A dramatic 21% drop in global health funding in 2025 is severely impacting efforts to control HIV and malaria in sub-Saharan Africa, raising urgent concerns among health experts and organizations. This steep decline threatens to reverse years of progress in combating these diseases in a region that remains one of the hardest hit by infectious illnesses.
According to a July 2025 report from the Institute for Health Metrics and Evaluation (IHME), international development assistance for health (DAH) plummeted from $48.5 billion in 2024 to $38.4 billion in 2025—a drop of over $10 billion, the lowest level since 2009. The reduction is largely driven by budget cuts from key donors, particularly the United States, which curtailed its contributions by approximately 67%, eliminating more than $9 billion in health aid. The U.S. cuts also included proposed cancellations of previously approved funds for programs such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and vaccine initiatives like Gavi.
Sub-Saharan Africa is bearing the brunt of these cuts, with an estimated 25% decline in health aid since last year and a further 7% projected over the next five years. Countries such as Malawi, Mozambique, Zimbabwe, Lesotho, Gambia, and Nigeria have been deeply affected, with Nigeria alone losing over $400 million in absolute terms. For many of these nations, external aid accounts for a significant share of total health expenditure—up to 30% in Malawi—making them highly vulnerable to donor funding shifts.
The consequences of funding reductions are already being felt on the ground. Efforts to control HIV and malaria face major setbacks as treatment programs, prevention campaigns, and vaccine distributions experience financial strain. Experts warn that the decline could lead to millions of new HIV infections and AIDS-related deaths, jeopardizing the global targets for epidemic control set for 2025-2030. Winnie Byanyima, former UNAIDS executive director, stated that the downturn in financing threatens to undo one of the most successful public health achievements in history, which has saved over 26 million lives.
Moreover, the cuts have ripple effects beyond HIV and malaria. Health systems struggle to provide maternal and child health services, vaccination programs are underfunded, and humanitarian organizations are downsizing or scaling back operations. The United Nations World Food Program, for example, faces a 40% funding reduction affecting nutrition responses in fragile contexts. UNAIDS is restructuring and reducing staff by over half.
The causes of the funding drop are multifaceted. Besides the U.S.-led cuts, European donors including the UK, Germany, and France have reduced global health aid, often citing domestic budgetary pressures or reallocations toward defense spending. Conversely, countries like Australia, Japan, and South Korea have modestly increased their contributions, though these gains are insufficient to offset overall declines.
Health experts emphasize the grave risks posed by this emerging health financing emergency. Dr. Angela Apeagyei, lead author of the IHME study, highlighted the dangers of abrupt reductions: “The drastic and abrupt reduction to global health aid could compromise the progress in health that has been achieved globally.” Dr. Kalipso Chalkidou of WHO warned that many countries reliant on external aid face health service disruptions “not seen since the peak of COVID-19” and urged governments to boost domestic funding through improved taxation and innovative financing mechanisms.
Real-life impact is evident in communities across the region where interrupted HIV medication supplies, reduced mosquito net distributions, and limited testing services threaten vulnerable populations. Patient advocacy groups and NGOs are grappling with downsized programs, compromising prevention and care efforts.
Summary and Next Steps
The sharp 21% drop in global health funding—primarily from major donors—poses a critical threat to HIV and malaria control in sub-Saharan Africa, risking a resurgence of infections and deaths. To avert a public health crisis, experts call for renewed global solidarity, increased domestic resource mobilization, and strategic, sustainable investments in health systems. Strengthening regional capacity to reduce aid dependency and exploring innovative financing are essential to maintain and advance gains in disease control.
Policymakers, multilateral organizations, and stakeholders are urged to act urgently to stabilize and restore funding streams ahead of upcoming international health and development forums. Without swift intervention, the health and lives of millions in sub-Saharan Africa and beyond could face severe jeopardy.
