The Emergency They'll Fund, the Prevention They Won't

When the US pledged $1 billion to UN humanitarian agencies on June 17 and then terminated all PEPFAR funding for South Africa two days later, the two decisions looked like whiplash. They were not. They were the same policy seen from different angles, and the pattern they reveal has now accumulated enough cases to be legible: the US is preserving the emergency humanitarian channels that generate diplomatic leverage while systematically dismantling the preventive health infrastructure that averts emergencies in the first place. The body count is no longer a projection. The Institute of Global Health of Barcelona estimates that the 2025 cuts alone will cause 700,000 excess deaths, with total preventable deaths potentially exceeding 9 million by 2030 ^[1]. The OECD reported a 23.1% drop in global official development assistance in 2025 — the largest annual contraction in its history — with the US driving 75% of the decline through a 57% cut and the dissolution of USAID ^[1].

Wealthy governments are turning their backs on the lives of millions of women, men and children in the Global South with these severe aid cuts. — Oxfam

What the administration has chosen to preserve is revealing. The $3.8 billion in humanitarian contributions this year flows overwhelmingly to food convoys and disaster response — the WFP, UNICEF, and Catholic Relief Services. When earthquakes struck Venezuela in late June, the US led the relief effort with over $300 million and military deployment ^[2]. When Cuba needed aid, Washington offered $100 million — routed through the Catholic Church to bypass the government. These are the channels that produce visible American convoys, grateful headlines, and diplomatic presence in contested regions. What has been dismantled is everything that would have prevented the emergency from occurring. PEPFAR's clinical networks across 41 countries — the largest HIV treatment infrastructure ever built — have been terminated or left to atrophy. The administration stopped spending Congressional appropriations for global family planning, closed rural clinics, and terminated community health workers ^[3]. Marco Rubio made the administration's position explicit.

There's no plan to spend that money. — Marco Rubio

The State Department framed the reproductive health cuts in ideological terms.

We're not going to do it. — Marco Rubio

Meanwhile, Tulsi Gabbard declassified evidence of more than 120 US-funded biolabs across 30-plus countries, and Executive Order 14292 terminated federal funding for global gain-of-function research — dismantling the overseas pathogen surveillance and biosafety infrastructure that served as an early warning system ^[4]. The administration reframed the surveillance network as a cover-up to be exposed rather than a public good to be maintained.

ODNI will continue to work closely with partners across the government to identify where these labs are, what pathogens they contain to end dangerous Gain-of-Function research that threatens the health and wellbeing of the American people and people around the world. — Tulsi Gabbard

The WHO, which coordinates the global disease surveillance the biolabs fed into, is being starved. The US owes $260 million in unpaid dues and has initiated formal withdrawal ^[5]. Tedros Adhanom Ghebreyesus warned of the consequence.

Where there is a vacuum, the virus wins. It’s as simple as that. — Tedros Adhanom Ghebreyesus

The first acute test of what that vacuum produces arrived this spring. The Bundibugyo strain of Ebola began circulating undetected in the Democratic Republic of Congo in March — precisely because the regional testing network that would have caught it early was already gone. By the time WHO declared a Public Health Emergency of International Concern on May 17, the virus had what Tedros called "a big head start." The outbreak has now surpassed 1,000 cases and 223 deaths, spreading into Uganda. WHO explicitly attributed worsening conditions to the US withdrawal and German budget cuts. Only 30% of the aid demand has been met. The US response followed the pattern precisely. Washington deployed Title 42 travel restrictions and secured a Kenya-based isolation facility to treat exposed Americans, prioritizing domestic protection over on-ground containment. It was China that dispatched medical experts and emergency responders to the DRC, invoking what it called a "70-year tradition of standing with African brothers and sisters." The UAE also sent emergency aid — vaccines, medical supplies, and prevention support through Africa CDC. The EU announced a €493 million program for medical support and vaccine research. But the African Union's $518 million response plan has received only 20% of its funding goal, and Africa CDC's Jean Kaseya warned costs could escalate to $7.5 billion if the outbreak is not contained within four weeks. The pattern amounts to a wager: that food, disaster relief, and the visible convoy buy enough goodwill to offset the consequences of dismantling the systems that keep emergencies from happening. The Ebola outbreak suggests the bet has a flaw — the emergencies the dismantled infrastructure was designed to prevent are arriving faster than the replacement channels can respond, and the countries filling the gap are not the United States.