F. Round table: Global health implications of US Foreign Aid review for EU in global health governance

Abstract Upon entering office last January, US President Trump's executive actions have impacted global health and foreign assistance at an unprecedented scale. KFF reports the US withdrawal from WHO; a 90-day review of foreign aid; a “stop-work order” that froze all payments and services for work already underway; the dissolution of USAID, including the reduction of most staff and contractors; and the cancellation of most foreign assistance awards. As a result, U.S. global health programs have been disrupted and, in some cases, ended. For HIV for instance, the President's Emergency Plan for AIDS Relief (PEPFAR) since 2003 has saved 26 million lives. However, following the Trump decrees, KFF reports that of the 770 global health awards identified, 379 included HIV activities, 71% of which were terminated, including several HIV treatment awards as well as most HIV prevention, disrupting HIV testing in 10 countries due to job loss of thousands of HIV workers, and stock outs. Moreover, a 90-day funding pause has been estimated to ‘result in over 100,000 excess HIV-related deaths over a year in sub-Saharan Africa only.’ (KFF). To globally govern such change requires a change in global governance. In this roundtable workshop we invite five different perspectives to evaluate the implications for infectious diseases and digital health, global health, politics and governance, law, and economics. The aims of the workshop are to: a) take stock of the latest known global impacts from US withdrawal on e.g. HIV, Tuberculosis, maternal and child health, pandemic preparedness and malaria; b) analyse what remains of the global health governance infrastructure in connection to on-the-ground health systems, services and community or informal care initiatives including digital health solutions; and c) revisit EU capacities and positioning in global health governance and collect collaborative, legal, digital, economic, and political options for action. The panel will critically examine these from different perspectives: 1. Dr. Biesma (global health) on the impact on HIV/PMTCT programmes with NGOs like JHPIEGO and AMREF in LMICs, highlighting local system fragility. 2. Prof. Anna Odone (infectious disease and digital health) on disease surveillance, treatment and digital solutions. 3. Dr. Joao Vasco Santos (economics) on the economic effects of cuts in development assistance, and the strategic importance of the EU. 4. Prof. Scott Greer (politics) on the geopolitics of the US withdrawal and the ways European countries could maximise their health impact in the context of other powers’ global health activities. The workshop facilitates 30 minutes of interaction, where the audience chooses the preferred Format: either in sub groups with one of the panel members, or multi-perspective plenary discussion of collaborative, legal, digital, economic, and political options for action by EU governments. Key messages • The dissolution of PEPFAR and other US foreign aid programs has led to horrific deaths and disease in other continents due to mass layoffs, lack of testing equipment and medication. • European governments, committed to multilateralism, can collaboratively facilitate the global health system’s redirection to prevent the reversal of successes such as HIV/AIDS and polio care. Speakers/Panellists João Vasco Santos University of Porto, CINTESIS, ARS Norte, Porto, Portugal Scott Greer University of Michigan, European Observatory on Health Systems and Policies, Ann Arbor, USA