SACHA PFEIFFER, HOST:
Some of the money that Congress has allocated that the Trump administration has not spent yet is for international health and development aid. NPR's Fatma Tanis covers global health and development, and she's here to tell us more. Hi, Fatma.
FATMA TANIS, BYLINE: Hi, Sacha.
PFEIFFER: How much overall did Congress allocate for global health this year?
TANIS: So more than 9 billion taxpayer dollars were earmarked for health programs all around the world. It's just a fraction of the overall health budget. But what's remarkable about it is that in 2025, the Trump administration slashed billions in global health funds. And then Congress came back the next year and set the budget at pretty much the same level with only about a 6% reduction. It appeared to be a clear message that there's bipartisan support for global health funding, but there's still about 1.3 billion that the administration hasn't spent.
PFEIFFER: And that 1.3 billion in unspent money, what was it intended for?
TANIS: For treatments and prevention for HIV and malaria and maternal and child health programs. Last week, Republican Senator Susan Collins from Maine wrote a letter to senior administration officials urging them to spend that money as it was intended before it expires on September 30. Stephen Morrison with the Center for Strategic and International Studies says this is part of the White House strategy.
STEPHEN MORRISON: They clearly want to continue to chip away at the authority of Congress to mandate spending in global health.
TANIS: So now the administration could allocate the money as Congress intended by September 30. They could also use it to pay for shutting down USAID, or they could do a pocket rescission. I should note that we have reached out to the State Department and the White House for comment.
PFEIFFER: Fatma, you know very well that last year, there were major cuts in global health aid in government - U.S. government spending. But the U.S. has been spending money on foreign assistance this year, so how is that money being used?
TANIS: Well, the core of it are these bilateral agreements they've reached with 35 low-income countries. The U.S. will be spending around $15 billion over the next five years, and partner countries will pitch in significant amounts, as well. The administration says its goal is to have these countries carry the financial burden for their own health issues and rely less on U.S. funding. Now, this is something that many global health experts say is a pragmatic approach and in the right direction. However, it's also a major pivot from the previous model of U.S. foreign aid. And the rollout of this has been rocky, according to Jocilyn Estes. She's with the Center for Global Development.
JOCILYN ESTES: They're sort of building the plane while flying it. And so if this administration's bet on this new approach doesn't work, there are real patients and real people who will suffer the consequences.
TANIS: Estes and others are concerned about whether these low-income countries will develop the technical capability to manage big health programs in such a short time frame.
PFEIFFER: The countries that have signed these agreements with the U.S., what are you hearing from them?
TANIS: So recently, I've spoken with officials from Liberia and Rwanda. On the one hand, this new system allows governments to set their own healthcare priorities rather than have a donor government decide it. On the other hand, it's significantly less money than they were receiving from the U.S. just a year ago, and countries are still grappling with the loss of those funds. Now they're expected to spend even more as part of these agreements. Tom Bollyky is with the Council on foreign relations, and he says it's going to be a big financial challenge for them.
TOM BOLLYKY: We've looked at the budgets announced by those countries - their domestic budgets and whether or not we see a sign that they are picking up the slack from the shortfall in U.S. development assistance. And there, too, it seems not.
TANIS: So far, we have not really seen these agreements being implemented. Many of them are more like frameworks without details at this point. So we expect to know a little bit more about what it's going to look like by the end of the year.
PFEIFFER: That is NPR's Fatma Tanis. Thank you.
TANIS: Thank you.
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