On July 23, 2025, the House Appropriations Committee approved the FY 2026 National Security, Department of State, and Related Programs (NSRP) bill, effecting a roughly 22% reduction (about $13 billion) in discretionary funding compared to FY 2025‐enacted levels . That deep cut reshaped the NSRP superstructure, constraining the budget envelope underpinning key State Department and global health programs. Within that broader rollback, Global Health Programs (GHP) were cut by roughly 5% ($512 million), bringing total global health assistance to $9.5 billion, significantly down from the previous year.
Although global health absorbed a smaller share of the NSRP reduction than other accounts, the broader political logic of deprioritization is clear: global health has been treated as optional extra, not a core component of national security.
Political Motives: “America First” and Foreign Aid Skepticism
Politically, the budget reflects a durable “America First” philosophy aiming to reclaim federal dollars for domestic priorities. Supporters of the cuts framed them as restoring fiscal discipline and scaling back foreign entitlements. Congressional leadership touted reductions as aligning NSRP with sovereign interests and eliminating “inefficient” global programs .
Simultaneously, polling data reveals mounting public ambivalence: while 50% of Americans in 2025 believed the U.S. should play a major or leading role in improving health abroad, 43% felt the U.S. already over-spent on such initiatives . Lawmakers may be appealing to that ambivalence to justify deeper retrenchment.
Institutional Targets: CDC, NIH, USAID, Fogarty
Although GHP funding remained visible, the broader Trump administration FY 2026 request envisioned sweeping reductions across other agencies: CDC budget down ≈39%, the CDC’s Center for Global Health dismantled; NIH funding slashed ≈40%, Fogarty International Center eliminated; and USAID’s main global health footprint drastically reduced .
These agency‐level severances signal a political calculus aimed at dismantling global health architecture rather than treating it as complementary to broader commitments. Congress, even while moderating some agency elimination, accepted the structural downsizing by embedding reductions within the NSRP envelope.
Spillovers to Health Programs: PEPFAR, Malaria, Nutrition, and Beyond
The impact on global health goes beyond headline totals. Proposed cuts entail deep reductions in programs combating HIV/AIDS, TB, malaria, as well as family planning and vaccine delivery activities. This retrenchment threatens essential initiatives like PEPFAR, the President’s Malaria Initiative (PMI), and Global Fund contributions.
Thousands of lives hang in the balance: a study in The Lancet published June 30, 2025, estimated that funding cutoffs and the dissolution of USAID could result in at least 14 million preventable deaths by 2030, including 4.5 million children under five. PEPFAR’s collapse alone could lead to 10.75 million new HIV infections and 2.93 million HIV‐related deaths . Other modeling projects HIV-related mortality surging by 630,000 deaths annually, and a potential 400% increase in AIDS‐related deaths, i.e. roughly 6.3 million deaths over four years .
PMI funding was already cut by 47% by June 2025, undermining antimalarial distribution and surveillance systems, with early signals of rising illness and potential deaths in places like the DRC . Nutrition, maternal and child health, immunization (including GAVI-related efforts), and global health security initiatives are similarly imperiled.
Broader Implications: Soft Power, Diplomacy, and Security
From a policy standpoint, these cuts represent more than humanitarian backsliding—they undermine U.S. geopolitical influence. Global health funding has long served as a tool of soft power and diplomacy, enhancing U.S. leverage in negotiations and shaping foreign perception of American leadership .
As analysts have warned, countries with fragile health systems are more prone to conflict and instability. Reductions in U.S. health diplomacy may thus weaken deterrence and amplify risks in regions of strategic concern. The recalibration away from health programming may reduce influence vis-à-vis rival powers increasingly investing in similar spaces.
Fiscal Discipline or Strategic Retreat?
The NSRP cuts reflect a Republican-led appetite for constrained foreign assistance. Congress’s willingness to “shrink-wrap” global health within an austere NSRP cap, rather than preserving its autonomy, suggests a political narrative that global health is expendable in times of broader belt-tightening. Moreover, as global health programs are tied to State Department and foreign‐policy budgets, they become convenient levers in broader partisan budget fights.
Whether future Congresses will restore capacity—and whether public opinion shifts—remains open. But at the moment, the FY 2026 NSRP cuts signal a strategic retreat from health as U.S. foreign policy priority.
A Final Note: The Political Cost of Disinvestment
By embedding global health within a sharply constrained NSRP budget, Congress has signaled that health is secondary to other constructions of national security. These political decisions carry enormous human cost: millions of preventable deaths, rollback of hard-won disease control gains, and weakening of America’s global credibility and influence.
If this trajectory continues, global health will cease to function as a pillar of U.S. diplomacy and soft power, instead becoming collateral in broader fiscal and ideological battles. The implications reach far beyond Washington budget halls; they extend to the lives of the most vulnerable and the global standing of the United States.
