April 18, 2025
Just three months since the US presidential inauguration, and still more developments affecting the future of HIV prevention, global health leadership, and pandemic preparedness. From African women leaders demanding action to save HIV prevention, to escalating US foreign aid cuts and the fragile progress of WHO’s Pandemic Agreement, this issue break down what advocates need to know now. Read on.
Foreign Assistance Leadership in Flux
In another chaotic series of developments around foreign assistance, an internal State Department memo reports that Jeremy Lewin—a 28-year-old tech entrepreneur with no prior government or foreign assistance experience—has now been named Acting Director of the State Department’s Office of Foreign Assistance, following a few weeks as the Acting USAID Administrator—all in the wake of Pete Marocco’s brief, but devastating tenure in both positions. Lewin was a key figure in the Department of Government Efficiency (DOGE) and the dismantling of USAID. He is now overseeing what remains of US foreign assistance following USAID’s absorption by the Department of State.
IMPLICATIONS: Lewin’s inexperience and previous role raise serious concerns about the future of US global health and development, especially as so few staff remain with relevant expertise and relationships with governments and implementation partners.
READ:
- DOGE Staffer Takes Over at the State Department’s Office of Foreign Aid—Devex
- Trump Official Who Led Efforts to Dismantle USAID Exits State Department—The Hill
Further Cuts to Foreign Aid
The administration is advancing major efforts to continue cutting US foreign aid and dismantling USAID. A draft Fiscal Year 2026 budget proposes cutting the State Department by nearly 50%—over $30 billion—with foreign aid reduced by up to 75%, including the closure of at least 27 US diplomatic missions, primarily in Africa and Europe. At the same time, the White House is preparing a formal request to Congress to cut $9 billion of previously approved funds. The cuts are aimed at USAID, State Department and public broadcasting programs. A KFF analysis examined the implications of the cuts, and among other assessments, found HIV-related programs are disproportionately impacted.
IMPLICATIONS: If enacted, these cuts would deliver a major blow to US global health and development leadership, severely undermining programs focused on HIV and disease prevention, and further accelerating the administration’s efforts to dismantle USAID. As AVAC’s Mitchell Warren said in Science, “We are in the middle of a massive earthquake. And when buildings fall, we can’t just build back what we had before. We need a whole new global health funding architecture, but we won’t be able to build it fast enough to avoid significant harm.”
READ:
- White House to Ask Congress to Cut $9B in Funds, Including for NPR, PBS, USAID—The Hill
- Trump Wants to Halve State Dept Budget, Slash Foreign Aid 75%—USA Today
- ‘What’s In’ and ‘What’s Out’ in USAID’s Global Health Programming—Devex
- Analysis of USAID’s Active and Terminated Awards List: How Many Are Global Health?—KFF
- Trump Has Blown a Massive Hole in Global Health Funding—And No One Can Fill It—Science
Restructuring HHS
A leaked HHS budget proposal this week outlines significant cuts to HIV programs in the US, including the elimination of the Ending the HIV/AIDS Epidemic Initiative (which was, ironically, started during President Trump’s first term and delivering results) and the Minority AIDS Initiative. The Ryan White Program under the new proposal would continue but with reduced funding, and the CDC prevention programs, including PrEP, face uncertainty due to consolidation. NIH’s HIV research funding could drop by 40%, jeopardizing progress in the fight against HIV.
READ:
- Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do—KFF
- Internal Budget Document Reveals Extent of Trump’s Proposed Health Cuts—Washington Post
- How Trump 2.0 is Slashing NIH-backed Research — In charts—Nature
WHO Warns of Budget Implications
At a press conference this week, WHO Director-General Tedros Ghebreyesus confirmed that health services in over 100 countries are being “severely disrupted” following the US’s withdrawal from the WHO and drastic cuts to foreign aid. He confirmed that there has been no formal dialogue yet between the new US administration and WHO. In his remarks, Tedros urged governments to protect the poorest and resist cutting public health funding. Moreover, WHO faces a $2.5 billion budget gap, which is forcing drastic downsizing and a massive restructuring of the agency.
IMPLICATIONS: In addition to the WHO, the US has also pulled out of pandemic treaty negotiations, citing false claims about sovereignty. This all points to reduced international pandemic preparedness, weakened surveillance systems, reduced access to vaccines, and growing health inequities—particularly in low-income countries most dependent on WHO support.
READ:
- No Talks Between WHO and US Despite ‘Severe Disruption’ in Health Services Since Trump Slashed Aid—Health Policy Watch
- World Health Organization Reorganization Plan Developed with Boston-based Consultancy—Health Policy Watch
Pandemic Agreement Reached
Just over five years since the COVID-19 pandemic disrupted the world and after several years of negotiating, WHO member states finally reached agreement this week on a draft pandemic treaty that, if ratified, would be a legally binding accord that lays the foundation for future pandemic prevention and response, including real-time sharing of vaccines, treatments, and diagnostics. For three years member states negotiated critical issues, with pressure from civil society to embrace key provisions on equity and intellectual property. Some of those provisions have been addressed in the final text, with the precise language used remaining contentious. The agreement is expected to be adopted at the upcoming World Health Assembly (WHA) meeting in May. However, negotiations on an Annex detailing the new Pathogen Access and Benefit Sharing mechanism will continue with the aim of concluding at next year’s WHA. Sixty countries must adopt the Accord for it to be in full force.
IMPLICATIONS: The agreement marks a major step forward for multilateralism and health security—even as the US remains absent from negotiations. Advocates warn that without civil society input and sustained investment, including restored US funding, the agreement’s promise may fall short.
READ:
- Countries Say YES to Pandemic Agreement—Health Policy Watch
- The Pandemic Agreement is Here—Medicines Law & Policy
- MSF Welcomes Progress on Pandemic Agreement Negotiations: A step toward equity in future pandemics and health emergencies—MSF statement
NIH Indirect Costs and University Pushback
The administration’s proposal to cap indirect costs for National Institutes of Health (NIH) research grants at 15% is being challenged with lawsuits by universities and others. This week, several organizations representing research institutions announced efforts to develop alternative models for a streamlined, transparent approach to funding indirect costs that balance efficiency and sustainability. Specific proposals are still under discussion.
READ: Universities Begin Search for Indirect-cost Fix that Might Assuage Trump Administration—STAT
African Women Lead: A Call to Sustain HIV Prevention
The African Women Prevention Community Accountability Board (AWPCAB) issued a statement calling on global health institutions, African governments, donor countries, the private sector, and philanthropies to urgently address critical gaps to ensure a sustainable HIV response. AWPCAB is led by a number of AVAC partners and staff and represents a collective of women and girls committed to advancing HIV prevention. The statement defines priority actions from local production to domestic financing and more. As they state clearly: “There is no ending AIDS by 2030 without prevention.”
READ: AWPCAB Calls for Urgent Action to Safeguard HIV Prevention and Centre Meaningful Community Engagement
It’s STI Awareness Week
In a new video, AVAC’s Alison Footman breaks down where we are in the fight against STIs, what we’ve gained, what’s at risk, and what happens next.
What We’re Reading
- How the United States Became a Science Superpower — And How Quickly it Could Crumble—Nature
- NIH Cuts Triggered a Host of Lawsuits: Nature’s guide to what’s next—Nature
- HHS Systems Are in Danger of Collapsing, Workers Say—Wired
- Kennedy’s Deep HHS Cuts Threaten HIV/AIDS Response—The Hill
- At Harvard, Scientists Worry Over the Consequences of Resisting the Trump Administration: $2.2B in grants frozen—STAT
- R2.82-billion. That’s What We Need to Plug the US Funding Gap, For Now—Bhekisisa
- Zimbabwe’s HIV Crisis: US aid cuts leave millions at risk—Be In the Know
Resources
- The USAID List of Terminated Global Health Awards – What Does it Tell Us—KFF
- The Impact of Suspensions and Reductions in Health Official Development Assistance on Health Systems—WHO
- The Status of PEPFAR’s USAID Programming—amfAR
- Tracking the Freeze: Real-Time Impact on Key Populations—GBGMC
- The Impact of Suspensions and Reductions in Health Official Development Assistance on Health Systems—WHO
- The Best Investment You Didn’t Know You Made: How NIH Funding Fuels Innovation and Economic Growth— amfAR
- Quick Take: HIV Research Matters for America—O’Neil Institute and amfAR
- What Do Federal Staffing Cuts and HHS Restructuring Mean for the Nation’s HIV Response?—KFF
- Domestic Funding Contributions to Health: Comparing Changes in Domestic Financing in PEPFAR and Non-PEPFAR Supported Countries—amfAR