The ignorance and arrogance emanating from leadership at the Department of Health and Human Services reared its head again this week. On January 28, news outlets reported that the Trump Administration is imposing new conditions on U.S. funding for Gavi, the Vaccine Alliance — specifically requiring Gavi to phase out the use of the vaccine preservative thimerosal in order to continue receiving American support. This move follows RFK Jr.’s announcement last summer that the United States would halt funding for Gavi because it failed to take vaccine safety seriously.
These decisions are extraordinarily dangerous. The United States has historically been one of Gavi’s largest donors, contributing roughly 13 percent of the alliance’s budget. Any disruption in U.S. support reverberates immediately and catastrophically through immunization systems that millions of children depend on for survival.
Gavi is the single largest provider of life-saving vaccines to children in the world’s poorest countries and has long enjoyed strong bipartisan support from both Congress and successive U.S. administrations. Over the past 25 years, this public-private partnership has helped vaccinate more than half of the world’s children against deadly and debilitating infectious diseases, preventing an estimated 20.6 million future deaths. Gavi played a central role in cutting global under-5 mortality by more than half, largely by expanding access to proven, cost-effective vaccines and strengthening health systems in low-income countries.
By improving access to new and under-used vaccines for millions of the most vulnerable children, Gavi has transformed families, strengthened GDPs, and made the world safer for everyone. As I wrote in 2023: when I was growing up in the developing world in the 1970s and early 1980s, a child’s chances of surviving past her fifth birthday were tenuous at best. While wealthy countries like the United States — where my mother was born — had already benefited from decades of public health advances, those same innovations were slow to reach the far corners of the globe. Gavi helped change that trajectory.
RFK Jr. has long trafficked in conspiracy theories about vaccines. But beyond his rejection of settled science lies an even more troubling failure for someone in his position: a profound misunderstanding of how life and health systems function in the global south. Thimerosal — the preservative he is demanding Gavi remove from its vaccines — is not only safe, but also essential. It allows multiple doses to be drawn from a single vial and ensures vaccine stability as those vials travel hundreds of miles across difficult and sometimes dangerous terrain to reach children who would otherwise be left behind.
In low-income settings, insisting on single-dose vials — as is common in the United States — is simply not viable. The costs would be enormous, drastically reducing the number of children who could be reached. RFK Jr’s inability or unwillingness to grasp this basic reality leaves only two explanations: either he lacks the competence required for his role, or he is willing to place his ideology and ego ahead of children’s lives.
This disregard for real-world consequences for kids has become a defining feature of the Trump Administration. Last year’s decision to allow Elon Musk to dismantle the U.S. Agency for International Development was akin to dropping an atomic bomb on global child survival efforts. Conservative estimates suggest that decision alone will result in an additional 4.5 million child deaths by 2030.
This is not what Americans signed up for. When polled, the public overwhelmingly supports — and takes pride in — the United States’ leadership in global health and child survival, especially when reminded that it costs us less than one percent of our federal budget. Yet because of RFK Jr. and others in the Trump Administration, 2025 is poised to become the first year since global tracking began in which under-5 mortality rises instead of falls. History will view this not as a policy failure, but as a moral one — born of egomaniacal, shortsighted decisions that needlessly cost children their lives.