AVAC welcomes today’s ruling affirming the constitutionality of the Affordable Care Act’s preventive services mandate, including coverage for HIV pre-exposure prophylaxis (PrEP) at no cost to patients. This decision represents a critical victory for public health, health equity, and the millions of people who rely on preventive services to stay healthy and safe. By rejecting efforts to strip away access to PrEP and other essential services based on ideological objections, the court has reaffirmed that public policy must be grounded in science, not stigma.
Since the original Braidwood decision, AVAC and our partners have worked tirelessly to raise awareness of the case’s far-reaching implications. We joined legal advocates, public health experts, and community leaders to underscore what was at stake: access to evidence-based care and decades of progress in preventing HIV and other serious conditions. Today’s ruling confirms the power of coordinated advocacy and the importance of protecting science-driven health policy from politically motivated attacks.
This outcome ensures that individuals can continue to access PrEP, both the medication and the clinical services necessary to support its use, without cost barriers. It preserves critical public health gains and sends a strong message that discrimination has no place in our health care system.
“This ruling is a relief in maintaining the critical role under the Affordable Care Act to cover preventive care services, including HIV pre-exposure prophylaxis (PrEP),” said Mitchell Warren, AVAC’s Executive Director. “Preventive services across healthcare are cost-saving and life-saving, and I am grateful that the Supreme Court found on the side of evidence, logic, public health, and human rights. There has been enormous progress in the fight to end the HIV epidemic, and just last week the FDA approved the newest form of PrEP, injectable lenacapavir. Lenacapavir can be a transformative option, but only if it is available to people who want and need it, and today’s ruling can make that possible.”
Looking ahead, AVAC will continue working to ensure that PrEP access is not only protected but meaningfully expanded, particularly for the communities that have long faced systemic barriers to care. This includes advocating for a national PrEP program, strengthening provider and patient education, supporting implementation by community-led organizations, and holding insurers accountable for compliance. Today’s ruling offers a strong foundation to build from, and we remain committed to a future where HIV prevention is accessible, equitable, and fully resourced for all.
Today’s Supreme Court decision does confirm enormous power with the Secretary of Health and Human Services, which under the current administration is cause for significant concern. “In the midst of today’s victory, we must be tempered by what has happened with the CDC’s Advisory Committee on Immunization Practices (ACIP), as it could be a harbinger of what a Secretary of HHS can do to twist committees and task forces that should be composed of technical experts guided by science to ones that are guided by ideology, illogic and political whim,” said Warren.
Global Health Watch: USAID in the Spotlight, Gavi Replenishment, Defense of the Rescissions Package and ACIP
Issue 22
This week brought major media attention to the devastating dismantling of USAID, even as the FDA’s approval of lenacapavir for PrEP signaled new hope in HIV prevention. At the same time, vaccines were under even greater assault as the US administration announced it would withdraw support from Gavi based on spurious claims, while the CDC’s Advisory Committee on Immunization Practices met for the first time since the Secretary of Health and Human Services fired leading vaccine experts and replaced them with a group of skeptics. Also, top administration officials defended reckless and unlawful proposals and actions in Congressional hearings. This issue unpacks it all.
Media Coverage Highlights USAID Dismantling Amid Regulatory Approval of New PrEP Option
Media outlets including The New York Times, The New Yorker, and NPR’s This American Life podcast spotlighted the devastating consequences of the US Administration’s dismantling of USAID while also covering the US FDA approval of lenacapavir (LEN) for PrEP last Wednesday. AVAC’s latest blog, The Cruel Irony of Prevention, highlights how scientific breakthrough and political sabotage collide at a critical moment in the global HIV response.
IMPLICATIONS: The approval of LEN should mark a turning point in the fight to end the HIV epidemic. But without restored funding, political leadership, and bold, coordinated action, the promise of this breakthrough could be squandered. AVAC’s court case challenging the foreign aid freeze and our advocacy tools—like the Gears of Lenacapavir for PrEP Rollout—offer a roadmap for protecting progress and accelerating equitable access.
Gavi Replenishment Meeting and the Assault on Vaccines
At this week’s Gavi replenishment meeting, US Health and Human Services Secretary (HHS), Robert F. Kennedy Jr. (RFK Jr.) shared a video message announcing that the US would withdraw support from Gavi, the Vaccine Alliance. Gavi leads efforts to ensure global access to vaccines and finances vaccines for more than 60% of children around the world. The withdrawal of support marks a dramatic departure from decades of bipartisan US leadership in global vaccination efforts. In his remarks, Kennedy amplified misinformation about the combination vaccine for diphtheria, tetanus and pertussis (DTPw vaccine), falsely implying it causes more harm than good. Gavi, which later announced that it secured $9 billion out of its total 2026-30 requirement of US$ 11.9 billion to support immunization in low-income countries through 2030, rejected RFK Jr.’s claims in a statement providing context and linking to data on the positive impact of the DTP vaccine, including saving an estimated 3 million lives every year.
In further efforts to undermine vaccines and vaccination programs, at the House Energy & Commerce Health Subcommittee hearing, RFK Jr. defended his overhaul of federal health agencies and his removal of all members of the US Advisory Committee on Immunization Practices (ACIP). Lawmakers challenged him sharply, including Rep. Kim Schrier, D-Wash., who is a pediatrician; watch her powerful video here. RFK Jr. appointed a new group of ACIP members, including a number of prominent vaccine skeptics, and the committee this week in sessions filled with mis-information.
IMPLICATIONS:
The US withdrawal and spread of vaccine disinformation at the Gavi replenishment threatens global access to vaccines that are part of the foundation of community wellness and resilience in low-income countries. This comes at a time when coverage is already backsliding and outbreaks of vaccine-preventable diseases are on the rise. Losing US support is destabilizing global health and eroding trust in lifesaving programs.
The hearing made clear that Kennedy’s sweeping restructuring threatens public health infrastructure and disrupts ongoing efforts in HIV prevention, STI research, and vaccine confidence. Discarding experienced experts and sidelining established science advisers risks undermining key disease surveillance and immunization guidance.
NIH Staff Ordered to Stop Certain Grant Terminations
Last week, a federal judge ruled that the National Institutes of Health (NIH)’s termination of more than 900 grants on politically sensitive topics, including vaccine hesitancy, was illegal. This week, the judge also rejected the government’s request to delay enforcement of his ruling, which means that the NIH must begin restoring funding immediately, even if the case goes to appeals. In an email, NIH instructed staff to halt any further grant terminations, however, NIH employees told Science they have not yet received instructions to restore terminated grants.
IMPLICATIONS: This decision shows positive steps in rebuking the Administration’s efforts to dismantle funding for science and biomedical research, and is a step toward preserving crucial grants related to HIV, STI, and DEI-focused research.
The US Senate Appropriations Committee heard additional testimony, including written testimony from Bill Gates, in another hearing on the US rescissions package, which proposes clawing back $9.4 billion in previously approved spending, including $8.3 billion from foreign aid (including PEPFAR/HIV programs). Budget Director Russell Vought defended the package, while senators, including Committee Chair Susan Collins and Vice-Chair Patty Murray, voiced strong opposition, warning that these cuts could undermine global health, humanitarian aid, and democratic institutions. July 18 is the deadline for the Senate to vote on the package.
IMPLICATIONS: This package would eliminate over $900 million from global health programs, and passage would codify, or make legal, the unlawful dismantling of USAID. In addition, Congressional approval of this package would lead to more requests for rescissions from the Administration. The proposed Fiscal Year ‘26 budget and rescissions package have far and deep implications for health, science, and research in the US and around the world. As we’ve stated in earlier analysis of the rescission package, it would dismantle the architecture for global health, including health programs and research that have broad bipartisan Congressional and public support, and which support the government’s stated aim of keeping Americans and the world safer, healthier and more prosperous.
Susan Monarez, PhD, the current acting director of the US Centers for Disease Control and Prevention (CDC) appeared before the Senate Health Committee. She is the nominee to lead the CDC and is respected among the scientific community. In her testimony, she strongly supported vaccines as safe and effective and pledged for evidence-based decision making in CDC decisions, including defending mRNA vaccine platforms and upholding integrity on the ACIP.
IMPLICATIONS: Monarez, if appointed, will have the difficult job of following HHS Secretary RFK Jr.’s leadership and evidence-based decision making. With scientific expertise and commitment to vaccine policy, she may serve as a stabilizing force at the CDC.
FDA approves LEN, while the administration destroys USAID
It’s been 22 weeks since the US president issued the executive orders that began the chaotic dismantling of USAID. See recent, remarkable, and much-neededNew York Times coverage on the destruction of USAID. And check out this new episode of the This American Life podcast on the aftermath of shutting down USAID.
We at AVAC took a public stand against this attack on global health and development in our court case, AVAC v. United States Department of State, filed by Public Citizen on February 10. We took this step because we understood the devastation that would come from such drastic and sudden divestment in the HIV response and global health. We also believe it was illegal and unethical.
In March, US District Court Judge Amir Ali ruled the foreign aid freeze was, indeed, unlawful, and that the administration had “usurped” the authority of Congress. Since that time, some 400 grants have been restored and the government is slowly complying with the Judge’s order to pay all invoices for work conducted through February 13. It’s a mere fraction of USAID’s former self, but each of these restored programs and payments represent an attempt to make America and the world stronger, safer and more prosperous. Just as important, our court case, along with a related one brought by the Global Health Council and colleagues, has forced into the public record the administration’s cynical maneuvers to dismantle global health; information that empowers advocates to fight and, we hope, finally spurs Congress to do its job.
“We cannot cede ground gained against HIV and other global health threats out of fear or paralysis in the face of these reckless actions. It is imperative to hold this administration responsible. And it’s imperative to invest in global health and sustain the gains in HIV. Global health advocates know this better than anyone, and we are fighting back,” said AVAC Executive Director, Mitchell Warren.
Nowhere is that fight to safeguard and advance HIV prevention more important than work to rollout injectable lenacapavir (LEN) for PrEP, just approved by the US Food and Drug Administration. LEN approval signals what could be a turning point in the epidemic – but only if the field invests in bold, strategic action.
“The science is remarkable, and the FDA approval is in. But it’s what happens next that makes the science count. It’s whether or not the technology is made available and becomes truly accessible that will bring impact. Will the world get it right this time? Because for 15 years we’ve squandered the potential of PrEP. That hope depends on fierce and effective advocacy,” said Warren.
“Scientific progress has been made over the years, and we celebrate them, but without truly having a prevention story to tell…yet. Now it’s time for that story to be told,” said APHA Executive Director Yvette Raphael.
“There’s much work advocates are doing, and much work ahead. Some donors have come forward, but it’s only a start. We also need to advocate with regulatory authorities at the country level, not to mention pushing for an affordable price, and a big enough supply from Gilead now to support demand creation at scale in order to build a sustainable market, which in turn will support generics and further reductions in price. Advocates are now and will continue to be fighting at the country level and the global level to move all this forward,” said HEPS Uganda Executive Director Kenneth Mwehonge and co-chair of the Civil Society Caucus of the Coalition to Accelerate Access to Long-Acting PrEP.
Check out the Caucus statement on priorities for LEN rollout, and these resources to support our collective advocacy:
“What all of us working together have tried to do for years and years and years, is to overcome the barriers from stigma to disinformation, that we’ve seen with oral PrEP, and with treatment 20 years ago. It will take Gilead, working with all of us advocates, to collectively ensure that this drug is accessible to all, so that the success depends not on the politics but on the product. We have to hold everyone, including ourselves, to account for keeping on task and for making sure that we do not squander this opportunity. So, let’s do this together and lay the groundwork for all future innovations to go faster, with speed, with scale and with equity for all,” Warren said.
The field is at a major inflection point, punctuated by both political challenges and scientific opportunity – and we can’t let the former overtake the latter.
Global Health Watch: LEN for PrEP approved by US FDA, South Africa’s HIV program in crisis, changes to oversight of NIH HIV guidelines
Issue 21
This week, we cover the US FDA approval of injectable lenacapavir (LEN) for PrEP, the “most transformative prevention product we’ve had in 44 years of this epidemic”, which demands urgent action if the remarkable science is translated into public health impact. Plus, updates on South Africa’s HIV program in crisis, oversight changes on NIH’s HIV clinical guidelines, and a court ruling halting illegal grant terminations. Read on.
FDA Approves Lenacapavir for PrEP—Advocates Demand Urgent Action
The US FDA approved injectable lenacapavir (LEN) for HIV prevention as PrEP. Developed by Gilead Sciences, LEN is a twice-yearly injectable that demonstrated nearly complete protection in the landmark PURPOSE 1 and 2 trials. The World Health Organization (WHO) is expected to release updated PrEP guidelines for LEN in July, and regulatory agencies in Brazil, Europe and South Africa are simultaneously reviewing the product. But the current political context, including a shuttered USAID and further disruptions across global health, demands an urgent and courageous response.
IMPLICATIONS: LEN for PrEP is poised to re-shape the HIV response, but only if this FDA approval is accompanied by bold, strategic, and equitable rollout. AVAC’s statement and Gears of Lenacapavir for PrEP Rollout outline what’s needed from all stakeholders to avoid repeating past delays in PrEP introduction. Watch AVAC executive director, Mitchell Warren’s take on what this moment demands.
South Africa’s HIV research infrastructure and programming are feeling the impact of the US Administration’s draconian actions after significant funding cuts. Cuts to PEPFAR and NIH have created a reported R430 million funding gap resulting in the loss of access to viral load testing, antenatal ARV care and the shutdown of clinics who serve key populations, including sex workers, transgender individuals, and people who inject drugs.
IMPLICATIONS: The impact of these cuts are threatening to reverse years of progress in a country shouldering a disproportionate share of the global burden of HIV and where AIDS denialism once dominated policy. Marginalized communities in South Africa may lose trust in programs and access to care, leading to increased rates of HIV transmission, including mother-to-child transmission, and jeopardizing global targets to end AIDS by 2030. South African stakeholders acknowledge they cannot plug the gap in funding alone.
Administration’s Attempt to Terminate NIH Research Grants Deemed Illegal
A US federal judge ruled that the Administration’s efforts to terminate certain NIH research grants was “void and illegal”. The ruling came during a hearing on the American Public Health Association’s lawsuit and another by a coalition of 16 states, which challenged the Administration’s termination of grants related to diversity, equity, inclusion (DEI), and LGBTQ+ health. Judge William Young, who was appointed by Ronald Reagan, noted, “I have never seen racial discrimination by the government like this” in his 40 years on the bench.
IMPLICATIONS: This decision shows positive steps in rebuking the Administration’s efforts to dismantle funding for science and biomedical research, and is a step toward preserving crucial grants related to HIV, STI, and DEI-focused research. However, the decision only applies to grants listed by the plaintiffs, and broader protections will depend on continued legal challenges and congressional decision making.
The Department of Health and Human Services (HHS) will transfer management of the NIH’s HIV clinical practice guidelines, which have been managed through the Office of AIDS Research (OAR). By June 2026, another HHS agency or organization will oversee the guidelines. An internal memo reports that “in the coming weeks, co-chairs and NIH Executive Secretaries will convene Panel members to discuss options for sustainable maintenance of the guidelines and discuss transition options.”
IMPLICATIONS: These guidelines have been a core pillar of HIV science, policy, and clinical alignment and the loss of NIH and OAR oversight of the HIV clinical guidelines is another action in undermining science, research and rights.
A Historic Milestone Must Now Be Matched by Urgent Action
AVAC welcomes the U.S. Food and Drug Administration (FDA) approval of injectable lenacapavir (LEN) as pre-exposure prophylaxis (PrEP). Developed by Gilead Sciences, LEN is a twice-yearly injectable PrEP option that showed nearly complete protection against HIV in the landmark PURPOSE 1 and 2 trials. Science Magazine named LEN the “Breakthrough of the Year” in 2024, a recognition that reflects its enormous potential. But that promise will only be realized if it is rolled out with speed, scale, and equity.
In our statement issued earlier today, we outline what’s needed from every stakeholder in the HIV response to meet this moment—and not squander yet another PrEP option.
As outlined in our Gears of Lenacapavir for PrEP Rollout, this moment demands unprecedented ambition, commitment, and leadership from governments, funders, implementers, policymakers, and civil society.
Advocacy Tools & Resources
Please check out all of AVAC’s advocacy tools and resources to support our collective work in advancing equitable LEN rollout as part of comprehensive, integrated and sustained HIV programs.
Our new report examines key insights from the rollout of oral PrEP and early introduction of injectable cabotegravir and the dapivirine vaginal ring to inform a faster, smarter and more equitable introduction of future HIV prevention tools, including long-acting injectable PrEP, such as lenacapavir.
This document outlines a focused plan for LEN for PrEP rollout over the next few years, specifying priorities by stakeholder and evaluating volume and pricing strategies.
This plan provides a broad view of all the moving parts and identifies actions and actors responsible for ensuring time is not wasted and opportunity not squandered.
This advocates’ primer provides background on lenacapavir for PrEP and its trials; a summary of the early findings of PURPOSE 1 & 2; key questions and next steps.
This episode of PxPulse goes deep on LEN for PrEP laying out recent research findings and what they mean. And Chilufya Kasanda Hampongo of Zambia’s Treatment Advocacy and Literacy Campaign and Mitchell Warren of AVAC talk about how to change a long history of squandered opportunities to get rollout right.
This is the moment for all stakeholders to build on the momentum science. LEN has moved faster through regulatory review than any prevention product to date. Now it’s up to all of us to make sure that that progress translates into real, sustained impact on the epidemic, led by communities around the world.
Let’s get to work.
Global Health Watch: Fired Vaccine Experts; House Rescissions Votes; CDC Staff Called Back; NIH Scientists Speak Out
Issue 20
This week brought the unprecedented removal of the US vaccine advisory committee, layoff reversals and confusion at the US CDC and a public letter signed by over 1,000 NIH scientists denouncing the administration’s actions. And just as this week’s issue was going to press, the US House of Representatives passed the President’s request for a rescission of billions of dollars – primarily for foreign assistance. This week underscored the urgency of defending evidence-based health policy.
US House Votes to Claw Back Funds for Foreign Assistance
The US House of Representatives passed a rescissions package that will claw back $9.4 billion of funds from FY25 spending, funds that were already Congressionally appropriated, but not yet spent. The package eliminates over $900 million from global health programs and includes cuts to PEPFAR, despite bipartisan support for these programs for more than two decades. The package also codifies into law the dismantling of USAID, which was initiated through presidential executive overeach and the reckless actions of DOGE.
IMPLICATIONS: The rescissions package would have far and deep implications for health, science, and research in the US and around the world. The House’s decision is the latest action in support of the Administration’s objective to slash foreign assistance funding and infrastructure. The Senate has until July 18 to approve.
Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. removed all members of the US Advisory Committee on Immunization Practices (ACIP), a panel of vaccine experts—with decades of experience in vaccine development, delivery and safety—responsible for developing the country’s vaccine recommendations for the Centers for Disease Control and Prevention (CDC), which then shape US health insurance policies and coverage. Kennedy replaced them with new members, many of whom are tied to anti-vaccine groups or have shared anti-vaccine views publicly.
IMPLICATIONS: These actions are the latest in a series of assaults on vaccine development and delivery systems, including defunding for CDC immunization programs, the NIH’s HIV vaccine development consortia, and global vaccine access efforts like Gavi. This new panel could take actions that turn this trusted scientific body into a platform for mis- and dis-information and anti-vaccine policies.
In April, widespread layoffs decimated the CDC and its critical divisions, including Reproductive Health, Population Health, and HIV and STD Prevention. This week, the Administration reversed itself on some of the layoffs. More than 450 CDC staff have been called back, including staff from the National Center for HIV, Viral Hepatitis, STD, and TB Prevention. HHS Secretary RFK Jr. admitted that at least 20% of cuts were “mistakes.”
IMPLICATIONS: While this reinstatement may restore some capacity, major damage has already been done: STI labs remain unable to collaborate with WHO, samples were discarded in the initial chaos, and costly disruptions are ongoing. Programs tracking HIV, STIs, and global health have been upended, and further reductions in force (RIFs) are still expected.
More than 1,000 current and former NIH staff published and signed a public letter denouncing the Administration’s proposed FY26 budget and the actions taken to date that threaten science, research and public health. The Bethesda Declaration specifically calls out the termination of research programs and the appointment of NIH Director Jay Bhattacharya. The solidarity behind this declaration speaks to the extraordinary harm these policy changes are having on a scientific community that historically avoids public protest.
IMPLICATIONS: Those that signed the declaration may be at risk of future retribution, but as the NIH faces a proposed $18 billion cut and changes to global partnerships, this effort signals growing pushback to the US government’s hostility to evidence-based science.
Senate Hearing on Proposed Fiscal Year 2026 NIH Budget
At Tuesday’s Senate Appropriations Subcommittee hearing on the NIH’s proposed FY26 budget, Senator Patty Murray and other senators forcefully challenged Dr. Bhattacharya over the drastic $18 billion in proposed cuts. Senator Murray pressed Bhattacharya on the abrupt termination of at least 160 clinical trials and questioned how such cuts will impact HIV research. Bhattacharya acknowledged that fewer clinical trials would be likely under the new budget, though he noted that it will depend on congressional action. Murray pushed back, noting the longstanding US leadership in global HIV research and warning against dismantling scientific partnerships. “We cannot allow politics to compromise science, especially when lives are at stake,” she said.
IMPLICATIONS: Without strong congressional pushback, the future of HIV clinical trials, the NIH vaccine consortia, and broader research infrastructure are at serious risk.
AVAC hosted a conversation, The Scientific Journey of Lenacapavir, reviewing how sustained US investment in NIH basic science and South Africa’s clinical research infrastructure made possible the development of lenacapavir (LEN) for PrEP. Linda-Gail Bekker, Wes Sundquist, and Mitchell Warren highlighted LEN’s long scientific journey, beginning with Sundquist’s HIV capsid research in 1991 to the pivotal PURPOSE clinical trials to today. The field is eagerly anticipating US FDA approval by next Thursday and a WHO recommendations next month. This week’s webinar focused on this moment of promise in HIV prevention and how sweeping attacks on science, research and the very systems that made LEN possible may squander this opportunity to bend the curve of the epidemic.
IMPLICATIONS: The potential of injectable LEN for PrEP is fragile in the midst of an all-out assault on research systems, global partnerships, and public health funding. Cuts to NIH, the dismantling of USAID, the closure of clinical trials, and the termination of HIV vaccine consortia put decades of progress and a pipeline of potential next generation products, at risk. As Bekker warned, “We are losing expertise the world can’t afford to lose.” The message was clear: we must act now to protect what made LEN possible and ensure a future pipeline of prevention.
A new AVAC report examines key insights from the rollout of oral PrEP and early introduction of injectable cabotegravir (CAB) and the dapivirine vaginal ring (DVR) to inform a faster, smarter and more equitable introduction of future HIV prevention tools, including long-acting injectable PrEP, such as lenacapavir.
Fight for Firewalls: HIV and Health Data Privacy, in the Snowballing Surveillance State
This webinar will explore the urgent risks to health data privacy, particularly for people living with HIV, in the context of rising surveillance and criminalization of healthcare.
AVAC Condemns Removal of the Advisory Committee on Immunization Practices
AVAC strongly condemns Secretary of Health and Human Services, Robert F. Kennedy, Jr., for removing all members of the Advisory Committee on Immunization Practices (ACIP). This committee of vaccine experts—with decades of experience in vaccine development, delivery and safety—is responsible for developing the country’s vaccine policies and recommendations for the Centers for Disease Control and Prevention (CDC). At a time when science is under political attack and vital programs are being defunded, AVAC stands with researchers, advocates, and communities calling for Congress to defend public health and unbiased science, which is essential to safeguarding the health of all Americans. The Secretary’s actions attack the integrity of ACIP membership and is a direct threat to public trust in our health systems and in the essential role of vaccines in disease prevention.
“Vaccines remain among the most powerful public health tools ever developed,” said Mitchell Warren, executive director of AVAC. “Vaccines have transformed the global response to infectious diseases, from smallpox to measles to COVID-19, and they are central to the vision of ending the HIV epidemic. At a moment when the US should be investing more in vaccine science, access, and public confidence, it is investing less and simultaneously undermining vaccines generally. Secretary Kennedy’s short-sighted and unceremonious removal of all ACIP members is an alarming escalation in this administration’s campaign to dismantle evidence-based health policy, science and research.”
ACIP’s long-standing commitment to base vaccine recommendations purely on the evidence represents the highest standards of ethical guidance to protect human health. The Secretary’s decision undermines not just US vaccine strategy, but global confidence in immunization programs and guidance that have long relied on US leadership. In addition, Kennedy appointed a new panel of members yesterday, many of whom have shared publicly their anti-vaccine views, with limited experience in vaccine policy or public health. This new panel could take actions that turn this trusted scientific body into a platform for mis- and dis-information and anti-vaccine policies.
The destruction of ACIP adds to the five-month litany of assaults on vaccines and the systems that support them. From proposed cuts to the Fiscal Year 2026 budget, to the defunding for global vaccine access programs like Gavi and domestic immunization initiatives at the US CDC, to the undermining of the essential role of measles vaccines, the closure of the leading NIH-funded HIV vaccine consortia (CHAVD), to the dismantling of USAID’s HIV vaccine R&D programs and the recommendation to remove COVID-19 vaccines from the US immunization schedule for children and pregnant women, this administration has worked to subvert the importance and impact of life-saving vaccines and erode public trust for vaccine science.
Vaccines work. Human papillomavirus (HPV) is responsible for 99% of cervical cancers. The HPV vaccine prevents over 90% of cancers caused by HPV, including anal, cervical, penile, throat, vaginal, and vulvar globally, and if more widely available, could prevent hundreds of thousands of annual deaths, according to the WHO. Similarly, hepatitis B (HBV) accounts for 1.1 million deaths globally, and yet the HBV vaccine prevents as many deaths every year, according to WHO. Furthermore, without a vaccine review panel, rollout of anticipated vaccines that protect against gonorrhea, could make access difficult for many Americans when drug resistant gonorrhea is on the rise globally.
“We are witnessing other countries eliminate cervical cancer through robust HPV vaccination and screening programs while the US risks reversing decades of progress,” says Alison Footman, AVAC’s senior program manager of STIs. “The ACIP plays a critical role in ensuring vaccines, including those that prevent STIs like HPV and hepatitis B, are accessible, and recommendations are guided by expert opinions. Now more than ever, we must protect the integrity of public health systems that save lives and prevent diseases.”
As public confidence in vaccines erodes, the value of vaccine science is paramount, representing one of the single greatest advances in the history of medical science, eradicating once life-threatening infections and mitigating the risk of illness from numerous diseases. In the field of HIV, the search for an effective vaccine is advancing thanks to decades of investment in basic science, clinical research, and global partnerships. This progress must be protected and accelerated. A vaccine would provide a durable, scalable form of HIV prevention that does not rely on frequent adherence or health system access, and it would be especially transformative for communities most marginalized by current systems.
AVAC calls on Congress, scientists, and civil society to speak out and stand up for science, for vaccines, and for the future of global and public health.
AVAC conducted in-depth interviews with policymakers, program implementers, and advocates in seven countries (Brazil, Kenya, Nigeria, South Africa, Vietnam, Zambia, and Zimbabwe) to understand how policy, procurement, service delivery, and community engagement have shaped the uptake of oral PrEP and the introduction on DVR and CAB. The findings offer critical insights into what must change, what must be sustained, and what must be built to ensure new HIV prevention options are rolled out with speed, scale and equity.
This analysis comes at a pivotal moment as the US Administration is actively working to dismantle HIV research and demolish the architecture of global health. The entire HIV response from basic research and clinical development to policy, programs, and global access to life-saving treatment and prevention is now under attack. All this as the field reaches a moment of historic promise in HIV prevention, with initial regulatory approval of LEN for PrEP from the US Food and Drug Administration expected by next Thursday, June 19. This report lays out what’s needed at this critical time to get HIV prevention into the hands of those that need it most.
At a time of extraordinary promise, and great political uncertainty, we hope you will join other advocates, implementers, and policymakers during this webinar and together chart the way forward.
Global Health Watch: Dismantling Decades of Progress, FY26 Proposed Budget and Rescissions Package and More
Issue 19
This week brought more devastating actions from the US administration, with serious consequences for global health. From a proposed rescissions package of the current year’s funding to deep cuts in the proposed Fiscal Year 2026 budget, the end of funding to the leading NIH-funded vaccine consortia, to proposed reductions to the Global Fund match and new immigration restrictions, the threats to health, science, global partnerships, research progress, and health equity are here. Read on.
The US’ Proposed FY26 Budget and Rescissions Package Could Dismantle Decades of Progress
On Friday, the Administration released more details on the proposed Fiscal Year 2026 (FY26) US budget that was sent to Congress to inform their drafting of the final budget. As we’ve said many times over the past four months, Congress has the Constitutional power of the purse – not the President. The proposed budget slashes PEPFAR by 34% and NIH funding by 36%, for a combined total of over $5.5 billion. It further targets the Global Division of HIV and Tuberculosis (DGHT) at the US Centers for Disease Control and Prevention (CDC) by eliminating it along with other global health programming at the agency, ends funding for Gavi’s global vaccine procurement, and more.
A subsequent proposed $9.4 billion rescissions package of Fiscal Year 2025 funds that were already Congressionally appropriated but not spent was shared by the President on Tuesday. This package would eliminate over $900 million from global health programs, with OMB Director Vought refusing to rule out rescission cuts to PEPFAR. This package also seeks Congressional approval to codify, or make legal, the unlawful dismantling of USAID, which was initiated through presidential executive order and the reckless actions of DOGE. The House is expected to vote on this package soon.
IMPLICATIONS: Budgets are not just about money; they clarify priorities and policies. The proposed FY26 budget and rescissions package have far and deep implications for health, science, and research in the US and around the world. They would dismantle the architecture for global health, including health programs and research that have broad bipartisan Congressional and public support, and which support the government’s stated aim of keeping Americans and the world safer, healthier and more prosperous.
NIAID’s Consortia for HIV/AIDS Vaccine Development (CHAVD) Will Not Be Renewed
On Friday, news came that the National Institute of Allergy and Infectious Diseases (NIAID) will not renew funding for the Consortia for HIV/AIDS Vaccine Development (CHAVD) when they expire next June. Founded in 2005, the CHAVD programs – based at Duke University and Scripps Research Institute – have been instrumental to advancing HIV vaccine research and development, contributing to progress toward an HIV vaccine and other scientific innovations.
IMPLICATIONS: The shutdown of CHAVD and broader NIH pullback from vaccine research, along with the constrains on funding for the Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections (ACTG), the HIV Prevention Trials Network, the HIV Vaccine Trials Network and the Adolescent Medicine Trials Network for HIV/AIDS Intervention, represent a massive – and destructive – shift in research funding. These actions squander a decades-long investment in the search for a preventive HIV vaccine, just as these efforts are gaining momentum.
In the US State Department’s justification of the President’s proposed FY26 budget, Secretary of State Marco Rubio notes that “should the Administration decide to provide contributions to the Global Fund in FY26, it would ensure the United States is only contributing its fair share by leveraging $1 from the United States for every $4 from other donors, instead of the current $1:$2 matching pledge.”
Under the Global Fund match requirement, the US contribution can only be unlocked after other donors deliver on the pledges they have made. This requirement leverages American generosity to get other donors to step up.
IMPLICATIONS: If the US Government changes the Global Fund match requirement from 1:2 to 1:4, according to Friends of the Global Fight, this would reduce the leverage power of the US contribution to the Global Fund, lower overall funding to fight AIDS, TB and malaria, slow down progress on transition to country self-reliance and limit the influence of the US in Global Fund decision-making.
President Announces Restrictions and Suspensions of Foreign Nationals from 19 Countries
The President issued a new immigration proclamation restricting or fully suspending entry into the United States for foreign nationals from 19 countries, including Afghanistan, Burma, Chad, Republic of the Congo, Equatorial Guinea, Eritrea, Haiti, Iran, Libya, Somalia, Sudan, and Yemen, while partial restrictions apply to Burundi, Cuba, Laos, Sierra Leone, Togo, Turkmenistan, and Venezuela.
IMPLICATIONS: In conjunction with the cancellation of US funding for research and partnerships with foreign partners, and US withdrawal from multilateral institutions, these new restrictions, which are framed under national security, will have significant implications for global health partnerships, research collaborations, and the ability of researchers, policymakers, clinicians, advocates and others to participate in collaborative work. They also signal an era of isolation, where partnerships, diplomacy, trust-building and global health take a backseat to grandstanding, isolationist politics.
The Gavi Board of Directors appointed Mark Kevin Lloyd, who was nominated by the new US Administration as its newest member. Lloyd is assistant to the administrator for global health at the US Agency for International Development (USAID), overseeing global health and conflict prevention. He takes Atul Gawande’s seat, which is typically held for a US government representative. Historically, five seats on the Gavi board have been held by representatives from donor countries.
Gavi is in its replenishment cycle and will hold a pledging summit later this month. In 2023, the Biden administration committed at least $1.58 billion toward the new cycle. Annual congressional appropriations are required to fulfill the pledge.
IMPLICATIONS: With Gavi’s funding zeroed out in the Administration’s FY26 budget request, it’s uncertain what this new appointment signals for US engagement with Gavi going forward.
Webinar: The Scientific Journey of Lenacapavir: From basic science to clinical development to impact
Join us on Wednesday, June 11 at 11am ET
Learn how sustained US support from NIH discovery science to South Africa’s clinical research infrastructure made the development of LEN for PrEP possible.
Speakers include:
Wes Sundquist (University of Utah), on the early-stage science behind capsid inhibitors.
Linda-Gail Bekker (Desmond Tutu HIV Foundation), on the PURPOSE 1 trial in South Africa, where not a single HIV infection occurred.
AVAC Denounces White House Effort to Codify DOGE Cuts to Health, Research and Foreign Assistance
AVAC denounces recent proposals and actions by the US administration that signal a clear intention to defund and eliminate lifesaving global health research, development and delivery programs. If passed by Congress, proposed funding rescissions for the current year’s budget would claw back billions of Congressionally appropriated dollars for critical, life-saving programs. In addition, the President’s Fiscal Year 2026 (FY26) budget proposal would further cut funding and entrench a wide range of anti-science and anti-public health policies, many of which undermine the rights of communities vulnerable to HIV. AVAC urgently calls on Congress to step-up in bi-partisan support that aligns the US federal budget with evidence and delivers impact.
“These actions are doing irreparable harm to health research and programs that form the backbone of global efforts to end HIV,” said Mitchell Warren, AVAC’s executive director. “This is not just a budget proposal; this is a shortsighted and reckless policy roadmap that provides further proof that this administration has no regard for science, research, or public health. Every day of unchecked executive overreach unravels decades of progress. Congress must fulfill its duties and intervene to protect policies and programs that have made Americans and the world safer, healthier and more prosperous.”
Released in May as a “skinny” version, the President’s full FY26 budget proposal would dismantle the architecture for global health, including programs and research with historically broad bipartisan Congressional and public support. The FY26 budget proposes slashing PEPFAR by 34% and National Institute of Allergy and Infectious Diseases (NIAID) funding by 36%, for a combined total of over $5.5 billion in cuts – potentially crippling HIV programs and research. The FY26 budget further targets the Global Division of HIV and Tuberculosis (DGHT) at the US Centers for Disease Control and Prevention (CDC) by eliminating it along with other global health programming at the agency. PEPFAR is severely weakened without the partnership of CDC’s global health division and USAID, which bring vast expertise and technical assistance in the implementation of programs at the country-level.
Additionally, the proposed rescissions package would eliminate over $900 million from FY25 global health programs. The rescissions package would cancel not-yet-spent funds, and the administration has not excluded PEPFAR from these further reductions. If passed by Congress, it would codify, or make legal, the unlawful dismantling of USAID, which was initiated through presidential executive overreach and reckless actions by DOGE across federal agencies. Just as important, harmful, ideological rhetoric across FY26 budget documents and the rescissions package attempt to justify targeted cuts to services for the LGBTQI+ community, family planning and reproductive health. Such policies are antithetical to a rights-based public health approach to meeting critical needs among communities who are the most marginalized and vulnerable to HIV and other diseases.
These actions by the administration also come on the heels of last week’s announcement of the elimination of NIH funding for the Consortia on HIV/AIDS Vaccine Development (CHAVD). Founded in 2005, the CHAVD programs – based at Duke University and Scripps Research Institute – have been instrumental to advancing HIV vaccine research and development, contributing to progress toward an HIV vaccine and other scientific innovations.
“A shuttered CHAVD imperils the ongoing quest for an HIV vaccine and sidelines scientific discovery at large, leaving some of the most accomplished scientists in the world without the federal resources needed to continue vital research,” said Stacey Hannah, director of Research Engagement at AVAC. “Americans need to be reminded that vaccines are one of, if not the most cost-effective, impactful health interventions. The CHAVD cuts represent an attack on fundamental science that protects the well-being of all and boosts prosperity in our country and the world.”
These actions are part of a broader anti-science agenda from this administration, which has already taken steps to severely constrain the work of the HIV Prevention Trials Network, the HIV Vaccine Trials Network, the Adolescent Medicine Trials Network for HIV/AIDS Intervention, and the Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections (ACTG).
“In a cruel irony, these combined cuts come just as the field reaches a moment of historic promise in HIV prevention,” said John Meade, senior program manager for Policy Advocacy at AVAC. “Later this month, the US FDA is expected to approve lenacapavir (LEN) as a twice-yearly injectable form of PrEP. This product represents the culmination of decades of investment in all stages of scientific innovation, including basic science and global research infrastructure, especially in South Africa. Without NIH investments over the past two decades, the world would not be on the cusp of approval and introduction of LEN for PrEP.”
AVAC calls on Congress to exercise its power of the purse under the Constitution by rejecting the President’s proposed cuts to global health, research, development and science. Congress must maintain this critical funding, which makes the world safer, healthier, and more prosperous. Congress should also immediately reject the rescissions package in its vote expected next week and do all it can to restore funding for HIV research and programming across the federal government.
The field must urgently make the case for sustained investment. Everyone concerned about the devastating effects of ongoing and threatened cuts should reach out to their Senators and Congresspeople immediately. Call the Capitol switchboard at (202) 224-3121, or reach out to your Senators online and Representatives directly.
