At the start of 2025, the world was healthier and safer because of the USA’s longstanding commitment to biomedical research.^1–3 Further progress was on the horizon as healthcare providers delivered new interventions targeting the leading infectious causes of illness and death worldwide.

For instance, in the latest phase of one of global health’s most significant milestones, more countries were rolling out recently approved malaria vaccines to children living in endemic regions.⁴ As a result of these efforts, tens of thousands of children will now live to see their fifth birthdays.⁴ The revolutionary vaccines are the result of decades of research efforts supported by the US government.⁵ Private enterprise alone would never have produced such results, as the risks were too high and the financial incentives were too low. Only sustained public leadership could have delivered such a success to the world’s most neglected communities.

While malaria vaccines reached children during routine visits, an emergency Ebola vaccine trial was launched during an outbreak in Uganda.⁶ This rapid response was possible only due to ambitious research supported by the US Departments of Defense and Health and Human Services.⁷ Although the vaccines are currently used only in a limited region of East Africa, their ability to contain outbreaks and preserve social stability underscores their global importance.⁸

Meanwhile, efforts to end the HIV epidemic reached a new phase with the approval of lenacapavir, a capsid inhibitor administered twice a year for pre-exposure prophylaxis.⁹ Its promised global impact is enormous. However, when National Institute of Health (NIH)-funded research elucidated the structure and function of the HIV capsid three decades ago, few could have imagined that these basic discoveries would lead to such transformative therapeutic application.¹⁰ Again and again, we see how today’s breakthroughs depend on yesterday’s research.

These three examples illustrate that biomedical innovation cannot occur in isolated regions or in isolated eras. While basic knowledge is often generated in high-resource settings with access to advanced technology and capital, clinical utility emerges only through global collaboration. Once proven safe and effective in a global context, these innovations can benefit humanity as a whole. In addition, while the health of all people depends on reliable global research platforms, the US government is now systematically dismantling the very infrastructure that fosters these breakthroughs.^11–13

The current state of US-funded research

Since March 2025, multitudes of research grants across the Centers for Disease Control and Prevention, NIH and National Science Foundation have been terminated.^11–13 The agency most profoundly impacted has been the NIH, the leading funder of biomedical research and of high-priority global health research on conditions such as HIV, tuberculosis and malaria. These grants were terminated because the research involved health equity, gender and sexual minority health, HIV, climate change, coronavirus disease 2019 (COVID-19) and/or vaccines. These terminations impacted global health research by targeting high-priority health conditions and stymying the reach of research disciplines. One example is implementation science research, a field of study that evaluates mechanisms to translate research knowledge into real-world settings. In one study that categorized the types of implementation science grants terminated as of April 2025, approximately one in six focused on global health.¹⁴

In May, the NIH halted research funded through the ‘foreign subaward’ mechanism pending the institution of a new grant-tracking system.^15,16 In fiscal year 2024, approximately 4,600 NIH grants were either awarded directly to non-US-based researchers or to multinational collaborations that involved grant subawards to non-US-based researchers.¹⁵ This halt has impacted approximately 80% of NIH–funded, non-US–based research.¹⁶ This has had immediate negative consequences for all the impacted researchers and has been particularly harrowing for research participants, especially clinical trial participants who were in the middle of investigational drug or device studies.^17,18 Subsequently, there has been an exception process instituted for clinical research that involves human participants, but non-US-based laboratory and animal-model-based research remain halted.¹⁹

In tandem with the terminations and halting of non-US-funded grants, the process of review, approval and disbursement of new and renewed grants has also been curtailed.²⁰ The awarding of new grants is at least 25% less than the average of years prior.²⁰ Additionally, some of the country’s top research–focused universities have had broad freezes of their federal funds, which have frequently included the totality of their NIH portfolios.²¹ In addition to the impact on on-going research projects, this has negatively impacted matriculation in graduate training programmes, which often have a sizable portion of students on foreign student visas.^21,22 Under the current US presidential administration, the US research enterprise has been significantly reduced through grant terminations, funding halts and the hampering of the operations of institutions with deep investments in global health. These actions culminate in the USA abandoning its commitment to leading global health research.

Looking towards the future

The impacts of these cuts to research have already been felt. There has been tremendous economic loss to the local economies of research institutions impacted by grant terminations, resulting in layoffs. Graduate and other training programmes have been hard hit. Nearly 40% of the approximately 2,200 terminated NIH grants were research and training grants.²³ The cessation of research funded through the ‘foreign subaward’ mechanism has imperilled longstanding research collaborations, as researchers scramble to find alternative funding mechanisms to support their work. Many clinical trial consortiums are multinational and enrol participants worldwide. Their research studies and the participants are in stasis, while researchers navigate a nebulous new grant-allocation process. Taken together, science has been halted in the middle of experiments and data collection. Without the restoration of funding, these scientific questions will go unanswered.

As researchers struggle to sustain their work in this new environment, they hope to prevent the devastating long-term consequences of the USA’s withdrawal from research. Due to this withdrawal, millions of people are projected to acquire HIV in the coming years, while the unchecked spread of antibiotic-resistant bacteria threatens to cost the global economy trillions of dollars.²⁴ Yet, the most significant effects of these policy decisions may be those we cannot foresee. The unprecedented speed of COVID-19 vaccine development under Operation Warp Speed proved the essential role of sustained governmental investment in science.²⁵ Without the decades of foundational research supported by such investments, the messenger RNA) vaccines that saved millions of people worldwide would not exist.²⁶ We cannot predict which discoveries will protect us in the next pandemic, but we do know that only a reliable research infrastructure can produce such knowledge. As the USA continues to erode research capacity and undermine global collaborations, the world is increasingly unprepared to face the next pandemic. The health of all people depends on a resilient, forward-looking global research network that creates knowledge today to protect us from the crises of tomorrow.