Global Health Watch: France Cuts Global Fund, US Bilateral Health Platform, PEPFAR Timeline Uncertainty, New Lancet Africa Journal

Issue 59

March 13, 2026

This week, France sharply cut its contribution to the Global Fund, adding to the replenishment shortfall and broader strain on multilateral global health financing. Meanwhile, the US launched a new global health funding platform tied to bilateral agreements, even as delays in MoUs and shifting timelines continue uncertainty about service delivery under PEPFAR and what its future and the future of multilateralism looks like. Amid these shifts in global health architecture, The Lancet launched the inaugural issue of The Lancet Regional Health – Africa to elevate African leadership in health research and policy.

France Cuts Contribution to Global Fund

France, traditionally the second-largest contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, has reportedly sharply reduced its pledge for the latest replenishment cycle. After increasing its support by 20% in each of the previous two cycles, France cut its contribution by 58%. This, combined with delays in a pledge from the European Commission and reductions in contributions from other major donors, brings the Fund well under its $18 billion target. As reported previously, the Global Fund Board approved $10.78 billion in country allocations for the 2027–2029 cycle and set aside $260 million in catalytic funding to accelerate access to innovations, including scale-up of lenacapavir for long-acting PrEP, new molecular tuberculosis diagnostics and improved malaria vector-control tools. 

IMPLICATIONS: France’s cut reflects a broader reduction in support for multilateral global health institutions at a time when the global health architecture is being reconstructed. As Health Policy Watch notes, “when it comes to healthcare, multilateralism has yielded many tangible benefits that are helping keep people alive. In a world where every country stands alone, these benefits will simply fall away.” Moving forward, the question is not only which multilateral organizations will be appropriately funded, but whether future global health partnerships can preserve the collective action needed to address HIV, tuberculosis, malaria and emerging health threats, and what forms those partnerships will take. 

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US Launches New Global Health Funding Platform as Bilateral MoUs and PEPFAR Timelines Pass

The US State Department launched the “Advancing Global Health” Annual Program Statement (APS), a new global health funding mechanism that could provide up to $4.5 billion into projects tied to the administration’s emerging bilateral health Memoranda of Understanding (MoU) agreements with partner countries. The platform is designed as a standing funding mechanism where international organizations, NGOs, universities and others can respond to targeted calls for grants and compete for funding awards between $500,000 to $250 million.

The US State Department also released the full text of MoUs with Ethiopia, Kenya, Mozambique, Nigeria and Uganda. The documents do not include data and specimen-sharing provisions, and only five of the 24 signed agreements have been published, despite the deadline to finalize MoUs by December 31, 2025. This delay led to PEPFAR-supported countries, which have not yet signed agreements or secured funding under the MoUs, being granted a three-month extension to continue to receive funding at current levels. PEPFAR programs had previously been expected to stop operating after March 31, 2026, but the last-minute authorization allows funding to continue as MoUs are negotiated and implementation plans are completed in countries with signed MoUs. In addition, appropriated third quarter funds have not been transferred to global HIV programs administered by CDC, with buffer funds being used to cover costs, threatening services disruptions, and further destabilizing health systems.

IMPLICATIONS: These developments continue the shift toward bilateral global health funding tied to broad government-to-government agreements negotiated in conjunction with mineral rights, data access and other provisions under the “America First” framework. While the new APS could mobilize significant resources, limited transparency across the APS and MoUs, delays in finalizing agreements and transferring appropriated funds, lack of civil society engagement and unequitable terms, raise concerns about how smoothly the transition will unfold and to what degree politics and power dynamics are driving the model. The need for a last-minute three-month extension for PEPFAR programs further highlights the operational risks of this shift and raises serious concerns about further disruptions to HIV services.

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The Lancet Launches New Journal to Elevate African Leadership in Global Health

The Lancet launched its inaugural issue of The Lancet Regional Health – Africa, a new publication to elevate African leadership in health research, policy and clinical practice. The journal aims to address longstanding imbalances by amplifying African voices and prioritizing research grounded in the lived experiences of communities, health systems and policymakers across the continent. A comment by Africa CDC colleagues reimagines a future global health architecture. 

IMPLICATIONS: Framed as part of a broader effort to decolonize, localize and re-center health and medical research, the journal will publish evidence and analysis on the issues most critical to African populations while challenging Western-centric paradigms that have historically dominated global health discussion and debate.  

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NIH Seeks Input on Next Strategic Plan

The US National Institutes of Health (NIH) is seeking feedback to inform its next five-year Agency-Wide Strategic Plan. Two webinars will be held to gather input on the framework guiding the plan’s development.

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