PAHO's Value Proposition to the United States
Access
Presence in countries the U.S. can't reach bilaterally
The Pan American Health Organization provides the United States with early warning, regional leverage, historical return on investment, and diplomatic access at a fraction of what comparable bilateral arrangements would cost. The question is not whether PAHO serves U.S. interests — historically and analytically it clearly does — but whether the United States currently values those interests enough to fund them.
Early warning
Disease detection before threats reach U.S. borders
Leverage
U.S. dollars pooled with 34 nations for outsized impact
Historical ROI
Disease eliminations that permanently reduced U.S. risk
I. Epidemic Early Warning and Border Security
The single most direct and least contestable benefit PAHO provides the United States is an early warning system for infectious disease threats originating in the Western Hemisphere. The United States shares a 1,954-mile land border with Mexico, processes hundreds of millions of border crossings annually, and is connected by dense air and sea routes to every country in Latin America and the Caribbean. Pathogens do not clear customs.
PAHO operates a 24/7 surveillance system that monitors social media, health authorities, and media to issue real-time alerts on emerging threats, including dengue, avian influenza, and novel pathogens. In 2024 alone the organization issued six dengue alerts, monitored avian flu risks, and coordinated cross-border outbreak responses. This intelligence reaches U.S. public health authorities — CDC, state health departments, border health units — faster and more comprehensively than any bilateral arrangement the United States could maintain with 34 individual countries. PAHO/WHO
The alternative to PAHO — fragmented bilateral surveillance agreements with each country in the region — would cost far more, achieve less coverage, and lack the neutral convening authority that allows PAHO to collect sensitive disease data from governments that might otherwise be reluctant to share it with Washington directly. A government that would not report an emerging outbreak to the United States for political reasons may nonetheless report it through PAHO's established epidemiological channels.
In the period July 2024 to June 2025, PAHO responded to more than 38 health emergencies, including dengue epidemics, mpox, and avian influenza, as well as natural disasters such as Hurricane Beryl. Each of these events carried potential spillover risk to the United States. Detecting and containing them in the region before they reach U.S. borders is vastly cheaper than managing them domestically. PAHO/WHO
II. Force Multiplication: U.S. Dollars Buy Regional Capacity
The United States is PAHO's largest contributor, but the leverage ratio is substantial. PAHO is approximately 75% self-funded by its WHO member states in the Americas region, meaning that U.S. assessed contributions are pooled with contributions from 34 other member states, Canada, and extra-budgetary voluntary funding, and deployed through a multilateral platform with established country offices, technical staff, procurement systems, and government relationships that the United States does not have to build or maintain bilaterally. Health Policy Watch
PAHO mobilized $552 million in voluntary contributions during the 2024–2025 biennium — a 111% increase compared with pre-pandemic levels in 2019. This represents resources from other donors, including European governments and development banks, co-investing in hemispheric health alongside the United States. When the U.S. funds PAHO, it is not simply paying for PAHO programs; it is buying co-investment by others in health security outcomes that benefit the United States. PAHO/WHO
The current USAID–PAHO Umbrella Agreement (2022–2027) supports a broad portfolio spanning tuberculosis, malaria, neglected infectious diseases, maternal and neonatal health, and health system strengthening. These programs do not simply benefit recipient countries in the abstract — they reduce the disease reservoir that feeds cross-border transmission, reduce the conditions that drive migration, and build the institutional capacity that makes future emergency response faster and cheaper. PAHO
III. The Revolving Funds: Market Power and Pharmaceutical Leverage
PAHO's Regional Revolving Fund for Access to Vaccines and its Strategic Fund for medicines are mechanisms that pool procurement demand across 33–35 countries to negotiate prices that no individual country — and certainly no small Caribbean or Central American state — could achieve alone. The Revolving Fund procured over $800 million in vaccines, medicines, and health technologies in 2024, including more than 10 million tests for HIV and viral hepatitis and 2 million tests for malaria, supporting elimination efforts across endemic areas. PAHO, PAHO
From a U.S. national interest perspective, this matters in two ways. First, immunized populations in Latin America and the Caribbean are less likely to seed outbreaks that reach the United States. Measles, for example, was eliminated from the Americas through sustained vaccination programs coordinated in part through PAHO — but measles elimination is only as durable as the weakest link in the regional immunization chain. Second, PAHO's bulk procurement function prevents the collapse of immunization programs in low-income member states during fiscal crises, which is precisely when disease outbreaks are most likely to occur and most likely to generate the migratory and humanitarian pressures that become U.S. border and foreign policy problems.
IV. Historical Return on Investment: Polio and Smallpox
The economic case for PAHO's value to the United States does not require speculation about future risks. It can be calculated from past achievements.
The elimination of smallpox from the Americas in 1971 — which PAHO helped coordinate — allowed the United States to eventually discontinue routine smallpox vaccination, which had been administered to millions of Americans annually at significant cost and with non-trivial rates of vaccine complications. The annual savings to the U.S. vaccination program, accumulated over more than five decades since cessation, substantially exceed the entire cumulative U.S. contribution to PAHO.
The Western Hemisphere's certification as polio-free in 1994 — following a campaign that PAHO Director Carlyle Guerra de Macedo launched in 1985 — similarly eliminated the risk of wild poliovirus importation into the United States from regional sources. As long as wild poliovirus circulates anywhere in the Americas, it can reach the United States. Eradication from the hemisphere closed that pathway permanently.
These are not marginal benefits. They represent existential disease threats permanently removed from the U.S. risk calculus, achieved at a fraction of what domestic containment and response would have cost had those diseases been allowed to establish endemic circulation in neighboring countries.
V. Diplomatic Infrastructure and Hemispheric Relationships
PAHO's country offices maintain working relationships with health ministries across 35 member states, including governments with which the United States has fraught or hostile bilateral relationships. In Cuba, Venezuela, Nicaragua, and other countries where direct U.S. engagement is constrained by sanctions, political tensions, or diplomatic ruptures, PAHO provides a channel through which epidemiological data flows and some degree of public health cooperation continues.
This is not incidental. From a U.S. health security perspective, the worst epidemiological scenario is a country whose disease surveillance is opaque to the outside world — a situation most likely to occur precisely in states that have severed or degraded their bilateral relationships with Washington. PAHO's institutional presence in those countries, maintained through its independent multilateral status, provides the United States with at least some epidemiological visibility it would otherwise lack entirely.
PAHO also serves as a soft-power instrument. USAID's partnership with PAHO, formalized through successive umbrella grant agreements, has supported country health systems across the Americas in ways that demonstrate U.S. commitment to hemispheric prosperity without the bilateral political complications that direct aid programs often generate. For many countries, PAHO-mediated U.S. assistance is a visible, credible signal of engagement — one that matters for the broader geopolitical competition for influence in Latin America. PAHO
VI. The Cost of Disengagement
In early September 2025, the United States announced a rescission of $45 million to PAHO, citing the use of Cuban health workers through a PAHO program as potential human trafficking of those individuals. The unpaid U.S. dues comprise the lion's share of the $116.9 million in unpaid member state dues owed to PAHO for 2024–2025. PAHO has already reduced its overall budget from more than $1.14 billion in 2022–23 to planned spending of $762 million for 2026–2027. Think Global HealthHealth Policy Watch
The specific Cuban health workers dispute reflects a legitimate policy concern. But the instrument being used to address it — withholding assessed dues from the entire organization — does not surgically resolve the Cuba program question. It degrades the surveillance networks, immunization programs, and emergency response capacity that protect the United States from the full range of hemispheric health threats. It also damages U.S. credibility as a reliable multilateral partner at a moment when China and others are actively expanding their presence in Latin American health institutions.
PAHO's 2025 Annual Report noted that it was delivering on its mission "even in the face of reduced global health funding and an increasingly complex public health environment," — a diplomatic acknowledgment that it is adapting to U.S. withdrawal. Adaptation in practice means diverting organizational attention toward fundraising and institutional survival and away from the technical programs that generate the health security benefits the United States values. National Today
Summary
PAHO's value proposition to the United States rests on four durable pillars: early warning (disease detection before threats reach U.S. borders), leverage (U.S. dollars pooled with other nations' contributions for outsized regional impact), historical return (disease eliminations that have permanently reduced U.S. domestic risk), and diplomatic access(institutional presence in countries and systems the United States cannot reach bilaterally). The assessed U.S. contribution to PAHO is, by the standards of comparable national security investments, modest. The question is not whether PAHO serves U.S. interests — historically and analytically it clearly does — but whether the United States currently values those interests enough to fund them.