Note: This report provides a detailed overview of executive actions taken by the Trump administration beginning in January 2025. It is updated to reflect the most recent developments as of June 11, 2026.
Since the first day of his second term on January 20, 2025, President Donald Trump has implemented a series of sweeping executive actions that have fundamentally restructured the United States’ approach to global health and international development. Central to this transformation is a commitment to an "America First" foreign policy, which has prioritized the dismantling of established multilateral frameworks, the centralization of foreign aid management, and a stringent redefinition of ideological and social parameters for funding eligibility.
The cumulative effect of these policies has been the dissolution of the United States Agency for International Development (USAID) as an independent entity, the formal withdrawal of the United States from the World Health Organization (WHO), and a pivot toward bilateral health agreements that emphasize "country ownership" over traditional U.S.-led assistance models.
Main Facts: The Pillars of the New Strategy
The administration’s shift is defined by four core operational pillars:
- Institutional Contraction: The absorption of USAID’s functions into the Department of State and the withdrawal from multiple international organizations.
- Ideological Realignment: The implementation of the "Promoting Human Flourishing in Foreign Assistance" (PHFFA) policy, which restricts funding based on stringent definitions of sex and family.
- Fiscal Re-prioritization: An aggressive effort to rescind previous appropriations and reduce foreign aid budgets, shifting focus toward direct service support.
- Legal Confrontation: A persistent clash between the executive branch’s authority to impound funds and the judiciary’s role in protecting congressionally appropriated assistance.
Chronology of Major Policy Actions
The transition began immediately upon the President’s inauguration. Below is a timeline of the most significant developments impacting global health infrastructure.
- January 20, 2025: President Trump issues initial rescissions of Biden-era executive orders, including those related to COVID-19 and global health security. Simultaneously, he initiates the formal withdrawal of the U.S. from the World Health Organization.
- January 24, 2025: The administration reinstates the Mexico City Policy and announces the U.S. will rejoin the Geneva Consensus Declaration.
- February 4, 2025: A directive is issued to review all U.S. participation in international intergovernmental organizations, with specific scrutiny applied to the U.N. Human Rights Council, UNESCO, and UNRWA.
- February 7, 2025: An executive order is issued targeting the Republic of South Africa, halting general foreign aid while creating exceptions for PEPFAR.
- March 10, 2025: Secretary of State Marco Rubio announces that 83% of USAID programs have been cancelled as part of a six-week efficiency review.
- July 1, 2025: USAID is officially dissolved; remaining functions are formally absorbed by the State Department.
- January 7, 2026: The administration announces a formal withdrawal from 66 international organizations, including UNFPA.
- January 22, 2026: The U.S. withdrawal from the WHO becomes legally effective.
- January 27, 2026: The administration releases the PHFFA policy, significantly expanding restrictions on global health funding.
- September 18, 2026: The State Department unveils the "America First Global Health Strategy."
Supporting Data and Institutional Impacts
The Dissolution of USAID
The transition from an independent agency to an integrated division within the State Department represents the most significant organizational change in the history of U.S. foreign aid. Following the March 2025 announcement that 5,200 contracts were being terminated, the agency faced severe legal challenges. Despite court-ordered temporary restraining orders (TROs) meant to protect existing funding, the Supreme Court eventually granted a stay on July 8, 2025, allowing the administration to proceed with massive workforce reductions. By September 2025, the agency had been effectively shuttered, with core functions migrated to the State Department’s "America First" offices.
Funding and Rescissions
The administration has aggressively pursued the rescission of funds. On June 3, 2025, the White House requested that Congress cancel previously appropriated funds for FY2024 and FY2025, including $1.2 billion specifically earmarked for global health. While the judiciary has limited the administration’s ability to unilaterally stop the flow of already-obligated funds, the long-term impact on global health funding remains dependent on congressional appropriations for the upcoming fiscal years.
Official Responses and Diplomatic Consequences
The international reaction to these policy shifts has been polarized. Recipient nations, particularly in the Global South, have expressed alarm at the sudden instability of funding for HIV/AIDS treatment, malaria control, and maternal health.
The government of South Africa issued a formal statement in February 2025 condemning the administration’s "misinformation and propaganda" following the executive order that threatened to halt aid. Conversely, the administration maintains that these moves are necessary to ensure that American taxpayer dollars do not support "ideological agendas" or "duplicative bureaucracies."
Regarding the WHO withdrawal, the U.S. absence was felt acutely at the May 2025 World Health Assembly, where the U.S. declined to participate. The loss of U.S. technical expertise and funding—historically accounting for 16–18% of the WHO’s revenue—has forced a recalibration of global health governance.
Implications for Global Health
The "America First" Global Health Strategy
The strategy released in September 2026 marks the new operational doctrine. It focuses on three pillars: making America safer, stronger, and more prosperous. By transitioning from traditional grant-based support to multi-year bilateral agreements, the U.S. aims to force partner nations into greater "country ownership." While this theoretically reduces reliance on U.S. funding, critics argue it places an undue burden on developing health systems that lack the infrastructure to sustain these programs independently.
Ideological Constraints (PHFFA Policy)
The PHFFA policy, implemented in early 2026, represents a dramatic expansion of the historical Mexico City Policy. It now extends to almost all non-military foreign assistance and includes prohibitions against the promotion of "gender ideology" and "discriminatory equity ideology." For NGOs working on the ground, this has created a complex compliance environment. Organizations must now certify that their non-U.S. funded activities also adhere to these restrictions, leading many to decline U.S. funding to preserve their programmatic independence.
Legal and Constitutional Tensions
The ongoing legal battles, specifically Global Health Council v. Trump and AVAC v. State Department, have highlighted the limits of executive power. While the Supreme Court allowed the administration to proceed with the rescission of $4 billion in aid in September 2025, the lower courts have repeatedly forced the administration to fulfill its obligations on contracts that were active before the January 2025 freeze. These cases have established a precedent that while the President has broad authority over foreign policy, he cannot easily override the Impoundment Control Act or the will of Congress regarding congressionally appropriated funds.
Conclusion
The period between 2025 and 2026 will be recorded as a seminal era in U.S. foreign affairs. By prioritizing national interests over multilateral consensus, the administration has fundamentally altered the landscape of global health. As of mid-2026, the long-term outcomes of these changes—ranging from the efficacy of bilateral health agreements to the durability of the State Department’s new structure—remain the subject of intense debate among policymakers, global health advocates, and the international community. The reliance on bilateral agreements and the stringent ideological requirements for NGOs suggest that the U.S. role in global health will remain leaner, more conditional, and more explicitly tied to domestic political priorities for the foreseeable future.
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