Since January 2025, the US government has begun reassessing its role in health and science at home and abroad. Early policy moves, alongside a broader review of foreign assistance and biomedical research, have created real uncertainty for the parts of the R&D ecosystem that underpin global health and pandemic preparedness.
This report focuses on the research and development dimension of those changes. It documents the changes made and proposed to date and estimates their implications for global health R&D. In doing so, it recognises that these developments are just a small part of the wider changes affecting public health and science more generally.
It examines several policy and funding changes made since the beginning of 2025: the effective dissolution of USAID as an independent entity; terminations or pauses of selected NIH awards; modifications to grant approval processes and indirect-cost limits; potential restrictions on overseas sub-awardees; and the halting of BARDA’s Project NextGen and mRNA-related programmes. It then estimates observed and likely near-term effects of the policies as they are most likely to be implemented, before turning to scenarios for longer-term budget setting that are less susceptible to litigation. The final section highlights the areas which are particularly reliant on US funding, as well as features that appear to confer resilience, before laying out some practical steps funders can take in response to the changes in US funding.
