The Johns Hopkins University laid off more than 2,000 employees last year and sharply curtailed international humanitarian programs following major cuts to U.S. foreign aid that disrupted global health operations.

But after the U.S. Agency for International Development was largely dismantled, federal officials directed unusually large new sums to a core group of government contractors — including one affiliated with Hopkins.

Jhpiego, a decades-old nonprofit focused on maternal and child health, received more than $352 million in fiscal year 2025, the fourth-most of any contractor and a 133% increase from the year before.

That’s from a new analysis of federal funding by the Health Security Policy Academy, a policy think tank connected to Mass General Brigham.

The money appears to benefit Jhpiego — pronounced JAH-pie-go — as Hopkins grapples with drops in federal funding. But officials cautioned in a statement Wednesday that they were strictly limited by the terms of the grants.

“Funding cannot be transferred to unrelated programs or employers and cannot be automatically translated into restored programs or positions in other areas,” Hopkins spokesperson Doug Donovan said in the statement.

KJ Seung, a member of the think tank team that conducted the analysis, said groups with the most money would likely struggle to adjust to a budget so drastically altered.

He said Jhpiego appears to have lost funding for many existing programs but gained major new funding for two: one addressing HIV and another directing medical care to pregnant women and children.

What happens next is “really opaque,” Seung said.

“All we know is there are these huge obligations of money that were done at end of the last fiscal year,” he added. “That’s not the same as spending it.”

The analysis concluded the groups would likely experience “operational shock” as they quickly ramp back up any programs slated for elimination and expand into new countries previously served by other contractors.

Managing Jhpiego’s budget falls to a newcomer, Allyson Bear, who took over April 1 as president and CEO after the retirement of longtime leader Leslie Mancuso.

Bear previously served as founder and CEO of the Baltimore-based public health consultancy VennHealth, but she’s also a veteran of USAID. Hopkins President Ron Daniels said in an email to staff last month that she came with “a proven track record.”

Bear declined an interview request through Hopkins, but the federal funding surge — and future uncertainty — suggests she’ll have a bumpy transition.

Jhpiego is highly reliant on federal dollars. According to its 2024 annual report, those funds made up about three-quarters of its budget. That share was affected by cost-cutting efforts by a federal initiative known as the Department of Government Efficiency, or DOGE, which sharply reduced USAID’s operations early in the Trump administration.

The courts and Congress restored some of the funding. But DOGE’s moves alarmed experts and observers not only at Hopkins, but also at Maryland-based global aid groups and private contractors that work overseas to curb diseases such as HIV/AIDS and tuberculosis and prevent deaths from vaccine-preventable illnesses and childbirth complications.

They also warned the pullback could erode goodwill toward Americans.

The latest moves have only increased concerns, said Sen. Chris Van Hollen, a Maryland Democrat who sought to maintain global aid and increase oversight of decision-making as a member of the Senate Foreign Relations Committee.

He called the move to dismantle USAID “illegal” and harmful not only to poor and vulnerable populations, but to the country’s national security.

And now, the senator said, “Instead of improving efficiency, this has created chaos and confusion, weakening our efforts to save lives around the world.”

Heather Wipfli sees it firsthand. She is a professor of global health at the University of Maryland whose HIV research in Uganda was disrupted last year by the USAID cuts when the clinic was suddenly unable to pay its staff.

She was at risk of losing four years of research, but the patients at the clinic were at risk of losing HIV care and prevention. She scrambled to help patch the shortfall, but once the clinic reopened, many patients didn’t return.

Patients felt betrayed by the abrupt end to funding from the United States, she said. When the money flowed again, it came from the Ugandan government.

“The bottom line was trust was just broken,” she said. “The overall message they heard was the clinic was no longer in existence, and now they don’t know what to believe or trust.”

That dynamic, Wipfli said, is unfolding in clinics across the globe.

More disruption is expected as the Trump administration moves to a new “America First Global Health Strategy.”

The State Department, which absorbed USAID and allocated the money, characterized 2025 as a transition year. Officials said they would soon stop long-standing partnerships with global aid groups and contract with foreign governments directly. Wipfli and others, however, cautioned not all of these governments have experience managing such services.

In a statement, federal officials said they already have 30 agreements with the governments and more are in the works. This, they said, would move the spending “onto a stable path toward self reliance.”

That leaves Jhpiego’s future uncertain. The nonprofit launched more than half a century ago as the Johns Hopkins Program for International Education in Gynecology and Obstetrics and became a major global health contractor for the federal government. It typically has managed hundreds of millions of dollars in programming in dozens of countries.

Hopkins also operates global aid programming from its school of medicine and another nonprofit aid group, the Center for Communication Programs, housed within the Hopkins Bloomberg School of Public Health. Both faced substantial cuts last year.

In March 2025, Hopkins announced 1,975 layoffs across 44 countries among those groups, which at the time had collectively lost $800 million in USAID funding, and another 257 in the United States, mostly in Baltimore, with dozens more employees furloughed or placed on reduced schedules.

With some funding restored for existing programs, Jhpiego may rehire some workers, though the new analysis found that could be a difficult task since many left a year ago. And the federal funding commitments are pledges rather than cash in hand, according to Seung. Groups must consider that the funding may not arrive as federal priorities continue to shift, he said.

The new allotments also came mostly late in the fiscal cycle, so groups didn’t know what was coming. By Sept. 30, the end of the fiscal year, the funding was highly concentrated, the analysis found, with the top 25 groups receiving 91% of global health funding, up from 67% the year before.

Johns Hopkins itself remained among the top 25 recipients, though at a fraction of Jhpiego’s total. It received about $35 million in funding in fiscal year 2025, down nearly three-quarters from 2024.

Federal obligations are normally made in small increments and monitored as groups spend the money over time. Windfalls are rare.

“Even large implementing partners with hundred-million-dollar portfolios are not built to absorb abrupt, unpredictable funding swings without consequences,” the analysis said.

And at Jhpiego, there are swings. After the spike last year, federal officials have awarded next to nothing to the group so far this fiscal year, which began six months ago — $73,900.

“A collapse,” Seung said.