This week marks 365 days of disruption and chaos across global health, with many organizations and journalists reflecting on one year after the foreign aid freeze and what the future of global health looks like. This week also saw the US Congress beginning to reassert its role on health funding, ongoing US disengagement from WHO, and new reporting on the hepatitis B vaccine trial in Guinea-Bissau.  

We are also watching closely for news of an expanded Global Gag Rule, that is reportedly coming out later today, just as this issue goes to press. It is anticipated that this new gag will include a dramatic expansion beyond abortion and now underscore the US administration’s war on gender, diversity, equity and inclusion. We’ll cover this in next week’s Global Health Watch; the struggle, most definitely, continues.

365 Days of Chaos and Disruption, What Comes Next for Global Health 

This week marks one year since the US Presidential administration issued a deeply cruel executive order freezing foreign assistance, halting billions of dollars in already-approved funding under the bad-faith claim of a “90-day review”. What followed was not a brief pause, but a drawn-out, chaotic disruption that stopped life-saving work across the globe, shutting down valuable organizations, and harming lives, health, and livelihoods. And that was just the beginning of a year of chaos. Many organizations and media coverage noted a growing recognition that the past year’s disruptions to global health were not just destructive, but catalytic, forcing a reckoning with how systems are built and for whom. Reporting from Bhekisisa reflected on how the sudden halt in US HIV funding exposed deep vulnerabilities in over-reliance on external aid, while also accelerating conversations about domestic financing, integration, and sustainability in the HIV response moving into 2026. At the same time, analyses from Health Policy Watch, Science, Nature, and The Lancet laid bare the human and scientific costs of abrupt policy shifts, shuttered programs, fractured research networks, and lost trust, while underscoring that simply restoring old funding streams will not be enough to meet future challenges. 

IMPLICATIONS: Together, these stories and analyses point to the need to rethink and rebuild with stronger country ownership, diversified and predictable financing, resilient research institutions, and governance structures that prioritize equity, accountability, and community leadership. Rather than recreating the same architecture, reimagined global health systems must be less dependent on external donors and political ideology. As Global Health Watch has tracked for 52 weeks, the path forward is not about returning to the pre-foreign aid freeze status quo, but about using this period of disruption to construct a more durable, equitable, and responsive global health architecture. As Canadian Prime Minister, Mark Carney, said so clearly at this week’s World Economic Forum in Davos, Switzerland, “Nostalgia is not a strategy.”

READ:  

• Fighting for billions: The legal battle to keep US foreign aid alive—Devex  
• [PODCAST] One year after Trump: The day HIV funding changed forever — and what came next—Bhekisisa  
• US science after a year of Trump—Nature  
• One Year Later: The Effect of US ‘Chainsaw’ on Global Health—Health Policy Watch  
• Four paradigm shifts to shape an agenda for global health reforms—The Lancet 
• Damage assessment: Which of Donald Trump’s changes are likely to last—and which will fade?—Science 

Congress Steps Up In Defending Domestic and Global Health

The US Congress is beginning to reassert its constitutional role in shaping federal spending. The joint House and Senate FY26 funding bill released last week covering foreign operations would maintain funding for core global health priorities, including HIV, tuberculosis, malaria, polio, family planning and reproductive health, neglected tropical diseases, Gavi, and UN agencies such as UNAIDS, UNICEF, and UNFPA. This week, legislators rejected nearly $2 billion in proposed cuts to US domestic HIV and related programs through the Labor, Health and Human Services Education and Related Appropriations Act (LHHS), a “major victory” credited to sustained advocacy by people living with HIV, advocates, and service providers. The proposed bill largely preserves funding for domestic public health and biomedical research. As AVAC’s Suraj Madoori said in a statement, “These crucial wins for global and domestic HIV now require us to not hold back, and urge Congress to swiftly approve all the FY26 bills, push the President to sign them, and for us to ensure accountability in the administration to spend and implement this lifesaving funding as instructed by the people and those who represent us in Washington D.C.” 
 
IMPLICATIONS: Together, these bills signal a return to a bipartisan appropriations process and, if enacted, provide a basis to push back against unilateral cuts by the administration. They also signal bipartisan pushback against attempts to cut health and scientific research investments. By rejecting the steep cuts proposed by the administration, they stabilize lifesaving programs and protect the research enterprise. The House passed the bills on Thursday, and the focus now shifts to the Senate, which must pass the bills by January 30. Then onto the President to sign, and, most critically, for the administration to actually spend all Congressionally appropriated funds.

READ:  

• MAJOR VICTORY: Bipartisan FY26 Bills Reject Nearly $2B in Proposed HIV Funding Cuts—Save HIV Funding  
• Beyond the Numbers: Three Policy Shifts in the FY26 Funding Bill Quietly Reshaping U.S. Global Health—Lights, Camera, Equity Substack
• Limit on multiyear funding of NIH grants is a sticking point in Senate budget talks—STAT   

US Disengagement and the Future of WHO

This week also marks one year since the US announced its intended departure from World Health Organization (WHO). Debate over its future and the US’ role within it intensified as pressure from parts of the administration collided with growing concern over the consequences of disengagement. US officials and policymakers aligned with the “America First” strategy call for WHO to be fundamentally reformed or replaced. Analysts note that the US remains a formal member of WHO until debts are paid. Meanwhile, the US administration continues to withhold funding and delay payments, leaving millions of dollars in unpaid US obligations.  
 
IMPLICATIONS: The current state, where the US remains technically engaged but substantively absent, poses serious risks for global health governance, disease surveillance and pandemic preparedness. As analyses from CSIS underscores, WHO reform is both necessary and possible, but meaningful reform requires constructive engagement, predictable financing, and political leadership, not abandonment.

READ: 

• MAGA-backed researchers call for WHO to be ‘reformed or replaced’ on eve of US withdrawal—The Telegraph 
• As U.S. prepares to exit WHO, it is stiffing the agency on a large bill—STAT  
• The Future of the WHO—and How the United States Can Shape It—CSIS
• A US return to the World Health Organization could hinge on whether Trump approves of its next leader—Politico   

Hepatitis B Vaccine Trial in Guinea-Bissau Undermines African Authority

Reporting this week is exposing a pattern of US actions that show deep disregard for African public health leadership, ethical research standards, and sovereignty. The US-funded hepatitis B vaccine trial in Guinea-Bissau is at the center of this. As we reported in previous weeks, the unethical trial would delay birth-dose vaccination for thousands of newborns despite overwhelming evidence, and WHO guidance, that immediate vaccination saves lives. According to Rolling Stone, the study was championed by US officials aligned with anti-vaccine ideology and advanced even as Africa CDC officials raised alarm and indicated the trial should be halted. At the same time, the US administration has been marginalizing Africa CDC more broadly, cutting engagement, undermining its authority, and sidelining African institutions in favor of unilateral decision-making. This is being reinforced, as The Guardian reports, by members of the US administration urging US diplomats to emphasize American “generosity” to African leaders even as USAID programs are shuttered and health funding withdrawn. 
 
IMPLICATIONS: Together, these developments signal a dangerous erosion of respect for African expertise, autonomy, and ethical authority in global health. Pushing forward research designs that would withhold proven interventions—while dismissing objections from Africa CDC and African scientists—revives patterns of extractive and unethical research long condemned by the global health community. Undermining Africa CDC while advancing ethically dubious trials weakens trust, damages partnerships, and threatens progress against hepatitis B, HIV, and other diseases where Africa has led with scientific excellence.

READ:  

• Trump administration to block aid from subsizing DEI and trans rights overseas—The Guardian 
• Trump’s HHS Trashes Top African Health Organization as “Fake” and “Powerless”—Futurism  
• Head of US Africa bureau urges staff to highlight US ‘generosity’ despite aid cuts—The Guardian  
• HHS Gave a $1.6 Million Grant to a Controversial Vaccine Study. These Emails Show How That Happened—Rolling Stone 
• Lipstick on a Pig: Why the Amended Hepatitis B Birth-Dose Trial in Guinea Bissau Remains Ethically Indefensible—BK’s Substack 
• ‘Suspended or Cancelled’: Guinea-Bissau Health Minister Halts Controversial Hepatitis B Trial—Health Policy Watch

Read AVAC’s ‘One Year Later’ series

This five-part series reflects on the tumultuous events of the past 365 days across five global health issues: the erosion of US foreign aid; dismantling of the research enterprise; attacks on vaccine policy; and shifts in the global health architecture.

READ

What We’re Reading

• US cuts to HIV programs in sub-Saharan Africa pose global risk, experts say—CIDRAP
• Trump dismantled USAID. Now these aid workers are running for office—Devex 
• EU Parliament Backs Critical Medicines Act, Sparking Supply Concerns In Africa—Health Policy Watch 
• A big announcement on AI in Africa—Bill Gates 
• Multilateral paralysis is harming global health. Gavi’s ‘minilateralism’ can get us back on track—World Economic Forum 
• Trump one year on: How six US researchers plan to protect science amid chaos and cuts—Nature  
• Talking back: An unprecedented assault has forced the U.S. scientific community to rethink its advocacy tactics—Science 
• The little-known vaccine panel that could have big consequences—STAT
• The near death – and last-minute reprieve — of a trial for an HIV vaccine—NPR   
• When Trump Took a Whack at the C.D.C., Atlanta Lost Something, Too—New York Times
• What Does America’s Government to Government Collaboration for Health Look Like?—Emily Bass Substack
• Is the $364 million US-Lesotho Health MoU unconstitutional?—Newsday 
• Africa pushes back on US health deals over data, power—SciDevNet
• Judge Orders Trump Administration To Restore $12M to American Academy of Pediatrics—The Hill  
• Most Vaccine Hesitancy Can Be Successfully Overcome, New Lancet Study Finds—Health Policy Watch 
• Pazdur warns that politics, ‘chaos’ are damaging FDA—STAT  
• Gates Foundation unveils $9 billion budget and plans to cut staff—Associated Press 

As new IDSA CEO, Jeanne Marrazzo warned in a webinar this week, rising HIV infections threaten progress, but “this is not a time to despair. It’s a time to fight.” Watch the recording and explore the 2025 People’s Research Agenda, which tracks the science, flags gaps, and centers community priorities to keep HIV prevention moving forward.

Resources

• Global Gag Rule, PAI
• US science after a year of Trump, Nature
• Global Health Funding in the FY 2026 National Security, Department of State and Related Programs (NSRP) Conference Bill & Explanatory Statement, KFF 

The Lancet journal ended the year with a provocative editorial – 2025: an annus horribilis for health in the USA. But sadly, it was not just in the US; it has been a year of chaos and disruption globally. This 49th issue of Global Health Watch looks back—like many news stories this week—across 2025 to highlight the most consequential decisions, disruptions, and debates that defined the year and will continue to shape what comes next.

The Foreign Aid Freeze and the Legal Fight to Restore it

On the first day in office, the new US Administration issued a sweeping foreign aid freeze that halted life-saving global health and HIV programs, severed active grants, research underway and cost millions of people their lives and livelihoods. In less than a month, AVAC responded suing the President, the State Department and the US Agency for International Development (USAID). The Global Health Council also led a similar lawsuit challenging the freeze as unlawful and harmful. Together, the two cases argued for months in various courts that the foreign aid freeze not only jeopardized health as a human right but also bypassed congressional authority and undermined trust in US leadership. Ultimately, the cases unlocked millions of dollars of development assistance for work done in January and February, but millions more dollars expired at the end of the fiscal year in September. The cases are ongoing and as important as ever, both to restore foreign assistance and to re-assert that it is Congress (and not the President) who has the power of the purse.

READ:  

• The Monthslong Legal Battle to Save Foreign Aid—New York Times
• AVAC v. United States Department of State—AVAC  
• “Lift the Freeze”: HIV/AIDS Advocates in Fight over Trump Foreign Aid Cuts—Democracy Now  
• The Supreme Court’s Major Cases During the 2025-2026 Term—Washington Post   
• Supreme Court has expanded presidential powers under Trump. How far will it go?—Washington Post 

Research Under Assault 

Science faced underfunding and systematic destabilization in 2025. In just one month under the new US Administration, the National Institutes of Health (NIH) abruptly canceled approximately 1,800 research grants. By April, mass layoffs and forced reassignments across Health and Human Services (HHS) agencies, including the Centers for Disease Control and Prevention (CDC), NIH, and US Food and Drug Administration (FDA), further crippled each agency’s capacity and expertise. A proposal to drastically cut the overall NIH budget and consolidate its 27 institutes was soon introduced along with the fiscal year 2026 budget, which proposed an $18 billion cut from the NIH and $1.5B cut in HIV prevention. Around the same time, the NIH signaled a major shift away from investments in basic science and clinical research, undermining the discovery pipeline that fuels future breakthroughs. Then, in November, HHS ordered the CDC to phase out all “non-essential” nonhuman primate research, threatening foundational preclinical studies, including those that have been pivotal to HIV PrEP and PEP, amongst many other health priorities. These actions were compounded by a pause or effective ban on some international research collaborations, a proposed cap on indirect cost rates that support core university infrastructure, and changes to the scientific review processes, together weakening the systems that sustain rigorous, independent research.

READ:  

• The Trump Administration’s Most Paralyzing Blow to Science—The Atlantic  
• HIV Prevention R&D at Risk: Tracking the Impact of US Funding Cuts—AVAC  
• Trump has blown a massive hole in global health funding—and no one can fill it—Science 
• Trump administration agrees to reconsider frozen and denied NIH grant submissions related to DEI—STAT  
• Presidential HIV council warns proposed cuts could reverse decades of progress—CNN  
• Nearly 2,000 top researchers call on Trump administration to halt ‘assault’ on science—STAT  

The Cruel Irony of the Best Shot at HIV Prevention

Despite all the chaos, 2025 offered remarkable milestones in HIV prevention science, and a stark illustration of the contradictions shaping global health. Injectable lenacapavir for PrEP (LEN), the six-month injectable, which provides nearly complete protection against HIV infection, moved with unprecedented speed from regulatory approvals and guidelines to real-world introduction. South Africa and Zambia authorized LEN within months of US and EU regulatory approvals; the World Health Organization (WHO) rapidly issued guidance and prequalification; and initial LEN delivery began in Brazil, Eswatini, South Africa, and Zambia, setting the stage for expanded access in 2026. At the same time, efficacy trials began of the next promising PrEP option, the monthly oral candidate MK-8527, reinforcing what’s possible when innovation, evidence, and advocacy align.  
 
Yet, all this scientific momentum occurred alongside the deepest assault on global health and the systems that make it possible. The cruel irony of this moment is that as the science breaks barriers, the infrastructure meant to support discovery, evaluation, and equitable delivery is being weakened, threatening the very gains the field has fought decades to achieve. As AVAC has emphasized, the greatest opportunity in HIV prevention lies in speed, scale, and equity.

READ:  

• In under a year, Trump administration has threatened decades of progress in global fight against HIV/AIDS—Prism
• A ‘Breakthrough’ Drug to Prevent HIV, an ‘Unprecedented’ Rollout—NPR  
• When Politics Trumps Science: Why the US isn’t giving South Africa LEN—Bhekisisa  
• ‘Best of Times, Worst of Times for HIV Prevention’—Managed Healthcare Executive 

Attack on Vaccine Science 

Actions in the last 11 months have eroded evidence-based policy, disrupted institutional capacities, and deepened mistrust and uncertainty in vaccine science. In May, NIH’s National Institute of Allergy and Infectious Diseases (NIAID) announced that funding for the Consortia for HIV/AIDS Vaccine Development (CHAVD) would end after the current grant cycle in June 2026 — eliminating $67 million annually and about 10% of global HIV vaccine research funding. Then, $500 million in Biomedical Advanced Research Development Authority (BARDA) grants for research and development of the mRNA vaccine platform were soon cancelled, and members of the CDC’s Advisory Committee on Immunization Practices (ACIP) were replaced. The US also stopped supporting Gavi, the vaccine alliance, and language on the CDC website was replaced with anti-science and anti-vaccine sentiment. As AVAC said in an August statement, “These actions dangerously sow vaccine disinformation and mistrust, which has proliferated since the COVID-19 pandemic. Dangerous ideology results in dangerous policymaking, putting many lives at stake and complicating efforts to both discover and implement clinical and cost-effective interventions to make America and the world healthier, safer, and more prosperous.”

READ:  

• We Don’t Seem to Be Making America Healthy Again—New York Times 
• This Is the Damage Kennedy Has Done in Less Than a Year—New York Times 
• Experts Question Denmark’s Vaccine Program as a Model for the U.S.—New York Times 
• The U.S. vaccine schedule is a jet engine. Denmark’s is a toy plane.—Washington Post 
• The Guardian view on mRNA vaccines: they are the future – with or without Donald Trump—The Guardian

Changing Global Health Architecture 

As rising nationalism, geopolitical tensions, and funding retrenchment intensify, the architecture of global health and how countries engage in it and with one another is being fundamentally reshaped. Longstanding multilateral systems are giving way to a more fragmented, country-to-country model under the US America First Global Health Strategy. The strategy prioritizes bilateral health Memorandums of Understanding (MoUs) with individual countries in exchange for funding support, data sharing, and pathogen access, signaling a major recalibration away from traditional multilateral institutions and frameworks. Meanwhile, the US stepped back from longstanding global health platforms including an unprecedented absence at the World Health Assembly, withdrawal from the WHO, and diminishing support for joint initiatives like Gavi, the vaccine alliance. Civil society and advocates are actively debating what this means for shared goals and equity in global health, even as institutions like WHO and UNAIDS explore how to adapt in a rapidly evolving landscape.

READ:

• ‘America First’ in Global Health: Oxymoron or opportunity?—Devex  
• 4 more African nations secure $2.3bn US health funding under America First strategy—Business Insider Africa 
• Writing in Real Time: How 2025 Rewired Global Health—and My Work Alongside It—Lights, Camera, Equity! Substack 
• UNAIDS board launches new process for transition amid sunset calls—Devex  

What We’re Reading:

• In a tumultuous year, US health policy has been dramatically reshaped under RFK Jr.—Associated Press  
• Podcast: Unmasking Global Health: Reflections on 2025—Global Health Unfiltered 
• How Cameroon Fought to Save Its Malaria Program After the U.S. Cut Critical Funding—New York Times
• Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis—The Lancet  
• Podcast: Global Health | The rollercoaster continues in 2026—Pandemia (German language) 

This week the UNAIDS board approved a new Global AIDS Strategy and launched a formal review of the agency’s future; turmoil at the NIH continues over gain-of-function research; and the scientific community rallies around the Infectious Diseases Society of America’s (IDSA) appointment of Jeanne Marrazzo as its chief executive officer. Also, the UK regulatory agency approved lenacapavir for PrEP (LEN) marking its seventh regulatory approval in just six months.

UNAIDS Launches Review Process on its Future

Following last week’s intense discussions at the UNAIDS Programme Coordinating Board (PCB), the UNAIDS board this week launched a new, formal process to examine the organization’s future and potential transition pathways. This comes from within the UN80 reform initiative that proposed to sunset UNAIDS by the end of 2026. But civil society and PCB members pushed back, and the board agreed to initiate a “structured review” that explores different scenarios for UNAIDS’ role, mandate, and positioning within a changing global health architecture. This announcement came on the heels of the PCB approving the Global AIDS Strategy for 2026–2031 and alarms raised by civil society about funding cuts, service disruptions, and the risk of losing a central coordinating body at a critical moment in the HIV response. 
 
IMPLICATIONS: The launch of this process to examine UNAIDS’ future raises important questions about governance, accountability, and continuity in the global HIV response. Civil society’s strong pushback underscores that any reform must preserve UNAIDS’ core mandate and ensure that the global HIV response remains centered on those most affected — especially women, girls, and key populations — rather than being quietly dismantled at a moment of crisis.

READ:  

• UNAIDS board launches new process for transition amid sunset calls—Devex  
• New Global AIDS Strategy and Transition Working Group adopted at UNAIDS’ 57th Board meeting—UNAIDS   

Continued Turmoil at the NIH – Gain-of-Function (GOF) Research 

Turmoil at the NIH continued this week as, John Beigel, a prominent influenza researcher and acting director of NIAID’s Division of Microbiology and Infectious Diseases (DMID), resigned following controversy over an NIH-supported seasonal flu virus study and how its potential risks were assessed and communicated. Beigel’s departure unfolds amid ongoing debate over how the NIH defines and oversees gain-of-function (GOF) research—work that could increase the transmissibility or virulence of pathogens with pandemic potential.  
 
Science reports that the controversy was a “‘pseudomanufactured concern’ that was meant to force him out, so officials could bring in a researcher who has strongly supported Trump.” Beigel is being replaced by an infectious disease scientist from NIH’s Fogarty International Center and who has publicly expressed support for the President and donated to his affiliated political committees.

IMPLICATIONS: Alongside last week’s revelations and Jeanne Marrazzo’s whistleblower lawsuit, Beigel’s departure heightens concerns about instability and governance at NIH at a time when scientific leadership and public trust are critical. Debates over GOF research, including its definition, oversight, and whether the White House or the NIH sets the rules show the precariousness of the agency. As Science reports, concerns about GOF work have gained momentum with the popularization of the belief that Chinese scientists who received NIH funding created the virus that caused the COVID-19 pandemic. Many Republicans have promoted this unproven theory, and Trump signed an executive order in May that called for stricter oversight of GOF work. 

READ:  

• NIH official resigns after flap over risks of seasonal flu virus study—Science  
• Researchers have a moral obligation to push back when their studies are twisted to promote false health claims—STAT 

Leaders Support Jeanne Marrazzo as new CEO of the Infectious Diseases Society of America (IDSA) 

Leaders in the scientific and infectious disease communities praised the Infectious Diseases Society of America (IDSA) appointment of Jeanne Marrazzo as its next chief executive officer. Former NIAID Director Anthony Fauci called her a “superb choice,” and AVAC’s Mitchell Warren said, “It speaks to IDSA’s desire to emphasize science over politics and science over ideology, and that’s what you will get with Jeanne Marrazzo.” Virologist Angela Rasmussen, said Marrazzo’s appointment “suggests to everybody who’s a member of that professional society that they’ve got a leader who’s actually going to do something about this rather than trying to protect the institution more than its members.” Marrazzo begins her tenure January 12. 

READ:  

• As Marrazzo prepares for helm at IDSA, scientific community praises choice—Center for Infectious Disease Research and Policy  

What We’re Reading

• Trump removes nearly 30 career diplomats from ambassadorial positions—Associated Press 
• 2025: an annus horribilis for health in the USA—The Lancet 
• Some patients face hurdles getting HIV prevention drugs. Here’s what to know—NPR 
• Podcast: Trans Life: How to Survive Trump’s 2nd Administration | Dr. Tatyana Moaton—A Shot in the Arm 
• Kennedy ‘deeply committed to ending animal experimentation’—Science  
• Perseverance Is the Prescription for Global Health Challenges—Harvard 
• I’m the former head of Pfizer R&D. I’m very worried about biopharma’s future—STAT  
• America’s new top health diplomat has strong opinions on abortion and gender—NPR 
• The vaccine cold chain: A fragile link in global health infrastructure—Health Policy Watch 
• UNICEF, Gavi deal slashes malaria vaccine price to $2.99 per dose—Devex  
• How HIV Capsid Research Sparked a New Era in Prevention—American Society for Microbiology
• U.S. Global Health Country-Level Funding Tracker—KFF
• Forget quiet quitting, the State Department appears to be quiet hiring—Devex 
• Trump Officials Celebrated With Cake After Slashing Aid. Then People Died of Cholera.—ProPublica 
• Exclusive: Senate Democrats introduce bill to protect UN Population Fund—Devex 
• California Hires Former C.D.C. Officials Who Criticized Trump Administration—New York Times
• Update on Lives Lost from USAID Cuts—CGD
• U.S. Global Health Country-Level Funding Tracker—KFF

This week covers the significant turmoil at the US National Institutes of Health (NIH), including a close look at the NIH deputy director’s role in disruptions in leadership and funding cuts, and a lawsuit filed by the former Director of the National Institute of Allergy and Infectious Diseases (NIAID). It also covers urgent civil society pushback against efforts to sunset UNAIDS, the rapid expansion of US “America First” bilateral health agreements across Africa, and what’s next for STI research, prevention and diagnostics.

NIH Leadership Turmoil

A new investigation by The Atlantic’s Katherine Wu examines the central role of the Deputy Director of the National Institutes of Health (NIH), Matthew Memoli, in recent leadership changes and funding cuts across the NIH, including the firing of former NIAID Director, Jeanne Marrazzo, and the reassignment of Carl Dieffenbach, longtime director of NIAID’s Division of AIDS, to another NIH center. The Atlantic’s reporting shows how these decisions have significantly weakened NIAID, with particularly acute impacts on HIV prevention and vaccine research, where programs, expertise, and long-term scientific capacity are being eroded amid broader restructuring and budget shifts.

In addition, this week, Dr. Marrazzo, the newly appointed chief executive officer of the Infectious Diseases Society of America (IDSA), filed a lawsuit against the US federal government. The lawsuit alleges that Marrazzo was illegally fired from her position and seeks to be reinstated as head of NIAID and to receive formal declarations that her rights were violated. The suit argues that her firing was retaliation for a whistleblower complaint she filed on September 3, in which she raised concerns about anti-vaccine positions held by newly appointed NIH officials; demands to halt clinical trials; and requests to cut international research collaborations. Twenty-two days after filing the complaint, Marrazzo was fired by Health and Human Services Secretary, Robert F. Kennedy Jr.

IMPLICATIONS: The developments at the NIH show instability at its leadership level and severe consequences for infectious disease research, particularly vaccine research. This comes at a time when sustained R&D investment is most critical. Without robust research support, future advances in next-generation options could stall. See the new People’s Research Agenda, which calls for a balanced HIV prevention portfolio that is optimized for impact. However, Marrazzo’s new role at the IDSA, which represents clinicians, scientists and public health experts who are driving policy and advocacy to address critical issues in combating infectious disease, will be pivotal in ensuring rigorous science, inclusion and equity in research, community engagement, and evidence-based communications remain central to tenors in global health discourse and debate.

READ:  

• AVAC Board Member Jeanne Marrazzo named CEO of IDSA—AVAC  
• The Most Feared Person at the NIH Is a Vaccine Researcher Plucked From Obscurity—The Atlantic  
• Fired NIH institute head sues Trump administration—Science  
• IDSA selects next CEO—Infectious Diseases Society of America 

Future of UNAIDS 

Member states and civil society convened at the 57th meeting of the UNAIDS Programme Coordinating Board (PCB) in Brazil this week to discuss urgent decisions about the future of the global HIV response amid deep funding cuts and a shifting global health landscape. They reviewed and approved the Global AIDS Strategy 2026–2031 and assessed the impact on communities from disruptions to services for HIV prevention and treatment. Civil society representatives on the PCB shared comments, and African women leaders and other civil society groups issued statements (and sign-ons) denouncing efforts to sunset UNAIDS by the end of 2026: “Any move to sunset UNAIDS before ending AIDS as a public health threat is premature and unacceptable. No sunsetting until we finish the job. AIDS is not over.”  

The PCB also held a special thematic session on long-acting ARVs for treatment and prevention. See this clip from Yvette Raphael where she included AVAC’s latest blog in her remarks about the current context: “We cannot let cruel international policy allow historic gains to collapse, just as a few highly effective prevention options arrive. That is why rolling out LEN to all countries that need it with speed, scale and equity must be our uncompromised, uncompromising priority. If we do this, we can change the trajectory of the epidemic, but only if we act at the pace that data and science demand.”

IMPLICATIONS: As the world moves toward the June 2026 High-Level Meeting on HIV, and the rollout of the new Global AIDS Strategy, the strong pushback by civil society at the PCB underscores that any reform must preserve UNAIDS’ core mandate and ensure that the global HIV response remains centered on those most affected — especially women, girls, and key populations — rather than being quietly dismantled at a moment of crisis.

READ:  

• African Women Leaders Condemn Any Move to Sunset UNAIDS: AIDS is Not Over—African Women Prevention Community Accountability Board 
• Deputy Secretary-General, Addressing UNAIDS Programme Coordination Board, Highlights Transition Strategy, Legacy as United Nations Success Story—Press UN 
• The Future of HIV Prevention Depends on Speed, Scale and Equity—AVAC  
• UNAIDS Must Be Retained as a Distinct, Independently Mandated Joint Programme within UN Reform—KP-TNC Statement 
• The HIV Response Orphaned: At the Cost of Women Living with HIV—ICWEA  

Eswatini and Mozambique Join Growing List of African Countries to Sign “America First” Bilateral Health MoUs

Mozambique and Eswatini are the latest countries to sign the bilateral health Memorandums of Understanding (MoUs) with the United States under the America First Global Health Strategy, adding to earlier agreements with Kenya, Liberia, Rwanda and Uganda. These agreements provide 5 to 10 years of funding and health support in exchange for co-financing, health data, pathogen-specimens, and national health system data, marking a major shift in how global health cooperation is structured under US leadership.   

IMPLICATIONS: The pace of these agreements shows how quickly the Administration is moving to reshape US global health with little time for discussion and debate on transparency, consultation, and how civil society fits within this evolving framework. As the landscape shifts, civil society and non-governmental organizations must quickly reassess their roles in the hope of preserving aid delivery, accountability, and equity. 

READ:  

• NGOs must prove relevance to survive in ‘America First’ health strategy—Devex  
• Far from over—Forsaken Substack 
• US-Africa Health Agreements Targets Don’t Add Up—To End a Plagues … Again Substack 

What We’re Reading

• Reimagining HIV prevention programmes: the time is right, but what needs to be done?—The Lancet HIV
• Is science diplomacy still possible?—The Lancet
  2025 Broke the System. 2026 Decides the Future of Global Health.—Lights.Camera.Equity Substack
• When politics Trumps science: Why the US isn’t giving South Africa LEN—Financial Mail
• Will New US Aid Strategy Improve Countries’ Self-Reliance?—Medscape
• World leaders adopt a historic global declaration on noncommunicable diseases and mental health—WHO 
• Forget quiet quitting, the State Department appears to be quiet hiring—Devex 
• Trump Officials Celebrated With Cake After Slashing Aid. Then People Died of Cholera.—ProPublica 
• Exclusive: Senate Democrats introduce bill to protect UN Population Fund—Devex 
• California Hires Former C.D.C. Officials Who Criticized Trump Administration—New York Times
• Update on Lives Lost from USAID Cuts—CGD
• U.S. Global Health Country-Level Funding Tracker—KFF

STIs Spotlight

AVAC’s STI program looks back at 2025—and ahead to 2026—tracking rising STI rates, major HPV vaccination gains, slow but promising diagnostics, the growing role of self-care, and what’s next for STI research, prevention and diagnostics.

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Decisions and actions this week further weaken the global HIV response — from the exclusion of communities in the new PEPFAR US global health strategy negotiations to a Global Fund replenishment that falls short of what’s needed to deliver emerging HIV, TB, and malaria innovations at scale. Major disruptions at the US CDC and NIH – including halted non-human primate research, politicized vaccine messaging, leadership changes that jeopardize HIV research, and “skipping” World AIDS Day — continue the erosion of accountability, trust, and the integrity of the public health system. 

US Global Health Strategy Negotiations Leaving Communities Behind 

African advocacy partners including Eastern Africa National Networks of AIDS and Health Service Organizations (EANNASO) and the Coalition to build Momentum, Power, Activism, Strategy & Solidarity in Africa (COMPASS) have been taking stock of the ongoing country negotiations around the US government’s Memorandums of Understanding (MoUs) as part of its new “America First” global health strategy. They are finding that communities are being systematically excluded from the “government-to-government” negotiations for new 5-year PEPFAR MoUs, a direct reversal of the community engagement that has defined decades of the HIV response. Efforts to ensure program effectiveness, implementer accountability, programs for key populations, and commodity security are all at stake. The new framework would also require partner countries to share pathogens and patient data, potentially with US commercial interests, without privacy safeguards or assured access to resulting products — for decades longer than the life of the actual MOUs. With an MoU signing deadline of December 12, there is a great need to mobilize to demand transparency, inclusion and fair terms for all parties. 

IMPLICATIONS: The exclusion of communities from the new MoU negotiations is an abrupt shift away from the community-centered model that has been at the center of PEPFAR’s success for decades. These closed-door, government-to-government negotiations undermine the hard-won progress on reaching key populations, protecting data privacy, and delivering services that are responsive to the real-life needs of communities. Sidelining communities threatens the effectiveness, and legitimacy of the next phase of the HIV response and without immediate transparency and meaningful engagement, these MoUs risk weakening impact and trust. 

READ: 

• No seat at the table—Forsaken Substack 
• First look: Full Text of America First Global Health Strategy Specimen Sharing Agreement—To End A Plague Again Substack  
• Will African nations lose their leverage in an ‘America first’ health plan?—Devex  
• South Africa May Be Excluded From Future US Grants for HIV Amid Political Row—Health Policy Watch 

Global Fund Replenishment Support, But Falls Short of Target 

Last Friday, donors pledged just over $11 billion at the Global Fund’s 8th Replenishment in Johannesburg. This was an important show of support, especially given the challenging political and economic climate, but well short of the $18 billion target needed to fully harness today’s unprecedented scientific advances against HIV, TB and malaria. The US pledged $4.6 billion, a decrease from the previous cycle, even as it reaffirms the 1:2 matching commitment, placing renewed pressure on Congress to fully appropriate funds, and on other donors to step up.  

IMPLICATIONS: As long-acting HIV prevention, new malaria tools and improved TB treatments enter the market, this shortfall threatens the speed, scale and equity of their rollout. And with communities already facing service disruptions, this shortfall could cost millions of lives and squander a historic opportunity to turn innovation into impact. 

READ: 

• Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States—Health Policy Watch
• Global Fund raised $11.34 billion with a surprising US pledge—Devex  
• Control of HIV, TB and malaria at risk after global health fund donations fall—The Guardian  
• Friends statement on the U.S. commitment to the Global Fund—Friends of the Global Fight  
• The ONE Campaign Applauds American Leadership on Global Fund, Highlights Need for Full Funding—One Campaign 
• AVAC Statement on the 8th Replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria—AVAC      

Big Disruptions at US CDC and NIH – and World AIDS Day

In the last week, decisions and actions at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health’s (NIH) Division of AIDS (DAIDS) further jeopardize the future of HIV research and confidence in vaccines. The CDC abruptly ordered an end to all non-human primate research, including critical macaque studies that have long supported HIV prevention science. The agency also altered language on its website implying a link to vaccines and autism and contradicting established scientific consensus. At the NIH, long-time DAIDS Director, Carl Dieffenbach, was reassigned to the Fogarty International Center, a move that removes a trusted leader who played a central role in guiding HIV research. See AVAC’s resource, HIV Prevention R&D at Risk, which tracks the impact of all this and more. Also, just ahead of December 1, the US administration announced that it will no longer commemorate World AIDS Day. 

IMPLICATIONS: Together, these actions continue the decline in US global health leadership, unraveling decades of scientific progress and trust in vaccines and public health institutions. Halting essential preclinical research in macaques, politicizing vaccine messaging and sidelining experienced leadership weakens the pipeline of innovation and threatens the integrity of HIV science at a moment when sustained investment and credibility are most needed. As for World AIDS Day, Congressman Mark Pocan, who leads the Congressional HIV/AIDS Caucus, said the administration’s refusal was “shameful and dangerous.” But it’s important to remember that World AIDS Day is not decided by the US government; it belongs to everyone – and the new UNAIDS report provides the theme: Overcoming disruption, transforming the AIDS response. Or as the International AIDS Society says: Rethink. Rebuild. Rise. 

READ: 

• Kennedy Says He Told C.D.C. to Change Website’s Language on Autism and Vaccines—New York Times   
• Exclusive: CDC to end all monkey research—Science 
• NIH shake-up to grant decision-making draws concerns of political meddling—Science 
• Trump Administration Will No Longer Commemorate World AIDS Day—New York Times 
• The United States Cancels World AIDS Day—Substack To End a Plague … Again 

What We’re Reading

• What Africa Lost Under Trump: At least $5 Billion. What It Got In Return: “True Chaos.”—Veza from the Center for Collaborative Investigative Journalism (CCIJ) 
• The 2025 HIV Market Report: The state of the HIV market in low- and middle-income countries—Clinton Health Access Initiative
• China pledges $3.5 million for South Africa’s HIV response—Reuters  
• UNICEF, Gavi deal slashes malaria vaccine price to $2.99 per dose—Devex  
• Ex-top USAID official details wish list on health and funding fixes—Devex 
• G20 summit in South Africa adopts declaration without the US—Devex
• DOJ Tries To Block Elon Musk Testimony In USAID Lawsuit—Forbes 
• HHS rehiring some people fired through reduction-in-force efforts—Politico
• Video: We Have a Chance to End the AIDS Pandemic—Public Citizen 
• “Miraculous” HIV drug to be rolled out after overcoming aid cuts threat—BMJ

This week’s newsletter publishes just as the Global Fund’s 8th Replenishment Summit in South Africa is taking place. The Global Fund represents one of the strongest symbols of global solidarity in the fight against HIV, TB, and malaria, but, despite early pledges from several European Union member states and private partners, key donors (including the UK, Germany and France) appear to be stepping back, with smaller or uncertain pledges at this critical moment, and it is not yet clear what the US will do. A budget-constrained Global Fund raises serious concerns about losing ground against all three diseases and failing to seize opportunities to scale up new innovations in all three, including long-acting injectable PrEP for HIV. This Global Fund Advocates Network (GFAN) tracker tallies pledges, and this resource for scenario building shows how potential donor pledges could impact the funds available for health programs. Be sure to watch AVAC’s channels for the latest on the pledges.  

Read on for more including the arrival of injectable lenacapavir for PrEP in Eswatini and Zambia, the uncertain future of US health funding post-shutdown, and new research exposing the impact of NIH clinical trial cuts.

Lenacapavir Arrives in Eswatini and Zambia  

The first doses of injectable lenacapavir for PrEP (LEN) arrived in Eswatini and Zambia. These initial deliveries mark a historic acceleration in PrEP access, moving faster than we’ve seen with past introductions (see  AVAC’s new graphic comparing the rollout of LEN to past PrEP products) and signaling momentum and an ability to apply lessons from past delays. With additional regulatory reviews underway across the region, this early action represents a promising step forward. 

IMPLICATIONS: While these first shipments are worth celebrating, they’re just a down payment on what’s needed to deliver LEN at scale with equity. The joint Global Fund and PEPFAR commitment to reach two million people in the first three years is far more ambitious than past introductions, but falls short of delivering the impact that is needed. For LEN to have maximum impact, global donors and governments must align on transparent volume commitments, prioritize high-need markets and ensure that rollout strategies are rooted in community-led approaches. While South Africa is slated to receive LEN with Global Fund support, the fact that they are excluded from PEPFAR’s program is a huge, missed opportunity. If we really want to build a sustainable market as quickly as possible, one that will drive volume up and prices down and deliver real impact, South Africa must be THE center of the market and needs PEPFAR and Global Fund both to work with the South Africa government. AVAC’s full LEN resource library, including infographics on supply and demand, is designed to support advocates working to make that vision real. 

READ: 

• First doses of HIV prevention drug lenacapavir delivered to Zambia, Eswatini—Reuters  
• A ‘breakthrough’ drug to prevent HIV, an ‘unprecedented’ rollout—NPR Goats & Soda 
• Trump HIV prevention plan shuts out South Africa — the nation most affected—Washington Post 
• South Africa is urged by advocates to issue a compulsory license for Gilead’s HIV prevention drug—STAT
• Trump Takes Credit for Lenacapavir Deal after His Administration Decimated U.S. International AIDS Prevention Programs—Public Citizen 
• Access Uncertain for New Injectable PrEP as the Affordable Care Act’s (ACA) Open Enrollment Begins—KFF    

US Government Reopens, Health Funding Remains Uncertain 

The US Congress officially reopened the federal government after the longest shutdown (43 days) in the country’s history. Funding for most agencies is now extended until January 30, and three appropriations bills were passed to cover several departments through all of fiscal year 2026 which ends next September. However, key health initiatives remain vulnerable: the deal keeps major health programs, including the nation’s HIV response, on a short-term continuing resolution only through January, and does not address spiking US health insurance costs. 

IMPLICATIONS: HIV prevention, treatment, and care programs will continue at last year’s levels through January 30, which avoid devastating cuts for the time being, with the fight to increase investments ongoing. The broader budget agreement also sidesteps major reforms demanded by lawmakers that threaten to gut these programs. It’s not clear if or when future disruptions might further impact public health programs and US global health engagement. 

READ: 

• The government has reopened, but Congress must protect HIV funding for 2026—The Hill  

Clinical Trials Affected by NIH Research Grant Terminations 

A new study published in the Journal of the American Medical Association (JAMA) shows that more than 74,000 clinical trial participants were affected when 383 clinical trials lost funding from the National Institutes of Health (NIH) between February 28 and August 15, 2025. These cuts disrupted research across a range of diseases, but most of the targeted trials were outside of the US and were testing preventive or behavioral interventions, primarily in infectious diseases. “Those findings suggest that there’s a bias towards termination of grants that have nothing to do with the quality of research being conducted,” the authors wrote.  

IMPLICATIONS: This is one of the first studies to officially document the impact of the Presidential Administrations’ hostile policies and funding cuts to science. The political willingness to gut science without warning erodes trust in public health institutions and undercuts the foundation of long-term innovation. The impact is being seen across geographies, industries, communities, and diseases. 

READ: 

• Clinical Trials Affected by Research Grant Terminations at the National Institutes of Health—JAMA   
• NIH grant cuts have disrupted hundreds of clinical trials, study finds—Fierce Biotech 
• Trump slashed spending on clinical trials. The toll is starting to become clear.—Washington Post  
• NIH funding cuts have affected over 74,000 people enrolled in experiments, a new report says—Associated Press 

What We’re Reading

• US health strategy aims to position African governments as customers—Devex 
• Could an HIV miracle drug actually reach people like my parents?—STAT 
• Lenacapavir Plus Broadly Neutralizing Antibodies Maintains Viral Suppression—POZ 
• MacArthur Foundation awards $100M to outbreak surveillance network, a boost amid global health cuts—Associated Press 
• Global Aid Cuts Could Reverse Decades of Progress in Health and Development—ISGLOBAL  
• Amid aid cuts, these countries have ramped up global health cooperation—Devex  
• DOGE Man Drives US Bilateral Health Agreements With African Countries—Health Policy Watch
• N.I.H. Worker Who Criticized Trump Health Policies Says She Is on Administrative Leave—New York Times 
• A Small Texas Think Tank Cultivated Covid Dissidents. Now They’re Running US Health Policy.—KFF 
• State department to cut 38 universities from research program over DEI policies—The Guardian 
• Senator Murray Slams Outrageous Political Retaliation at NIH, Demands Answers from Trump Administration—Senator Patty Murray 

Resources