2025 in Global Health
A Devastating Setback—and a Test of Our Resolve
By Roberto Valadéz
The year 2025 will be remembered as one of profound disruption. For those in global health, political retrenchment undermined decades of progress, leaving health systems strained and communities newly vulnerable. It was, by nearly every objective measure, a deeply destructive year.
Among the most profound consequences of the global health funding crisis is the projected increase in deaths for children under five—the first such rise in a century. The estimated 4.8 million deaths are largely due to preventable causes, including pneumonia, malaria, diarrhea, and complications of childbirth. This reversal did not occur because we lacked solutions. It happened because we failed to sustain them.
At the center of this disruption is a sharp contraction in financing. President Trump’s Executive Order calling for the abrupt closure of the U.S. Agency for International Development (USAID) marked the United States’ abdication as the global leader in development assistance. The sudden withdrawal of that support fractured supply chains, shuttered clinics, and destabilized health systems already stretched thin.
For NGOs, the effects were immediate. Programs built over decades—often delivering the only health services available in rural or conflict-affected regions—were forced to scale back or shut down entirely. Millions have been deprived of life-saving HIV prevention and treatment medication due to the interruption of services. Gaps in malaria prevention led to resurgences in high-burden areas. Community health workers, who are often the backbone of primary care, trained to share vital information and services to the most remote or vulnerable populations, lost salaries. The result was predictable: preventable illness, avoidable death, and broken trust.
These shocks were compounded by broader financing woes. In May, the Gates Foundation announced plans to spend down its $200 billion endowment by 2045—a commitment to accelerate its mission to save lives, but also somber news that one of global health’s most benevolent and reliable funders will cease operations in the near future, with no replacement in sight.
Meanwhile, the Global Fund to Fight AIDS, Tuberculosis and Malaria—the world’s largest multilateral funder for global health—fell $5.7 billion short of its fundraising goal. Previous donors, including France, Japan and the European Union failed to share how much they might contribute (if at all), and the U.S., which remains the fund’s leading donor, reduced its pledge from $6 billion to $4.6 billion. The shortfall places the potential of ending HIV, malaria, and TB as public health threats further from reach.
Yet despite such profound adversity, progress remains not only conceivable, but attainable. Strategic investment in emerging innovations can overcome today’s setbacks with monumental game-changers.
In the fight against HIV/AIDS, one of the most consequential treatment breakthroughs in decades was discovered in 2024. Lenacapavir, a long-acting injectable HIV prevention medication administered just twice a year, has demonstrated nearly 100% effectiveness in clinical trials; combined with new licensing agreements that enable production of a generic version at an estimated cost of roughly $40 per patient per year in countries with high rates of HIV, this intervention could fundamentally alter the trajectory of the AIDS epidemic. For the first time, sustained HIV prevention may be achievable without the daily barriers that have long constrained progress.
Malaria, which claimed more than 600,000 lives globally in 2024—most of them children—has similarly entered a new era. The rollout of the WHO-recommended RTS,S and R21 vaccines, alongside advances in next-generation insecticide-treated bed nets and progress toward simplified treatment regimens, is creating a layered defense against one of the world’s deadliest diseases. Modeling suggests that widespread deployment of these tools could save over 5 million children by 2045. As with HIV, the science is no longer the limiting factor, delivery and financing are.
These breakthroughs underscore a central lesson of 2025: innovation alone does not save lives. Systems do. In an era of constrained budgets, investment must focus on the most cost-effective and evidence-based solutions. The Gates Foundation’s Goalkeepers Report is unequivocal on this point—primary health care and routine immunization remain the smartest investments in global health.
Primary health care is the quiet workhorse of successful health systems. It is the network of local clinics and community health workers that treats pneumonia before it becomes fatal, ensures safe childbirth, and delivers essential vaccines. Evidence shows that strong primary care systems—costing less than $100 per person per year—can prevent up to 90% of child deaths. Beyond humanitarian impact, these networks of care underpin national resilience, economic productivity, and pandemic preparedness.
Vaccines, meanwhile, remain the single highest-return investment in global health. Since 2000, vaccinations have reduced child mortality by half. And every dollar spent on childhood immunization generates an estimated $54 in economic and social benefits by preventing illness, averting outbreaks, and protecting education systems. Maintaining—and expanding—support for vaccine delivery is simply not optional. It is especially critical as newer vaccine technologies simplify dosing and distribution, reducing logistical costs while expanding reach.
Together, these investments offer a clear path forward through this time of austerity. The tools to save millions of lives exist. What remains is the collective resolve to deploy them strategically, equitably, and at scale. In a year defined by loss, this is where optimism must be anchored—not in wishful thinking, but in proven pathways for survival.
Roberto Valadéz is the former director of communications and special initiatives for the United Nations Ambassador for Global Health, where he led high-stakes global campaigns, including the office’s work on COVID-19. As the founder of True You, he now equips underestimated C-suite leaders with the tools to level up their leadership and amplify their impact by harnessing their authenticity.
RFK Jr is the biggest threat to human health hands down. To not have an HHS secretary is better than having a bad one. At least we would have department heads who are competent and capable of carrying on. What we have is someone looking to profit from our misfortune. We have what we need to keep Americans healthy and the world at large. But unfortunately we’ve allowed the wrong people to mismanage our government.
Thanks for the shot of hope, after all they've done to inflict pain.