Global Health Watch: Zambia approves LEN, what “America First” means for global health, new documentary on impacts of foreign aid freeze

November 7, 2025

This week, Zambia joined South Africa in approving injectable lenacapavir for PrEP (LEN), marking a new era of accelerated efforts to scale-up access. At the same time, there’s sharpening analyses of the major shifts in US strategy for foreign aid and global health leadership, with deep implications for the future of funding, multilateralism, and equity.

What Lies Ahead for “America First” Global Health Strategy? 

It’s been six weeks since the US Department of State issued its “America First” global health strategy, and global health leaders in the US are now sharing insights on the real-world implications of the new strategy. A new Think Global Health piece looks at questions posed by key pillars of the US strategy: a pivot from multilateralism to bilateralism, a narrow focus on funding for commodities and frontline health workers, pooled procurement and time-limited support with the aim to ‘graduate’ countries from assistance. Meanwhile, Devex offers perspectives from several leaders in the field who weigh opportunities, contradictions, and raise red flags about sidelined NGOs and the communities they serve, reduced ambition in US global health programming, and weakened multilateral partnerships. 

IMPLICATIONS: The way forward requires a major recalibration by implementers, partner countries and communities. The next chapter under this new system could exacerbate ongoing service disruptions and existing challenges in HIV prevention and treatment delivery, in particular to key populations. As funding becomes more conditional and bilateral agreements take precedence, mechanisms for community-driven priority setting, program monitoring, comprehensive data collection and sharing, and universal access to prevention tools must be preserved.  

READ: 

• Questions for the America First Global Health Strategy—Think Global Health 
• ‘America First’ in global health: Oxymoron or opportunity?—Devex  

New Resources on the Foreign Aid Crisis 

Two powerful new resources shed light on the far-reaching impacts of the United States’ foreign aid cuts. The New Yorker released Rovina’s Choice, a new documentary that follows a mother in Kenya navigating the collapse of care for her daughter living with HIV. The film captures the cascading effects of the loss of USAID support, including the dismantling of HIV wards, malaria clinics, refugee camps and health centers. Atul Gawande, the last Assistant Administrator of USAID, penned an accompanying commentary, The Shutdown of USAID Has Already Killed Hundreds of Thousands. Devex also launched The Aid Report, a central hub for tracking funding reductions, program disruptions, and structural shifts across the ecosystem of global aid. 

Meanwhile, The New York Times and Washington Post highlighted AVAC and the Global Health Council’s court cases against the foreign aid freeze as part of a broader test of executive power, with direct implications for foreign assistance policy. See AVAC’s trackers to stay abreast of the impact of US cuts to foreign aid and HIV prevention research.  

IMPLICATIONS: These resources demonstrate the scale and impact of US disengagement from global health leadership. They document how political decisions in Washington are directly destabilizing care systems, reversing progress, and threatening lives—especially in communities already facing high burdens of disease. The loss of predictable US funding has ended vital health programs around the world and is shifting the architecture for global health to a transactional model that may deprioritize equity, local voices, and long-term sustainability. 

READ: 

• The Shutdown of USAID Has Already Killed Hundreds of Thousands—The New Yorker 
• The Monthslong Legal Battle to Save Foreign Aid—The New York Times 
• Supreme Court has expanded presidential powers under Trump. How far will it go?—Washington Post 
• WHO issues guidance to address drastic global health financing cuts—World Health Organization  
• Withdrawal of US aid has hurt South Africa’s HIV programme—Spotlight South Africa 
• Impact Trackers—AVAC  

Zambia Approves LEN for PrEP

Zambia is the latest country to approve injectable lenacapavir for PrEP (LEN), following the South African Health Products Regulatory Authority (SAHPRA) approval two weeks ago. These are the first low- and middle-income countries to approve an HIV prevention method within just months of regulatory approvals in the US and EU. Regulatory reviews are also underway in a number of additional countries, with decisions expected over the next few months.

IMPLICATIONS: These swift approvals mark a major milestone in the global HIV response and set a new precedent for accelerating the process of scaling-up biomedical interventions in high-burden regions. But approvals alone are not enough. Turning access into impact will require aligned funding, community engagement, strong demand creation, and clear strategies for equitable rollout. These early regulatory wins are a strong start, but continued advocacy is essential.  

READ:  

• Moving a Product to the Real World—AVAC (infographic) 
• Lenacapavir Regulatory Approval—AVAC (infographic)  
• Access Strategy for Long-Acting PrEP—Gilead Sciences 
• Gears of Lenacapavir for PrEP Rollout—AVAC

What We’re Reading

• Exclusive: The Trump administration dismantled the CDC’s peer review system. Staffers scrambled to salvage it.—Inside Medicine Substack
• ‘You cannot fight an invisible problem’: Atul Gawande on US aid cuts—Devex
• Top researchers consider leaving U.S. amid funding cuts: ‘The science world is ending’—PBS Newshour
• Public Health Was a Place for Warriors Once. It Needs to Be Again.—The Nation
• On Eve of Record Shutdown, Trump Administration Threatens Pain Could Worsen—The New York Times
• UN staffers depart Manhattan’s urban canyons for Kenya’s leafy capital—Devex
• New Covid virus found in wild Brazilian bats—The Telegraph
• Nancy Pelosi announces her retirement from Congress—Washington Post
• Vaccine-Preventable Disease: A Global Tracker—Think Global Health

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