January 22, 2026
One year in from the inauguration of a new American president, the US has stepped back its longstanding support for global health—including an unprecedented absence at the World Health Assembly, withdrawal from the WHO, and eliminating support for joint initiatives like Gavi, the vaccine alliance. Other donor countries are following suit, with widespread reductions in funding for foreign assistance, threatening the 60-year-old architecture for coordination, funding and policy on global health.
In its place, the US is advancing what it calls the “America First” Global Health Strategy, comprised of a series of country-by-country (bilateral) health agreements, with little transparency in the process and many questions about their scope, metrics and accountability.
But advocates, scientists, affected communities and national governments that are navigating the upheaval are not simply ceding the ground. African leaders have been advancing continent-wide planning and strategy toward health sovereignty, focusing on increased domestic spending, local production of vaccines, drugs and diagnostics, investment in research, and innovative financing models. At least one government, Kenya, is mounting challenges to its MOU with the US. And critically, civil society and HIV prevention champions are organizing to influence policy and demand that affected communities are supported to play a leadership role in the strategy and implementation of effective and equitable access to HIV prevention, and wider healthcare services.
“The last year has been one of chaos, anger, panic, and frustration. I think the coming year has to be one of strategic rebuilding and building something different—not building back, but building forward. That means a different architecture at the country level, community level, regional level, and global level. A year from now, I suspect we’ll see fewer acronyms, but hopefully the ones that remain will be stronger than ever,” said AVAC’s Mitchell Warren in this Bhekisisa podcast.
“Durable health systems don’t rest on government signatures alone. They depend on buy-in from civil society, professional associations, community groups, and implementing partners who surface problems early and help manage risk before it becomes failure. Right now, consultation has been selective, civil society engagement uneven, and local private-sector voices largely absent. That imbalance is a real vulnerability. That’s why transparency and oversight matter. MOUs should be public. Progress should be measurable. Congressional engagement should be ongoing. Oversight is not a partisan exercise; it’s how durable policy is built,” said Jirair Ratevosian, of the Duke Global Health Institute and author of the Lights, Camera, Equity Substack.
A proactive agenda needs to prioritize what delivers impact. There’s a role for technology, for new kinds of partnerships, and for new leadership. Stakeholders must understand and advance what is absolutely necessary to achieve impact.
Stephanie Psaki, AVAC board member and President Biden’s US Coordinator for Global Health Security, pinpoints where advocacy may find leverage: “The State Department’s strategy seems to recognize the enduring bipartisan support among the American people for long-standing US global health goals, even as it shapes those aspirations to fit the president’s imperatives. Overall, the document appears crafted to win back those among the president’s allies who have long supported US programs in global health.” Psaki notes that the strategy outlines dramatic changes to how the United States has operated in global health historically, posing new challenges as we move forward.
“We recognize the global health landscape has changed. We, as a movement, need to prioritize ruthlessly, collaborate differently, and build systems that governments can lead and sustain, while upholding the rights of impacted communities and key populations. That includes integrating across diseases and aligning with health systems rather than siloed programs. We need to redefine sustainability—not as sustaining a funding stream or an institution but sustaining impact against HIV,” said AVAC’s Director of Policy and Advocacy Suraj Madoori.
This work depends on:
Coordinating and Integrating: The past has shown that innovation all too often does not reach the people who need it most. A new era in global health should design and invest for resilience. Resilience requires coordinated systems that work across diseases.
Redefining Sustainability with Community in the Lead: Sustainability is not about preserving a budget line, program or organization; it’s about delivering results. Community leadership and local ownership in the creation of systems and programs are integral to achieving these results, and fundamental to any approach to sustainability.
Developing Innovative Models of Financing: Success depends on establishing sources of funding that do not rise and fall on the whims and manipulations of politicians or any single funder.
In this moment of crisis lies the need for transformation. What is built next must be more effective and resilient than before, and more responsive to the people it serves. Champions of global health must define the architecture of the future, or it will be written by people bent on dismantling it.