Global Health Watch News Brief: Issue 1

The last week has brought an alarming series of developments affecting global health and human rights. Here’s a brief overview of critical changes and their implications:

  • Pause on PEPFAR and humanitarian programs: On Monday, US officials announced a suspension of all PEPFAR programs, threatening access to lifesaving HIV treatment and prevention for millions worldwide and jeopardizing decades of progress in global health. US officials were told to stop providing technical assistance to national ministries of health and PEPFAR’s data and computer systems were taken offline. On Tuesday, Secretary of State, Marco Rubio, a longtime supporter of PEPFAR, approved an “Emergency Humanitarian Waiver”, allowing “life-saving medications” to continue to be delivered. However, official guidance on how to interpret the waiver is lacking and it’s unclear whether providing HIV treatment can resume.

    IMPLICATIONS: More than 20 million people living with HIV could lose access to treatment, with widespread job losses expected across multiple countries. Most urgently, the delivery of ARVs funded by PEPFAR has already been disrupted. According to an analysis from amfAR, 222,333 people start new ARVs daily, meaning that many individuals now face the life-threatening possibility of interrupted treatment. Beyond these immediate impacts, the broader cessation of ARVs for over 20 million people would have catastrophic consequences. 

    Learn more from amfAR’s Country Analysis on treatment, testing and other social determinants of health. 
  • Federal financial freeze: Also on Monday, the new administration issued (via the Office of Management and Budget, OMB) a freeze on federal financial assistance, which impacts funding for research, healthcare, diversity programs, and energy projects among other efforts. Democrats are arguing that the freeze is unlawful and would harm communities across the US. Some states are pursuing lawsuits. Due to substantial community backlash and legal challenges, the administration rescinded the memo in less than 24 hours. The administration meanwhile asserts the Executive Order is still in effect

    IMPLICATIONS: The President’s pause on foreign assistance at the State Department remains in effect. Most international health and humanitarian efforts remain frozen, except for those covered by the waiver for “life-saving medications” referenced above. Even as the status of these federal funding freezes are still being clarified, the administration can be expected to continue to pursue strategies to impound, rescind, and limit access to federal funding for public health research and programs, and use misinformation and rhetoric to justify these actions. 

    Listen to Mitchell Warren on the Bhekisisa podcast, Weaponising aid: The cruel ways of #Trump2025. 
  • USAID leadership shake-ups: The new administration has placed career USAID officials on administrative leave, including leaders who run USAID’s Bureau for Global Health, impeding HIV prevention and civil society support worldwide. In addition, many of the agency’s institutional support contractors (ISCs), who comprise more than 50% of the Global Health Bureau, have already been, or are expected to be, let go. Contractors at the State Department Bureau of Global Health Security and Diplomacy (GHSD), including PEPFAR, were also laid-off Wednesday.

    IMPLICATIONS: This signals a deliberate effort by the administration to remove anyone seen as disloyal. Reports of loyalty tests for staff, including inquiries about their “moment of MAGA revelation,” reflect a broad-reaching plan to remove anyone or anything that could scrutinize the administration’s orders. Contractors at USAID and GHSD are essential to the Bureau’s operations, and their expulsion paralyzes the USAID, GHSD and PEPFAR.
  • Emerging threat as Uganda confirms new Ebola outbreak: Uganda’s Ministry of Health confirmed a new outbreak of the Ebola virus in its capital, Kampala. One death has been reported on Wednesday. This is the first outbreak since 2022, when it took four months to contain the spread of the virus.  

    IMPLICATIONS: The US intent to withdraw from the WHO and the suspension of communication with the US CDC, the country’s lead government agency, makes it impossible for infectious disease control to coordinate with their international counterpart to mitigate this threat.
  • National Institutes of Health employees may move to schedule F: In a publicly shared memo, employees of the National Institutes of Health (NIH) may be reclassified as “schedule F”, which strips them of key worker protections as civil servants. This move could allow the administration to dismiss or vet career employees and scientists based on their perceived loyalty to the administration’s political and ideological positions, including the research they oversee.  

    IMPLICATIONS: This shift could have a chilling effect on new researchers entering the field, potentially undermining the integrity and independence of scientific research. 
  • NIH clinical trials and participant travel continues with uncertainty: Despite NIH restrictions, clinical trials and participant travel to trial sites may still continue, according to an email to staff at the NIH from its Acting Director, Matthew Memoli. Scientists may also discuss ongoing research that was initiated before January 20, given there is no data sharing or public communication outside of those who are part of the research or its funding, leaving the impact on new research uncertain.

    IMPLICATIONS: Critical purchases and contracts related to human and animal health, security, and biosafety could proceed, but there are many unanswered questions, especially over the pause in grant reviews and funding decisions. 
  • Fighting the Global Gag Rule: One of the early actions of the new administration was the Executive Order to reinstate the Global Gag Rule. However, the Global Health, Empowerment, and Rights Act, a bill to permanently end the Global Gag Rule, was reintroduced in the House and Senate on January 28, making this Act all the more important. AVAC and partners have endorsed the act. Read Congresswoman Lois Frankel’s statement here and watch this space for further updates.
  • Confirmation Hearings for Russell Vought, nominee for Director of Office of Budget and Management: Russell Vought may be selected to lead the Office of Management and Budget (OMB), an influential office, which plays a key role in developing the annual budget request. In this position, Vought will essentially serve as a key gatekeeper, shaping the Executive Branch’s agenda. Confirmation hearings were scheduled for January 30. However, Democratic senators are demanding the vote be delayed, while debate escalates around federal domestic funding freeze.

    IMPLICATIONS: Vought, one of the authors of Project 2025, the conservative blueprint for reshaping the US government, is poised to implement the vision at the highest levels of government. If confirmed, he will have power over foreign assistance, research, and all the programs that save lives in the US and abroad. He will be able to accelerate firings, work stoppages, and withhold federal grants/funds already underway. His leadership represents a direct threat to public health and human rights.

    Live in the US? Call your Senator (202) 224-3121 to vote “no” on this confirmation and send a message to Washington that HIV prevention advocates stand firmly against Project 2025 and its writers.

In Case You Missed It

AVAC and PrEP4All urged donors at last week’s FCAA Summit to mobilize emergency funding and unite against these threats.Together, we can protect global health and human rights.

Read the opinion editorial in POZ Magazine.

What we’re reading

  • The New Yorker: Behind the Chaotic Attempt to Freeze Federal Assistance: Discusses the new administration’s attempt to freeze federal assistance, which led to widespread confusion and concern among federal agencies and aid organizations, highlighting the challenges and potential consequences of such a sudden policy shift. Discusses the new administration’s attempt to freeze federal assistance, which led to widespread confusion and concern among federal agencies and aid organizations, highlighting the challenges and potential consequences of such a sudden policy shift. 
  • Brownstone Institute: The State of Pandemic Preparedness, the WHO, and the US Withdrawal: Discusses the Executive Order withdrawing the United States from the World Health Organization (WHO) and ceasing negotiations on the WHO Pandemic Agreement and International Health Regulations, highlighting concerns about the potential impact on global pandemic preparedness. 
  • Project Syndicate: Trump at Davos: Reviews the new presidential policies in a world of competing crises, eroding institutions, and increasing geopolitical instability and how these actions are accelerating these challenges. and how these actions are accelerating these challenges. 

Resources

Working in Solidarity: Join the effort to track the Impact 

Introducing Global Health Watch! Tracking US actions and their impact

The last week has been intense and sobering. As strategic and dedicated advocates, we already know the profound impact elections have on our work and our world. Recent developments in the United States underscore the challenges ahead, especially with the new administration’s alignment with the Project 2025 agenda—a playbook designed to reshape US federal agencies and policies drastically. 

There are already Executive Orders—which are directives issued by the President of the United States—that have significant implications for our collective work, in the US and around the world. This is, we fear, just the beginning. Administrative actions, such as pausing foreign assistance, including the lifesaving PEPFAR program; halting diversity, equity and inclusion (DEI) initiatives; curtailing public communications; and “scrubbing” agency websites represent a systematic effort to control narratives and stifle dissent. And many of the Executive Orders from this past week are aimed at changing who is in control of information.  

Some of the new political and policy shifts that we are tracking and what they mean for the programs and systems that matter most to HIV prevention efforts, include:  

AVAC will continue to track these developments, analyze their implications, and convene and coordinate with partners to strategize responses. Beginning this week, we will share a weekly synthesis and insights report, Global Health Watch to help navigate this challenging terrain and ensure our advocacy for an evidence- and rights-based, equitable response to the HIV epidemic continues.  

In addition, AVAC and PrEP4All published a new commentary in POZ magazine asking philanthropic funders gathered at this week’s Funders Concerned About AIDS (FCAA) Summit to adapt to these urgent threats. AVAC urges donor partners and advocates to support one another, and join together in an emergency effort, with immediate funding. As a united front, we can and must defend global health and human rights at this crucial time when collective action by donors, multilaterals, advocates and impacted communities is imperative.   

Stay strong, stay safe, and stay sane. It’s a long road ahead, but with our partnerships, we must persevere. 

The Votes Are In

What’s next for the US’ role in global health and HIV prevention?

In the days, months and years ahead under a new US presidential administration, advocacy for choice, freedom, science, and rights will require intentional strategies to protect hard fought gains in HIV treatment and prevention and in global health generally, and to safeguard policies and programs that advance it. What to do?

For a start, listen to AVAC’s newest PxPulse podcast. Jen Kates, Senior Vice President, Director of Global Health & HIV Policy at KFF, a nonpartisan health policy research organization and AVAC’s Director of Policy, Suraj Madoori lay out the challenges and the priorities in 2025 and beyond.

As the field prepares for new US leadership, advocates must take stock, identify allies, work in solidarity and seize opportunities. In the months and years to come, AVAC will be there, offering tools, analysis, and perspectives to support our collective work to advance HIV prevention and equity in global health.  

The Trump administration will likely have a fundamentally different worldview about US engagement in global health and in development. One that is much more isolationist, much more transactional. Why should the US be engaged in these programs? What is in it for us? And I think the challenges that will come up there, is where or will the US continue to play a leadership role diplomatically, financially, because the US is the largest funder of all global health programs.

Jennifer Kates
SVP and Director of Global Health & HIV Policy at KFF

There’s such a vibrant advocacy community outside the United States who want to engage their own governments in mobilizing domestic resources for HIV, who want to share their stories to Congress about the impact of PEPFAR and other lifesaving programs. That is a lot of untapped advocacy and a lot of North-South collaboration that will be so important to get us through at least the next two years into the midterms, if not the entire four years of this new administration.

Suraj Madoori
Director: Policy & Advocacy, AVAC

Fighting the Same Fight Again

Civil Society and Community Engagement in Global Health Initiatives
Authors: Samantha Rick (AVAC), Quentin Batreau (GFAN), Eolann MacFadden (Frontline AIDS)

Pandemic Accord negotiations have so far failed to effectively engage advocate and civil society voices. With key parts of the Pandemic Accord moving toward further negotiation over the next few years, the Coalition of Advocates for Global Health and Pandemic Preparedness calls on advocates in and around the World Health Assembly to continue to rally for meaningful engagement with civil society and community and leadership roles for both in the ongoing multilateral process for pandemic prevention, preparedness, and response (PPPR).

For decades civil society and community organizations have been recognised and legitimately engaged as vital stakeholders and leaders in the HIV response. But this principle of inclusion has been inadequately upheld in other health areas, and vitally important initiatives, including the negotiations of the Pandemic Accord, have failed to build on the success of the HIV response and fully utilize existing models and mechanisms for engagement. Without them, these efforts exclude critical stakeholders when they should integrate civil society organizations (CSOs) as a crucial driver of policy and programming. Although certain initiatives have created some opportunities for CSO involvement, organized campaigns and public outcry have been necessary to garner a seat at the table. With every new program, fund, or secretariat, advocates are compelled to engage in the same repetitive battle to obtain a minimum of two voting seats and consultation prior to decision-making.

Civil society representation at the World Health Assembly has been reduced, a formal mechanism for engagement at UN High Level Meetings has been rejected, requests for even observer status during Pandemic Accord negotiations have also been rejected, and civil society and community advocates have experienced hostility at international convenings such as International Conference on AIDS and STIs in Africa (ICASA). Preventing, preparing, and responding to disease outbreaks requires public trust, understanding of regional or cultural ways of working, geographical limitations, and the true needs of communities. We cannot build effective health infrastructure by erecting barriers to civil society and community leadership. 

It is absolutely crucial that civil society and communities band together to demand meaningful engagement in the processes that follow and refuse to permit governments and institutions from rolling back CSO access and decision-making power even further. 

We have seen throughout the 40 years of the HIV/AIDS response that meaningful engagement  turns the tide when biomedical innovations fall short of their potential because of real-world challenges. Decision makers, government representatives, and multilateral institutional leaders must enshrine a baseline level of meaningful civil society engagement practices where and when international decisions are made. As lessons from the global HIV response show us, it is possible, if not probable, that many of the outstanding issues in the Pandemic Accord could have been solved with civil society input and influence, as knowledge-brokers who bring unique insights, find solution, and foster trust where it’s needed most.

The Coalition of Advocates for Global Health and Pandemic Preparedness is a group of organizations advocating for an integrated and holistic approach to preparedness that emphasizes equity, inclusion, and synergies of multiple global health programs in advancing preparedness. We believe that all global health initiatives should be centered on the key principles of community leadership, equity, access, and human rights and that efforts to fight current epidemics and strengthen health systems are central to equitable pandemic preparedness.

The biggest lesson from the fight against HIV, TB, and malaria is that if space is not reserved for civil society, we must take it – “Nothing For Us Without Us”. Join us at the World Health Assembly or watch the recording of our side event focused on civil society engagement if you can’t make it to Geneva, and keep demanding meaningful engagement in every global health initiative.

Even a baseline level of meaningful civil society engagement within international fora will do

We cannot build effective health infrastructure by erecting barriers to civil society and community leadership.

By Sam Rick, Multilateral Engagement and Pandemic Preparedness Advocacy Specialist at AVAC

From the beginning of the global HIV/AIDS response movement, often before governments and policymakers became engaged, civil society and communities have led the charge. In addition to providing direct prevention and treatment services – particularly to those often excluded from the health system due to discrimination, stigma, affordability, and physical access barriers – civil society organizations (CSOs) serve crucial roles holding governments and policymakers accountable, leading activists to demand essential services, and building trust within the community. 

This legacy is felt in the operations of the President’s Emergency Program for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, TB, and Malaria (GFATM). Both give civil society and affected community groups explicit roles in their governance and operation and provide direct funding to support their efforts or build capacity where needed. These programs have contributed to the growth of CSOs across HIV-burdened countries and increased recognition of the impact that strong civil society and community engagement can have on health outcomes. They support government program implementation by monitoring delivery at the local level, use their knowledge and expertise of hard to reach populations to inform program design, and urge public and private partners to act on emerging issues where political will and commitment falls short. The transformative impact of strong CSO and community engagement is the most important and enduring lesson from the global HIV/AIDS response.

Despite the hard-fought battles to secure the legitimacy and recognition of the baseline requirement of civil society engagement in the HIV/AIDS response over decades, new initiatives in other health areas have failed to meaningfully build upon existing engagement mechanisms and fully integrate CSOs as an essential driver of policy and programming. While some initiatives have opened up limited room for CSO engagement, the space at the table has only been secured after public criticism and organized campaigns. Advocates continue to be forced to have the same fight over and over with each new program or fund or secretariat, fighting to secure the absolute minimum of two voting seats and consultation before decisions are made. 

This is not a complete surprise. Globally, civic spaces are shrinking as global anti-rights movements are gaining momentum. Growing insecurity in the wake of international conflict flare-ups gives policymakers justification for rationalizing the limitation of meaningful civil society engagement. This dynamic has plagued international negotiations that had previously instituted meaningful engagement structures, including in the scaling back of civil society representation at the World Health Assembly, refusal to sanction a formal engagement mechanism for UN High Level Meetings, continuously dismissed requests for even observer status during Pandemic Accord negotiations, and hostility toward civil society and community advocates at international fora such as ICASA. For many governments, the global circumstances necessitate bypassing consultation and opting for rapid, decisive action, resulting in severely missed opportunities to improve health outcomes and program effectiveness. Beyond just a more limiting environment, the fiscal environment is shrinking as well, and meaningful engagement is costly. Bringing people to the table and giving them the space to truly influence decisions takes time and effort. Gathering wide input can often change scope and plans, sometimes throwing champions of a given initiative back to the drawing board.

Yet the cost of doing business and delaying start up in order to be sufficiently inclusive is an essential investment – what good is it to get money out the door quickly if it doesn’t go where it is needed? If services aren’t used, products expire, and disease spreads further? The short-term trade-offs of meaningful engagement are real, but they can be mitigated. We have over 20 years of experience to build on and leverage, and civil society and community advocates have decades of expertise in direct global health governance and service delivery to draw from. And as anyone who has spent any time in a Global Fund board meeting will tell you, there is little basis in some of the fears governments have around open, consultative processes. They do not descend into petty squabbles or dead-ends. They do not slow action or stymy decisions – for example, the Global Fund, with three voting seats allocated to civil society and communities, was among the most agile institutions during the COVID-19 crisis.

We call on decision makers, government representatives, and multilateral institutional leaders to enshrine a baseline level of meaningful civil society engagement practices within international fora, and to fight back against the growing tide of penning in valuable and essential expertise and networks.

We have seen in the 40 years of HIV/AIDS that meaningful engagement really turns the tide where biomedical interventions have plateaued in their usefulness. Preventing, preparing, and responding to disease outbreaks necessitates population trust, understanding of regional or cultural ways of working, geographical limitations, and true community needs. We cannot build effective health infrastructure by erecting barriers to civil society and community leadership.

Who’s Driving This Ship?

Over the last year, governments and health leaders have been working to restructure the global health system to ensure pandemic prevention, preparedness, and response. The COVID-19 pandemic forced a reckoning, exposing a deeply inequitable global health system, and advocates, civil society, health workers and leaders representing southern populations, have called on governments to rewrite the world’s contract – in particular, asking Global North governments to finally give up some power and, in the service of preventing and preparing for pandemic threats, agree to join a system that is equitable and aims to prevent health threats everywhere and prepare everyone.

At AVAC, we have put a lot of hope in the processes of the Pandemic Accord, the UN High-Level Meeting (HLM) on Prevention, Preparedness, and Response (PPPR), and the development of a medical countermeasures (MCM) platform. (To understand how these three efforts fit together, see AVAC’s Advocate’s Guide to PPPR.) However, sadly, and in honesty, predictably, many high-income countries seem unwilling to alter the status quo. We see four main sticking points that come down to whether these countries will relinquish control:

Data sharing

Global agreements to share pathogen data and genomic sequencing in the event of a novel pandemic threat represent one of the most important areas of negotiation in these processes. Understandably, many countries are keen to ensure they can have access to data on newly discovered pathogens so they can create a vaccine or treatment as soon as possible and protect their citizens. But since research, manufacturing capacity, and resources are concentrated in the Global North, such an agreement presents a bad deal for countries in the Global South. Such an agreement would require them to share the data they have access to, but continue to be last in line for the vaccines or other interventions that get developed from that data.  To add insult to injury, they may well be punished for sharing it, as was the case when the Republic of South Africa shared data on the Omicron mutation of COVID-19 and then saw Global North countries subsequently block entry to their citizens.

But so far, the countries pushing to secure agreements on data sharing refuse to grapple with these concerns. They have not budged and remain unwilling to support language that would ensure access to the beneficial medical countermeasures and that are developed from shared data. While the potential for open science and a platform for data sharing holds promise, these efforts will predictably result in simply exacerbating inequalities unless these agreements beef up commitments around equity. Negotiations on this issue have been tense, with no resolution in sight.

R&D

The concentration of research capacity in the Global North represents another major hurdle. Because the majority of resources for R&D are held by either Northern governments or corporations headquartered in the North, their priorities dictate the answers to questions such as which pathogens, what intervention to pursue, and what populations to help first. For example, $35.8B was spent on medical research worldwide in 2022, but only $3.95B was invested in R&D on diseases with an outsized impact on people living in the global south (including HIV, tuberculosis, and malaria) in 2020. Some governments, like the countries in the ‘Group on Equity’, are calling for more distributed investments, more collective resources dedicated to pathogens of pandemic potential (such as those in the Africa CDC’s priority list), and agreed-upon standards for the diversity of populations that must be included in clinical trials. Negotiations are ongoing, with a lot of opposition coming from pharmaceutical corporations.

MCM platform

We are quite concerned with the current process of developing an MCM platform that has been proposed by the G7 and G20, along with WHO’s support. The stated aim of the platform is to coordinate equitable development, distribution, and delivery of medical countermeasures for pandemics, including vaccines, therapeutics, diagnostics, and other tools, and to implement the platform in ‘peacetime’ before the next pandemic hits so we’re ready. So far, however, the development process has been largely driven by G7 and G20 countries, both because it will take investment from these countries and because less-resourced countries simply do not have capacity to engage in another PPPR-related process in addition to the Pandemic Accord and UN HLM. Discussions between civil society and country representatives are not happening – while WHO and different agencies have held official meetings with countries, civil society have been relegated to separate discussions. Some global health leaders, from both countries and agencies, have expressed a desire to leave ‘thorny’ issues out of it. But public health advocates and civil society insist that these issues such as intellectual property, clinical trials and R&D prioritization, allocation, the inclusion of marginalized groups, and governance must be considered now before the platform is stood up. It’s unclear who is making the decisions here, but it is certainly not those most burdened by disease.

Financing

The Pandemic Accord draft and the draft UN Declaration on PPPR include few concrete references to PPPR financing targets or finance reform. One of those few is the mention of new-to-the-field Pandemic Fund as a primary resourcing vehicle. This apparent reliance on the Pandemic Fund raises serious questions, as the Fund has offered just $300M in the first round of funding. PPPR agreements that defer finance commitments to the Fund are misguided at best and reveal a lack of ambition to effectively confront pandemic threats. The world currently needs to turn this ship around. Pandemic preparedness must not be an afterthought, a half-hearted boondoggle that only serves the interest of rich countries. All of the issues raised here, in addition to the need to upgrade and expand surveillance systems, increase and strengthen the health workforce, and build up regional manufacturing capacity, need resources to be implemented. On top of those pressing needs, many of the countries that are in most need of investment in pandemic preparedness are straining to manage enormous debt burdens imposed by wealthy countries.  Advocates are asking that governments include, in the UN Declaration on PPPR and Pandemic Accord, reference to existing mechanisms such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria (currently the largest funder of PPPR worldwide), the WHO Contingency Fund for Emergencies, and the IMF Resilience and Sustainability Trust as existing vehicles for pandemic preparedness resourcing. PPPR will advance equitably and effectively, and less resources will be needed, if countries commit to leveraging what has already been built in the ongoing responses to HIV, tuberculosis, and malaria. PPPR must learn from twenty years of demonstrated success fighting pandemic and epidemic threats.

So who is driving this ship?

It appears that those who have historically held control have not learned their lesson after yet another global pandemic that abandoned poorer countries and left all of us more vulnerable to the next pandemic. Instead of facing the reality that disease knows no borders and resetting the global health system, those who hold the purse strings seem content to continue with the status quo – hoarding the fruits of science, reinforcing exclusive and hegemonic systems, consolidating power among the few, and keeping health systems fragmented and underfunded. It’s an upside-down system – with those most secure and least in touch with the impact of their decisions in charge. The PPPR ship must be driven by those most burdened by pandemic threats and ongoing epidemics, or we will most certainly face another devastating pandemic and decision-makers will wish they turned it around now.

Our Take: Are the UN Declaration on PPPR and the Pandemic Accord going in the right direction?

The last few weeks have been filled with high-level negotiations among UN Member States on the way forward for global pandemic prevention, preparedness, and response (PPPR) efforts. Below, please find an analysis of the negotiated language to date in the Pandemic Accord, and the UN Declaration on PPPR, and their implications for equity in PPPR. These analyses were conducted by AVAC and partners working in collaboration to track progress toward equity in these agreements and develop an advocacy agenda for provisions in both that ensure equity in global health advances. The Declaration is an agreement that involves heads of state and potentially a role for all ministries of government. The Pandemic Accord is being negotiated by members of the WHO to strengthen PPPR.

The Pandemic Accord: A look at negotiations to date

The first draft of the WHO-led Pandemic Accord was released in May, containing edits to the zero draft from the Member States. As expected, edits from high-income countries introduced challenges to equity provisions in the text— particularly provisions aimed at ensuring that agreements to share access to data on pathogens is paired with commitments to also share the benefits developed from research using those data (termed pathogen access and benefits sharing). Other equity provisions that were challenged include intellectual property, and language on how the world should allocate vaccines, therapeutics, and diagnostics in the event of a global pandemic threat. Throughout the document, certain high-income Member States inserted caveats or wording, such as “encourage” or “as appropriate”, which would make implementation voluntary or compliance more subjective. Other phrases to weaken the agreements, such as replacing “commit to” with “recognize the importance of”, were also inserted.

Negotiations so far have resulted in weaker, alternative language to several key articles than in the so-called zero draft of the accord. These include articles on technology transfer, the Pathogen Access and Benefit Sharing (PABS) System, health workforce strengthening, and the proposed Supply Chain & Logistics Network. There are, however, some clauses that have been strengthened. Global R&D networks, laboratory networks for genomic surveillance, knowledge translation, and the harmonization of regulation to accelerate WHO pre-approval and authorization all have stronger commitments and more details than before. You can find the first draft here and a closer analysis of the changes made between the zero and first draft here.

The UN Declaration on PPPR: What’s in the Zero Draft?

The zero draft of the UN Declaration on PPPR, set to be adopted at the High-Level Meeting on September 20, was released in June.

Many provisions in the draft Declaration are positive, recognizing and affirming key points related to human rights and inclusive provisions that prioritize vulnerable and marginalized populations. The draft recognizes vaccine inequity as a vital concern, affirms key principles of equity and non-discrimination and the need to ensure adequate support for both health workers and the WHO. However, there are very few, if any, concrete targets set, leaving little to hold countries accountable. Missing from the Declaration, in particular the section on Overarching Health Related Issues, is the need for countries to prioritize and commit to building on the global responses to ongoing epidemics, including HIV/AIDS, TB, malaria, polio, other neglected disease outbreaks such as Ebola, Marburg, and cholera, and antimicrobial resistance (AMR).

This is a missed opportunity with enormous implications. It signals a troubling and serious global inability to build on existing health and community infrastructures, integrate responses, and avoid erecting isolated pillars in global health architecture. Many of the capacities needed for PPPR already exist in the response to these other health threats. They can and must be expanded and strengthened for broader pandemic preparedness. In addition, the history of the responses to HIV/AIDS, TB, and malaria have made clear that community leadership in the response and civil society engagement are essential to achieve success in PPPR. The current response to existing health threats, which through trial and error have built resilient and effective systems, should serve as the foundation for any future pandemic preparedness and response efforts. The Declaration’s silence on this issue is gravely concerning.

The Declaration’s clauses relating to agreements on pandemic-related tools and products are strong, and notably stronger than those in the first draft of the Pandemic Accord. But equity provisions, and access to those tools, could be strengthened further, by including compulsory licensing and transfer of know-how when necessary.

It’s vital for advocates to engage with these processes, and leverage their power to influence the emerging architecture in global health. Decisions being made now will have implications for years to come. And the voices of advocates are having an influence. For example, the US government’s contribution to the current draft of the UN declaration recently added specific recommendations from AVAC and partners on the inclusion of Good Participatory Practice. It’s up to all of us to make sure GPP and other provisions that ensure equity in global health are in place when the drafts become final.

You can find the Declaration zero draft here and see our analysis and the changes we call for here.

What’s Next

These negotiations are setting the direction for pandemic readiness for years to come. As discussions continue in the weeks and months ahead, it’s imperative for advocates and countries to be raising their voices and calling for language and commitments that will ensure equity in PPPR. Building on the lessons the world has learned from ongoing epidemics, and integrating the response must be a priority to ensure the tragic results of inequity in global health are not repeated, again and again.

AVAC will be sharing these analyses with our partners and governments with whom we work with. For more background, read AVAC’s Advocates Guide for PPPR. And you can take action now by sending these resources to your country’s UN representatives and other influential voices in your networks!

New Px Pulse Episode on LGBTQIA+ Advocacy in Uganda

Our latest podcast, LGBTQIA+ Advocacy in Uganda: Facing down fear and fighting for justice, is available now!

This episode looks at Uganda’s just-passed anti-homosexuality bill, that now awaits final action from President Museveni. The broad-reaching legislation further criminalizes LGBTQIA+ people and is part of a wave of anti-gay hate laws and actions by authorities that are sweeping across the region with recent crackdowns in Ghana, Kenya, Rwanda, Tanzania and Zambia.

The Ugandan bill would make it a crime to even identify as lesbian, gay, bisexual, transgender or queer, with sentences up to life imprisonment. It gives authorities wide powers to crackdown on anyone who does not report on same-sex couples or who promote gay rights, including prohibitions on news coverage and media. And the law could impose death sentences in some cases, including for the transmission of HIV. Uganda’s President Museveni has the power to stop the bill. But so far he is issuing statements for other African countries to follow Uganda down this path.

This podcast episode features several leading Ugandan advocates, whose fierce and imperiled voices are readying to fight for LGBTQIA + people in Uganda, but at AVAC, we know they are fighting for all of us. Listen as they dig into the specifics of how these attacks have gained momentum and their ties to US-based religious extremists. For the full podcast episode, resources to learn more on the issue, and the archive of previous episodes, visit avac.org/px-pulse. And subscribe on Apple Podcasts, Spotify or wherever you get your podcasts!

Uganda-based advocates are urgently organizing and raising money to challenge this law. You can donate to SMUG and Chapter Four Uganda.

Catch Up on the Advocacy for IP Waivers, Tech Transfers and PPPR

In case you missed it, highlights from our April 6 webinar, Global PPPR Equity: Why do we need agreements on IP and tech transfers?, are a must read. Panelists, bringing a range of expertise, explored lessons learned from the HIV/AIDS epidemic on IP and tech transfer advocacy and what’s next in the fight for global equity in pandemic prevention, preparedness and response (PPPR).

Featured speakers included:

-Fifa Rahman, ACT-A CSO and Health Poverty Action
-Brook Baker, Northeastern University and Health GAP
-Fitsum Lakew, WACI Health
-Esteban Burrone, Medicines Patent Pool

Listen to the webinar to learn:

-Why patents matter for diagnostics, despite assertions from industry that they do not
-The impact of intellectual property monopolies during COVD-19
-About the need for rapid scale up of manufacturing in African countries and more

“There are five key reasons we need licensing and tech transfer: they reduce prices, accelerate access to new and innovative treatments and other technologies, enable production of greater volumes, contribute to supply security, and support geographical diversification of manufacturing.” – Esteban Burrone, Medicines Patent Pool

Check out our summary of the webinar, watch the recording, download the slides and find links to a host of resources on PPPR, including an Advocate’s Guide to PPPR and two recent podcasts on the global architecture being put in place to make investments and coordinate resource sharing.

With pandemic prevention, preparedness and response an area of increasing investment and planning, these voices are sharing insights and messages that are instrumental for collaboration and advocacy. Tell us what you think and contact [email protected] to get involved!

AVAC at the 2023 Biomedical HIV Prevention Summit

The Biomedical HIV Prevention Summit, now in its seventh year, will be held in Las Vegas, Nevada, on April 11-12. This annual meeting focuses on biomedical interventions for treatment and prevention of HIV and approaches to implementation of these tools to end the epidemic.

This year’s theme highlights the role of sex and pleasure and includes a plenary featuring advocacy to right the wrongs of a failed US federal PrEP response with a US National PrEP Program.

AVAC and partners are involved in a number of sessions and activities; scroll down for information on these and click here to check out the full conference agenda.

And finally, be sure to follow our Twitter feed, @HIVpxresearch, Tuesday, April 11, when our Senior Program Manager for Policy, John Meade Jr., takes it over to report on the meeting live from Las Vegas.

AVAC and Partners at the Biomedical Prevention Summit

Tuesday, April 11:

10:30 to 12:00 PM PDT: No Data No More: A research scorecard for transgender inclusion
Session 1 Workshop
If we are to end the epidemic, we need biomedical research data that are representative of transgender communities. AVAC has designed a Scorecard tool with which to hold researchers accountable for the meaningful inclusion of transgender people in all HIV clinical trials. Join this session to learn how milestone HIV studies from 1991-the present have scored on transgender inclusion—and how you can ensure “No Data No More.”

4:30 to 6:00 PM EDT: Long-Acting Injectables: Revolutionary prevention drugs require revolutionary adaptations in delivery
Session 3 Workshop
Current delivery models for longer-acting injectable (LAI) PrEP require consumers to travel to outpatient settings and be seen by providers qualified to deliver injections. Yet, many providers serving HIV-impacted populations do not have sufficient capacity to offer LAI PrEP at the volume necessary to end the epidemic. Additionally, structural barriers and serious inequities within the United States healthcare system prevent many from engaging in HIV prevention. This workshop will explore how the HIV prevention community can draw lessons from other fields to successfully develop, advocate for, and implement alternative delivery models for LAI to increase access, and realize the promise of these revolutionary interventions.

4:30 to 6:00 PM PDT: PrEP in Black America: An equity movement in HIV prevention
Session 3 Workshop
Black people in the US bear a disproportionate burden of HIV, representing approximately 13 percent of the population while comprising more than 40 percent of incident HIV diagnoses in 2019. Despite this, biomedical HIV prevention tools remain underutilized by Black people and more than 90 percent of those who can benefit from PrEP have not been prescribed PrEP. The PrEP in Black America Summit (PIBA) was convened by a cadre of Black HIV activists, advocates, leaders, and public health professionals to address these frustrating factors on the 10th anniversary of the Food and Drug Administration’s approval of the first medication for biomedical HIV prevention. Summit leaders gathered more than 150 individuals, in person and virtual, in the spirit of confronting the historical injustices and race-based discrimination that continue to drive HIV and other sexual health inequities experienced by Black communities to develop a Black-focused agenda or “roadmap” for HIV prevention.

Wednesday, April 12:

10:30 to 12:00 PM PDT: CAB 4 PrEP: Opportunity for advancing equity and improving access
Session 4 Workshop
Injectable PrEP uptake in the US has the potential to reduce HIV infections, but only if its introduction can address the impediments to its implementation. Participants will engage with panelists that have experience with injectable cabotegravir in this workshop.