Over the past two months, the United States has made financial commitments that hint at a limited return to global health and humanitarian assistance partnerships, after the abrupt severing of many of those relationships a year and a half ago.

Last week, the State Department notified Congress that it would send $600 million to Gavi, an organization that helps low-income countries buy essential childhood immunizations, a year after Health Secretary Robert F. Kennedy Jr. withdrew U.S. support.

It was the latest in a series of financial commitments from the U.S. government to international organizations, working on issues such as hunger and tuberculosis, totaling nearly $2 billion.

In most cases, these payments move money that had been appropriated by Congress but that had been stuck since the Trump administration took office in January 2025 and instituted a freeze on foreign aid.

It was not yet clear whether the disbursements represented a lasting shift, or how close any further commitments would bring the total to what the United States used to spend on aid and global health. People who have been part of talks with the State Department about this funding said there were at least two motivations behind the money flowing to resumed partnerships.

First, recent health threats including, most notably, the ballooning Ebola outbreak in Congo, reinforced the need for funding multilateral agencies that work on global health security.

Second, with the Trump administration’s dismantling of the U.S. Agency for International Development and absorption of a skeleton crew of its staff into the State Department, there was no longer the infrastructure or staff for the United States to move humanitarian assistance on this scale by itself, making these large international agencies necessary partners.

“What may be happening here is that reality is sinking in for decision-makers,” said Mark A. Green, who served as administrator of USAID during President Donald Trump’s first term and who is president of ONE, an advocacy organization for foreign assistance. “The good news is that Secretary Rubio clearly realizes that global health is what we do, and we’re really good at it. That’s why you’re starting to see more money moving,” he said, referring to Secretary of State Marco Rubio.

He added, “I think there’s a realization that global health security is also American national security, too.”

Eighteen months ago, the freezing of assistance was perceived internationally as a significant U.S. retreat from multilateralism. It created immediate financial crises for many aid institutions, leaving gaping holes in budgets such as that of the World Food Program, which provides emergency food aid in war and disaster zones. And it presented an existential crisis for a humanitarian assistance and global health architecture that had long been predicated on bedrock U.S. support.

Jeremy Lewin, the top official for foreign aid at the State Department, said his team continues to be focused on remaking foreign assistance to be leaner and more efficient and to end recipients’ dependence.

“These international organization relationships, we can use them tactically where they’re important, but it doesn’t mean we need to fund them year after year after year when they don’t have that same nexus to something that we care about,” Lewin said.

In addition to the money for Gavi, recent major funding announcements from the State Department include:

• $800 million for the World Food Program to fight malnutrition in countries including Ethiopia, Myanmar and Ukraine

• $218 million for UNICEF to work improving child health through nutrition, water and sanitation projects

• $100 million to Operation End Starvation, a new public-private partnership working to lower child mortality from malnutrition

• $50 million to the Coalition for Epidemic Preparedness Innovations for the development of new Ebola vaccines

• $203 million to the International Committee of the Red Cross and the International Federation of Red Cross and Red Crescent Societies for disaster response and humanitarian assistance

• $220 million for the Ebola response in Congo and $350 million in new humanitarian funding to the affected region, as of June 12

• $661 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria, a payment against what was owed from prior year appropriations

“I’m hoping we’re back to a regular order of payouts that are consistent with the Global Fund being an important partner,” said Chris Collins, the president of Friends of the Global Fight, an advocacy group that lobbies for support of the Geneva-based health organization.

Gavi CEO Sania Nishtar also expressed relief about the restoration of U.S. support this past week. “This new funding is vital,” she said. “It will help us maintain emergency vaccine stockpiles for Ebola and other deadly diseases and help countries turn the tide on malaria.”

At the outset of Trump’s second term, he and his officials were sharply critical of most of the big international organizations the United States used to disburse assistance, calling them bloated and wasteful, and saying American participation in large U.N. agencies was an ineffective use of funds.

Lewin said the international agencies receiving State Department funding have made significant changes to their operations to align with the administration’s priorities. He said U.N. agencies were charging lower rates of overhead than they did for USAID contracts, and providing more accountability to U.S. auditors and more transparency into their operations.