In the latest episode of the Apinions X Spaces liveshow by Apierion, healthcare economist Dr. Andrea Feigl and global health strategist Michael Lindenmayer joined host Michael “Dersh” Dershem for a high-stakes discussion on the unraveling of global health funding and what comes next.
The live X Spaces conversation aired on May 13 tackled the growing fallout from the U.S. government’s withdrawal from the World Health Organization (WHO) and slashed USAID support for health systems in developing countries. With development aid in retreat and billionaires hesitant to fill the void, Feigl and Lindenmayer painted a sobering picture of global health on the brink—but not without pathways forward.
“WHO doesn’t deliver programs, it delivers the ability for countries to stand up critical systems,” said Feigl, founder of the Health Finance Institute. “That’s what’s at risk.”
Feigl, a health economist with deep experience in development financing, explained that the U.S. pullback could leave WHO with a shortfall of up to $130 million in 2024 alone, disrupting critical efforts from pandemic preparedness to childhood nutrition. Meanwhile, she warned of on-the-ground collapse already occurring. In Kenya, she noted, USAID cuts forced midwives to abandon deliveries in real time.
Lindenmayer, a former Morgan Stanley executive turned Northwestern University faculty member, offered a systemic lens: “Cutting funding is like stripping away our immune system. Detection is how we see threats coming.”
The two guests agreed that health funding has long been misaligned with population needs. Feigl cited data showing that less than 3% of global health aid goes to chronic diseases, despite those illnesses making up over 60% of the burden in low- and middle-income countries. The reason? Donor priorities are often driven by geopolitics or optics.
“We are living in a donor reality where diseases, not people, are prioritized,” she said.
When asked about the role of private philanthropy in filling the gap, the panel took a nuanced stance. Bill Gates, for instance, recently pledged $200 billion over two decades but publicly stated he would not make up for government deficits. Feigl called for a model that aligns donor dollars with national priorities, not billionaire whims.
“One rich person can’t rebuild global health systems. That’s not fair, and it’s not how governance works,” she emphasized.
Despite the dire outlook, both guests ended with cautiously optimistic notes. Lindenmayer predicted a messy but adaptive future: more decentralization, better prevention, and the integration of new technologies like AI and blockchain for transparency and fraud prevention.
“We’ll fail forward. We’ll decentralize. We’ll adapt. Not because we want to, but because we have to,” Lindenmayer added.
Feigl was more guarded but agreed progress was still possible if funding flows are restructured and governments recommit to long-term health system strengthening.
Host Dershem closed the conversation with a rallying metaphor: “In the short term, we may see tidal waves—but there’s a blue ocean in front of us if we act in good faith.”
The episode underscored a defining truth for global health in 2025: the safety net is fraying, but how, and whether, we reweave it may determine the trajectory of billions of lives.