Proposed US budget cuts, HIV supply chain disruptions, evolving Global Fund commitments, and a renewed attempt to undermine US vaccine policies highlight a landscape under rapid shifts this week.

Proposed US 2027 Budget Signals Major Cuts and Restructuring of Global Health Programs

The US President released his Fiscal Year 2027 budget request, proposing cuts in and restructuring of global health funding—approximately 46%—under a consolidated Global Health Programs account aligned with the America First Global Health Strategy. The proposal eliminates funding for key HIV prevention and health services, including voluntary medical male circumcision (VMMC), LGBTQ-focused programming and broader reproductive health services. It also removes disease-specific budget lines that have historically enabled Congressional oversight of HIV, TB and malaria investments. Notably, the request preserves the match for the US contribution to the Global Fund but does not specify an amount, or include funding for Gavi, the Vaccine Alliance. The proposal also includes language changing PEPFAR’s funding duration from 5 years to 3 years and codifies the Promotion of Human Flourishing rules (also known as the expanded Global Gag Rules). The budget also includes a proposed 12% cut to the NIH budget—last year, the President proposed a 40% cut to the NIH, which Congress rejected outright.

IMPLICATIONS: The US Congress ultimately determines final appropriations, as per the US Constitution. Congress has historically rejected cuts of this level, but the proposal signals a clear determination of the US President to deprioritize science, research and global health programs—and the first 15 months of this Administration has also shown its rejection of Congress’s power of the purse.

• Global Health Funding in the FY 2027 President’s Budget Request—KFF
• Save HIV Funding Campaign Responds to Trump FY27 Budget, Urges Congress to Protect People Living with & Vulnerable to HIV by Rejecting Cuts & Providing Funds to Meet Urgent Health Care Needs—Save HIV Funding
• White House proposes 12% cut to federal health agencies in 2027 budget request—STAT
• Slasher sequel: Trump again proposes major cuts to US science spending—Science
• Trump’s Foreign Aid Overhaul Sent Millions More Dollars to Big US-Based Contractors—New York Times

Abrupt Shutdown of US Global Health Supply Chain Raises Risks for HIV, TB and Malaria Programs

The US Department of State abruptly announced plans to terminate, by May 30, 2026, the Global Health Supply Chain–Procurement and Supply Management (GHSC-PSM) mechanism, which has been implemented by a consortia led by Chemonics and which is responsible for end-to-end procurement and delivery of HIV, TB and malaria commodities. In March, State Department Senior Official Jeremy Lewin, decided to extend Chemonics’ contract until 2027. This reversal of that decision comes without a clear transition plan, posing significant risk of medication stockouts and disruption in getting diagnostics and medications to communities. There has been some discussion of a future shift toward the wambo.org platform used by the Global Fund, which primarily serves as a pooled procurement mechanism, and hasn’t historically provided logistics support, such as warehouses and last-mile distribution. Two hundred and fifty civil society organizations signed on to a letter to the US Secretary of State calling for immediate reversal of this decision and retaining the earlier decision made by Lewin.

IMPLICATIONS: Without proper planning and capacity, an abrupt transition from GHSC-PSM to wambo.org or other platforms risks severe disruptions to HIV, TB and malaria care. Advocates stress that any transition must be deliberate, transparent and centered on continuity of care, with sufficient time to vet new partners to avoid the waste, fraud and abuse that can plague procurement processes. The priority now is not just opposing the timeline, but identifying and securing the components of a responsive, resilient supply system and ensuring that any new mechanism can meet those standards before critical systems are dismantled.

• US Upends Global Supply Program for Malaria and HIV Amid Warnings—Reuters
• Exclusive: Country Deadlines for Emergency Closeout of US Global Health Supply Chain—To End a Plague…Again Substack
• Sudden Termination of US Global Health Supply Chain Program Will Cost Lives—Health GAP
• When the Supply Chain Is the System—Alain Casseus Substack
• The Global Fund veteran building Africa CDC’s pooled procurement platform—Devex

Global Fund Commitments Update

In a delayed announcement, the European Commission finally pledged €700 million to Global Fund to Fight AIDS, Tuberculosis and Malaria at this week’s G7 One Health Summit—a slight reduction from their previous pledge in the last three-year cycle. As reported previously, the Global Fund Board approved $10.78 billion in country allocations for the 2027–2029 cycle and set aside $260 million in catalytic funding to accelerate access to innovations, including scale-up of LEN, new molecular tuberculosis diagnostics and improved malaria vector-control tools.

IMPLICATIONS: This pledge reflects commitment, but also broad-based reductions in contributions from large country donors such as the UK and France and uncertainty across global health budgets. Together, these developments reinforce the Global Fund’s importance and value, but the question is not only which multilateral organizations will be appropriately funded, but whether future global health partnerships can preserve the collective action needed to comprehensively address HIV, tuberculosis, malaria and emerging health threats, and what forms those partnerships will take.

• Commission announces new global health commitments at One Health Summit—European Commission
• Flurry of Pledges at G7 One Health Summit—Health Policy Watch
• Drastic UK Aid Cuts Hit Fragile African Health Systems—Health Policy Watch
• How UK aid spending fell sharply in 2025—Devex

New ACIP Charter Reopens Path for Changes to US Vaccine Policy

The US Administration issued a new charter for the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP), which reopens a potential path for Health and Human Services Secretary (HHS) Robert F. Kennedy Jr. to push through devastating changes to national vaccine policy. The charter alters the structure and mandate of the ACIP, broadening criteria for individuals to be eligible, including those focused on vaccine injury and safety concerns, and potentially allowing for the reappointment of members whose qualifications had been challenged in court. Last month, a US federal judge blocked RFK Jr.’s attempt to overhaul pediatric vaccine policy and restructure the ACIP.

IMPLICATIONS: These changes—alongside ongoing petitions to make routine vaccines optional under “shared clinical decision-making”—could further destabilize US vaccine guidance and contribute to growing confusion about immunization standards and trust in public health. As Global Health Watch highlighted last month, “dangerous ideology results in dangerous policymaking, putting many lives at stake and complicating efforts to both discover and implement clinical and cost-effective interventions.”

• With New Charter, Kennedy Redesigns Vaccine Committee and May Sidestep Court Ruling—New York Times
• RFK Jr. Has Stopped Talking About Vaccines. A Memo Shows Why—Bloomberg

Tracking the America First Global Health Agreements

A new report from amfAR digs into the first US global health MoUs, raising concerns about transparency, metrics and accountability.

Track it all:

• amfAR report
• KFF MoU tracker

What We’re Reading

• The foreign aid blame game—Devex
• US CDC Delays Publishing Report Showing COVID Vaccine Benefits Wapo Reports—Reuters
• Top CDC Official Delays Report on Covid Shot’s Effectiveness—New York Times
• Trump administration drops court fight to cap NIH payments for research overhead costs—STAT
• ‘No more than a drop in the ocean’: this drug could end new HIV infections in Eswatini – why isn’t there enough?—The Guardian
• Is there enough of this game-changing HIV prevention drug?—HealthBeat
• Lenacapavir and the Access Impasse: Understanding Why Gilead Said No to MSF—Health Quotient Newsletter
• Civil Society Calls for Greater Engagement in Rollout of HIV Prevention Drug Lenacapavir As Global Tensions Grow—Health Journalist Network (Uganda)
• Integration Without Loss both at Local and Global Levels: Lessons from the MSF–Gilead Lenacapavir Case—The Global Advocacy Data Hub
• Our LEN is here. Now for quality checks in Ireland—Bhekisisa
• Subscription pricing could expand access to HIV prevention breakthrough while controlling costs—STAT
• Merck’s experimental HIV prevention pill could be made for less than $5 a year, researchers say—STAT
• Monthly Islatravir Shows Comparable Safety for HIV PrEP, Lowers Lymphocyte Counts—Infectious Disease Society
• Rebalancing power in infectious disease modelling: Toward inclusive and contextual approaches—PLOS Global Public Health
• The Pasteur Institute of Iran illustrates important truths about global public health—STAT
• Pharma fallout from Iran war won’t end with ceasefire—Axios

This week, the global health world lost a true leader, Stephen Lewis, whose life was defined by an unwavering commitment to creating a better, more just world. Lewis’ unwavering passion and fearless advocacy continue to set the standard, reminding us that global health demands urgency, equity and accountability. This week’s issue follows that charge. It covers growing calls for transparency: from Zambia’s bilateral MoU, to the anticipated proposal to cut 20% cut from the US National Institute of Health’s 2027 budget, and the pricing and access negotiations around lenacapavir, as well as the Global HIV Prevention Coalition’s new Prevention Access Framework.

Advocates Challenge US Plan to Tie HIV Funding to Zambia Minerals Negotiations

In response to a leaked draft memo, more than 100 civil society organizations sent a letter to the US Secretary of State urging him to reject reports that the US may withhold Zambia’s HIV and health funding if the country does not agree to a critical minerals deal as part of the America First Global Health Strategy. Advocates warned that “threatening these programs — and the lives of those reliant on them — to gain leverage in trade negotiations is ethically indefensible…[withholding] these vital medicines would only deepen poverty and suffering in Zambia and the surrounding region, creating a ripple effect of instability that could have unforeseen impacts on US interests over the short, medium and long term.” The State Department dismissed the letter, characterizing the signatories as partisan advocacy groups and questioning their credibility rather than addressing the substance of their concerns.

IMPLICATIONS: Angola became the 27th country overall and 22nd in Africa to sign an agreement this week. Linking HIV and public health funding to broader economic negotiations is a coercive model of global health security and diplomacy. It undermines trust, country ownership and the stability of programs. As more countries sign-on to these agreements, the precedent being set raises urgent questions about equity, sovereignty and the long-term sustainability of the HIV and larger global health response.

READ:

• Secretary of State Rubio Urged to Reject Threatening HIV Assistance to Zambia in Critical Minerals Negotiations—Trade Justice Education Fund
• Save HIV Funding Responds to State Department Comments Amid Zambia Health Funding Controversy—Save HIV Funding
• Zambian CSOs demand transparency over US- Zambia health deal—Sound of Africa
• CSOs reiterate concerns over proposed $1 billion US health aid, say deal could undermine Zambia—Zambia Monitor
• Lesotho organisations push back against US health deal—Ground Up

A Proposed 20% Cut to US NIH 2027 Budget

The US Administration is expected to propose a 20% cut to the National Institutes of Health (NIH) in the President’s fiscal year 2027 (FY27) budget request, which is a significant reduction from the agency’s current $47.2 billion budget. Congress already rejected deep cuts to the FY26 NIH budget and instead increased funding to the agency. The new proposal revives earlier efforts to scale back investment in biomedical research and may include restructuring elements – and highlights the concern that the Administration will make budget decisions, irrespective of Congress’s constitutional power of the purse. This all comes amid the instability of the US health and research infrastructure with delays in grant disbursement, cancellations and ongoing funding uncertainty.

IMPLICATIONS: Even before any formal cuts are enacted, the combination of proposed reductions, funding delays and policy shifts is already slowing research and destabilizing what is left. Researchers warn that prolonged uncertainty risks stalled studies, layoffs and a growing “brain drain,” threatening the US’s long-standing leadership in biomedical innovation and global health. Multi-year cuts of this scale could also have cascading economic and public health consequences, weakening the pipeline of discoveries that drive prevention, treatment and global health security.

• White House to propose 20 percent cut to NIH funding—Roll Call
• Research advocates prepare for next NIH budget fight—Axios

Lenacapavir Access Dispute: Where is the Transparency?

Médecins Sans Frontières (MSF) issued an open letter to Gilead Sciences, criticizing its refusal to sell lenacapavir for HIV PrEP (LEN) directly for use in MSF’s programs. The issue comes amid limited public information on pricing, volumes and supply timelines. Gilead has been channeling all LEN supply through the Global Fund’s procurement mechanism, with PEPFAR also procuring via this route. Gilead’s current production of LEN for LMICs is based on orders from Global Fund for approximately 600,000–700,000 person-years for 2026. While Gilead earlier said they could manufacture larger volumes, they have a 6-9 month manufacturing lead time, meaning that it is hard to secure additional product this year. MSF, which is already accessing limited supply of LEN through the Global Fund, is seeking additional doses to reach populations beyond the early adopter countries. Gilead told MSF that increased LEN supply would not be available until 2027 and only through existing procurement channels.

Meanwhile, new modeling research suggests that the investigational MK-8527 once-monthly oral PrEP pill “could be manufactured at extremely low cost, suggesting that intellectual property and licensing arrangements, rather than production feasibility, will determine equitable access in LMICs.”

IMPLICATIONS: These issues hit on the main challenge: closing the gap between scientific breakthroughs and the systems needed to deliver them with speed, scale and equity to deliver public health impact. Constraining LEN access to limited procurement channels and timelines risks slowing its uptake and excluding populations outside of government-led programs. At the same time, as advocates have been saying for decades, we need to plan for accelerated, equitable access from the start. Products can be produced at large scale and low prices, if policy choices like pricing, licensing, volumes forecasting, market shaping and transparency are prioritized.

• ‘No more than a drop in the ocean’: this drug could end new HIV infections in Eswatini – why isn’t there enough?—The Guardian
• The estimated cost of MK-8527 produced at scale for once-monthly oral HIV pre-exposure prophylaxis (PrEP) in low- and middle-income countries—PLOS Medicine
• Gilead Refuses to sell Doctors without Borders HIV Drug—Public Citizen
• Doctors Without Borders calls Gilead ‘unconscionable’ for refusing to sell HIV prevention drug to the organization—STAT
• Open letter to Gilead: Prevention should not be a privilege—Medecins Sans Frontiers

HIV Prevention 2030 Global Access Framework 

The Global HIV Prevention Coalition shared a new Access Framework outlining how, by 2030, countries can ensure that 90% of people in need of HIV prevention services have access and that 90% of people living with HIV are virally suppressed. This, in combination, would lead to a 90% reduction in new HIV infections globally. 

What We’re Reading

• Is Trump killing the heralded US effort to help the world battle HIV?—Science
• The 45-year fight against HIV is one of humanity’s greatest victories. It’s also in danger—Vox
• HHS Officials’ Year in Purgatory Is Ending—The Atlantic
• NIH director’s invocation of Vannevar Bush’s legacy to promote Trump science policies sparks pushback—STAT
• With US aid slashed, Nigerian HIV volunteers went door‑to‑door to keep patients alive—Reuters
• Faster, bigger, riskier: The new era of US foreign aid—Devex
• Global health: the long road from saviorism to justice—PLOS Global Public Health
• Diplomacy is not peripheral to public health—it is now public health gets done—PLOS Global Public Health
• African bid to lead United Nations roils region—Devex
• The Global North is increasingly unsafe for global health meetings—The Lancet
• The Horrors That Could Lie Ahead if Vaccines Vanish—ProPublica
• Special edition: Moving mother and child health ‘into the fast lane’—Devex
• Advancing ethical biomedical HIV prevention research for pregnant and lactating people—AIDS
• IAVI announces the onset of first-in-human Phase 1 clinical trial of broadly neutralizing antibodies (bnAbs) to prevent HIV transmission—IAVI
• Sustaining Tuberculosis Innovations to Counter Foreign Aid Cuts—Think Global Health
• Senegal president signs tough new anti-LGBT law doubling jail terms—BBC
• Health orgs warn of ‘dangerous’ supply shortages amid Mideast crisis—Devex

Pandemic treaty negotiations ahead of the World Health Assembly in May show rising tensions, as countries push for equity in pathogen sharing, alongside the expansion of US bilateral health deals and the evolving role of the Global Fund within this shifting architecture. This issue also covers calls to declare recent US global health policy shifts a Public Health Emergency of International Concern, deepening instability at the US Centers for Disease Control and Prevention (CDC), and updates on US government bilateral agreements.

Pandemic Agreement Deadline Nears as Key Countries Put Equity at Center of Pathogen Sharing Negotiations

Negotiations on the Pandemic Agreement’s Pathogen Access and Benefit-Sharing (PABS) system entered a tense new phase. At the Intergovernmental Working Group (IWG) meeting, tasked with negotiating and drafting the annex, many African and low- and middle-income countries pushed back on a revised draft of the PABS, rejecting elements of the text they say weaken commitments to equitable access, particularly around guarantees that countries sharing pathogen samples will receive timely access to vaccines, diagnostics and treatments in return. The PABS annex “is intended to create a system for rapidly sharing pandemic pathogen samples and genetic data while significantly improving equitable access to vaccines, treatments and diagnostics for parties and better equipping the WHO and the international community to respond to future pandemics.”

IMPLICATIONS: Key African governments, with the support of civil society, have successfully forced a recalibration of negotiations, putting equity and sovereignty at the center of the debate over how pathogen data is shared and who benefits. If the PABS annex is not agreed upon by Saturday, it may not be presented in time for the World Health Assembly to ratify it in May. The EU member representative noted, “Without this annex, the Pandemic Agreement will not be open for signature, and ultimately, our collective capacity to effectively prevent, prepare and respond to future pandemics will be significantly reduced and limited.”

• Tense Start To Final Pandemic Agreement Talks As Africa Rejects New Draft Text –Health Policy Watch
• “We Mean Business”: Key African Countries Force Recalibration of the Negotiations on Pathogen Access Benefits Sharing System at the WHO—Geneva Health Files
• African CSOs call for equity as pathogen access talks hit final stretch—Devex

Experts Urge WHO to Declare US Policy Actions a Global Health Emergency

A group of global health and legal experts are calling on the World Health Organization (WHO) to declare recent US policy actions, including the massive cuts to global health funding, withdrawal from the WHO, attempts to alter the US pediatric vaccination schedule and disruptions to programs like PEPFAR, a Public Health Emergency of International Concern (PHEIC). These decisions constitute an “extraordinary event” under the International Health Regulations, they argue, which creates a high risk of cross-border disease spread even before outbreaks fully materialize. The authors warn that halted HIV, TB, malaria and vaccination programs could lead to millions of additional deaths by 2030, with early signs already visible in disrupted services and rising vulnerability across low- and middle-income countries.

IMPLICATIONS: It would be unprecedented for WHO to declare a PHEIC in response to political decisions and not specific pathogens. But even the consideration of it could catalyze urgent action to bring in more resources, enable tools like compulsory licensing to expand access to vaccines or other lifesaving medications and reinforce multilateral cooperation. Declaring a PHEIC could result in backlash from the US administration and further strain global institutions. Ultimately, this brings to light the shift underway: global health threats are driven by pathogens AND by policy choices. How existing systems adapt and those being reenvisioned respond to this new era of politically driven health emergencies will be telling.

• The United States is driving a public health emergency of international concern—BMJ

Continued Instability at US CDC Raises Concerns for US and Global Health

New developments within the US’ CDC underscore even deeper instability. Wednesday night marked the deadline for the US President to nominate a new CDC Director, but uncertainty remains as the administration missed the deadline. At a CDC staff meeting on Wednesday, Acting Director Jay Bhattacharya, who also leads the National Institutes of Health (NIH), told employees he would continue leading the agency by serving “in the capacity” of director during the process to identify and confirm a new director. STAT reports that in the staff meeting, Bhattacharya struck a different position from other administration officials, stating: “I think it is vital that every kid in this country get the measles vaccine—absolutely vital,” while urging staff to “remove politics” and “focus on what we know how to do.”

At the same time, turmoil continues within the CDC’s Advisory Committee on Immunization Practices (ACIP) following the departure of controversial committee member Robert Malone. This comes following last week’s ruling from a federal judge who blocked Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s attempt to restructure the committee. RFK previously replaced all 17 members with a mix of anti-vaccine and anti-science representatives, including Malone. The ACIP remains unable to convene amid ongoing litigation. Adding to concerns, a recent New York Times investigation based on interviews with 43 current and former CDC employees describes staffing losses, political interference and a shift away from science-based decision-making, showing an agency under significant instability.

IMPLICATIONS: While Bhattacharya’s efforts to emphasize scientific norms this week may try to offer some reassurance, it’s clear week after week with the erosion of stability and independence, that there is intentionality to the dismantling of the CDC and its ability to effectively respond to current and future health threats. This will have ripple effects for global health governance and confidence in US scientific and health leadership.

• Inside the Turmoil at Robert F. Kennedy Jr.’s C.D.C.—New York Times
• CDC vaccine adviser Malone steps down to avoid ‘drama’—Roll Call
• ACIP conflict is test of Trump’s support for RFK Jr.’s vaccine policy overhaul—STAT
• Kennedy’s Vaccine Agenda Hits Roadblocks, Diminishing His Clout—New York Times
• RFK Jr. Is Losing His Grip on the CDC—The Atlantic
• Bhattacharya addresses CDC director role, works to bolster staff morale in first all-hands meeting—STAT
• A leadership vacuum adds to strains on the CDC—NPR

US Bilateral Health MoUs Expand as Global Fund Steps In

Senegal became the 26th country overall and 21st in Africa to sign an agreement with the US as part of the $12.6 billion effort under the America First Global Health Strategy, with agreements combining US funding and domestic co-investment to support HIV, malaria and health system strengthening. At the same time, attention is turning to the role of the Global Fund to Fight AIDS, Tuberculosis and Malaria within this new architecture. While not a formal party to the bilateral agreements, Devex reports that Global Fund experts have been involved in negotiations and implementation discussions, and its procurement platform is being considered as a mechanism to support broader commodity delivery and coordination.

IMPLICATIONS: The expansion and complexity of the US’ shift toward bilateral global health agreements is real. With reduced and restructured US funding, countries and advocates are increasingly looking to the Global Fund to help fill gaps, particularly for HIV services and key populations that may not be prioritized in bilateral agreements.

• What role will the Global Fund play in the US bilateral health deals—Devex
• U.S. aid returns to Africa as Senegal signs onto $12.6B health deal as 26th nation—Business Insider Africa

What’s New & Next in the HIV/AIDS Response

AVAC Executive Director Mitchell Warren joined Congressman Herb Conaway, Judith Feinberg, Greg Millett, and JD Davids at the SYNChronicity conference for a discussion on Opportunities, Controversies & Cruel Ironies. 

What We’re Reading

• Is PEPFAR about to run out of money?—Devex
• Another round—The Forsaken Substack
• This lab that’s determined to discover new drugs isn’t where you might expect—NPR
• Four truths about covid that have become clouded over time—Washington Post
• Le grand invité Afrique – Santé en Afrique: «Nous voulons que nos pathogènes, nos maladies, puissent être d’abord traités par les Africains—RFI
• US aid deals with religious element risk ‘fanning flames of division’—The Independent
• UK lays out the development priorities of a shrinking aid budget—Devex
• Waste, Fauci and ‘Transgender’ Mice: How MAGA Is Warming to Animal Rights—New York Times
• NIH grant terminations affected women scientists more than men, study finds—STAT
• Stop pretending USAID’s takedown was about doing development better—Devex
• Here’s what we know about Trump’s expanded Mexico City Policy—Devex
• America is getting sicker, not healthier, under Trump and RFK Jr. | Opinion—Newsweek
• The AI push in health care is deepening medicine’s trust crisis—STAT
• Artificial intelligence for public health in Africa: moving beyond pilots to public value—The Lancet Regional Health Africa
• Why the expanded global gag rule is a deadly triple tripwire for recipients of US foreign aid—The BMJ

The Impact Report highlights the power of advocacy, research translation, and partnership to advance HIV prevention and global health equity. In this first edition:

• The introduction of lenacapavir (LEN) for PrEP in Zambia
• How AVAC and partners are standing up for science
• New efforts to translate evidence for decision making

Strengthening access planning: The launch of lenacapavir in Zambia

Zambia remains among the top ten countries most affected by HIV globally, despite significant progress over the past decade to reduce new infections. Sustaining these gains—and continuing to drive down incidence—requires ongoing prioritization of differentiated prevention methods that meet the diverse needs of communities. 

Against this backdrop, lenacapavir (LEN) for PrEP, a six-month injectable, responds to community demands for flexible and acceptable prevention options. Just 18 months after groundbreaking Phase II trial results were announced at the AIDS 2024 conference, Zambia administered its first injections of LEN for PrEP at a World AIDS Day (WAD) commemoration on December 1, 2025. As one of five African countries to implement LEN to date (just months after the approval and launch in the US), this milestone represents a new record for speed in launching a new prevention product, and reflects the culmination of sustained advocacy and strong stakeholder collaboration. The progress made in reducing new HIV infections in Zambia can be attributed to the Ministry of Health’s (MOH’s) commitment to expanding the national prevention ‘basket of choices’—enabling meaningful collaboration across civil society groups, donors, product developers, and global advocates, aligned around a shared strategy to support LEN rollout. 

To support Zambia’s readiness for LEN introduction, AVAC provided targeted technical support while also laying critical groundwork across the region in anticipation of rollout. Leveraging its role as a global convener, leading advocacy voice, and secretariat of the Coalition to Accelerate Access to Long-Acting PrEP, AVAC helped align efforts across early adopter countries, including Zambia. 

Standing up for science: The fight to save HIV research

On March 7, 2026, advocates and concerned citizens observed a National Day of Action to Stand Up for Science, taking to streets, airwaves, and the internet to raise awareness about the ongoing threats posed to science and public health by the current US administration. In this environment, AVAC has continued to serve as a champion for research, and continuing to call on policymakers and donors to defend against harmful cuts that aim to dismantle US global leadership in biomedical research.

Since January 2025, AVAC and partners have defended the critical role of research. One of the greatest milestones in this defense was seen in rapid response to attacks by this administration, when AVAC worked with a volunteer coalition of the nation’s leading HIV researchers and advocates to organize and host the 24-Hour Marathon to Save AIDS Research. The virtual marathon provides 24-hours of interactive presentations, discussions, and learning sessions about the lifesaving contributions of HIV research and what is at stake if funding continues to be stripped away. Using convening  power, research expertise, and research translation, this group of dedicated individuals brought advocates and researchers together in solidarity and shared critical messages about why HIV research matters with the larger global community.

Bridging the gap between science and communities: Delivering accessible information and leading global conversations

In an era of misinformation and scientific skepticism, access to credible, clear information on HIV is critical. Principles of Good Participatory Practice (GPP) in research and rollout hinge on data being accessible, understandable, and actionable. Yet the gap persists between global scientific forums, like the Conference on Retroviruses and Opportunistic Infections (CROI), and the information broader audiences can actually access, digest, and act on. To meet this need, AVAC translates complex science into accessible resources and ensures it reaches advocates, communities, and decision-makers to advance strong, community-centered HIV prevention research, policies, and rollout plans. From proactively disseminating resources for use at CROI, to convening real-time discussion spaces, and sharing digestible recaps and first-person perspectives from staff attending the conference, AVAC served as a key source for close watchers of HIV science news.

AVAC Impact Reports highlight the power of advocacy, research translation, and partnership to advance HIV prevention and global health equity. Read also about the introduction of lenacapavir (LEN) for PrEP in Zambia and how AVAC and partners are standing up for science.

By Grace Tetteh

In an era of misinformation and scientific skepticism, access to credible, clear information on HIV is critical. Principles of Good Participatory Practice (GPP) in research and rollout hinge on data being accessible, understandable, and actionable. Yet the gap persists between global scientific forums, like the Conference on Retroviruses and Opportunistic Infections (CROI), and the information broader audiences can actually access, digest, and act on. To meet this need, AVAC translates complex science into accessible resources and ensures it reaches advocates, communities, and decision-makers to advance strong, community-centered HIV prevention research, policies, and rollout plans. From proactively disseminating resources for use at CROI, to convening real-time discussion spaces, and sharing digestible recaps and first-person perspectives from staff attending the conference, AVAC served as a key source for close watchers of HIV science news. 

AVAC ensures the science of HIV research reaches a broad audience as the conference is unfolding. Each day during CROI, AVAC, EATG, Fiocruz, TAG, and other partners hosted Community Breakfast Clubs (CBC), virtual webinars featuring researchers and advocates breaking down important prevention, treatment and cure science presented at CROI and the implications for the field.  AVAC leveraged its network to coordinate high-level researchers and implementers into these curated sessions. Hosted each morning of the conference, the CBCs provide an accessible space for all, designed to extend conference conversations beyond the meeting itself, especially during a period of significantly heightened barriers to entering the United States.

These sessions are about connecting top researchers with advocates so communities can shape how HIV innovations are used on the ground. By creating this space, we make complex science accessible and ensure it meets the real needs of the people we serve.

Grace Kumwenda

AVAC

The sessions connected top experts in the fields of HIV prevention, cure, and treatment with attendees able to go deep, ask questions, and share perspectives rom their own contexts. Spaces like the CBCs help bridge the gap between HIV science and communities working to advocate for innovations that fit their realities.    

AVAC works with researchers, scholars, advocates and civil society members to develop and share resources that contextualize science at conferences like CROI. Speakers drawing from AVAC resources at CROI included Dr. Linda-Gail Bekker, Director of the Desmond Tutu Health Foundation and investigator on nearly every PrEP and HIV vaccine trial, who gave the opening session’s N’Galy-Mann Lecture, and Dr. Andrew Hill from the University of Liverpool who presented a Global Analysis of HIV Oral PrEP-to-Need Ratios in 2025. Dr. Raphael Landovitz from the University of California Los Angeles (UCLA) and a Principal Investigator for the HIV Prevention Trials Network (HPTN) called AVAC infographics “an invaluable and terrific resource,” thanking AVAC for “historical and continued fierce advocacy and support.”  

When clear visuals are embedded in conference presentations and included in coverage, they reach people beyond those in the room — including journalists, advocates, and community members who find and use them long after the event ends.

AVAC Impact Reports highlight the power of advocacy, research translation, and partnership to advance HIV prevention and global health equity. Read also about the introduction of lenacapavir (LEN) for PrEP and new efforts to translate evidence for decision making.

By Grace Tetteh

On March 7, 2026, advocates and concerned citizens observed a National Day of Action to Stand Up for Science, taking to streets, airwaves, and the internet to raise awareness about the ongoing threats posed to science and public health by the current US administration. In this environment, AVAC has continued to serve as a champion for research, and continuing to call on policymakers and donors to defend against harmful cuts that aim to dismantle US global leadership in biomedical research.  

Since January 2025, AVAC and partners have defended the critical role of research. One of the greatest milestones in this defense was seen in rapid response to attacks by this administration, when AVAC worked with a volunteer coalition of the nation’s leading HIV researchers and advocates to organize and host the 24-Hour Marathon to Save AIDS Research. The virtual marathon provides 24-hours of interactive presentations, discussions, and learning sessions about the lifesaving contributions of HIV research and what is at stake if funding continues to be stripped away. Using convening power, research expertise, and research translation, this group of dedicated individuals brought advocates and researchers together in solidarity and shared critical messages about why HIV research matters with the larger global community.  

The marathon has already reached more than 7,000 advocates, researchers, stakeholders, policy makers, journalists and community members from 28 countries and 30 U.S. states. The event featured 75 presenters representing major research institutions, public health organizations, civil society organizations and communities impacted by HIV all over the world, along with 42 endorsing organizations. The marathon covered a breadth of topics, including the legacy of innovation from HIV research;; the role of advocacy in an equitable and effective HIV response; the implications of intersecting and emerging epidemics; advances in prevention, treatment, vaccine and cure research; the growing portfolio of Africa-led HIV prevention research; innovative models for delivering care; and community movements to sustain access to HIV services. 

AVAC has also worked with the HIV Medicine Association (HIVMA) and the Treatment Action Group (TAG) to launch the Research Matters effort, which has supported previously-funded NIH researchers, advocates, and professional organizations to sound the alarm on the government’s attacks on public health, scientific research, and science at large. By mobilizing leading voices in research, strengthening advocacy skills through teach-ins, tools, and resources, educating policy makers, and disseminating timely and accurate information to track the impact of cuts to HIV research, AVAC helped researchers and advocates bring critical messages about the urgency of reversing funding cuts and the real-world impact of breakthroughs in HIV research to a larger audience. 

As the field navigates the constantly evolving threats to science, AVAC will continue to do the critical work of tracking and translating the latest scientific and funding developments, and ensuring advocates are informed and supported in the ongoing fight to end HIV. Mitchell Warren, AVAC’s Executive Director affirmed, “Saving AIDS research is not a 24-hour exercise; it is a commitment from all of us involved to tackle this collective challenge.” 

AVAC Impact Reports highlight the power of advocacy, research translation, and partnership to advance HIV prevention and global health equity. Read also about how AVAC and partners are standing up for science and new efforts to translate evidence for decision making.

By Grace Tetteh

Zambia remains among the top ten countries most affected by HIV globally, despite significant progress over the past decade to reduce new infections. Sustaining these gains—and continuing to drive down incidence—requires ongoing prioritization of differentiated prevention methods that meet the diverse needs of communities. 

Against this backdrop, lenacapavir (LEN) for PrEP, a six-month injectable, responds to community demands for flexible and acceptable prevention options. Just 18 months after groundbreaking Phase III trial results were announced at the AIDS 2024 conference, Zambia administered its first injections of LEN for PrEP at a World AIDS Day (WAD) commemoration on December 1, 2025. As one of five African countries to implement LEN to date (just months after the approval and launch in the US), this milestone represents a new record for speed in launching a new prevention product, and reflects the culmination of sustained advocacy and strong stakeholder collaboration. 

The progress made in reducing new HIV infections in Zambia can be attributed to the Ministry of Health’s (MOH’s) commitment to expanding the national prevention ‘basket of choices’—enabling meaningful collaboration across civil society groups, donors, product developers, and global advocates, aligned around a shared strategy to support LEN rollout. 

To support Zambia’s readiness for LEN introduction, AVAC provided targeted technical support while also laying critical groundwork across the region in anticipation of rollout. Leveraging its role as a global convener, leading advocacy voice, and secretariat of the Coalition to Accelerate Access to Long-Acting PrEP, AVAC helped align efforts across early adopter countries, including Zambia. 

For over a year, AVAC worked with MOHs, donors, implementing partners, technical assistance providers and civil society partners across 11 early-adopter countries to support introduction planning. AVAC launched a community of practice for MOHs, creating space for countries to share lessons, align approaches, and learn from one another. In parallel, AVAC partnered with civil society to support local consultation meetings on LEN, ensuring that community perspectives were reflected in national planning from the outset. Together, these efforts helped foster a more coordinated and country-led approach to rollout and ensured other countries could directly and rapidly learn from Zambia’s successful launch. 

In Zambia, AVAC complemented this regional coordination with direct technical support to update national PrEP guidelines, adapt social and behavioral change (SBC) materials, and train community mobilizers and clinical staff. These efforts also prioritized early demand generation, ensuring communities were informed, engaged, and ready to access LEN at launch. 

On the day of the launch, two people were initiated on LEN and by day five, 77 people had started, demonstrating early demand and the effectiveness of coordinated rollout and demand generation efforts. Beyond these initial numbers, this process has created a framework and strengthened systems for rapid introduction of future new options, improved coordination across partners, and reinforced the central role of communities in shaping prevention access. 

During the launch event, Idah Mulala, program manager at AVAC’s partner, Ascend Futures Foundation, reflected on her experience at the HIV Research for Prevention (HIVR4P) conference in 2024, where the PURPOSE 2 trial results were announced: “I remember asking one critical question [to panelists]: ‘At what cost will this option be made available, and when can communities expect access?’ One year later, I am proud to witness and be part of a historic moment. Lenacapavir is now available for use in Zambia.” 

The momentum for early approval and introduction of LEN across Africa has not slowed. To date, 12 African countries have approved LEN. Eswatini, Kenya, Nigeria, and Zimbabwe have also launched LEN, while implementation science studies already launched in South Africa, as well as Brazil and the US with an additional project about to launch in Zambia. Other countries prioritized by Global Fund and PEPFAR for LEN introduction, including Lesotho, Mozambique, and Uganda, have received supply and are expected to introduce LEN imminently. 

For AVAC, celebrating the LEN launch on WAD 2025 marked 30 years of championing science, promoting community leadership, and advancing equitable access in the HIV response. Looking ahead, our newest collaboration with Access Bridge, an independent Kenya-based nonprofit incubated at AVAC, will further advance regional leadership as we carry this work forward. 

Lenacapavir comes at a time when communities need it most. We look forward to continuing to work with partners to ensure this momentum is not lost—and that the promise of speed, scale and equity in LEN introduction becomes the new normal for future HIV prevention options and all other global health technologies. 

From spotlighting the impact of US-supported HIV research to advancing the future of the HIV response; accelerating pediatric HIV cure research to shaping the global STI agenda, AVAC is driving and tracking the critical conversations defining HIV prevention and advocacy. Read on for this week’s resources and perspectives.

“International research is not an optional ‘add-on’ to the US HIV effort—it is a foundational engine of innovation, testing, and learning and it provides the scaffolding for creating a cascade of benefits for HIV management in the US and for research beyond HIV,” write University of California, San Francisco’s Judith Auerbach, Duke Global Health Institute’s Jirair Ratevosian and AVAC’s Mitchell Warren in a new Health Affairs piece. The authors highlight how US-supported international HIV research—particularly in African countries— delivers direct benefits to Americans, and why cuts to that research may undermine those benefits.

Practical Considerations for Pediatric Cure Research

AVAC Senior Program Manager Jessica Salzwedel joins leading HIV cure researchers from Johns Hopkins Medicine on a new podcast discussing a recent publication on the ethics of pediatric HIV cure research, HIV Cure Research: Ethical and Real-World Practical Considerations for Pediatric and Adolescent Populations in the Journal of Pediatric Infectious Disease Society. The episode covers work born out of the PAVE Collaboratory, the only NIH-funded HIV cure research consortium focused on perinatal HIV. Learn more about AVAC’s broader cure portfolio.

AVAC and Access Bridge Join Kenya Health Integration Summit 2026 

At the Kenya Health Integration Summit, AVAC and its partner Access Bridge shared key insights on strategies to support KP integration and PrEP rollout, and strengthening people-centered health systems—underscoring the critical role of advocates and communities in driving progress. Together, AVAC and Access Bridge work to ensure effective scale-up of new prevention options while safeguarding equitable access for all populations amid a volatile funding landscape.

AVAC at AIDSWatch 2026 and SYNChronicity 2026

John Meade, AVAC Senior Program Manager for Policy, took the stage as a plenary speaker at AIDSWatch this week, where more than 600 advocates converged to push US Congress to support HIV research and programs. “The same forces dismantling PEPFAR and expanding the Global Gag Rule are also attacking LGBTQ+ people, public health and bodily autonomy here in the US,” said John, calling for coordination across domestic and global HIV advocacy movements.

Also this week, AVAC Executive Director Mitchell Warren joined Congressman Herb Conaway, Judith Feinberg, Greg Millett, and JD Davids at the SYNChronicity conference for an important discussion on What’s New & Next in the HIV/AIDS Response. Slides from his presentation are available.

AVAC’s Alison Footman to Co-Chair the 2026 STI Prevention Conference

Mark your calendars for the 2026 STI Prevention Conference in Atlanta from August 31-September 2. AVAC’s Senior Program manager, Alison Footman, who leads our STI program is co-chairing the meeting with Barbara Van Der Pol of the University of Alabama at Birmingham. At a critical moment for STI advocacy, this convening is designed to spark conversations and collaboration about prioritizing prevention strategies, service delivery models, research and policy approaches that are responsive to community needs as funding remains precarious.

Other Must See Resources From This Week

• Putting Communities First in HIV Research with Yvette Raphael — Global Health Unfiltered podcast
• CAB-LA: The prevention jab that never had its moment, and what it leaves behind as LEN arrives — Bhekisisa article by Ida Jooste
• Speeding Up Access to PrEP — AVAC infographic charting the time from efficacy results to key milestones for injectable LEN and CAB, the DVR and oral PrEP
• Gilead Could Potentially End HIV. But Will It Be Able To? — PharmaVoice
• 180,000 Infections in 2024, 47,000 by 2045 — If SA rolls out the twice-a-year HIV prevention jab fast enough — Bhekisisa

A US federal court blocked the US Administration’s efforts to overhaul the CDC’s Advisory Committee on Immunization Practices (ACIP) amid intensifying challenges to vaccine science, while the National Institutes of Health (NIH) Director sought to reassure lawmakers over funding delays and shifting research priorities. At the same time, the State Department quietly removed five “America First” health agreements from public access as scrutiny grows over Zambia’s draft MoU, and Argentina announced its intent to withdraw from the World Health Organization (WHO). 

Court Blocks ACIP Overhaul as Broader Challenges to Vaccine Science and Policy Intensify 

A US federal judge blocked Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s attempt to overhaul pediatric vaccine policy and restructure the ACIP, a gold-standard panel of medical experts. RFK Jr. previously replaced 17 members of ACIP with a mix of anti-vaccine, anti-science representatives, and the ACIP subsequently began to undermine vaccine recommendations. Tuesday’s court ruling came in response to a lawsuit filed by a number of leading public health organizations, arguing that the Administration’s actions bypassed established scientific and procedural safeguards, raising concerns about political interference in long-standing vaccine recommendation processes and policy. Read AVAC’s An Assault on Vaccine Science and Policy, and the Stakes for Global Health. Also this week, a US federal working group drafted a confidential report proposing the creation of a diagnostic category specifically for COVID-19 vaccine injuries and side effects to be reviewed by the recently restructured ACIP. 

IMPLICATIONS: The court ruling underscores the ongoing tension between political leadership and scientific governance in US public health institutions. By intervening, the court has temporarily safeguarded the integrity of evidence-based vaccine policy, but the dismantling of vaccine science and abdication of the country’s historic role as a leader in evidence-based public health continues. As AVAC’s Alison Footman PhD, MPH warned 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.”  

READ: 

• Judge Blocks RFK Jr.’s Overhaul of Vaccine Recommendations—MedPage Today  
• Federal judge puts RFK Jr.’s new vaccine schedule, advisers on ice—Politico  
• Fewer Americans trust government’s childhood vaccine recommendations: Survey—The Hill 
• Federal judge stalls health secretary RFK Jr.’s overhaul of vaccine policy—STAT  
• Judge Strikes Down Kennedy’s Vaccine Policies—New York Times 
• A New Level of Vaccine Purgatory—The Atlantic 
• Viewpoint: Uncertain victories mustn’t distract us from staying focused on defending health—CIDRAP 
• Federal judge blocks RFK Jr’s overhaul of vaccine recommendations—The Guardian 
• Confidential Report Calls for Sweeping Changes to Track Covid Vaccine Harms—New York Times 

NIH Director Testifies, Promises to Disburse Funds as Agency Calls for Input into Strategy 

US NIH Director Jay Bhattacharya testified on Tuesday at a closely watched House Appropriations hearing, acknowledging the slowdown in grantmaking and assuring lawmakers that the NIH will work to secure agreement from the Office of Management and Budget (OMB) to spend the full $48.7 billion NIH budget by the end of fiscal year 2026. Rosa DeLauro (D-Conn.) raised the right issue: “I find it disconcerting that it took a congressional oversight hearing to prompt OMB to do what it should have done weeks ago.” A day prior, the NIH launched its first public webinar to solicit input on its next five-year strategic plan, signaling an effort to engage stakeholders in shaping future priorities. Yet, the NIH’s evolving approach to soliciting and funding research proposals (see last week’s Global Health Watch), including shifts in how projects are reviewed and prioritized, is being hotly debated. Join the next NIH strategy webinar April 8 and provide input to comments and suggestions on their “Framework for the NIH-Wide Strategic Plan for Fiscal Years 2027-2031”. 

IMPLICATIONS: While NIH leadership is seeking to reassure Congress – and the research community – that funding will be fully deployed and that strategic planning remains inclusive, the slowdown in awards and changes to funding processes suggest otherwise. At a time when sustained investment and scientific independence are critical, short-term disruptions have lasting impact. 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,” warned AVAC’s Stacey Hannah in an August statement.   

READ: 

• NIH pivots away from agency-directed science—Nature  
• White House lifts hold on NIH research spending—Science  
• NIH will spend its full budget this year, agency director promises House appropriators – STAT 
• NIH Director Sails Through House Appropriations Oversight Hearing—MedPage Today 
• US State Department not answering aid oversight questions—Devex   
• Bhattacharya Appropriation Oversight Hearing—Drug Monkey 

State Department Pulls “America First” Health MoUs as Zambia Draft Reveals Contentious Terms 

The US Department of State quietly and without explanation removed the five previously published Memoranda of Understanding (MoUs) with African countries from its website. This further limits transparency around the agreements, which were only posted publicly last week following pressure from civil society in the US and MoU partner countries. At the same time, analyses on Zambia’s draft MoU reveal significant funding reductions, co-financing requirements, and links to broader economic and mineral access negotiations.

IMPLICATIONS: The shift toward bilateral, co-financed “country ownership” models is increasingly highlighting significant cuts to US investments in global health, uneven disclosure, non-transparency and growing indications of transactional terms tied to broader geopolitical and economic interests. The quiet removal of the publicly available MoUs underscores a pattern of limited transparency and accountability, making it difficult for countries, civil society, and implementers to assess obligations, plan for continuity or respond to risks.

READ:  

• State Department Removes Controversial Health Agreements with African States from Website Without Explanation—Public Citizen 
• U.S. Considers Withholding H.I.V. Aid Unless Zambia Expands Minerals Access—New York Times  
• Zambia’s Draft Memorandum of Understanding With the U.S. Government: What Do We Know?—Health Gap
• The Department of State has an (even bigger) Accountability Problem—To End A Plague…Again Substack

Argentina Announces Plans to Depart from WHO

Argentina announced its intention to withdraw from the WHO, marking a significant shift in its global health engagement. The decision represents ongoing skepticism toward multilateral institutions and a push to reassert national control over health policy and financing. Argentina’s exit follows months of criticism of the WHO guidance during the COVID-19 pandemic, and closer ties with the White House.

IMPLICATIONS: Argentina’s withdrawal raises concerns about fragmentation in global health multilateralism and governance at a time when coordinated responses are essential. This is a broader trend in reduced support for multilateral health institutions, including the US’ decision last year to withdraw from the WHO, signaling growing strain on global cooperation at a critical moment for global health. For the HIV response and pandemic preparedness, reduced cooperation risks slowing responses to new and resurgent infectious diseases, undermining shared accountability, and complicating efforts to ensure equitable access to prevention, diagnostics and treatment worldwide. 

READ:

• Argentina says it will withdraw from the World Health Organization, echoing Trump—Associated Press 
• Argentina to withdraw from WHO after Trump exit, citing ‘deep differences’—Reuters
• Video: What Happens When the Next Pandemic Hits?—Georgetown University Global Health Institute 

“International research is not an optional ‘add-on’ to the US HIV effort—it is a foundational engine of innovation, testing, and learning and it provides the scaffolding for creating a cascade of benefits for HIV management in the US and for research beyond HIV,” write University of California, San Francisco’s Judith Auerbach, Duke Global Health Institute’s, Jirair Ratevosian, AVAC’s Mitchell Warren in a new Health Affairs commentary. 

What We’re Reading

• Pressure Builds as Pandemic Talks Reach Final Week with Little Consensus—Health Policy Watch
• After a Decade of Progress Against HIV, PrEP Enters a Precarious Era—JAMA
• White House Puts RFK Jr.’s HHS on Tighter Leash After MAHA Setbacks—Wall Street Journal
• United States is cutting ties with influential global cancer agency—Science
• The indirect — and sometimes surprising — benefits of vaccines—STAT
• Cambodia advances in HIV fight, but new infections continue—KHMER Times
• US pulls away from family planning. What about the $600M saved for it?—Devex
• New International Planned Parenthood chief steps in amid anti-rights surge—Devex
• Merging UNFPA and UN Women would undermine gender equality globally—Devex
• 180 000 infections in 2024, 47 000 by 2045 – if SA rolls out the twice-a-year prevention jab fast enough—Bhekisisa
• CAB-LA: The prevention jab that never had its moment, and what it leaves behind as LEN arrives—Bhekisisa
• Podcast: Putting communities first in HIV Research with Yvette Raphael—Global Health Unfiltered
• UK government axes flagship global health project—The Guardian
• Wellcome Report: Aid Cuts Catalyse Global Health Reform and Regional Cooperation—Health Policy Watch
• US State Department not answering aid oversight questions—Devex
• HIV Cure Research: Ethical and Real-World Practical Considerations for Pediatric and Adolescent Populations—Journal of the Pediatric Infectious Diseases Society
• How AI “Besties” in South Africa Are Changing Uptake of HIV Medication—Think Global Health

US-funded HIV research conducted in Africa and other high-burden settings isn’t just a foreign aid story — it’s a direct driver of American public health gains. What gets discovered there impacts how healthcare is delivered here. It shapes the drugs Americans take, the guidelines their doctors follow, and the public health initiatives that serve the hardest-hit communities.

A new Health Affairs piece by Judith Auerbach, Jirair Ratevosian, and AVAC’s Mitchell Warren makes the case that cuts to US-supported global HIV research don’t just hurt partner countries. They undermine the scientific pipeline that delivers those advances to Americans most in need. As the Administration scales back global health investments, the US risks squandering decades of research returns just as they’re beginning to pay off.

Read the full piece.