Impact Statement on the Executive Order to Reevaluate and Realign U.S. Foreign Aid in Sub-Saharan Africa

January 28, 2025

Impact Statement on the Executive Order to Reevaluate and Realign U.S. Foreign Aid in Sub-Saharan Africa

Sunil K. Khanna
Director, Center for Global Health
College of Health
Oregon State University

The recent executive order to reevaluate and realign U.S. foreign aid (1), including the discontinuation of work related to USAID and PEPFAR’s AIDS Antiretroviral Therapy (ART) programs, poses serious risks to the health and well-being of millions in sub-Saharan Africa.

These initiatives have been pivotal in combating HIV/AIDS and TB epidemics, and their withdrawal threatens to reverse decades of progress.

Public Health Impact

HIV/AIDS Treatment and Prevention

Since its inception in 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) has provided life-saving anti-retroviral therapy (ART) to millions with funding supporting bilateral programs and U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Termination of this aid jeopardizes treatment continuity, risking a resurgence of AIDS-related illnesses, increased HIV transmission, and collapsing health systems reliant on these programs.

Health System Strengthening

USAID and PEPFAR have fortified health systems through workforce training, supply chain improvements, and disease surveillance. Abrupt withdrawal will create critical gaps in infrastructure and capacity, undermining broader health outcomes.

Economic and Social Impacts

Economic Stability

ART programs boost economic productivity by enabling healthier lives. Without them, economies could suffer reduced workforce participation and strain on fragile economies.

Social Equity

Vulnerable population groups, especially women, children, and marginalized groups disproportionately affected by HIV/AIDS, will face heightened health and social inequities.

Global Health Security

Pausing or discontinuing HIV/AIDS programs threatens global health security by increasing the risk of drug-resistant HIV strains and cross-border disease transmission. HIV’s genetic diversity allows it to evolve rapidly, complicating treatment and control. Without consistent intervention, the situation could spiral into a global health crisis.

Diplomatic Relations

U.S. foreign aid has long been a cornerstone of diplomatic relations and soft power. Halting programs like USAID and PEPFAR risks damaging partnerships with African nations and international allies, reducing cooperation on broader health and development goals.

Conclusion

While realigning foreign aid to maximize efficiency is a laudable goal, pausing or terminating critical programs like PEPFAR’s ART initiatives risks a humanitarian crisis, economic strain, and diminished global standing. Policymakers must explore alternative approaches that preserve these gains while meeting new policy priorities.

1) On the evening of Tuesday, January 28, 2025, the Trump administration announced a waiver for lifesaving medications and medical services to support PEPFAR. However, it is still unclear whether the waiver covers preventive drugs or other services provided by PEPFAR.