“It will likely shut out the majority of low- and middle-income country research institutions from applying as they don’t have the administrative capacity yet to manage an NIH grant with all of its complicated budget and reporting requirements—as well as the fact that NIH grants require you to spend the money first and then get reimbursed from the NIH every few months,” Levine says. “And many institutions don’t have the working capital to do that.”

The administrative burdens challenge US faculty and staff too. Professor of Medicine Rami Kantor, MD, an infectious diseases physician, says that time dedicated to scrutinizing grant language is better spent elsewhere.

“As changes were evolving, I’ve spent a lot of time trying to follow this guidance instead of doing other things,” says Kantor, the director of the Drug Resistance Laboratory at the Providence-Boston Center for AIDS Research.

Last year, Kantor faced delays in hiring Kenyan and US staff and a change in research focus for a grant to study drug resistance in people with HIV in western Kenya. While he was relieved to not lose money for it, these setbacks made it harder to carry out the research effectively.

“Stopping programs and funding for HIV care and research will potentially increase HIV drug resistance,” Kantor says. “On a clinical level, it can be devastating.”

Even if things go back to how they were pre-2025, the damage may have already been done. “The impact may take years to fix. Not giving people HIV medications or stopping certain types of research and research collaborations all has long-term impacts. The programs and collaborations we’ve built for so long may be in danger,” he says.

But those collaborations make impactful work possible. Anne CC Lee, MD, MPH, founding director of the Brown Global Alliance for Infant and Maternal Health Research, counts on strong local partnerships to guide her neonatal research in Ethiopia.

In a recent study, she examined whether pregnancy interventions, like enhanced infection management and nutrition supplement packages, could improve birth outcomes. The research was co-designed and co-led by Ethiopian colleagues.

“We don’t want to introduce an external technology or solution that no one will actually use,” Lee says. “The best solutions come from the communities and patients themselves. When solutions are owned by the community and embedded within existing health systems, they are much more likely to scale and last.”

Disruptions in US funding are jeopardizing such cooperative efforts. Seth Berkley ’78 MD’81, P’27MD’31, senior adviser to the Pandemic Center at Brown’s School of Public Health, says this unreliability has dire consequences.

“Trust takes a long time to build and an instant to destroy,” he says. “Looking at what happened with our nation’s tariffs, if we were to do the same thing with funding bilateral deals, others may not trust us in the end, anyway.”

In the Trump administration’s crusade for greater accountability for research funding, it may have paradoxically introduced more opportunities for fraud, Berkley says.

“In the past, a lot of the accountability was done through international NGOs and academic institutions, and if you don’t have that, that also raises a whole series of other risks,” he says.

Private organizations, which don’t face as much scrutiny from governmental entities or simply aren’t used to dealing with specific types of grants or research, may be more likely to misuse resources, he says: “That will lead to a greater loss of confidence.”

The cuts are also undermining the very system that made it possible to develop the COVID-19 vaccine in just 327 days. If that foundation of basic research into SARS and mRNA vaccines, in the decades leading up to 2020, had been disrupted like this, it wouldn’t have been just researchers and academia feeling the effects.

“It puts the world at risk because US science has traditionally been a huge part of world health,” Berkley says.

And the risk for more disease outbreaks, whether natural, accidental, or through bioterrorism, is growing. Previously eradicated or contained diseases are ballooning again thanks to vaccine hesitancy, which is on the rise around the world.

Last year, in addition to withdrawing from the WHO, the US pulled funding from Gavi, The Vaccine Alliance, which purchases vaccines for children in low- and middle-income nations. Berkley, the former CEO of Gavi, says the loss of funds could mean 75 million fewer children vaccinated, and 1.2 million deaths.

“The only way to deal with the increasing risk of infections is to have a surveillance system in place and the ability to quickly create countermeasures,” Berkley says. “If we’re not doing any of that, we are in worse shape than before the pandemic.”

Throughout his decades-long career in global health, Peter Kilmarx MD’90, acting director of the NIH’s Fogarty International Center, has advocated for robust research ecosystems to respond to emerging health threats. The NIH did not make Kilmarx available for comment for this article, but on Fogarty’s website he wrote that the center has long championed research “capacity building—the strengthening of research skills, staff, tools, and infrastructure—as a cornerstone of global health.”

Kilmarx calls the process a “strategic investment” leveraged by initiatives like institutional partnerships and training programs. “By strengthening research ecosystems around the world, we help ensure that when health challenges emerge—wherever they arise—the response is faster, more grounded in evidence, and more fair,” he wrote. “Building research capacity is not only central to global health resilience, it is also crucial to American leadership in science worldwide.”

UNCERTAIN FUTURE

As labs shutter and grant opportunities close, they take with them opportunities for the next generation of investigators to step in. Senior faculty navigating the maze of new global health funding rules have less time to properly mentor junior researchers. Some young scientists unable to get their foot in the door in global health are now considering different career paths, Levine says.

“In many ways, one of the greatest fears I have is that we are going to lose an entire generation of global health leaders,” he says. “If we’ve lost a generation of trainees who would be the ones carrying on this work, we’re going to be in a lot of trouble, even if funding returns.”

Stephanie Garbern F’19, MD, MPH, the director of medical student research at Brown, is already seeing this happen. She says some students who were excited to dive into careers in global health now have doubts amid widespread funding cuts and layoffs.

“I can’t count how many colleagues or friends that have had their jobs terminated, many with senior leadership positions,” says Garbern, an associate professor of emergency medicine. “These are all extremely knowledgeable people, and many are still looking for jobs.”

Jennifer Friedman says the mentorship aspect of her research is complicated by the loss of a reliable NIH model.

“I’m worried about our junior faculty,” she says. “It’s a tough question now—how do you start as a junior investigator and essentially re-navigate an already difficult path? Some of these opportunities for grant writing and funding were part of a beautiful model, but how do you get into any field like that with such a big loss?”

Berkley, whose daughter is a junior in the Program in Liberal Medical Education, has seen those doubts taking hold at Brown: A number of her classmates who had hoped to do summer research now find those plans up in the air, he says, especially as student financial aid tightens considerably.

“Lo and behold, when all of these cuts occurred, most of those international events and opportunities dried up and got canceled,” Berkley says. “What that does to a young student having the carpet pulled out from under them is they’re now asking if this is really something they want to do or not.”

BUILDING BACK

Many researchers agree it was a major liability to have relied so heavily on the US government for research funding. Now, out of necessity, most Brown faculty are seeking research grants from new sources.

“One of the things I’ve said even before this year is you can’t put all of our eggs in one NIH basket,” Levine says.

The new grant requirements are further pushing researchers to investigate other opportunities.

“I’m definitely considering new funding mechanisms beyond the NIH, as there has been a lack of clarity in how to allocate research funding to international settings and how to handle international collaborations,” Kantor says.

Garbern was in the fifth and final year of a project to develop a digital, wearable device-linked tool to help care for children with sepsis in resource-limited settings. She hopes to continue the work, which she carried out in Bangladesh, in community and rural hospitals in other nations, but there’s now a tense uncertainty about its future.

“For almost a year I was planning to apply for another NIH grant and keep the staff we had employed, but now there is a gap in the process,” due to changes and delays in new NIH policies regarding funding international collaborations, Garbern says. She’s now seeking funding from other sources.

“At best, it’s a one- or two-year-long delay, but to delay a project that has had years of momentum and is at the leading edge of global digital health is just sad,” she says. “It’s very disheartening that this type of work appears less valued, or not of obvious interest to current federal priorities.”

It’s a frustrating situation for researchers, Levine says, not least because of the NIH’s reputation as one of the most equitable funders of medical research in the world, with clear criteria that were applied on a consistent basis. Levine says few other agencies use that approach.

“Even something like the Gates Foundation doesn’t have an objective evaluation process like this,” he says. “Most foundations that are smaller may use even less rigorous criteria. In the end, not only are we applying for less money, but it’s much less objective and less certain about what is or isn’t a good project.”

To help insulate global health research from future cuts, scientists need to educate the American public about how their work overseas can benefit people back home.

“The average lifespan of people living in Mississippi is the same as for people living in Bangladesh, and far lower than in other US states,” Levine says. “There may be innovations we develop in resource-limited settings abroad that can benefit rural areas in the US.”

Even if funding is restored, Garbern says researchers face other, more intangible losses.

“People don’t realize that research is not just about these projects—it’s about people,” she says. “It’s about building trust and community. When funding is cut … you lose those connections and collaborators, alongside their trust. Sometimes they might be prepared for it, but it’s hard right now to make a case to work with a US-funded investigator right now because of all of these changes.”

But Berkley, who attended this year’s World Economic Forum in Davos, Switzerland, believes the global misgivings about the US don’t extend to individual scientists.

“They don’t hate Americans, they hate the administration,” he says. “I think people still have trust for Americans as collaborators, and the people that care about these institutions realize they’re being destroyed by a malignant force. They also understand that perhaps this is not due to the change of perspective of the entire American population.”

While the importance of funding can’t be understated, Levine points out that after the economic recession of 2008, the world emerged on a better course for global health. Maintaining trust and partnerships around the world may be just as important as the money.

“Economics by itself is not a complete barrier to the development and improvements in global health outcomes,” he says. “Some of the biggest improvements we saw essentially happened between 2000 and 2015. We were able to lift billions of people out of poverty, reduce maternal mortality by two-thirds, and expanded care in ways we had never done before. A lot of that was done despite economic headwinds and under both President George Bush and Barack Obama.”

Levine says Brown has stepped in to provide training and logistical support, as well as some funding, as its health researchers navigate this “traumatic” period.

But the damage is widespread and will likely be long-lasting, Kantor says.

“This affects basically everyone that I talk to professionally, locally and nationally,” he says. “I don’t think anyone has a magic wand. We’re seeing increases with the stress, the lack of confidence, and lack of security, and that’s ultimately where we are.”