Global Health Watch: NIH Orders Pause on HIV Trials, Zimbabwe + Zambia Health MoUs, WHO + Global Fund leadership, Foreign Assistance Funds

Issue 89

October 9, 2026

The US National Institutes of Health (NIH) said its HIV clinical trial networks should “temporarily hold off on launching new studies that had not yet enrolled participants and that would not be complete by November 30, 2027, when their current funding is set to expire.” This potentially devastating development comes as new questions emerge about how billions in US foreign assistance funding were spent, and details on the impacts of an end of US health assistance to Zimbabwe emerge. Also, a new candidate for WHO leadership and growing civil society calls to protect UNAIDS.

NIH Orders Pause on New HIV Clinical Trials Amid Funding Delays 

The National Institutes of Health (NIH) instructed leaders of its four HIV clinical trials networks to temporarily pause launching new studies that have not yet begun enrolling participants and would extend beyond November 30, 2027 (when funding expires). As The New York Times reports, this comes amid continued delays in releasing Notices of Funding Opportunities (NOFOs) to renew the networks and the Centers for AIDS Research (CFARs) for the next seven years, threatening research infrastructure built over decades and potentially disrupting clinical trials and services for participants. In response, AVAC, along with allies PrEP4All, HIVMA, TAG, and AIDS Action Baltimore as part of the Save HIV Funding Campaign are inviting sign-ons to a letter to Congress demanding that the US Department of Health and Human Services (HHS) authorize the long overdue funding announcements. Organizations can sign-on by October 15. 

IMPLICATIONS: The affected clinical trial networks include the Advancing Clinical Therapeutics Globally for HIV (ACTG), HIV Prevention Trials Network (HPTN), HIV Vaccine Trials Network (HVTN), and the International Maternal Pediatric Adolescent AIDS Clinical Trial Network (IMPAACT). The delayed renewal of the networks and the directive to hold off on launching new studies create uncertainty for the research pipeline, potentially delaying scientific advances, disrupting services for trial participants and weakening infrastructure built over decades. These networks have yielded critical advancements for HIV treatment and prevention and are important catalysts for tuberculosis treatment and prevention research, and for other emerging infectious diseases. Simultaneously, the proposed NIAID reorganization raises questions about the future of centralized clinical research oversight and support. As AVAC shared with the NIAID Council and the AIDS Research Advisory Committee (ARAC) at their meeting September 27, “Collectively, these programs have saved millions of lives over the last several decades and advanced some of the most important scientific discoveries and implementation science advances. Delays in the release of the NOFOs are forcing clinical trial sites to prepare for lapses in funding that could harm study participants, halt promising clinical trials, and erode the scientific workforce and infrastructure that has taken decades to develop.” In sum, the continued attacks on the HIV research infrastructure could reshape the trajectory of research for years to come.

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US Health Assistance Ends in Zimbabwe as Zambia Signs New Agreement 

The US Department of State was said to begin implementing its America First Global Health Strategy across 35+ partner countries on October 1, the start of the US fiscal year. But this is all evolving differently across countries. In Zimbabwe, US bilateral health assistance ended September 30 after the two countries failed to reach an agreement. Health GAP details the disagreements, which include sharing health data and biological specimens, but more importantly, major reductions in US funding and co-financing requirements that would have required Zimbabwe to increase its contributions by 290% in the first year. It proposes several next steps to avert the crisis. Health Policy Watch reports that “researchers project that there could be over 75,000 new HIV infections in Zimbabwe within a year ‘as a consequence of full PEPFAR withdrawal and no additional government or international support’.” 

In contrast, the US and Zambia signed a five-year, $2.49 billion health agreement yesterday, following months of negotiations. Zambia reports that requirements to share patient-level health data and biological specimens were removed, while negotiations over critical minerals were separated from the health agreement. Meanwhile, South Africa is preparing for the phaseout of PEPFAR support by March 2027, raising concerns about the future of community-based HIV prevention and treatment services. 

IMPLICATIONS: The withdrawal of US health assistance in Zimbabwe could dismantle decades of progress against HIV, TB and malaria, with consequences beyond the immediate term. Health GAP warns that the crisis could disrupt Zimbabwe’s introduction of injectable lenacapavir for HIV PrEP, jeopardizing access to one of the most important recent advances in HIV prevention. The implications are particularly alarming because these are interconnected programs: disruptions to community health workers, laboratories, supply chains and service delivery can undermine responses to all three diseases simultaneously. 

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Foreign Assistance Funds Committed as Questions Over Spending Persist 

The US 2026 fiscal year ended on September 30, and the picture is becoming slightly clearer on how billions of dollars of Congressionally-appropriated global health funding was actually spent. According to Devex and in court filings, the US Department of State committed more than $4 billion in foreign assistance funding just before the end of the fiscal year, preventing much of that money from expiring. A new filing in the Global Health Council and AVAC court cases shows that only $18,919 in Global Health Programs funding for which the State Department was responsible expired without being committed. However, the filing also identifies funds committed to covering the costs of closing out USAID, rather than supporting health and development programs as Congress had intended.  

IMPLICATIONS: This adds to concerns raised last week about the transfer of $2.5 billion originally intended for global health and development assistance into an alternative or ‘miscellaneous’ account. While the government appears to have met much of the deadline for committing funds, questions remain about where the money is going, whether it is being used as Congress intended and when it will actually reach programs and communities. As AVAC’s Mitchell Warren summarized last week, “the issue extends beyond foreign assistance or the HIV response; it is fundamentally about Congress’s constitutional power of the purse.” 

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WHO and Global Fund Leadership Updates

Last week, leadership candidates for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and WHO were announced. This week, China confirmed its nomination for WHO Director-General, expanding the known candidates to seven and raising questions about geopolitical influence as the US withdraws from the organization. On his Global Health Insights Substack, former WHO Adviser Peter Singer published a scorecard examining how specifically candidates have articulated plans to deliver measurable results and protect WHO’s scientific independence. And in Lights. Camera. Equity!, former Global Fund Board member Jirair Ratevosian called for greater public engagement in the Global Fund’s selection process. He reported that the Fund confirmed it has no plans for a public candidate forum, with engagement instead taking place through Board constituencies. 

IMPLICATIONS: These developments raise questions about transparency and accountability in choosing the next generation of global health leadership. These new leaders will face immediate decisions that will shape how these institutions define their roles in an evolving architecture. WHO is already reducing its staff significantly after the US refused to support it, and the Global Fund is facing difficult decisions about where and how to invest its smaller Grant Cycle 8 budget. 

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Civil Society Calls for Protecting UNAIDS

Ahead of the October 26 UNAIDS Programme Coordinating Board (PCB) meeting, more than 225 civil society organizations signed an open letter urging members of the PCB to protect the Joint Programme from being dismantled through proposed funding, staffing and operational cuts. Advocates warn that proposals to reduce UNAIDS to a $30 million budget and just 34 staff could undermine its ability to coordinate the global HIV response, defend human rights and ensure meaningful community leadership and accountability. 

IMPLICATIONS: The upcoming UNAIDS PCB meeting will be a defining moment in determining the Joint Programme’s essential functions and whether and how reform can preserve UNAIDS’ leadership, accountability and community engagement.

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