CEO, said in an interview. “There is so much at stake.”

Measles, polio and other diseases have resurged around the world, in part because of disruptions to immunization campaigns during the COVID-19 pandemic, as well as misinformation that percolated during the pandemic.

Polio seemed tantalizingly close to eradication a couple of years ago, but new cases have sprung up in dozens of countries this year, including in Papua New Guinea, which was declared polio-free 25 years ago.

An estimated 3.2 million children in the World Health Organization’s Western Pacific Region, which includes Papua New Guinea, did not receive a single dose of vaccine between 2020 and 2023. This year, several countries in the region, including Cambodia, the Philippines and Vietnam, are reporting the highest number of measles cases since 2020, according to the WHO.

The Global Measles and Rubella Laboratory Network, which comprises more than 700 labs in more than 150 countries, is at risk of imminent closure, precipitated by the Trump administration’s decision to stop funding it. So is the WHO’s National Public Health Support Network, which monitors immunization for polio, measles and other diseases in India.

“The U.S. has been extremely generous over many years, and is of course within its rights to decide what it supports, and to what extent,” said Christian Lindmeier, a spokesperson for the WHO.

“But the scale, scope and abrupt nature of the U.S. cuts will lead to more disease and death, and countries have not been able to plan a sufficient transition,” he said. “We hope the U.S. will reconsider and continue their legacy of leadership in global health.”

The polio eradication effort faces a 40% budget deficit in 2026, Dr. Hanan Balkhy, a senior WHO official, told the World Health Assembly in Geneva last month.

“We are at a tipping point,” she said. “Either we invest now to finish the job or risk a global resurgence.”

The Trump administration has also canceled contracts that support local health systems and disease surveillance for malaria, said Martin Edlund, CEO of the advocacy group Malaria No More.

The budget proposes to cut funding for the U.S. President’s Malaria Initiative, a program to fight the disease around the world, by 47%. The proposal leaves flexibility for the State Department to support the Global Fund, which finances the majority of the campaigns worldwide against HIV, malaria and tuberculosis, but says the U.S. should contribute $1 for every $4 from other donors instead of the current $1 for every $2.

Edlund said the change “will undoubtedly have a chilling effect on other donors.”

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which supplies HIV treatments in developing countries, fared somewhat better than expected.

In January, the Trump administration halted disbursement of funds from the program. The State Department later issued waivers to allow treatments to resume but did not restore funding for HIV prevention.

The 2026 budget proposes just under $3 billion for the program, less than half its previous funding. On Tuesday, the Trump administration also asked Congress to approve clawbacks of $9.4 billion from programs, including PEPFAR, that were already authorized for 2025.

PEPFAR is credited with having saved more than 20 million lives since its inception in 2003, and is widely regarded as the most successful global health campaign in history.

A spokesperson for the federal Office of Management and Budget said the president’s proposed budget “prioritizes lifesaving global health activities, including PEPFAR treatment for those on lifesaving medications and global health security to prevent infectious diseases from reaching our homeland, while eliminating programs that do not serve Americans and where other countries and donors should be contributing their fair share.”

She added that the budget eliminates programs that focus on transgender and LGBTQ+ people as well as “programs that have supported abortions.” She did not address questions about immunization programs.

The budget references a “responsible off-ramp” for PEPFAR, aiming to transfer control of HIV programs to recipient countries.

“In effect, the administration is signaling an intent to wind down the most successful U.S. global HIV initiative in history,” said Jirair Ratevosian, who served as chief of staff for PEPFAR during the Biden administration.

He praised the proposal’s embrace of artificial intelligence and long-acting HIV prevention technologies, as well as the explicit call for handoff to countries.

“But these transitions cannot succeed atop weakened or dismantled infrastructure,” he said. Coupled with the deep cuts proposed, “this approach risks hollowing out the very systems needed for a successful handover.”