This week marks one year since AVAC and the Global Health Council filed their lawsuits over the sweeping foreign assistance freeze — cases that challenged the Administration’s withholding of Congressionally appropriated funds and underscored the stakes for global health and HIV programs. That broader dispute over executive power and federal spending continues to reverberate, as four US states sued the administration this week over its decision to withhold $600 million in public health grants supporting disease surveillance, emergency preparedness, vaccination, and HIV prevention. This Global Health Watch issue also examines ongoing signs of erosion in vaccine confidence and regulatory stability and calls for early global access planning for Merck’s investigational monthly oral PrEP candidate. 

Four US States Sue HHS Over $600 Million in Public Health Grants 

Last week, the US administration announced it would withhold approximately $600 million in previously allocated public health grants for disease surveillance, emergency preparedness, vaccination programs and HIV prevention from states it argues are not aligned with administration priorities. In response, these states, which are led by Democrats: California, Colorado, Illinois and Minnesota, filed a lawsuit against the US Department of Health and Human Services (HHS), seeking to block the cuts. The funding is primarily distributed through the US Centers for Disease Control and Prevention (CDC) and the states argue that the administration cannot retroactively impose new conditions on congressionally appropriated funds or withhold them based on policy disagreements.

IMPLICATIONS: This case mirrors broader disputes over executive authority and federal spending, including AVAC’s lawsuit, that have surfaced repeatedly over the past year. Beyond the immediate budget impact, the decision to withhold public health funds risks destabilizing prevention and preparedness systems that rely on sustained, predictable financing. For HIV and other infectious diseases, interruptions in surveillance, community outreach, and prevention programming can quickly translate into increased transmission and weakened response capacity. While $600 million in funding is on the line, so is the principle that public health infrastructure cannot function effectively if appropriated funds are subject to shifting political leverage. 

READ:  

• Four States Sue Administration Over Loss of Public Health Funds—New York Times 
• Four states sue Trump administration over cuts to public health funding—Reuters  
• ‘Sanctuary’ States Get Judge to Pause Trump’s Public Health Cuts—Bloomberg  
• Save HIV Funding Campaign Denounces Cancellation of Vital HIV and STI Funding, Urges the Administration to Immediately Restore Grants

Vaccine Confidence Continues to Be Undermined 

Vaccine confidence continues to be undermined across multiple fronts this week. The US Food and Drug Administration (FDA) declined to review Moderna’s mRNA seasonal influenza vaccine candidate, raising questions about the regulatory pathway and timeline for review and introduction of new flu products. At the same time, the American Medical Association (AMA) announced its plans for its own independent vaccine safety and effectiveness review initiative, which signals growing concern about trusted scientific assessment processes. And a survey found declining public perceptions of the safety of COVID-19, influenza, and MMR vaccines, underscoring persistent erosion of vaccine confidence. 

IMPLICATIONS: This week’s developments signal mounting stress on the scientific and governance systems that underpin vaccine confidence and access and risk fragmenting systems that were grounded in evidence and transparency. At a moment when routine immunization rates remain fragile and misinformation continues to spread, sustained regulatory clarity, transparent scientific review, and stable engagement in multilateral vaccine processes are essential to maintaining public trust and global health security.

READ:  

• F.D.A. Refuses to Review Moderna Flu Vaccine—New York Times 
• Vinay Prasad’s Vaccine Kill Shot—Wall Street Journal 
• Prasad overruled FDA staff to reject Moderna’s flu vaccine application—STAT  
• AMA launching its own vaccine safety, effectiveness review system—The Hill 
• Study Finds Declining Perceptions of Safety of Covid-19, Flu, and MMR Vaccines—Annenberg Public Policy Center of the University of Pennsylvania  
• Mexico state steps up health screening in schools as measles cases grow nationwide—Associated Press 
• FDA’s rejection of Moderna threatens to stifle broader vaccine industry—STAT  
• US participating in influenza vaccine meeting: WHO—The Hill

Advocates Urge Early Access Planning for MK-8527 

More than 170 groups representing people living with HIV, advocates and providers across 30 countries called on Merck to commit now to a global access strategy for its investigational monthly oral PrEP candidate, MK-8527. Signatories argue that early decisions on pricing, licensing, and regulatory pathways will determine whether the product becomes a transformative addition to the HIV prevention toolkit or follows the slow, inequitable rollout patterns seen with the rollout of oral PrEP. The groups urged Merck to build on the momentum of Gilead’s accelerated work on lenacapavir and pursue regulatory pathways through the European Medicines Agency and the World Health Organization to accelerate approvals in low- and middle-income countries; seek registration in at least 10 high-burden African countries within six months of a major regulatory approval; commit to pricing at or near generic oral PrEP levels (under $40 per person per year); and negotiate non-exclusive voluntary licenses before approval to enable timely generic production.

IMPLICATIONS: This moment reinforces a lesson the HIV field has learned repeatedly: that access needs to be embedded in the design and development of new products. Decisions made during product development around pricing, licensing, regulatory strategy, and manufacturing shape whether innovation translates into impact or inequity. We are already seeing how early, proactive access planning with lenacapavir for PrEP can accelerate timelines, align donors and regulators, and drive what is now the fastest rollout of a new prevention product since oral PrEP. Advocates are pressing Merck to apply those same principles to MK-8527 now, before trials have results, to avoid the delays and disparities that have historically limited uptake of new prevention options in low- and middle-income countries.  

READ:  

• Merck is urged by patient groups to ensure widespread access to an HIV prevention pill being tested—STAT  
• Letter: Ensuring Equitable Global Access to MK-8527 for HIV Prevention 
• Speeding Up Access to PrEP: Time from efficacy results to key milestones—AVAC  
• The Gears of Lenacapavir for PrEP Rollout—AVAC 

What We’re Reading

• Four States Sue Administration Over Loss of Public Health Funds—New York Times
• EU To Pledge ‚700 Million To Global Fund, Less Than Previous Years—Health Policy Watch
• Will Africa’s health care reset leave patients footing the bill?—Devex
• As The Aid Model Collapses, Africa Is Rewriting Its Health Future Through The ‘African Leadership Meeting’—Health Policy Watch
• Dozens of researchers will move to France from US following high-profile bid to lure talent—Nature
• Malawi struggles to fill development gaps after US aid cuts—Devex
• One year after USAID’s shutdown, Ethiopian aid workers are still struggling—Devex
• UN presses for clarity on nearly $4 billion owed by US as financial crisis looms—France 24
• Zimbabwe’s youth pay the price of US funding drawdown—Devex
• WHO director-general calls plans for US-funded vaccine trial ‘unethical’—STAT
• Kenya second-largest Africa vaccine trial hub—The Star (Kenya)
• By Slashing Foreign Aid, Trump is Fueling the Spread of HIV in Uganda—The Intercept
• UN presses for clarity on nearly $4 billion owed by US as financial crisis looms—France 24
• US Global Health Spending Watch—PIH 

This week a $50 billion US foreign affairs spending bill was signed into law, averting severe proposed cuts; a new modelling analysis projects millions of additional preventable deaths by 2030 if global aid cuts continue; and the financial crises facing the UN and WHO continue. We are also following plans to transition or close the Oregon National Primate Research Center, a leading research institution that has contributed enormously in biomedical and HIV research.

US Signs Foreign Affairs Spending Bill Amid Ongoing Uncertainty 

The US Congress passed the $50 billion foreign affairs spending bill and the President signed it into law Tuesday, ending a brief government shut-down. The appropriations bill restores billions in foreign assistance, along with companion bills that restore critical support for biomedical research at the NIH and domestic HIV programs, that had been at risk of deep proposed cuts, though it still represents a reduction from previous years and questions remain about how fully the administration will implement the funding and priorities laid out by lawmakers.

IMPLICATIONS: While this bill averts the most severe proposed cuts and sends a strong signal for continued engagement by Congress, the reduced funding level and uncertainty of whether global health and humanitarian programs will receive the funding Congress appropriated leave many reluctant to celebrate. Coordinated advocacy and sustained Congressional oversight will be needed to ensure all appropriated funds are obligated and spent. 

READ: 

• US Congress passes $50 billion foreign affairs bill—Devex  
• UPDATE: Final Passage of FY26 Spending Package Protects Funding for Domestic & Global HIV Programs after Hard Won Fight, Concerns about Funding for DHS Persist—Save HIV Funding 
• Devex Newswire: Foreign affairs spending bill becomes law after shutdown—Devex

New Modelling Quantifies the Impact of Aid Cuts 

A new modelling analysis published in The Lancet Global Health finds that ongoing cuts to official development assistance, particularly from long-time donors like the US, UK and Germany, could lead to between 9.4 million and 22.6 million additional deaths by 2030 across 93 low- and middle-income countries. This includes more than 5 million children under age five. 

IMPLICATIONS: This analysis reinforces the need to sustain strategic investments now to avoid deaths and setbacks on all fronts, from HIV to maternal and child health to chronic diseases. 

READ: 

• Impact of two decades of humanitarian and development assistance and the projected mortality consequences of current defunding to 2030: retrospective evaluation and forecasting analysis—The Lancet Global Health 
• Global aid cuts could lead to 9.4 million deaths by 2030, study projects—Washington Post 
• Aid cuts could cause 22m avoidable deaths by 2030, study finds—The Guardian

UN and WHO Face Deepening Financial Crisis

Global health and humanitarian institutions are facing an escalating financial and political crisis. UN Secretary-General António Guterres warned that the United Nations risks “imminent financial collapse” if member states, specifically the US, do not pay their dues on time, or fail to agree to revise the financial rules, which require the UN to repay governments hundreds of millions of dollars in credits for programs, even ones that were never implemented. At the same time, the World Health Organization (WHO) launched its 2026 emergency appeal amid its biggest financial decline in a decade and while the US withdrawals and other countries question their engagement.  

IMPLICATIONS: While WHO and the UN pursue reforms toward more sustainable and flexible financing, failure by member states to stabilize funding and modernize governance could strip capacity from global institutions at a moment when they are needed most with major implications for health security, equity, and trust in the global response system. 

READ: 

• US retreat from WHO harms global health and the HIV response—Positively Aware  
• US funding pledge insufficient to avert UN financial woes—Devex  
• Global health systems ‘at risk’ as funding cuts bite, warns WHO—UN News  
• Building healthy bridges towards peace: WHO launches $1 billion appeal—UN News  
• Days After US Leaves WHO, Israel Warns It Faces Pressure To Withdraw—Health Policy Watch 
• What kind of leader does WHO need next?—Devex

NIH to Transition Primate Research Center Amid Broader Shift Away from Animal Testing

In the last week, NIH Director, Jay Bhattacharya, confirmed plans to transition the Oregon National Primate Research Center at Oregon Health & Science University (OHSU) into an animal sanctuary. This is the first of possibly seven of the NIH’s National Primate Research Centers to close or transition and is part of a broader national push to reduce animal testing. The NIH said last year it would spend $87 million to develop a standardized alternative to animal testing. OHSU’s board of directors will meet Monday to consider negotiations with the NIH. They previously estimated it would cost $241 million over eight years to close.

IMPLICATIONS: This move reflects a broader pattern of policy decisions that risk eroding the foundational research systems underpinning early-stage biomedical science, including HIV prevention, treatment, and cure research. While developing alternatives to animal research is important, rapidly dismantling animal research—particularly nonhuman primate capacity at these centers and at the CDC—without validated replacements could weaken the early-stage pipeline that has been critical to breakthroughs such as HIV PrEP, PEP, long-acting prevention, vaccine and cure research and development.

READ:  

• NIH looks to turn primate research center into a sanctuary—Politico  
• As US officials move to reduce animal testing in research, focus may shift to restrictions on imports—STAT

What We’re Reading

• ‘Biblical Diseases’ Could Resurge in Africa, Health Officials Fear—New York Times
• What Will HIV Funding Look Like in 2026?—Bhekisisa
• By-disease investment trends for the first 15 American global health agreements—To End a Plague…Again Substack
• Thanks, but no thanks—The Forsaken Substack
• Gates doubles down on goals in a world weighed down by crisis, CEO says—Devex
• Q&A: How Can Humanitarians Navigate The New Expanded Global Gag Rule?—Health Policy Watch
• Good health is the world’s best investment – and the key to economic resilience—Gavi
• Whose ethics govern global health research?—Nature Medicine
• FDA Commissioner Marty Makary tries to soothe staff concerns over voucher program—STAT
• We asked whether principal investigators have plans in place for how research can continue without them—STAT
• The Only Thing That Will Turn Measles Back—The Atlantic
• Trump Administration to Make It Easier to Fire 50,000 Federal Workers—Wall Street Journal
• Evaluation of an Artificial Intelligence Conversational Chatbot to Enhance HIV Preexposure Prophylaxis Uptake: Development and Usability Internal Testing—Journal of Medical Internet Research
• A Year of Disruption: 5 Resources to Understand Foreign Aid Cuts—Partners in Health
• NIH rolls back red tape on some experiments — spurring excitement and concern—Nature
• Conflicts and Vaccine Hesitancy Undermine Global Immunization Efforts—Health Policy Watch

New this week: resources on the impact of harmful US policies on the HIV response; updated infographics on the ups and downs in PrEP; and an opportunity to apply for the US HIV Cure Academy in North Carolina this April.

The US withdrawal from WHO has made Americans less safe, further damaged diplomatic relationships and will ultimately make America less healthy, writes AVAC Executive Director Mitchell Warren in Positively Aware.

Milestones for access to injectable lenacapavir for PrEP (LEN) are being met faster than any other PrEP product before it. Learn how and why.

The PEPFAR stop-work order resulted in major declines in initiations of PrEP. Between January–September 2024 and January–September 2025, PrEP initiations dropped by 13-66% in high-volume countries, with the steepest declines occurring in PEPFAR-dependent programs disrupted by stop-work orders.

From Devex’s The AID Report, this article features the voices of veteran HIV advocates including AVAC’s Maureen Luba and HEPS-Uganda’s Kenneth Mwehonge. The article traces the impact of the US foreign aid freeze, illuminating how outreach, prevention and monitoring systems are fraying across four African countries critical to the HIV response.

This Bhekisisa piece explores how HIV programs must adapt after US funding cuts. AVAC’s Mitchell Warren argues that survival requires consolidation, new partnerships, boosting domestic government contributions, and sharply refocusing on HIV prevention.

The US HIV Cure Research Academy: April 22-24, 2026 

The US HIV Cure Research Academy brings together researchers and community members from across the United States to learn about HIV cure science and translation. This two and a half-day intensive training program includes interactive discussions, skill-building workshops, and networking sessions. Full scholarships will be awarded for up to 15 attendees. Applications close February 13 at 11:59pm ET. Apply here: US HIV Cure Research Academy 2026!  For further information please contact [email protected].

As this issue goes to publication, the US fiscal year (FY26) budget remains unresolved in the Senate, adding to uncertainty for global health funding. A short-term funding deal reached last night would delay, but not resolve, a potential government shutdown, as negotiations over the administration’s deadly mass deportation efforts continue. For global health programs already under strain, this limbo continues to carry serious consequences. This week’s issue tracks the expansion of the Global Gag Rule under the new “Promoting Human Flourishing in Foreign Assistance” (PHFFA) policy, the US’s formal withdrawal from the World Health Organization (WHO), growing pushback on concerning vaccine policy, and the new finding that nearly half of US CDC surveillance databases have been paused or stopped.

Weaponizing Foreign Aid with the Expanded Global Gag Rule

Last Friday, the US administration expanded the harmful Global Gag Rule (GGR), also known as the Mexico City Policy, under a new Promoting Human Flourishing in Foreign Assistance policy, which broadens restrictions on US foreign aid. Originally enacted in 1984, the GGR barred non-US organizations receiving funding for global health from providing or promoting abortion services (even with their own, separate resources). Each Republican president enforced the GGR, while each Democratic president rescinded it. Now, this administration’s restrictions are being drastically expanded and extend to programs that engage in what the administration labels “gender ideology” and diversity, equity, and inclusion initiatives. It now applies not only to non-governmental organizations (NGOs) based abroad, but US NGOs, multilateral organizations and direct aid to foreign governments. Many organizations, including AVAC, Global Health Council, PAI, Planned Parenthood, Health GAP, and others called for the immediate rejection of the policy as weaponizing US foreign assistance and imposing political ideology at the expense of improving global health and international cooperation.   

IMPLICATIONS: As this Think Global Health editorial from Stephanie Psaki states, “PHFFA applies not just to global health funding but to all non-military US foreign assistance, approximately $30 billion annually—or 50 times more than what was covered by the original Mexico City Policy… At best, the rules will waste US taxpayer dollars and impede the administration’s ability to implement its America First Global Health Strategy. At worst, the policy will cost lives, stall progress against key global health challenges including HIV/AIDS, and further damage US credibility with key partners—particularly across Africa.” Our colleagues at KFF, provide a very useful analysis of this latest expansion here.  

READ:  

• Trump expands policy banning aid to groups abroad that discuss or provide abortions—NPR  
• The Trump Administration’s Latest Expansion of the Mexico City Policy: A Funding Analysis—KFF 
• Latest US Restrictions On Aid ‘Bully’ Recipients To Accept ‘Extremist Ideology’—Health Policy Watch 
• New US funding rules tie aid to abortion, gender ideology, DEI bans—Devex  
• Expanding the Mexico City Policy Undermines Global Health—Think Global Health 

US Formally Notifies WHO of its Withdrawal 

As this issue was going to publication last week, the US formally notified the World Health Organization (WHO) of its decision to withdraw. This triggered responses from WHO and the United Nations noting that the US was a founding member in 1948 and a central partner in major global health gains ever since, and warning that the US departure makes the US and the world less safe.  

IMPLICATIONS: The US withdrawal from the WHO underscores a deeper shift in global health governance where health is a bargaining chip for a new imperialistic ideology around foreign policy and national interest. This move heightens, rather than diminishes, the importance of multilateral cooperation. As Chatham House Fellow, Ebere Okereke, writes in Think Global Health, the “US withdrawal from the WHO increased the relevance of multilateral cooperation for Africa. The WHO remains the primary source of global health norms and coordination, even in its weakened state. Disengagement would leave African countries more exposed to power-based bargaining during crises.” 

READ: 

• WHO statement on notification of withdrawal of the United States—World Health Organization 
• US withdrawal from WHO ‘risks global safety’, agency says in detailed rebuttal—United Nations 
• Joint Statement by Secretary of State Marco Rubio and Secretary of Health and Human Services Robert F. Kennedy, Jr.—US Department of State 
• What U.S. Withdrawal From the World Health Organization Means for Africa—Think Global Health 
• As the U.S. bids adieu to the World Health Organization, California says hello—NPR 
• The Trump administration says it won’t pay what it owes WHO—Devex  
• Withdrawing From the WHO: America Is Not First in Isolation—Medscape   

American Academy of Pediatrics Issues its Own Immunization Schedule

As US policy shifts and vaccine mis- and dis-information fuels mistrust and confusion—including this week’s chair of the CDC’s Advisory Committee on Immunization Practices (ACIP) shockingly questioning longstanding recommendations for polio vaccination—many organizations are stepping up to defend vaccine science and evidence. The American Academy of Pediatrics issued its own 2026 immunization schedule, continuing to recommend routine vaccination against 18 diseases, a broader program of vaccine protection than the new schedule of vaccines released by the US administration a few weeks ago. The AAP’s recommendations are backed by numerous professional groups including the American Medical Association and National Medical Association. The Center for Infectious Disease Research and Policy (CIDRAP) also launched an effort to boost evidence-based vaccine information by partnering with communicators and rapid-response teams to counter misinformation and clarify vaccine safety and effectiveness.

IMPLICATIONS: The AAP’s decision to publish its own comprehensive vaccine schedule, and the broad coalition endorsing it, signals a powerful pushback and commitment to evidence over ideology. This mixed guidance with the medical and scientific community differing from federal recommendations will continue to erode trust and will undermine routine immunization and confidence in public health, ultimately threatening the gains achieved against vaccine-preventable diseases such as measles, influenza, and polio. 

READ:  

• American Academy of Pediatrics departs from CDC with childhood vaccine revisions—The Hill 
• CIDRAP launches new effort to boost evidence-based vaccine information—CIDRAP  
• Rejecting Decades of Science, Vaccine Panel Chair Says Polio and Other Shots Should Be Optional—New York Times

Nearly Half of US CDC Surveillance Databases Stopped Updating 

New research published in the Annals of Internal Medicine shows that nearly half of US Centers for Disease Control and Prevention (CDC) data systems have been paused. Of 82 databases meant to update monthly, 46% show unexplained pauses, most lasting six months or more, and of those paused, approximately 87% track vaccinations. 
 
IMPLICATIONS: As Infectious Diseases Society of America (IDSA) CEO Jeanne Marrazzo writes in an accompanying editorial, “Until the United States restores the CDC and its partner agencies to their former stature, we are not only flying blind in the face of emerging and reemerging threats to human health and well-being—we are being deprived of effective weaponry.”

READ:

• CDC Stopped Updating Key Vaccine, Infectious Disease Databases in 2025—Medpage Today 
• Nearly Half of Once Frequently Updated CDC Databases Are Now Outdated—The Scientist 

What We’re Reading

• The anti-HIV jab Buhle trusts — and 456 000 South Africans can soon get for free—Bhekisisa
• Transformative’ HIV PrEP shot slowly overcomes cost hurdles—The Hill
• One year after US aid freeze, HIV care in Africa is in retreat—Devex
• Zambia US Talks Tie Medical Aid to Mining—Lusaka Times
• US gives 5 weeks for 5-Year Aid Plans—To End A Plague…Again Substack
• US loses Gavi board seat after withholding funding—Devex
• US Freezes All Funds to Gavi Over Vaccine Preservative Thimerosal—Health Policy Watch
• Pandemic Agreement on Hold: Can Countries Bridge the Divide on Pathogen Access and Benefit Sharing—Health Policy Watch
• Lessons From William H. Foege, A Global Health Legend—Forbes
• Kennedy Plan to Test a Vaccine in West African Babies Is Blocked—New York Times
• Trump and allies at odds over COVID shots—Axios

Last week marked one year since the US president took office and began systematically dismantling global health and equity. Below is a roundup of essential conversations and resources summarizing the past 365 days and what’s at stake as we move forward.

READ: One Year Later: Global Health Chaos and Disruption 

AVAC shared a series on the impact of the past year on five key areas of global health and development: the erosion of US foreign aid; the assault on vaccine science and policy; the dismantling of the research enterprise; the cruel irony of funding cuts in the context of the breakthrough technology of long-acting lenacapavir for PrEP; and the profound shifts underway in global health architecture. These original articles by AVAC show how the field navigated a year defined by disruption and resilience—and how policy decisions reverberate through science, programs, and communities. 

WATCH: The People’s Research Agenda

Last week, hundreds joined AVAC for a conversation about The People’s Research Agenda for Speed, Scale and Equity, with Jeanne Marrazzo, former NIAID Director, CEO of the Infectious Diseases Society of America (IDSA), and AVAC Board member. Watch the recording to hear what it will take to deliver science that meets the moment and how advocates can use the People’s Research Agenda, which offers a people-led framework that tracks the science, highlights where investments align with community priorities and identifies critical gaps to ensure the prevention pipeline meets the needs of diverse populations in a reimagined HIV response.

LISTEN: One year after Trump: The day HIV funding changed forever — and what came next 

One year ago, Donald Trump was inaugurated as president of the United States and, overnight, US policies on HIV funding for countries like South Africa changed. Bhekisisa’s Mia Malan speaks with AVAC Executive Director Mitchell Warren to find out how international aid has changed.

READ: Fighting for Billions: The legal battle to keep US foreign aid alive 

Devex’s in-depth retrospective chronicles how legal action became a critical line of defense against the dismantling of lifesaving programs by the US administration — including the ongoing cases by AVAC, the Global Health Council and partners challenging the foreign aid freeze. The piece highlights where we are with the case and why the outcome still matters.

READ: Expansion of the Global Gag Rule 

Late on Friday, the US Administration dangerously expanded the Global Gag Rule, which further restricts the ability of organizations to engage in advocacy, education programs, discrimination protections, and legal reform, anywhere in the world, in any program, with anyone’s funding. 

Download: The Latest Infographics from AVAC

Check out three essential infographics on the HIV vaccine clinical trials pipeline, PrEP products currently available and in late-stage clinical trials and lenacapavir regulatory approvals—to visualize where the field is today and what lies ahead.

Since first established in 1984 by President Ronald Reagan, the Global Gag Rule has harmed global health and disrupted sexual and reproductive health and HIV programs. Reports on the dangerously expanded rules likely to be issued today would move beyond the assault on women’s health and bodily autonomy and lay bare the US administration’s broader war on gender, diversity, equity and inclusion, underscoring their relentless agenda of control over people and programs. 

The expanded Gag Rule restricts the ability of organizations to engage in advocacy and education programs, discrimination protections, and legal reform, anywhere in the world, in any program, with anyone’s funding. This will silence healthcare providers, undermine civil society, and deny people access to essential information and services. The expansion of this policy threatens the very integrity of evidence-based care and foreign assistance. 

“This cruel Gag Rule is bad politics and bad policy,” said AVAC Executive Director Mitchell Warren. “Expanding it represents further weaponization of US funding to impose ideology at the expense of lives and livelihoods. Restricting information and activities that providers deem necessary puts individuals, communities and especially women, girls, LGBTQI+ people, and others at higher risk of poor sexual health outcomes including HIV and other infections. It also weakens the very systems required to respond to global health emergencies and prepare for future pandemics.” 

People’s needs—not politics—must be at the heart of what drives US investments, programs, and global engagement. The Global Gag Rule plays politics with people’s health and lives. AVAC calls for the immediate rejection of the Global Gag Rule and any expansion of it and urges US lawmakers to uphold science, human rights, and public health. 

One year in from the inauguration of a new American president, the US has stepped back its longstanding support for global health—including an unprecedented absence at the World Health Assembly, withdrawal from the WHO, and eliminating support for joint initiatives like Gavi, the vaccine alliance. Other donor countries are following suit, with widespread reductions in funding for foreign assistance, threatening the 60-year-old architecture for coordination, funding and policy on global health.

In its place, the US is advancing what it calls the “America First” Global Health Strategy, comprised of a series of country-by-country (bilateral) health agreements, with little transparency in the process and many questions about their scope, metrics and accountability.  

But advocates, scientists, affected communities and national governments that are navigating the upheaval are not simply ceding the ground. African leaders have been advancing continent-wide planning and strategy toward health sovereignty, focusing on increased domestic spending, local production of vaccines, drugs and diagnostics, investment in research, and innovative financing models. At least one government, Kenya, is mounting challenges to its MOU with the US. And critically, civil society and HIV prevention champions are organizing to influence policy and demand that affected communities are supported to play a leadership role in the strategy and implementation of effective and equitable access to HIV prevention, and wider healthcare services. 

“The last year has been one of chaos, anger, panic, and frustration. I think the coming year has to be one of strategic rebuilding and building something different—not building back, but building forward. That means a different architecture at the country level, community level, regional level, and global level. A year from now, I suspect we’ll see fewer acronyms, but hopefully the ones that remain will be stronger than ever,” said AVAC’s Mitchell Warren in this Bhekisisa podcast.

“Durable health systems don’t rest on government signatures alone. They depend on buy-in from civil society, professional associations, community groups, and implementing partners who surface problems early and help manage risk before it becomes failure. Right now, consultation has been selective, civil society engagement uneven, and local private-sector voices largely absent. That imbalance is a real vulnerability. That’s why transparency and oversight matter. MOUs should be public. Progress should be measurable. Congressional engagement should be ongoing. Oversight is not a partisan exercise; it’s how durable policy is built,” said Jirair Ratevosian, of the Duke Global Health Institute and author of the Lights, Camera, Equity Substack.

A proactive agenda needs to prioritize what delivers impact. There’s a role for technology, for new kinds of partnerships, and for new leadership. Stakeholders must understand and advance what is absolutely necessary to achieve impact.

Stephanie Psaki, AVAC board member and President Biden’s US Coordinator for Global Health Security, pinpoints where advocacy may find leverage: “The State Department’s strategy seems to recognize the enduring bipartisan support among the American people for long-standing US global health goals, even as it shapes those aspirations to fit the president’s imperatives. Overall, the document appears crafted to win back those among the president’s allies who have long supported US programs in global health.” Psaki notes that the strategy outlines dramatic changes to how the United States has operated in global health historically, posing new challenges as we move forward.

“We recognize the global health landscape has changed. We, as a movement, need to prioritize ruthlessly, collaborate differently, and build systems that governments can lead and sustain, while upholding the rights of impacted communities and key populations. That includes integrating across diseases and aligning with health systems rather than siloed programs. We need to redefine sustainability—not as sustaining a funding stream or an institution but sustaining impact against HIV,” said AVAC’s Director of Policy and Advocacy Suraj Madoori.

This work depends on:

Coordinating and Integrating: The past has shown that innovation all too often does not reach the people who need it most. A new era in global health should design and invest for resilience. Resilience requires coordinated systems that work across diseases. 

Redefining Sustainability with Community in the Lead: Sustainability is not about preserving a budget line, program or organization; it’s about delivering results. Community leadership and local ownership in the creation of systems and programs are integral to achieving these results, and fundamental to any approach to sustainability.

Developing Innovative Models of Financing: Success depends on establishing sources of funding that do not rise and fall on the whims and manipulations of politicians or any single funder. 

In this moment of crisis lies the need for transformation. What is built next must be more effective and resilient than before, and more responsive to the people it serves. Champions of global health must define the architecture of the future, or it will be written by people bent on dismantling it.

Over the course of the past year, the story of injectable lenacapavir (LEN) for PrEP has been a stark illustration of what’s at stake for global health as the US government defunds and dismantles fundamental programs within the HIV response. A profound contrast can be seen in this moment—on the one hand, there is a historic opportunity of every six-month LEN injections, which provide near perfect protection, and the speed at which the world can move with this intervention. On the other and, the field is facing unprecedented attacks on the infrastructure required to deliver LEN and other HIV prevention options. Science is breaking through formidable barriers in understanding HIV and how to prevent it, just as the infrastructure for delivering groundbreaking technology is defunded and destabilized. 

2025 was a year of extremes. The field reached important milestones in accelerating access to LEN and advancing HIV prevention science. LEN 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 and the World Health Organization (WHO) rapidly issued guidance and prequalification. Initial LEN delivery has now begun in Brazil, Eswatini, South Africa, and Zambia, setting the stage for expanded access as the year ahead unfolds. Each of these efforts reflect a global commitment to learn critical lessons from the all-too-slow rollout of oral PrEP and injectable cabotegravir and get rollout right this time.  

Yet this momentum occurred as the new US administration launched an extensive assault on global health and the systems that make it possible. One of its first actions was the dissolution of the United States Agency for International Development (USAID). Damaging policies imposed on the President’s Emergency Plan for AIDS Relief (PEPFAR) soon followed, including threats that prevention would be restricted to narrow populations at risk. Of equally deep concern, PEPFAR has not released program data since 2024. Data-driven programming, and inclusion of gay men and other men who have sex with men (MSM), transgender people, and other key populations in PEPFAR-supported PrEP programs is essential to the end-goal of achieving epidemic control. AVAC Executive Director Mitchell Warren calls it a time of erasure, “people in greatest need of lenacapavir are not being tracked, counted or engaged by PEPFAR.”

In its place, the US is driving a nationalistic “America First” Global Health Strategy, signing bilateral memorandums of understanding (MOUs) country by country. The process is short on transparency, excludes civil society and rolls back decades of hard-fought wins aimed at ensuring community priorities, and evidence, inform national strategies and spending on HIV prevention. Some MOUs have come under criticism and court challenge for provisions that advantage American interests at the expense of the partner country and at the expense of a genuine effort to advance global health.

In the meantime, other major institutions that advance global health priorities are struggling to maintain momentum. WHO and UNAIDS are confronting steep funding cuts. The Global Fund, which is playing an instrumental role in supplying LEN for PrEP, fell short of its $18 billion goal, securing pledges so far of only $11.34 billion, with several major donors, including the US, pledging lower amounts than in previous years.

Restrictive, underfunded, siloed or shuttered programming for LEN for PrEP (and other HIV prevention options) threatens this once-in-a-generation opportunity to bend the curve of the epidemic. Moreover, gains the field has fought decades to achieve are threatened. Instead of taking a giant step forward, the world is at risk of tumbling backwards. Instead of ignoring or reinforcing barriers faced by key populations, programs must diversify, decentralize, train and empower providers and peer educators, and innovative to reach marginalized communities with a choice in PrEP options—including LEN for PrEP. Instead of reduced funding to major providers of LEN for PrEP, such as the Global Fund, donors must seize this opportunity to fully fund robust, comprehensive, coordinated efforts to scale it up. Instead of gutting normative agencies such as the WHO and UNAIDS that set targets and standards for achieving impact, international coordination should be reinforced as the foundation for success at a global level.

Global health champions stand at a bend in the road. It’s time to reimagine an HIV response that reaches beyond past success and never backs down in its demand for speed, scale, and equity. Moving forward into this new reality, health leaders, scientists and communities must accept nothing less than a new architecture for global health that brings effective HIV prevention, including LEN for PrEP, and access to care to everyone who needs it.

AVAC’s ‘One Year Later’ series reflects on the tumultuous events of the past 365 days across five global health issues. Our third piece is below. View the full series here.

The United States has witnessed a sustained assault on the research enterprise that underpins global health progress. Documented weekly in AVAC’s Global Health Watch, what has unfolded is a 365-day cascade of policy, programmatic and financial actions that threaten US leadership and the scientific ecosystem responsible for lifesaving breakthroughs from HIV prevention to pandemic preparedness.

In the first month of this US administration, approximately 1,800 National Institutes of Health (NIH) research grants were abruptly canceled, sending shockwaves through universities, research institutes, and global collaborations. In March, Health and Human Services (HHS) began to shrink its workforce by tens of thousands, with approximately 3,500 positions cut at the Food and Drug Administration (FDA), 2,400 at the Centers for Disease Control and Prevention (CDC), and 1,200 at the NIH as part of broader reductions and consolidations. Many scientists, recently hired staff, and early-career researchers lost their jobs, while senior leaders like Jeanne Marrazzo, then-director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), and Kathy Neuzil, then-director of the NIH’s Fogarty International Center, were unceremoniously placed on leave or offered reassignment to distant posts as part of the reorganization. As Nature reports, there was an exodus of more than 25,000 people, many of whom were at early career stages across the science agencies. These disruptions hit core functions in disease surveillance, vaccine and drug development, and infectious disease research, and removed institutional capacity and decades of expertise needed to drive science and public health forward.

The administration then proposed restructuring of the NIH itself, alongside the President’s FY2026 budget request that proposed to cut $18 billion from its funding—a nearly 40% reduction. The administration’s proposal signaled a fundamental shift away from sustained investments in basic science and clinical research, the very foundation of discovery that enables future innovation across all health areas and diseases categories.

As AVAC has repeatedly warned, science does not operate with an on/off switch, it depends on sustained investment, stable institutions, and trust. “When the Administration stops research funding abruptly, it rewinds scientific progress. It will take time and even more resources to get these studies back online—squandering the potential of future breakthroughs that are based on established, gold-standard science.”  

In September, the HIV research community responded to the assault on research: AVAC and partners convened 24 Hours to Save AIDS Research, a global, day-long virtual marathon featuring more than 70 scientists, clinicians, advocates, and community leaders to document what decades of federally supported HIV research have delivered—and what stands to be lost if investments continue to erode. Speakers shared firsthand accounts of how sustained NIH funding enabled breakthroughs in HIV treatment, prevention, and vaccine science, and warned that abrupt cuts threaten to dismantle research networks that cannot be easily rebuilt. The effort underscored that defending the research enterprise is essential to protecting lives, progress, and future innovation. Watch the videos here.

In November, HHS ordered the CDC to phase out so-called “non-essential” nonhuman primate research, jeopardizing preclinical studies that were central to the development of HIV PrEP and PEP, vaccines, and other critical interventions. Additional actions, including pauses on some international research collaborations, proposed caps on indirect cost rates that support university infrastructure, and changes to peer review processes, have further destabilized the system that ensures scientific rigor and independence.

These developments come at a pivotal moment of extraordinary scientific promise. Long-acting HIV prevention options like injectable lenacapavir demonstrate what sustained investment can deliver when science is allowed to progress. As AVAC’s Mitchell Warren recently noted, “We are in a golden moment where innovation, evidence, and opportunity align—but breakthroughs only matter if the systems to deliver them remain intact.” Undercutting research infrastructure now risks slowing or derailing the next generation of prevention tools before they ever reach communities and deliver impact.

Meanwhile, Congress is in the midst of negotiations over the FY2026 appropriations process. While lawmakers on both sides have pushed back against the most severe cuts proposed in the Administration’s budget, the outcome remains uncertain. The decisions made in the coming months will determine whether the US can regain its leadership position or retreat at a time when global health challenges demand more, not less, scientific leadership.

The implications extend far beyond US borders. American investments have long anchored global research networks, supported scientists around the world, and accelerated progress against HIV, TB, malaria, and emerging threats. Dismantling that infrastructure weakens global preparedness, fuels mistrust in science, and leaves communities everywhere more vulnerable.

NIH funding, which supports an estimated 60-70% of South Africa’s medical research, significantly disrupted South Africa’s biomedical research enterprise. In March, NIH grant managers were told to “hold all research awards” for the country, labeling South Africa as a “country of concern” and halting sub-awards and freezing or blocking new and existing grants. A briefing in May shared that 27 HIV trials and 20 TB trials would likely be affected. “We will see lives lost. In excess of half a million unnecessary deaths will occur because of the loss of the funding, and up to a half a million new infections,” Linda-Gail Bekker told Al Jazeera. “Though the issues related to research cuts are a global challenge, South Africa does bear the brunt of so much of this new US presidential administration’s ire,” Mitchell Warren told the Financial Mail. “It is very clear that the President is using budgets and terminations of previously agreed to programmes to redefine agendas, and in this case, ones that defy science and are clearly political and ideological.”

Evidence, equity, and public health must remain guiding principles. AVAC will continue to track, analyze, and elevate what’s at stake, because defending the research enterprise is essential to saving lives. The future of HIV prevention, vaccine development, and global health depends on it.