Twenty years ago, Science celebrated “a revolution that is fundamentally altering the way the haves of the world assist the have-nots”: Governments and philanthropies were donating tens of billions of dollars to global health annually. “Everyone started dreaming,” no longer “scraping for the pennies that would fall off the table,” declared Jim Yong Kim, who would later become president of the World Bank.
Those days are over. The U.S. Agency for International Development, where I once worked, is shuttered, and the Gates Foundation has announced it will wind down by 2045. The World Health Organization projects a 40% decline in 2025 from its 2023 funding levels, and the Organization for Economic Cooperation and Development cites huge cuts by four major donors — France, Germany, the United Kingdom, and the United States — the biggest decline in almost 30 years.
