In this episode of Devpolicy Talks, Robin Davies interviews Nina Schwalbe about the dramatic shifts in US global health policy under the Trump administration and their far-reaching consequences. As founder of Spark Street Advisors and a global health expert with extensive experience in multilateral organisations, Nina provides a sobering account of how these changes are reshaping international development assistance.

The conversation begins with an exploration of the US withdrawal from WHO and its freezing of foreign assistance payments. Nina highlights how these actions have crippled WHO’s core finances and programs in immunisation, maternal health, non-communicable diseases and emergency response. She also discusses the removal of CDC secondees from WHO offices worldwide, further weakening global health capacity.

The discussion then turns to other multilateral organisations like the Global Fund and Gavi. While Gavi is less reliant on US funding, the Global Fund faces existential risks due to uncertainty about unpaid commitments and potential conditionalities tied to future funding. Nina explains how these developments are undermining critical programs for HIV/AIDS, TB, and malaria.

On the pandemic treaty negotiations, Nina offers cautious optimism. She notes progress in areas like vaccine production regionalisation and surveillance but acknowledges that key issues – such as equitable vaccine distribution and financial mechanisms – remain unresolved. She emphasises that while the treaty may lack strong commitments now, it provides a framework for future improvements.

The interview concludes with a reflection on broader risks to global health security. Nina warns that US disengagement is occurring against a backdrop of ongoing outbreaks – from Ebola to H5N1 – underscoring that another pandemic is not a matter of if but when. She also shares her personal observations on the devastating impact of mass layoffs at USAID and other agencies on public servants dedicated to improving global health.

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