US president Donald Trump has taken a series of decisions that have delivered body blows to the global management of health. He has announced that the US will leave the World Health Organization. And a 90-day freeze has been placed on money distributed by the US Agency for International Development (USAid) pending a review by the US State Department. This includes funds for the President’s Emergency Plan for Aids Relief (Pepfar). The decisions have triggered alarm in the global health sector.