The Trump administration has permitted the resumption of a range of global health initiatives despite its ongoing foreign aid freeze, offering a boost to programs targeting scourges like malaria and tuberculosis.
In a memo dated Tuesday and obtained by STAT, a USAID official said the agency is “taking steps to resume or continue activities deemed to be lifesaving humanitarian assistance.”
It’s unclear, however, how quickly the money will start flowing again. Much of the U.S. support for these health initiatives goes through USAID and relies on its staff and contractors, and the administration has been moving to slash the agency’s staff and ordering people working abroad to return to the U.S. (Friday afternoon federal judge Carl Nichols said he would temporarily block plans to put some 2,200 employees on paid leave and to recall nearly all agency workers posted abroad.)
The U.S.’s widely heralded HIV/AIDS initiative known as PEPFAR has also received a waiver allowing some of its work to resume, but some groups that rely on the program are reportedly still not getting funding.
In the memo, the USAID official, Nicholas Enrich, wrote that services that go to addressing childhood and maternal mortality and those focused on preventing and treating malaria and tuberculosis should restart within 30 days. It also says that the U.S. should resume emergency responses to infectious disease outbreaks, such as mpox and Ebola.
In a statement, Martin Edlund, the CEO of the group Malaria No More, said the waiver “is an important step toward getting malaria medicines to millions of people who urgently need them — mostly young children and pregnant women — across sub-Saharan Africa,” and added that “we urge the State Department to communicate a start-work order to all programs.”
When President Trump was inaugurated last month, in addition to halting foreign aid for 90 days so it could be reviewed, his administration issued a stop-work order to groups that relied on that funding, meaning that work supported by existing funding had to be paused as well. Organizations could not distribute U.S.-supported medicines or bed nets, even if they were sitting at a clinic.
Within days, and amid a global uproar, the State Department issued a waiver permitting programs that provided lifesaving medical services and food aid to continue. But advocates and aid experts said the update was issued in such a vague and slapdash way that it was difficult to know what was allowed and what was not. The department clarified days later that HIV testing and treatment work was included under that waiver. (It did not extend to most HIV prevention efforts, except for pregnant and breastfeeding women.)
Groups focused on other disease areas have spent recent days making the case that other programs needed to be maintained as well or else there could be dire consequences.
In the case of malaria, the U.S. has contributed over a third of global funding for malaria control programs over the past 15 years. Much of it is spent through the President’s Malaria Initiative, a program that, like PEPFAR, was started by the George W. Bush administration.
The U.S. provides technical support to countries in Africa and Asia trying to counter the mosquito-borne parasite. It pays for insecticide-treated bed nets and mosquito spraying, two key prevention methods. It covers the cost of rapid diagnostics and treatments, as well as the drugs that are given to kids during peak transmission periods to protect them from infection. It enables community health worker training and the surveillance of mosquitoes and the parasite itself to see if they are developing resistance to insecticides and medicines.
Surely that counted as lifesaving medical care under the waiver, advocates contended.
“If the administration sees value in the HIV program, then hopefully they see value in the incredible success of the President’s Malaria Initiative, and we can make sure all these incredible gains we’ve had up until this time we don’t lose,” Bernard Nahlen, who was deputy coordinator of the PMI from 2007 to 2017, told STAT ahead of the news that the waiver extended to malaria programs. Nahlen is now the director of the University of Notre Dame’s Eck Institute for Global Health.
Roughly $4 billion was spent globally on malaria control and elimination in 2023. The disease still kills about 600,000 people a year, mostly young children in sub-Saharan Africa.
Even a brief pause in malaria control efforts can lead to a spike in infections, research has shown. And in regions where there is seasonal transmission of the parasite (some areas have year-round circulation), measures have to be implemented at precise times if they are going to be effective. Researchers worried that the freeze meant that children would have to go through a malaria season without the preventative drugs that have proven so effective.
“We’re going to backslide significantly if this isn’t restored — the money, the contracts, the people, all of it,” said Allison Tatarsky, the director of the Malaria Elimination Initiative at the University of California, San Francisco.
Malaria No More estimated that a 90-day freeze would prevent the delivery of 15.6 million doses of medicines that treat malaria infections, 9 million bed nets, 25.3 million diagnostic tests, and 48 million doses of the preventative drugs.
Experts say that the fight against malaria needs all the support it can get at this moment. The progress that the world has made in cutting deaths has stagnated in recent years. There are also new tools, including the world’s first malaria vaccines, that are starting to roll out and that advocates hope can help protect the most vulnerable kids from the disease.
With the clarification on the waiver, aid groups will now look to see how quickly the money starts flowing again, and how quickly the paused work can resume. Some groups may have laid off staff, and it’s not clear how the turmoil at USAID will affect the ability of organizations to procure and deliver supplies. The fear is that the infrastructure that’s been built up over 20 years could already be teetering.
“Let’s assume that at the end of this 90-day review, things can suddenly come back online,” Nahlen said, speaking before the announcement about the waiver. “I can assure you it’s not going to be easy to rebuild that.”