What to Know About the Shift in U.S. Global Health Funding
- May 14
- 3 min read
“Economic and social inequity damages the moral fabric of societies and weakens democratic governments. People should act freely to implement measures that promote equality of opportunity for their fellow human beings.”
As citizens of an interconnected world, the quality of our co-existence depends on others we will never meet. Global health is one example of this. A respiratory illness contracted in Topeka, Kansas, might spread to Dublin, Ireland, from one family vacation. Different levels of access to healthcare create inequities, such as in Afghanistan, where people still suffer from polio, a disease long ago eradicated in the U.S. and elsewhere. These connections to one another and discrepancies in care warrant an effective global health system.
Most Americans are surprised to learn that although the U.S. spends more money on foreign aid than any other country, only 1% of the federal budget goes to other countries. And only a fraction of that 1% funnels to global health. Global health funding reaches individuals and families in two ways: through bilateral agreements, between two nations, and multilateral agreements, between several nations or partners. The U.S. has participated in both types of programs, using a hybrid approach to assist other countries and work toward a healthier global population.
However, a trend away from multilateral programs began in 2025 with the second Trump administration’s dissolution of the U.S. Agency for International Development (USAID). Instead, the government is entering into separate bilateral agreements, called memorandums of understanding (MOUs), to address health issues on a case-by-case, or country-by-country basis.
Examples of partnerships with other nations
Bilateral: The President’s Emergency Plan for AIDS Relief (PEPFAR) assists individual countries with treatment utilizing separate agreements specific to each country’s needs. As of 2025, PEPFAR was credited for saving 26 million lives. The U.S. continues to fund PEPFAR and other global health programs, though with decreased funding and without the standard five-year renewal cycle.
Other examples of bilateral models include the 27 MOUs between the U.S. and other countries, and the President’s Malaria Initiative (PMI).
Multilateral: Previously, the U.S. was a founding member and joined other “member states” or countries to form the World Health Organization (WHO). With 193 members, WHO contributes globally to major disease prevention and eradication and is credited for completely eradicating smallpox by 1980. The U.S. withdrew from WHO on January 22, 2025, ending a collaboration that began in 1948.
Other examples of multilateral approaches include Gavi, UNICEF, and the Global Fund.
Comparing U.S. global health programs
Factors | Bilateral | Multilateral |
|---|---|---|
Number of governments | U.S. negotiates with one country in need | Three or more countries support at least one country’s needs |
2025 share of total U.S. funds for global health | ||
Funding stream | U.S. funds go directly to receiving country | U.S. and country partners fund an international agency that manages and distributes funds inside receiving country or countries |
Political impact | Helps shape foreign policy and guide diplomacy between U.S. and receiving nation | Sets global expectations and standards |
Health impact | Target country directly benefits | Many countries benefit directly, and overall global health indirectly |
Decision makers | U.S. controls much of planning, implementation, and spending | Shared control with other countries and agencies |
Accountability | Receiving country | Shared across agencies and governments |
Flexibility | High flexibility due to ongoing cooperation between two governments | Lower flexibility due to number of stakeholders |
Coordination | Challenging due to separate agreements between the U.S. and many individual countries | Successful due to pre-determined collaborative efforts |
Speed | Relatively rapid response once an agreement is reached | Takes years to develop from legislation to implementation |
The bottom line
Ultimately, both bilateral and multilateral approaches offer distinct strengths that allow them to be utilized most effectively under different circumstances. Bilateral programs allow for tailored, flexible responses that reflect the specific needs and priorities of a country, while multilateral efforts enable broader coordination, shared resources, and large-scale impact across regions and populations.
These approaches are not competing alternatives, rather effective partners that when used together can leverage the responsiveness of one with the reach and coordination of the other. This combination strengthens the ability of the United States and other nations to address global health challenges in a comprehensive and effective way.
This article was written by Sherilyn Stevenson, lead researcher and writer for Mormon Women for Ethical Government, and Jill Fairholm, family health and well-being specialist for Mormon Women for Ethical Government.
