Public health experts are worried about the Trump administration’s plans to downsize global aid programs that have saved millions of lives. One such program is the President’s Emergency Plan for AIDS Relief (PEPFAR). The program was initiated in 2003 during the administration of President George W. Bush. It is widely credited with saving 26 million lives. Some thought it unlikely that Trump would slash a program that has been effective and that was launched by another Republican president.

But the program will be dramatically cut, from $2 billion to $150 million yearly. The cutbacks will occur under the auspices of Trump’s America First priority. Rationale: If people die in other countries, it’s not our problem.

This article appeared in Medpage Today and was written by Rachel Robertson::

A major change to how the popular President’s Emergency Plan for AIDS Relief (PEPFAR) program operates took effect on June 1, which experts warn will result in a massive decline in the U.S.’s public health presence abroad.

Historically, the U.S. State Department brokered Congress-appropriated dollars for PEPFAR programs and CDC would receive approximately $2 billion in PEPFAR funds annually for the agency’s programs around the world. But under the new plan, foreign nations will choose à la carte what services they want to buy from CDC, though countries that receive more than $125 million in U.S. aid will have to purchase a minimum package.

The new guidance is part of the Trump Administration’s “America First Global Health Strategy” and was first brought to light opens in a new tab or window by Emily Bass, an AIDS activist who has written a book about PEPFAR, last month on her Substack. In a document detailingopens in a new tab or window the government’s strategy, the State Department claims that this “America First” approach will disrupt a “culture of dependency” in how U.S. global health programs currently operate. But slipped in there is that foreign health assistance from the U.S. could also leverage access to other countries’ resources, like key minerals.

Tom Frieden, MD, MPH, who served as CDC director from 2009 to 2017 and is now president and CEO of the nonprofit Resolve to Save Lives, told MedPage Today that “the underlying concept is a good one, with countries deciding what services they want partnership on and with which partners. But the reality is that you cannot order off a menu if the restaurant is closed, and this approach would end CDC’s ability to support partner countries and protect Americans.”

Frieden noted that under this State Department plan, the funding that CDC receives from PEPFAR could plummet to $150 million, or 7% of the fiscal year 2025 level, which is not nearly enough to continue the agency’s global operations.

Frieden and seven other former CDC directors published an op-ed in STAT opens in a new tab or window last week urging the State Department to reform PEPFAR instead of “dismantling it.” They cautioned that the government’s plans could result in at least 18 CDC global outposts closing by year’s end, since most are sustained with PEPFAR funding, and up to 85% of the agency’s global presence being pulled back in the next 2 years.

“Without a transition plan and a manageable timeline, the result will not be a more effective PEPFAR — it will be the rapid dismantling of America’s overseas public health capability and the relationships that have taken years to build,” they wrote.