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The Trump administration intends to terminate the United States’ financial support for Gavi, the organization that has helped purchase critical vaccines for children in developing countries, saving millions of lives over the past quarter century, and to significantly scale back support for efforts to combat malaria, one of the biggest killers globally.
The administration has decided to continue some key grants for medications to treat H.I.V. and tuberculosis, and food aid to countries facing civil wars and natural disasters.
The documents provide a sweeping overview of the extraordinary scale of the administration’s retreat from a half-century-long effort to present the United States to the developing world as a compassionate ally and to lead the fight against infectious diseases that kill millions of people annually.
The cover letter details the skeletal remains of U.S.A.I.D. after the cuts, with most of its funding eliminated, and only 869 of more than 6,000 employees still on active duty.
Dr. Austin Demby, the health minister of Sierra Leone, which relies on Gavi’s support to help purchase vaccines, said he was “shocked and perturbed” by the decision to terminate U.S. funding and warned that the ramifications would be felt worldwide.
Gavi is estimated to have saved the lives of 19 million children since it was set up 25 years ago. The United States contributes 13 percent of its budget.
The loss of U.S. funds will set back the organization’s ability to continue to provide its basic range of services — such as immunization for measles and polio — to a growing population of children in the poorest countries, let alone expand to include new vaccines.
By Gavi’s own estimate, the loss of U.S. support may mean 75 million children do not receive routine vaccinations in the next five years, with more than 1.2 million children dying as a result.
Dr. Sania Nishtar, Gavi’s chief executive, said that she hoped the Trump administration would reconsider the decision to end its support. Gavi’s work keeps people everywhere, including Americans, safe, she said.
Gavi’s structure requires countries to pay part of the cost of vaccines, with their share growing as income levels rise; middle-income countries are weaned from support.
Cuts to malaria response are deep. While awards that fund the bulk purchase of bednets and malaria treatments have been preserved, many of the programs to deliver these and other malaria control efforts in countries such as Cameroon and Tanzania — among the most affected in the world — have been terminated.
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