This week, the US Administration continues to move to consolidate control over science, restructure the systems that underpin PEPFAR and global health security, and redefine US global health engagement through regulatory influence rather than long-term public health partnerships.

Restructuring PEPFAR and Weakening the US CDC

The US Administration is moving forward with its plan to significantly reduce the US Centers for Disease Control and Prevention’s (CDC) vital role in PEPFAR and global health programs, shifting much of the authority and funding to the US Department of State, which many argue, does not have the expertise or capacity to manage the programs. In contrast to CDC’s historical role in implementing PEPFAR in-country programs, the plan would require countries to “purchase” CDC technical assistance services (ranging from disease surveillance to laboratory support) through new bilateral agreements in a “fee-for-service” public health model. The future of in-country CDC offices and technical staff is uncertain under this new plan.

The Administration already significantly weakened PEPFAR’s infrastructure by shutting down USAID last year and delaying HIV funding in an interagency transfer to CDC. This new proposal could further undermine the CDC from much of the work that helps deliver HIV services and supports disease detection around the world. As eight former CDC directors – appointed by both Republican and Democratic presidents – warned previously, the proposed restructuring could disrupt not only HIV services but also the laboratory networks, surveillance systems, trained workforce and trusted relationships with ministries of health that support outbreak detection and response worldwide.

IMPLICATIONS: “This will completely destabilize HIV work abroad,” former CDC official Michele Montandon told the New York Times. “We’ve seen service disruptions, deaths and babies born with HIV after shuttering USAID, and we can expect more to come if CDC is also shut out of this work.” The rapid restructuring of PEPFAR could decimate HIV programs, complicate the transition to country ownership, and fracture global disease surveillance and outbreak-response systems built through decades of US investment. While there is broad stakeholder agreement about the importance of increasing country ownership and transitioning away from donor dependence, the accelerated pace and structure of the proposed changes makes technical expertise and relationships precarious before sustainable alternatives are in place. These changes come at a time of a rapidly unfolding Ebola epidemic in Central Africa, complicating current crises and creating doubt in response capacity for future epidemics.

READ:

• New Plan Scales Back C.D.C.’s Work on Diseases Abroad—New York Times
• The Global Health Spending Stall is Worse than it Looks—Global Health Security Academy
• Protect PEPFAR & Protect CDC’s Global Health Work!—Action Network
• New Change to PEPFAR Will Slash CDC’s Presence Abroad—MedPage Today
• The State Department Say Foreign Countries Will Decide on US CDC Budget for Global Work—To End a Plague … Again Substack
• Congress should embrace strategic health diplomacy—STAT News

Political Control Over Science Moves Ahead

The proposed new regulations that would significantly expand political interference in federal funding decisions across all US government grants by the White House’s Office of Management and Budget (OMB) remains at the center of current controversy. In a recent New England Journal of Medicine editorial, editors warned that this Administration is increasingly using budgetary and regulatory tools to bypass longstanding scientific peer-review and congressional processes, including withholding appropriated funds, restructuring federal agencies, and proposing rules that would give political appointees greater influence over research funding decisions. At the same time, Hal Duncan, the nominee to serve as the Deputy Director of the OMB, defended the “pocket rescission” strategy during his confirmation hearings this week in front of Senate leaders. This strategy would allow the Administration to use additional spending cuts through “pocket rescissions,” which would allow funds to expire before Congress has an opportunity to act.

IMPLICATIONS: The moves by OMB signal increasing efforts to shift decision-making authority away from Congress and scientific peer review and toward the Executive Branch, giving the President more control over how federal money is spent and what research and programs get funded in alignment with ideology. For the last 18 months, the question of who gets to decide what scientific research and public health programming are funded and whether Congress’s decisions are carried out as intended continues to be raised, and the answer increasingly appears to be the White House rather than Congress or the broader scientific and public health community.

• How cuts to CDC are dismantling its capacity to protect Americans’ health—The Conversation
• Trump administration has its sights set on destroying international research collaborations—BMJ

Scientists Issue Bethesda Declaration: One Year Later

Nearly 40 former and current staff at the National Institutes of Health (NIH) authored a new report, The Bethesda Declaration One Year Later, Continuing Harms to the NIH Mission, which outlines nine deepening concerns at the NIH over the last year along with proposed solutions. This report comes one year after hundreds of NIH employees accused the Administration of politicizing biomedical research through the original Bethesda Declaration. The new report notes that the Administration is slowing medical research, disrupting international collaborations, weakening ethical safeguards, driving away experienced staff and undermining public trust in science. Approximately 24% fewer NIH research projects were funded in 2025 than in 2024 and more than 5,500 peer-reviewed grants were terminated. The report also warns that the White House’s proposed Office of Management and Budget (OMB) rule, which would subject federal grants to greater political review and require alignment with presidential priorities, would institutionalize many of the changes researchers have opposed in the last year.

IMPLICATIONS: The updated Bethesda Declaration shows growing concern from the scientific community about the politicization of science. The NIH has served as the foundation of HIV research, from supporting basic science, vaccine development, implementation of new prevention technologies and global research partnerships. As political oversight expands and international collaboration is deconstructed, the US risks undermining the scientific infrastructure that has fueled decades of innovation and partnership.

• OMB nominee ‘can’t commit’ to forgoing ‘pocket rescissions’ funding gambit this year—Politico
• The OMB and the Politicization of Science—NEJM
• House Budget Bill Threatens Public Health, Defend Public Health Says—Defend Public Health

US FDA and African Medicines Agency Enter Into New Partnership

The US Food and Drug Administration (FDA) and the African Medicines Agency (AMA) have signed a new Memorandum of Understanding (MoU) to create a shared framework for information sharing and regulatory cooperation. The agreement could allow African regulators to draw on FDA assessments and regulatory decisions when evaluating medical products, while also facilitating greater cooperation on inspections, scientific reviews and regulatory capacity building.

IMPLICATIONS: This agreement between two stringent regulatory authorities (SRAs) is another example of the Administration’s evolving approach to global health and in-line with the US government’s recent “America First” global health strategy. This partnership could be interpreted as a regulatory harmonization effort that would allow for the rapid influx of American-made health technologies for emerging markets in Africa. The expansion and procurement of US-made health commodities is a central feature to the US government’s new transactional approach to global health. However, this comes in stark contrast as the US cuts funding for global health programs, reduces the CDC’s international role and restructures PEPFAR, it is replacing long-term public health partnerships with narrower bilateral agreements focused on regulation and innovation. The disconnect between developing new health technologies and supporting the health systems needed to deliver them complicates the vision for greater regulatory cooperation between SRAs that is required for scale-up and access to the latest treatment and prevention modalities.

READ:

• African Regulators Will Share Information, Could Rely On US FDA Decisions—The Pink Sheet
• Statement of Cooperation Between the United States Food and Drug Administration and The African Medicines Agency Regarding Cooperation to Enhance Activities of Mutual Interest

What We’re Reading

• HIV Response Faces ‘Biggest Storm’ in Its History After Funding Nosedive—Health Policy Watch
• Funding cuts drive sharp drop in HIV prevention, UNAIDS says—Reuters
• Inside Trump’s Reversal on HIV—Politico
• Zambian AIDS Patients Pay the Price of Dispute Over America’s Demand for Preferential Access to Minerals—The New York Sun
• HIV Prevention Is Solved. Delivering It Is Not—Forbes
• MSF pushes for affordable HIV medicine Lenacapavir—The Star (Kenya)
• The 3-Pronged Attack on Scientific Communication – Inside Higher Ed
• Game-changing HIV prevention medicine must be available for USD40 per year, everywhere—MSF
• Aid is being replaced by investment. That’s a dangerous mistake—Devex
• We published in Nature Medicine in 2025 for free. In 2026, it cost us $12,850—STAT
• NIH launches new office to advance human-based research and reduce animal use—National Institutes of Health
• Scientists Call Charges Against NIH Virologists ‘Chilling’—MedPage Today
• Kennedy Seeks to Expedite Appeal of Ruling That Blocked His Vaccine Policies—New York Times
• Scores Fall Ill at Air Force Base After Hegseth Makes Flu Vaccine Optional—New York Times
• REPORT ON ACCESS to PrEP in EUROPE, 2026—AIDS Action Europe
• Trump admin paying thousands of dollars per month to store ruined USAID contraceptives—The Hill
• ACTG Launches HIV Cure Study Evaluating Novel Approach Targeting the HIV Reservoir—POZ
• Global Fund partners with CIFF to bring new TB tests to 13 countries—Devex
• WHO launches first global database on the prevalence of sexually transmitted infections—WHO
• As a physician, I have never been more concerned about rates of congenital syphilis—STAT
• Trump Administration Global Health Agreements: Negotiations Tracker—Public Citizen

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)