Hundreds of millions of dollars in U.S. foreign aid for global vaccines are at risk of expiring in just a few months—thanks to an unprecedented intervention by U.S. Health and Human Services Secretary Robert F. Kennedy Jr.
The famously anti-vaccine head of the U.S. domestic health agency has inserted himself into the aid disbursement process, despite having no legal authority to do so. Now, Gavi, the Vaccine Alliance—which provides vaccines to low-income countries for child immunization campaigns—is facing a critical funding shortfall that it says could result in the deaths of more than 1 million children.
Hundreds of millions of dollars in U.S. foreign aid for global vaccines are at risk of expiring in just a few months—thanks to an unprecedented intervention by U.S. Health and Human Services Secretary Robert F. Kennedy Jr.
The famously anti-vaccine head of the U.S. domestic health agency has inserted himself into the aid disbursement process, despite having no legal authority to do so. Now, Gavi, the Vaccine Alliance—which provides vaccines to low-income countries for child immunization campaigns—is facing a critical funding shortfall that it says could result in the deaths of more than 1 million children.
Congress over the last two fiscal years has directed a total of $600 million to Gavi. But those funds have yet to be provided due to the unusual and legally questionable deference U.S. Secretary of State Marco Rubio has extended to Kennedy, who is pressuring Gavi to make changes to its vaccine portfolio.
Amid the escalating Ebola outbreak in East Africa, Democrats and even some Republicans are increasingly frustrated at the aid funding holdup and have pressed Rubio—a longtime vaccine and Gavi proponent during his time in the Senate—to overrule Kennedy. The funding’s congressional authorization expires at the end of September.
“This is Secretary Rubio’s authority and Secretary Rubio’s authority only, and so we’re about to find out who’s in charge,” Sen. Brian Schatz, the top Democrat on the Senate spending panel that sets foreign aid levels, said in an interview. “The law requires that the money be released. … I’m very hopeful that he will demonstrate that he is in charge very shortly.”
Schatz pressed Rubio at a recent foreign aid hearing to explain why he had permitted Kennedy to interfere in an area in which Congress has not authorized the health secretary to have a role. Gavi funding was previously administered by the U.S. Agency for International Development (USAID), but oversight was transferred to the State Department last year following USAID’s dismantlement.
Rubio justified giving Kennedy and the Department of Health and Human Services (HHS) a role at the “directive” of President Donald Trump.
“Ultimately, we would like to see this problem solved, and we think we can,” Rubio said, noting that the U.S. government in the last year had lost its longtime Gavi board seat because of the failure to pay its organizational dues. “We’re certainly going to try, because we want it to be solved.”
A Gavi official told Foreign Policy that the organization has yet to receive any firm indication of when the $600 million would arrive.
Gavi, which was established in 2000 by the U.S. government, the United Nations, and the Bill and Melinda Gates Foundation, is a multilateral global health financing entity that, among other functions, hosts global emergency vaccine stockpiles for diseases such as yellow fever and Ebola (though not for the Bundibugyo strain currently circulating in the Democratic Republic of the Congo, which there is not yet a vaccine for).
“Gavi, as you well know, plays a critical role in preventing the spread of infectious diseases around the globe and helps to protect public health in our country as well by stopping outbreaks before they reach our borders, and that’s particularly important right now as the world is responding to the Ebola outbreak in the DRC,” Republican Sen. Susan Collins, the Senate’s top appropriator, said to Rubio at the hearing, pressing him to distribute the $600 million as directed by Congress.
It’s not that unusual for the State Department to consult with HHS and its scientists about matters of global public health, said a Democratic Senate aide, who was not authorized to be quoted. “The abnormal part is the HHS secretary having veto power over funds that are congressionally directed to go to the State Department for disbursement to Gavi,” the staffer continued.
Kennedy is focused on Gavi’s usage of the preservative thimerosal in a portion of its vaccine portfolio. The mercury-based ingredient is used in multidose vials as part of mass vaccination campaigns that Gavi runs in poor and hard-to-reach rural areas where refrigeration is logistically difficult. While Gavi and other organizations, including the U.S. Centers for Disease Control and Prevention, have published studies on the safety of thimerosal in vaccines, the preservative has been phased out of usage in the United States.
But public health advocates defend Gavi’s continued usage of thimerosal, because maintaining constant cold storage of vaccines is unrealistic in the low-income countries where it operates. Still, Gavi has announced a strategy for phasing out thimerosal vaccines thanks to the development of new vaccine technologies.
“We have always said that we are completely confident with the safety and programmatic use of thimerosal vaccines. That hasn’t changed,” said the Gavi official, who would speak only on background. “What is a stated objective is to migrate some of our vaccines that do contain thimerosal to a new generation of more powerful vaccines that happen not to contain thimerosal.”
Sen. Jeanne Shaheen, a senior Democrat with oversight of foreign aid policy, in April questioned Kennedy during a health policy hearing about his reasons for blocking the disbursement of the funding. She warned that the loss of the promised U.S. funding could result in many children needlessly dying.
“It is your department and you personally who’s holding up funding for Gavi,” Shaheen said. “Gavi estimates that loss of the funding could result in 75 million children not receiving routine vaccinations over the next five years, and that will lead to the deaths of more than 1.2 million children.”
Kennedy defended himself and called Gavi “intransigent.” He said that he worried Gavi might use some of its U.S. funding, which is fungible, to provide support to the World Health Organization (WHO). Kennedy is a strong critic of that body, which the Trump administration has withdrawn from over disagreements with the U.N. agency’s pandemic response policies.
“Gavi has a tremendous amount of money. In fact, Gavi is giving hundreds of millions of dollars to WHO, which we got out of because it was doing such a miserable job,” Kennedy told Shaheen. “I asked them, is our money going to you so that you can funnel it to WHO? They refused to answer that.”
The WHO does have a relationship with Gavi as the U.N. health agency is one of its founders.
“Gavi’s alliance structure is built around optimizing unique functions from across the public and private sectors, including WHO,” the Gavi official said. “We are proud of the impact these diverse skillsets have made, helping us to halve child mortality in children under 5 and protect over 1.2 billion children since 2000.”
But, Gavi is facing a funding shortfall after its most recent replenishment fundraising drive secured pledges of $10 billion against a goal of $11.9 billion, according to the Gavi official, who attributed the gap to the U.S. funding halt as well as a broader climate of donors reducing their foreign assistance spending.
“The reality is we have fallen short,” the official said, adding that the U.S. funding is needed to “unlock” Gavi’s plans for phasing out the thimerosal-containing vaccines and to replace them with newer, more powerful versions.
The State Department declined to respond to questions on the matter.
“HHS and the State Department continue engaging directly with Gavi and remain cautiously optimistic that ongoing discussions can produce greater transparency, accountability, and a constructive path forward,” HHS press secretary Emily Hilliard said in a statement.
