The global health landscape in 2025 is marked by growing inequities, stalled progress, and unprecedented disruptions, amplified by the U.S. withdrawal from key international commitments, including the World Health Organization and foreign aid programs. With official development assistance declining and critical funding gaps emerging in areas like HIV, immunization, and maternal health, the international community faces a profound leadership vacuum. In response, Aspen Institute Germany – supported by the Gates Foundation, Public Private Strategies Institute, and the Aspen Partnership for an Inclusive Economy – has launched the initiative „Redefining Power and Responsibility“ to explore how the private sector can step in as a central actor in sustaining and reimagining global health leadership. By convening U.S. and German stakeholders particularly from the business sector, the project seeks to foster transatlantic dialogue on global health and chart a path toward more inclusive, resilient, and accountable health partnerships.
The world is experiencing a global health and foreign aid crisis of unprecedented scale. Multiple overlapping factors contribute to this fragile state: the lasting effects of the COVID-19 pandemic on health systems, rising geopolitical tensions that disrupt aid flows, and significant funding withdrawals by key donors, most notably the United States. At the same time, armed conflicts – such as Russia’s war against Ukraine and the escalating violence in the Middle East – are creating acute humanitarian emergencies and straining the international response capacity. Climate-induced disasters further exacerbate these challenges, particularly in vulnerable regions of the Global South.
Between 2000 and the onset of the COVID-19 pandemic, global population health had steadily improved. Progress was made across multiple areas, including increased access to clean water and sanitation, better maternal and child healthcare, and declining mortality from diseases such as HIV/AIDS, according to data by the World Health Organization, the United Nations, and the World Bank. These advances contributed to a broad reduction in mortality across the lifespan, with both life expectancy and healthy life expectancy (HALE) rising between 2000 and 2019. However, this positive trend was disrupted by the COVID-19 pandemic, which caused significant setbacks in health systems and led to a reversal in many of these gains. Notably, life expectancy declined in several regions, marking a rare global regression in population health.
The world community is falling short in several critical areas. Maternal and child health improvements have largely stalled. At the same time, the global burden of noncommunicable diseases – such as heart disease, cancer, and diabetes – continues to grow. Mental health conditions are also on the rise. Progress on tackling infectious diseases is uneven: while HIV and tuberculosis are in decline, malaria has resurged in some areas, and global vaccination coverage has not fully recovered since the pandemic, putting millions of children at risk of preventable illnesses. The growing threat of antimicrobial resistance further complicates treatment and containment of infections.
In addition, the risk of future pandemics remains alarmingly high. Despite the devastating lessons of COVID-19, global preparedness remains dangerously uneven. Health emergency financing remains fragmented and underfunded while global vaccine manufacturing remains highly concentrated in a few regions. For example, many of the 20 most widely used vaccines rely on around two suppliers each.
Underlying many of these setbacks are deep-rooted health inequities. Life expectancy varies widely between and within countries, driven by disparities in income, education, gender, and access to care. Weak health information systems, limited data infrastructure, and persistent shortages in the health workforce further constrain countries’ ability to plan and respond effectively.
Official Development Assistance (ODA) plays a vital role in supporting fragile health systems, especially in low- and middle-income countries. As defined by the Organization for Economic Co-operation and Development (OECD), ODA is “government aid that promotes and specifically targets the economic development and welfare of developing countries.” It funds critical infrastructure, vaccines, disease surveillance, and emergency response mechanisms. However, according to preliminary OECD data, global ODA fell by 7.1 percent in real terms in 2024, totaling 212 billion USD, marking the first decline since 2017. This setback compounds an already significant global health financing gap.
The United States has historically been the largest bilateral donor for global health. However, on his first day in office, President Donald Trump signed Executive Order 14169, titled “Reevaluating and Realigning United States Foreign Aid”, pausing most foreign assistance for 90 days and led to the closure of USAID on July 1, 2025. On the same day, he signed Executive Order 14155, formally initiating the withdrawal of the United States from the WHO and halting all U.S. financial and personnel engagement. This decision has far-reaching consequences: the WHO now faces a projected funding shortfall of 560–650 million USD for the 2026–27 biennium, despite other member states pledging to step up their contributions to help fill the gap. For example, the U.S. contribution to the treatment of tuberculosis alone, the world’s deadliest infectious disease, amounted to 200–250 million USD annually, around a quarter of donor funding for TB treatment worldwide, according to WHO data. The sudden gap in financing jeopardizes the continuity of life-saving programs and threatens to undo decades of multilateral health gains.
In May 2025, the administration of President Donald Trump submitted its proposed federal budget for fiscal year 2026 to Congress with substantial retrenchments across U.S. foreign assistance commitments. The One Big Beautiful Bill Act (initially H.R. 1) was passed by the House (May 22 – 215–214), amended in the Senate (July 1 – 51–50), repassed by the House (July 3), and signed into law by President Trump on July 4, 2025. It combined sweeping tax cuts with spending cuts and reallocations, including reductions in critical foreign aid programming. The Act authorizes rescinding around $9 billion from USAID foreign aid appropriations. A later amendment reinstated 400 million USD for PEPFAR (HIV/AIDS treatment), but reporting from the New York Times published on July 23, 2025 suggests that the State Department might already be working to shut down the program in the coming years.” Current deliberations on the 2026 budget by both houses of Congress, a process called “appropriations”, similarly mention significant cuts to global health programs: The House Appropriations Bill for the Fiscal Year 2026 stipulates a budget of 9.52 billion USD for global health, 511.7 million USD less than the current year’s budget.
These dynamics have created critical gaps in global health infrastructure, weakened preventive measures against pandemics, and reduced the effectiveness of coordinated development efforts. Without renewed leadership and investment from both the public and private sectors, the risk of widening global inequality and declining health security remains substantial. These risks directly threaten global stability and peace: fragile states with weak health systems are more vulnerable to unrest, conflict, and forced migration, which in turn undermines international security. A declining global health environment also poses a significant drag on prosperity, economic growth, and trade, as recurrent health crises disrupt supply chains, reduce workforce productivity, and erode consumer confidence.
The U.S. withdrawal from key global health and development commitments has also exposed growing transatlantic rifts, particularly around multilateral engagement, funding priorities, and the role of democratic values in global governance. These tensions are further compounded by differing approaches to climate policy, international institutions, and long-term strategies for global health equity. While the United States increasingly emphasizes domestic priorities and strategic competition, many European partners – especially Germany – continue to advocate for robust international cooperation and a strong rules-based order.
Meanwhile, the private sector, with its innovation capacity, global networks, and investment potential, has become an essential player in shaping future-ready global health systems. For businesses, the changing global health landscape is not peripheral but central. Global health instability increases operational risks, exposes vulnerabilities in globalized supply networks, and challenges business continuity across markets. At the same time, rising expectations for corporate responsibility mean that companies must adapt their business models to address health resilience, sustainability, and social impact.
In the light of these developments, The Aspen Institute Germany is launching a new project initiative in collaboration with the Public Private Strategies Institute, with support from the Gates Foundation, and the Aspen Partnership for Inclusive Economies: “Redefining Power and Responsibility: U.S. Foreign Aid, Global Health Leadership, and the Role of the Private Sector.” The project will explore how global health leadership can be sustained and redefined in an era marked by the United States’ retreat from international health and development commitments.
The initiative seeks to facilitate a structured dialogue between private sector leaders, civil society actors, and public health experts from both sides of the Atlantic. It will explore how companies can forge sustainable partnerships with governments and international organizations to deliver long-term impact, especially in areas like pandemic preparedness, supply chain resilience, access to essential medicines, and health system strengthening.
By convening key stakeholders in digital and in-person formats, the project aims to generate practical insights and new ideas for more inclusive, resilient, and accountable global health cooperation – driven not just by governments, but by a dynamic and engaged private sector.
This project is supported by the Public Private Strategies Institute.
