When Governments Retreat, Philanthropy Must Step Forward

We are living through a period of profound disruption to the architecture of global health. The retraction of American foreign aid, the dismantling of USAID, and the United States’ withdrawal from the World Health Organization have not merely created funding gaps, they have fractured the institutional scaffolding that the world built, over decades, to protect human health. For Australia, this global crisis arrives at a moment when our own domestic research funding is under quiet but serious pressure. The confluence of these forces makes one thing clear: philanthropy in health and medical research is no longer a generous supplement to government investment. It is an urgent necessity.

The Global Rupture

In January 2025, President Donald Trump signed an executive order withdrawing the United States from the WHO and, within weeks, initiated the dismantling of USAID. Within months, 83 per cent of USAID’s projects had been cancelled. UNAIDS lost nearly 80 per cent of its project funding. The President’s Emergency Plan for AIDS Relief (PEPFAR), which had supported some 20 million people on antiretroviral medication, was gutted and restructured. The WHO, which had relied on the US for roughly a quarter of its combined assessed and voluntary contributions, began cutting staff and rationing programmes. A year on from those decisions, researchers at the Institute for Health Metrics and Evaluation are reporting that the funding cuts are “bigger than expected, not less”, with 97 per cent of bilateral US funding to countries like Bangladesh simply gone.

The human consequences are not abstract. In Uganda and Tanzania, people living with HIV are rationing doses of their medication. In the Democratic Republic of Congo, incomplete water connections from defunded NGO projects are leaving communities without safe water. In Ukraine, emergency health systems that had been shored up by US-funded humanitarian organisations have been abruptly abandoned. The dominant and lasting impact, as Harvard’s Humanitarian Initiative has observed, “is the rapid reduction in critical assistance that will impact millions who rely on lifesaving food aid, health care, and relief services.”

This is not only a crisis for the developing world. It is a signal that the global health order that Australia has depended upon, collaborated within, and benefited from for generations is being remade along narrower, more transactional lines. And it falls to countries like Australia, to civil society, and to private philanthropists to decide whether they will help fill the void.

A Domestic Reckoning

Against this global backdrop, Australia’s own health and medical research sector is confronting a quieter funding emergency of its own. For decades, the National Health and Medical Research Council (NHMRC) has been the cornerstone of our research enterprise, funding the full spectrum from basic discovery science through to clinical research, public health, and health systems innovation. It has been, rightly, the institutional expression of our national commitment to evidence-based medicine and scientific progress.

But the data on NHMRC funding tell a concerning story. According to analysis by the Nature Index, NHMRC grant funding fell from approximately US$320 million in 2020 to just US$134 million by 2023, a decline of more than half in three years. While the Medical Research Future Fund (MRFF) was established in part to broaden the funding base, it too has been underperforming its mandate: despite being designed to distribute $1 billion annually at maturity, it has been capped at $650 million per year since 2021, leaving an estimated $350 million per annum unspent against the fund’s original intent.

The consequences ripple through the research workforce. NHMRC’s Ideas Grants (the scheme designed to support bold, curiosity-driven discovery research) carry a success rate of just 8.1 per cent. The Investigator Grant scheme, the primary mechanism through which senior researchers secure their salaries and research support, succeeds only 14 per cent of the time. The sector, as one prominent commentator writing in the Medical Journal of Australia has put it bluntly, “is at breaking point.” Brilliant ideas, and the researchers who carry them, are being lost.

This is not simply a matter of missed scientific opportunity. It is an economic miscalculation. Analysis by Nous Group, commissioned by the Association of Australian Medical Research Institutes (AAMRI), finds that Australia’s medical research institutes generate an estimated $4.07 billion in annual economic benefit and deliver a return of $3.90 for every $1 invested. Clinical trials return even more, $5.80 for every dollar invested. A KPMG analysis found that medical research conducted between 1990 and 2004 alone delivered net present gains of $78 billion to the Australian economy, $52 billion in health gains and a further $26 billion in broader economic value. To underfund this sector is not fiscal prudence; it is fiscal short-sightedness.

The Philanthropic Imperative

Into this gap private philanthropy must step with renewed purpose and scale.

Australia already has a tradition of philanthropic support for health and medical research that is worth celebrating and building upon. Foundations like the Sylvia and Charles Viertel Charitable Foundation have invested more than $90 million in medical research over 30 years, supporting fellowships that have produced some of Australia’s most distinguished researchers and clinicians. Research Australia, the national peak body, notes that over 80 per cent of its member organisations raise philanthropic funds to support their own research or fund the work of others. The NHMRC has formally established a Philanthropic Engagement Working Committee, recognising that peer-reviewed, high-quality grant proposals exist that simply cannot be funded from the public purse alone.

But the scale of what is needed now demands a step-change in how Australians think about private giving to research.

Philanthropic investment is particularly critical at the earlier, riskier stages of discovery — the basic science that generates the foundational knowledge upon which all subsequent clinical and translational research depends. Government funding bodies, by their nature, are drawn toward research with demonstrated preliminary data, clear translational pathways, and measurable near-term impact. Philanthropy, by contrast, can take the long view. It can fund the researcher whose hypothesis is bold and the evidence still thin. It can back the laboratory pursuing a question whose answer may not be known for a decade. And in doing so, it seeds the entire pipeline.

This is not charity in the conventional sense. Philanthropic support for health and medical research is an investment in the knowledge infrastructure from which better health systems, more effective treatments, and stronger public health outcomes are eventually built. The pathway from a molecular discovery in a university laboratory to a changed clinical guideline or a new public health intervention is long and requires sustained support at every stage: discovery, translation, clinical validation, and implementation. Philanthropy that understands and commits to this full spectrum is philanthropy that changes lives at scale.

Australia’s Moment

The Australian Government’s emerging National Health and Medical Research Strategy explicitly names philanthropy alongside government, industry, and academia as a pillar of the research ecosystem. That is an important signal. But the strategy will only be as strong as the private capital prepared to flow alongside it.

Australia is a wealthy country with a growing philanthropic sector. The 2023 Productivity Commission Review of Philanthropy identified significant headroom for growth in structured, strategic giving. Our tax system provides meaningful incentives for donations to eligible research organisations with deductible gift recipient status. And our medical research institutes provide platforms for philanthropic investment that are world-class in their rigour and reach.

Meanwhile, global health need is not retreating. Antimicrobial resistance, pandemic preparedness, mental health, dementia, chronic disease burden, and health equity across our Indo-Pacific region all represent challenges that will define the next generation of health systems. Australia’s research capacity is a national asset with global relevance. Maintaining and growing that capacity in the face of declining government investment and a retracting United States is not optional, it is a strategic obligation.

Philanthropy cannot replace government. Nor should it be expected to. What it must do is fill the critical gaps that public funding leaves exposed, back the bold ideas that bureaucratic systems find too risky, and sustain the pipeline of researchers and discovery upon which all future progress depends. In a world where the institutions we relied upon are fracturing, and where the governments we counted on are retreating, private investment in health and medical research is one of the most consequential decisions any individual, family, or foundation can make.

The science is ready. The researchers are capable. The need, both here and globally, has never been greater. The question is whether Australian philanthropy will rise to meet the moment.

References:

Cullinan, K. ‘One Year Later: The Effect of US ‘Chainsaw’ on Global Health’, Health Policy Watch. 20 January 2026.
Baker, S. ’Research funding in Australia: what are the latest trends?’, Nature Index. 19 December 2024.
Speight, J., Holmes-Truscott, E. & Skinner, T.C. ‘The hidden ethics crisis in Australian health research funding’, InSight+. 8 December 2025.
‘New report: Australia’s medical research institutes deliver billions in economic value and national capability’, Association of Australian Medical Research Institutes (AAMRI). 30 March 2026.