INFO MEMO FOR THE USAID ADMINISTRATOR AND DEPUTY ADMINISTRATOR Date: March 4, 2025

To: XXX

From: Nicholas Enrich, Acting Assistant Administrator for Global Health

CC: Assistant to the Administrator Mark Lloyd

Assistant to the Administrator Tim Meisburger

Assistant to the Administrator Ken Jackson

Acting Chief of Staff Joel Borkert

Subject: Risks to U.S. National Security and Public Health: Consequences of  Pausing Global Health Funding for Lifesaving Humanitarian Assistance

Key Takeaway: The temporary pause on foreign aid and delays in approving lifesaving  humanitarian assistance (LHA) for global health will lead to increased death and disability,  accelerate global disease spread, contribute to destabilizing fragile regions, and heightened  security risks—directly endangering American national security, economic stability, and public  health. If the pause leads to permanent contract terminations, the $7.7B in resources  appropriated by Congress are no longer be used to support these lifesaving global health  programs, which could potentially result in wasted resources. The impacts on mortality and  morbidity are summarized in the tables below. While the Foreign Assistance Review is set to  take place in the coming weeks, it is important to recognize that a mechanism-by-mechanism  approach may overlook the broader impact of these programs across global health program  areas. This includes missed opportunities to enhance efficiency and cost-effectiveness within  LHA program areas.

Illustrative quantifiable impacts of halting global health programing on the mortality and  morbidity of lives can be summarized as follows (see full table here):

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Deleted: being

Estimated number of people impacted annually in the absence of global health LHA (see full  table here):

Policy Recommendation: Resume all mechanisms with submitted life-saving waivers to avert  crisis-level expenditures, prevent mortality and morbidity, and protect national security.  Upholding these programs is not only a legal and humanitarian obligation but also a critical  strategic investment to make America safer, more secure, and more prosperous.  

Background

On January 20, 2025, the President issued an executive order mandating a 90-day pause on  most foreign assistance activities to allow for a comprehensive review. Eight days later, on  January 28, Secretary of State Rubio issued a temporary waiver to this pause, as outlined in the  President’s Executive Order on Reevaluating and Realigning United States Foreign Aid (EO),

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allowing lifesaving humanitarian assistance (LHA) activities to proceed. While this temporary  pause is intended to assess and realign foreign aid priorities, delaying approvals for LHA  programs presents serious risks to national security, public health, and decades of progress in  global health. Americans consider it a moral strength to not only protect their fellow citizens  but to also ensure U.S. medical innovations are made available to those less fortunate,  particularly those in extreme poverty. The suspension of essential LHA during this review period  is disrupting a range of critical health services, including maternal and child health and nutrition  programs, malaria and tuberculosis treatment, and polio eradication efforts. Additionally, the  canceling of critical contracts, prevents the ability to respond to the most pressing and urgent  life-threatening challenges in the near-term.

As a result of the pause and programming delays, millions of individuals now face heightened  risks of preventable diseases such as malaria, HIV/AIDS, TB, and multidrug-resistant  tuberculosis (MDR-TB). Furthermore, setbacks in maternal and child health and nutrition  initiatives threaten overall health outcomes in affected regions. Beyond the immediate  consequences, these disruptions weaken critical disease surveillance and health supply chain  systems, increasing the likelihood of unchecked outbreaks of emerging infectious diseases such  as avian influenza, Ebola, and mpox—threats that can spread globally and endanger American  citizens.  

Historical data demonstrate that reductions in funding for global health initiatives and lifesaving  health programming correlate with surges in disease incidence, reinforcing the urgency of  sustained support for these programs to protect both global stability and domestic security. A  failure to contain infectious diseases at their source heightens the risk of transmission to the  United States, posing a direct threat to public health and economic stability. The consequences  extend beyond human health, impacting American businesses and families by increasing  healthcare costs, disrupting international trade, and straining domestic resources.

This memorandum outlines the critical consequences of withholding global health funding for  LHA activities, emphasizing how this decision undermines the congressionally mandated efforts  of USAID and jeopardizes American security by allowing preventable diseases to spread  unchecked. USAID’s Congressional legislative mandate per foreign assistance law and current  funding status can be found in the Annex 1 of this memorandum.  

Impact of Terminating Lifesaving Humanitarian Aid (LHA) Awards in Global Health

While we are currently in a 90-day review period regarding lifesaving humanitarian aid (LHA)  awards, this section outlines the potential consequences should all LHA activities be  permanently suspended. Such a suspension is expected to deteriorate public health outcomes

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both domestically and globally, burden the U.S. economy and healthcare system, and escalate  national security risks, including increased vulnerability to biothreats

Deterioration of American Public Health and Increased Global Mortality Key Impact 1: Resurgence of preventable diseases: Domestic and global implications.

● Halted interventions and treatments fuel the rise of preventable diseases: The  suspension of critical global health funding for lifesaving humanitarian assistance  threatens not just global health but also the well-being of American communities.  Without essential services—such as antiretroviral treatments, malaria prevention,  routine immunization, and tuberculosis control—preventable diseases like HIV/AIDS,  malaria, TB/MDR-TB, measles, diphtheria, pertussis and others will surge, undoing years  of progress. As outbreaks spread unchecked, the consequences will extend beyond  borders, increasing the risk of infections reaching the U.S., straining healthcare systems,  and endangering American lives.  

○ A systematic review of malaria resurgence events in 61 countries between the  1930s and 2000s, indicated 91% were due to a weakening of malaria control  programs of which resource constraints contributed to over half of these1.  Following the end of the 14-year Global Malaria Eradication Program in 1969,  there was a global resurgence of the disease during the 1970s and 1980s2.

● Resurgence of MDR-TB: A growing American public health threat: Tuberculosis  programs worldwide keep drug-resistant TB in check. If these efforts collapse, the U.S.  will see more cases of hard-to-treat TB arriving at its doorstep. Treating one patient with  multidrug-resistant TB (MDR-TB) in the U.S. costs over $154,000 (and an average  $494,000 for an extensively drug-resistant TB case)3. Without timely and effective  treatment, multidrug-resistant tuberculosis (MDR-TB) cases will surge, posing a direct  threat to both American and global public health. As international travel and migration  increase, uncontrolled MDR-TB outbreaks abroad heighten the risk of transmission to  the U.S., where containment efforts would require significant federal and state funding.  The escalating burden of MDR-TB will not only drive up healthcare costs but also  endanger frontline workers, making prevention and early intervention an urgent  national priority.

● Prevention Is More Cost-Effective Than Emergency Funding of Programs: The 2014–16  Ebola outbreak cost the U.S. approximately $4.3 billion in response efforts, highlighting  

1 Institute for Health Metrics and Evaluation. https://www.healthdata.org/research-analysis/library/malaria-resurgence systematic-review-and-assessment-its-causes 2 https://www.ncbi.nlm.nih.gov/books/NBK525190/ 3https://www.csis.org/analysis/protecting-united-states-health-security-risk-global

tuberculosis#:~:text=Treatment%20of%20a%20typical%20patient,of%20XDR%2DTB%20costs%20$494%2C000.4

that reactive spending far exceeds proactive prevention costs. The COVID-19 pandemic  further underscored how unplanned emergency spending can lead to trillions in  economic losses. USAID-funded programs have historically curbed disease spread,  saving lives and billions in economic costs. For example, immunization is among the  most cost effective interventions in public health, saving an estimated 2-3 million deaths  each year; for every dollar invested in immunization, up to $52 ROI is generated from  saved costs of treating illnesses4. Sustaining these programs is crucial to avoiding costly,  reactive crisis management. There is a $94 return in economic growth for every $1  spent on maternal and child health-specific foreign aid due to deaths prevented and  improvements in the health status of populations in poor countries.

● Reduced disease surveillance and undetected outbreaks: Cuts in humanitarian  assistance compromise surveillance systems essential for early detection of emerging  infectious diseases. The diminished capacity to monitor and respond swiftly enables the  unchecked spread of deadly outbreaks such as avian influenza and mpox. This lack of  surveillance risks turning localized outbreaks into widespread public health  emergencies, further endangering both local populations and global health security.

Key Impact 2: Humanitarian and regional instability fueled by worsening health crises.

● Increased instability in fragile states through disease outbreaks: Weak governance and  poor infrastructure leave fragile states highly vulnerable to disease outbreaks, which can  quickly escalate crises. In the Democratic Republic of Congo (DRC), ongoing violence and  an aid cutoff have led to the collapse of health services, worsening malnutrition and  

cholera and measles outbreaks. Over 400 mpox patients were left stranded after fleeing  overwhelmed clinics, while more than one million displaced people around Goma—and  another 150,000 near Bukavu—face critical shortages of shelter, clean water, and  medical care. In Burkina Faso, where 100% of the 23 million total population is at risk for  malaria, “30 percent of health care facilities were either partially or fully non-functional  due to frequent attacks on facilities and equipment, medical personnel, and medication  shortages, adversely affecting 4 million people5.” Additionally, in FY2024 over 34 million  seasonal malaria chemoprevention doses were procured with PMI/USAID funds to  protect children under five in three Sahel countries (Burkina Faso, Mali and Niger); these  vulnerable children are now at greater risk with the high transmission malaria season  rapidly approaching. In such conditions, the risk of a new pandemic looms large. From  the Sahel to South Asia, cutting off health aid in fragile states threatens to turn crises  into full-scale humanitarian disasters.  

4 https://immunizationevidence.org/immunization_terms/return-on-investment/ 5 https://reliefweb.int/report/burkina-faso/burkina-faso-complex-emergency-fact-sheet-1-fiscal-year-fy-20245

● Amplification of migration pressures and regional destabilization: Failing public health  systems fuel migration crises, forcing people to flee when they can no longer access  food, medicine, or basic security. Collapsing healthcare infrastructure not only displaces  populations but also spreads disease across borders. This was evident in Venezuela in  the late 2010s, where a breakdown of the health system—alongside economic  collapse—led to resurgences of measles, diphtheria, and malaria, driving millions to flee  and triggering a regional refugee crisis. The spread of Venezuela’s measles outbreak into  neighboring countries underscored the direct link between public health failures and  migration. More recently, the COVID-19 pandemic and its economic fallout intensified  migration pressures in Central America, particularly in Guatemala, Honduras, and El  Salvador, where overwhelmed healthcare systems and food insecurity forced many to  seek refuge in the U.S. Similarly, the ongoing conflict and health crises in Haiti—where  gang violence has crippled hospitals and cholera has resurged—have led to a surge in  migration to the U.S. and neighboring countries. As public health crises worsen,  migration pressures will continue to rise, contributing to regional instability and  humanitarian challenges. (citations documented)

Key Impact 3: Greater risk of disease spillover to the U.S.

● A halt to global health aid programs increases the risk of dangerous diseases reaching  the U.S.: In a globally connected world, outbreaks abroad don’t stay overseas. When  public health systems fail to contain infectious diseases, the chances of U.S. exposure  rise—whether through travel, military personnel, or migration. Measles outbreaks in  the U.S. in the past decade, for example, have often been traced to imported cases, as  the disease was eliminated domestically. In 2023, the U.S. saw its first locally acquired  malaria cases in 20 years, likely due to travelers introducing the parasite into mosquito prone states like Florida and Texas6. 76% of US recorded TB cases annually are among  foreign born individuals.  

● Uncontrolled epidemics abroad could trigger serious outbreaks in America:  Mathematical models illustrate this risk. For example, if global TB rates and drug  resistance reached U.S. levels due to failed international control efforts, the  consequences would be severe—over 33,000 TB deaths annually and treatment costs  exceeding $11 billion7.

Economic and Healthcare System Strain

Key Point 1: Costs of responding to outbreaks far exceed prevention investments.

6 beatmalaria.org

7 cgdev.org

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● Outbreak response costs dwarf prevention investments: Historical data underscores  that reactive spending on disease outbreaks significantly exceeds the costs of proactive  prevention. For example, the U.S. response to the 2014-16 Ebola outbreak reached  approximately $4.3 billion8, covering direct healthcare expenditures and extensive  economic disruptions from emergency measures and loss of productivity. If the U.S.  elects not to provide aid for future outbreaks abroad, larger and less-contained  epidemics may develop, ultimately necessitating even more costly domestic responses.  This approach risks disrupting global trade, supply chains, and market stability,  ultimately imposing far greater economic burdens on the U.S. than if robust prevention  and early intervention measures had been maintained.

● Unchecked pandemics trigger profound economic fallout: The COVID-19 crisis vividly  illustrated how insufficient preventive measures can precipitate widespread economic  damage. Beyond overwhelming healthcare systems, the pandemic disrupted global  supply chains, destabilized labor markets, and led to substantial declines in economic  output. These impacts highlight the critical need for robust global health investments as  a means of averting far greater future costs.

Key Point 2: Strain on U.S. healthcare infrastructure due to imported infectious disease cases.

● Collapse of disease surveillance leads to more importations: Global health programs  fund disease surveillance networks that act as an early warning system for outbreaks. If  these networks falter, the U.S. will frequently be flying blind until diseases show up at its  own border. That scenario is a recipe for more imported outbreaks on U.S. soil. For  instance, the quick detection and containment of Ebola in West Africa is what kept the  2014 outbreak from becoming a larger U.S. crisis. Even so, the few Ebola cases that did  reach America illustrated the heavy burden of managing dangerous contagions: a single  Ebola patient in New York in 2014 cost the city health department $4.3 million in  response measures (contact tracing, specialized treatment, etc.), and no secondary  cases occurred9. If global surveillance and response capacity erode, the U.S. could face  multiple such cases or simultaneous threats (e.g. Ebola, drug-resistant malaria, novel  coronaviruses). American hospitals and the public health system would be stretched by  needs like isolation units, specialized diagnostics, and round-the-clock epidemiological  investigations.  

● Maternal Health Emergencies and Medical Supply Shocks: USAID programs have been  pivotal in supporting maternal and neonatal care in low-income countries – from  training midwives to supplying essential medicines (like oxytocin for hemorrhage or  

8 yalejournal.org

9 cdc.gov

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magnesium sulfate for eclampsia). A permanent aid halt means many of these supply  chains and services will collapse10. The ripple effects can reach the U.S. in unexpected  ways. For example, global supply disruptions during COVID-19 led to shortages of  medical products in America; similarly, a breakdown in the international supply of  maternal health commodities could affect availability of critical drugs or equipment  domestically. Moreover, when maternal health crises escalate abroad, there can be  secondary impacts such as increased medical evacuation cases, migration of high-risk  patients, or calls on U.S. humanitarian responders, all of which ultimately put pressure  on U.S. hospitals.  

Key Point 3: Global economic repercussions impacting U.S. trade and markets.

● Reduced productivity in key trade regions due to heightened disease burdens: Diseases like malaria, HIV, and TB primarily strike working-age adults or their children,  impairing productivity and economic output in Africa, Asia, and beyond. For example,  malaria costs Africa an estimated $12 billion per year in lost GDP from worker  

absenteeism, lower productivity, and healthcare expenses11. Every $1 invested in malaria  control returns $19 in economic growth.12 Unchecked high rates of maternal and childhood  morbidity or mortality can further exacerbate impacts on productivity. Undernutrition  can reduce a nation’s GDP by as much as 16.5 percent13, as malnourished children  perform worse in school and experience productivity losses as adults. Maternal and  child health and nutrition foreign assistance makes America stronger by creating greater  economic and political stability through improved family health, which increases the  likelihood that children will attend school and grow into healthy, productive adults,  thereby reducing conflicts, poverty, and radicalization of youth. Instability abroad risks  affecting Americans - be it on our soil or by destabilizing markets from afar.14,15 Lower  

10 reuters.com

11 archive.cdc.gov 12 https://endmalaria2040.org/assets/Aspiration-to-Action-Dashboard.pdf 13 Union, A. (2014). The cost of hunger in Africa: Social and economic impact of child undernutrition in Egypt, Ethiopia,  Swaziland and Uganda background paper. Abuja, Nigeria. https://archive.uneca.org/sites/default/files/uploaded documents/CoM/com2014/com2014-the_cost_of_hunger-english.pdf 14 Each additional year of schooling can boost a girl’s earnings as an adult by up to 20 per cent -

https://www.unwomen.org/sites/default/files/2022-09/Progress-on-the-sustainable-development-goals-the-gender-snapshot 2022-en_0.pdf

More girls in school = greater GDP: If 10 percent more adolescent girls attend school, a country’s GDP increases by an average  of 3 percent.

More school for girls = greater earnings: An extra year of secondary school for girls can increase their future earnings by 10- 20%.

Education = more lives saved: A child whose mother can read is 50 percent more likely to live past age five. 15 “First, a 10 per cent increase in health expenditures boosts annual average real GDP per capita by 0.24 per cent. This is an  economically meaningful result, given the average annual growth rate in the sample period of 2 per cent. Second, this paper  also confirms the long-held view that health matters for economic growth. There is a statistically significant and economically

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productivity in these regions weakens their economic output and trade capacity,  thereby diminishing their ability to import U.S. goods and services. This contraction in  trade not only limits market opportunities for U.S. businesses but also undermines the  economic resilience of global supply networks that support U.S. markets.

● Reduced partnerships with American farmers: Through USAID’s humanitarian  assistance and nutrition programs, the U.S. engages American farmers and  manufacturers in the delivery of commodities as part of food aid for food security and  treatment of acute malnutrition in children16. Although USAID food aid programs  account for less than 1% of current U.S. agricultural exports, they have historically  provided American farmers and manufacturers with a stable $2 billion market17,  supporting an estimated 15,000–20,000 jobs. Permanently suspending these programs  would likely reduce commodity prices, lower farm incomes, and trigger layoffs across  food processing, manufacturing, and transportation sectors—ultimately weakening the  global competitiveness of U.S. agriculture.

● Global supply chain disruptions: A strong global health system is essential for  maintaining stable global trade. The COVID-19 pandemic vividly illustrated how health  crises can cripple supply chains—factory shutdowns, travel restrictions, and worker  illnesses in one region can quickly trigger shortages and price spikes worldwide. If U.S.- funded health programs that prevent outbreaks and strengthen health systems are  halted, developing regions will face greater instability, increasing the risk of production  disruptions. Key sectors of the U.S. economy remain vulnerable to such shocks. For  example, a significant portion of pharmaceuticals and medical supplies—including  generic drugs and personal protective equipment (PPE)—are manufactured in India,  China, and other global hubs. A major epidemic in these regions could halt production,  causing shortages that directly impact U.S. hospitals and pharmacies. Likewise, global  health emergencies threaten agriculture and food supply chains; pandemic lockdowns in  2020 disrupted food processing and shipping worldwide, underscoring the far-reaching  economic consequences of health crises18.

● Weakened Trade Partners and Global Markets: Over the longer term, the cumulative  impact of widespread disease and reduced human capital in low- and middle-income  countries will undermine global economic growth. America’s prosperity is deeply  intertwined with global markets – U.S. companies invest in and source from these  countries, and emerging economies constitute important consumer bases. If those  economies are continuously set back by health disasters, the global GDP will be smaller  

meaningful negative relationship between economic growth on the one hand and maternal and infant/child mortality on the  other hand. There is also a positive and significant impact of adult life expectancy on economic growth.” Source 16 How the United States Benefits from Agriculture and Food Security Investments in Developing Countries 17 Betterworldcampaign.org 18 pmc.ncbi.nlm.nih.gov

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than it otherwise would be, acting as a brake on U.S. growth as well. Moreover, health driven economic stresses can fuel political instability and conflict, which threaten U.S.  interests. Indeed, abrupt surges in unemployment, poverty, food insecurity, and illness  can spark unrest or migration waves, destabilizing regions. Such instability often  demands U.S. humanitarian, diplomatic, or even military responses, all of which carry  significant costs. In contrast, stable and healthy nations make good trade partners and  contribute to a stable international system that benefits the U.S. economically. By  preventing the collapse of health systems abroad, USAID programs help countries  remain stable, keep their economies functioning, and continue trading with the United  States.

National Security and Biothreat Vulnerabilities

Key Point 1: Increased risk of bioterrorism and pandemic emergence.

● Diminished surveillance increases vulnerability to undetected pathogen spread: Weakened disease surveillance doesn’t only jeopardize natural outbreak detection – it  also creates openings for malicious actors. Global health monitoring systems serve as  the “smoke alarm” for unusual disease patterns that could signal a bioterrorism event. If  those alarms are switched off or muted due to lack of funding, a deliberate release of a  pathogen could spread for weeks under the guise of a normal outbreak. Terrorists or  rogue states might exploit surveillance gaps, targeting regions with poor monitoring to  launch a biological attack, knowing it would take longer for the world to notice and  respond. Indeed, the very technologies to engineer pathogens have become more  accessible over time, lowering the bar for would-be bioterrorists (better citation?  citation).

● National Security Impacts: Pandemics and biological threats don’t respect borders, and  their consequences extend beyond public health – they are national security concerns.  An undetected pathogen can undermine military readiness, as disease spreads among  troops or across bases before protective measures are in place. Widespread illness can  also weaken domestic security forces and first responders, who fall ill in the line of duty.  Moreover, adversaries could use a biological event to sow chaos: a sudden epidemic can  destabilize economies, foment social unrest, and even be used as cover for  disinformation or cyber attacks. The U.S. Department of Defense and intelligence  community routinely list pandemic disease among top security threats, alongside  bioterrorism, for these reasons. A collapse in global disease surveillance heightens these  risks, as threats will be harder to see coming. As a recent analysis by global health  experts warned, actions that “undermine work to detect and contain disease outbreaks”

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could quickly “roll back years of progress” and “put lives, the economy, and national  security at risk19.”

Quantified Impacts of Discontinued Aid by Disease Area - 2025

19 cgdev.org

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12

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Estimated number of people impacted annually in the absence of global health LHA 2025

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Conclusion and Policy Recommendations

Any decision to halt or significantly reduce global health funding for lifesaving humanitarian  assistance (LHA)—despite approved waivers—and USAID global health programming, despite  congressional mandates, would have severe domestic and global consequences. Such an action  could lead to a sharp increase in preventable diseases, substantial economic losses, and  heightened security risks. The effects would be felt both in the United States and worldwide, as  rising disease burdens strain healthcare systems, disrupt economies, and contribute to global  instability.

We recommend that the U.S. immediately resume life-saving humanitarian activities to prevent  unnecessary mortality and morbidity, avert costly crisis-level expenditures, and safeguard  national security. These programs are not only a legal and humanitarian obligation but also a  vital strategic investment in America’s safety, security, and economic prosperity. Failing to  uphold them would undermine U.S. leadership, weaken global stability, and increase long-term  costs.

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Annex 1

Congressional Legislative Mandate

USAID operates under a comprehensive legal framework established by Congress to govern its  global health assistance programs. This framework consists of both authorization and  appropriation legislation, which define the agency’s legal authorities, funding allocations, and  programmatic requirements. The following sections outline the key legislative mandates  shaping USAID’s global health initiatives.

Authorization Legislation: USAID’s global health assistance is primarily authorized under  Section 104 of the Foreign Assistance Act of 1961 (FAA), as amended. Key amendments  include the 2000 Global AIDS and Tuberculosis Relief Act and the United States Leadership  Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (PEPFAR Authorization), with  subsequent reauthorizations in 2008, 2013, and 2018. Additionally, the annual State and  Foreign Operations Appropriations Act (SFOAA) provides more specific authorizations and  requirements for health assistance. Other relevant legislation includes the Global Malnutrition  Prevention and Treatment Act of 2021 and various FAA provisions outside Section 104 that  address global health programs. Furthermore, the annual SFOAA and select provisions of  other legislation, such as the National Defense Authorization Act, define and grant additional  legal authorities for USAID’s global health efforts.

Appropriation Legislation: Funding for USAID’s global health programs is appropriated  annually through the SFOAA, which imposes specific legal requirements that must be met  each fiscal year. USAID is not authorized to deviate from these funding allocations except in  rare, exigent circumstances and only with statutory approvals and notifications. Additionally,  certain Congressionally mandated disease-specific directives may not be fulfilled due to the  termination of awards.  

Congressional Directive Categories20:

● HIV/AIDS, which includes the following sub-activities identified by Congress:  Global  

● Fund to Fight AIDS, Tuberculosis and Malaria, Joint United Nations Programme on  HIV/AIDS (UNAIDS), and Microbicides. Associated Program Area: HL.1 HIV/AIDS.  $330M appropriated for this purpose in FY24 alone.

● Tuberculosis, which includes the following activities identified by Congress: Global  TB Drug Facility. Associated Program Area: HL.2 Tuberculosis. $394.5M  

20 Congressional directive categories are outlined in the Global Health Programs account table included in the Joint Explanatory Statement accompanying each annual appropriations act. For example, for the Department of State, Foreign Operations, and  Related Programs Appropriations Act, 2024, P.L.118-47, Division F, the Joint Explanatory Statement is available at  https://docs.house.gov/billsthisweek/20240318/Division%20F%20SFOPs.pdf.

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appropriated for this purpose in FY24 alone.

● Malaria, Associated Program Area: HL.3 Malaria. $795M appropriated for this  purpose in FY24 alone.

● Global Health Security, Associated Program Area: HL.4 Global Health Security in  Development (GHSD) $700M appropriated for this purpose in FY24 alone.

● Other Public Health Threats, which includes the following sub-activities identified  by Congress: Neglected Tropical Diseases, Global Health Workforce, Health  Reserve Fund. Associated Program Area: HL.5 Other Public Health Threats (NTDs).  $130.5M appropriated for this purpose in FY24 alone.

● Maternal and Child Health (MCH), which includes the following activities  identified by Congress: Polio, Gavi, the Vaccine Alliance (Gavi), Water Supply,  Sanitation and Hygiene (WASH), and Maternal and Neonatal Tetanus. Associated  Program Area: HL.6 Maternal and Child Health. $915M appropriated for this  purpose in FY24 alone.

● Family Planning/Reproductive Health.

Associated Program Area: HL.7 Family Planning and Reproductive Health  (FP/RH). $523.95M appropriated for this purpose in FY24 alone.

● Nutrition, which includes the following activities identified by Congress: Iodine  Deficiency Disorder, Micronutrients (of which, Vitamin A), and Ready-to-Use  Therapeutic Foods. Associated Program Area: HL.9 Nutrition. $165M  

appropriated for this purpose in FY24 alone.

● Vulnerable Children, which includes the following activity identified by Congress:  Blind Children. Associated Program Area: ES.4.1 Education & Social Services - Vulnerable Children. $31.5M appropriated for this purpose in FY24 alone.

Funding Status21 

Of the $3.985B in Fiscal Year 2024 resources appropriated directly to USAID for Global Health  Programs (GHP-USAID account) for the specific health objectives described above,  approximately $2.559B (64%) has been blocked from obligation to partners.

Estimated Amounts of FY24 GHP-USAID Funding Impacted by Obligation Pause, by  Congressionally Directed Program Area

21 Funding data pulled from Phoenix Viewer/Enterprise Reporting Portal as of 2/27/2025. All figures are estimates based on  high level data analysis.

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Notes: These figures are likely underestimates of the amounts planned but with obligation paused from moving to implementing partners, as they do not account for funds bilaterally obligated into a USAID Mission Development  Objective Agreement, which are no longer able to be subobligated to partners. FY24 funds are the most recent year  of health resources available to USAID, as no FY25 GHP-USAID resources have yet been appropriated, and the  Agency has not sought access to any of these resources under the current Continuing Resolution. All GHP-USAID  resources from appropriation years prior to FY24 were 100% obligated in advance of their expiration.

Of the total GHP-USAID resources appropriated directly to USAID from all fiscal years, at least  $5.143B is currently obligated to implementing partners but not yet expended/disbursed – this  total (100%) has been suspended as a result of the foreign assistance pause and related  terminations from further use towards the specific health objectives mandated by Congress and  described above.

Estimated Amounts of Previously Obligated GHP-USAID Funding (All FYs) Paused from  Expenditure/Disbursement, by Congressionally Directed Program Area

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Notes: The figures above reflect total amounts of currently unexpended/undisbursed Global Health funding obligated to implementing partners. Virtually all expenditures, disbursements, and payments to partners have been  halted due to lack of essential staff, lack of systems access, and foreign assistance review processes superimposed  over regular procedures, impacting this full total. The total estimated amount of Global Health funds obligated to  implementing partners from all fiscal years according to Phoenix data as of 2/27/2025 is $76,327,410,581. The  ~$5.1B pending expenditure/disbursement represents 6.7 percent of these total obligations.

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