For Global Health Care Providers, the Stakes Have Never Been Higher

The U.S. government enacted sweeping changes to global health funding in 2025 that have dramatically reduced America’s role as the world’s largest provider of aid. As part of the shift, about 83% of the U.S. Agency for International Development’s (USAID) global health programs were canceled, and the agency is in the process of being dissolved.

The impacts have rippled across disease-control efforts worldwide, sending unprecedented shocks to critical services for HIV, tuberculosis, malaria, cancer, chronic disease control, maternal and child health, and nutrition. Researchers anticipate these cuts could contribute to more than 14 million preventable deaths over the next five years, reversing decades of progress in global health outcomes.

Executive Director Payam Nahid, MD, MPH, is leading UCSF’s Institute for Global Health Sciences (IGHS) through this moment, which coincides with the center’s 25th anniversary. An internationally recognized tuberculosis researcher with more than two decades of experience in global health research, clinical care, and capacity building, we asked Nahid what he sees ahead for the field and IGHS.

Why is global health work important?

At its core, global health isn’t about aid, it’s about strengthening capabilities and systems that support healthy communities. It’s about translating medical advances developed at universities like UCSF into contextually appropriate solutions for people everywhere, whether that’s rural California or sub-Saharan Africa.

At IGHS, our activities in global health strengthen local systems and not just individual outcomes. Many people say that global health is one of the smartest investments wealthy countries can make, because it creates more secure governments and societies, it stabilizes economies, and it helps make the planet a safer, healthier, more secure place for all of us. Infectious diseases don’t see borders, so where one community is at risk, so is our whole planet.

How would you describe the current state of global health?

I would describe it as a crisis — a true “code red” moment. The abrupt dismantling of aid and international investment by the U.S. government is causing direct harm now and will do so far into the future. While the disruption of each program is important and impacts real people right now, the bigger issue is the erosion of systems — including infrastructure, workforce, supply chain, and actual supplies — that allow for reliable, resilient, and equitable delivery of health care.

Disbanding the international global health ecosystems is short-sighted because we’re just kicking the invoices down to the next generation when the crises land on their front door. It costs a lot more to rebuild systems than to maintain them, and prevention and preparedness will always cost a fraction of an emergency response.

One great example close to home is the success of programs targeting tuberculosis in the U.S., leading to significant reductions in cases. But when government agencies saw the improved health metrics, they cut funding for detection, treatment, and prevention, and the diseases were soon on the rise again. The cost to put those diseases back in check was greater than what was needed to maintain those programs.

What metrics do you track to keep tabs on global health?

Mortality is the most reliably tracked indicator, even though it’s still imperfect. A recent Lancet article predicts that these steep cuts in funding could result in more than 14 million additional all-age deaths by 2030, including 4.5 million children younger than age 5.

But deaths only tell part of the story. We also care deeply about quality of life, catastrophic health costs, and long-term disability — things that are harder to measure but profoundly important.

How is IGHS responding to this moment?

Our new strategic plan is focused on locally driven public health, so we can have a bigger impact with a smaller footprint by engaging in equitable partnerships across our mission.

First, we are doubling down on education, training, and mentorship. I am worried that the current attacks on public health are sending a message to young people that this isn’t a viable career. That’s why sustaining and growing future global health scientists is critical, especially when young people may feel discouraged by the current environment. Our master’s (the first global health program in the country) and PhD programs remain central to our mission, even as financial constraints limit how many qualified students we can support.

Second, we are building a reciprocity-focused approach, which is a major shift from the way global health used to operate. We’re now partnering with ministries of health, hospitals, and local institutions to co-design solutions to questions they define — not ones imposed from the outside.

A third important focal point is our consulting work to build skills and systems that empower communities.  We’re integrating our research, education, and capacity-strengthening efforts so we can provide rapid-response technical assistance and build local capacity. We hope this will help policymakers make evidence-based decisions in real time, even with fewer resources.

Looking ahead, what gives you hope?

The next generation of leaders gives me hope. I am inspired by our students and early state investigators who are motivated to tackle complex public health challenges. I’m also hopeful because we’re entering a new era with practical tools that work even in strained health systems. Twice-yearly HIV PrEP prevents infection before it happens. HPV vaccination, paired with screening, puts cervical cancer elimination within reach. And simple, scalable approaches to blood pressure control prevent heart attacks and strokes worldwide. These are highly effective prevention tools with enormous impact.

I’m also encouraged by advances in diagnostics, including a new molecular-based, rapid testing platforms for infectious diseases like tuberculosis that are highly accurate and increasingly affordable. And AI tools are reading EKGs, x-rays, and pathology slides, bringing specialty care to rural settings — and addressing health inequities that are driven by the unbalanced distribution of experts.

As a leader of IGHS, I feel how dire this moment is. But I truly believe there is light at the end of the tunnel, and our work is more important now than ever as we face today’s challenges.