This week the proposed US Fiscal Year 2026 budget was released by the White House and would slash funding across the entire federal government, gutting the National Institutes of Health (NIH) and other agencies in the Department of Health and Human Services, and further reduce foreign assistance. In addition, a hostile critic of the US Food and Drug Administration (FDA) is appointed to lead its Center for Biologics Evaluation and Research, which oversees vaccines amongst other things. Also, the UN is looking at significant cost-cutting, with UNAIDS looking to shed more than half its staff, along with reports of possibly folding it into WHO. Read on for more. 

Join us later today for Science in the Crosshairs: Research Advocacy in a Time of Crisis, a webinar unpacking what these changes mean for communities, research, and advocacy, and how we can fight back.

FY26 Proposed Budget and Implications for Research and Global Health

The US presidential administration proposed a Fiscal Year 2026 (FY26) “skinny budget” that would drastically cut global health, HIV prevention, and biomedical research. While only a topline framework submitted to Congress (since Congress has the actual “power of the purse”), the budget proposes $163 billion in cuts to non-defense discretionary spending, including a 26% reduction to the Department of Health and Human Services (HHS), the department that oversees the US National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and FDA. The proposed budget would cut the NIH by nearly $18 billion, continue to gut USAID’s global health work, and eliminate research and programs on gender, DEI, and climate.  

IMPLICATIONS: This proposed skinny budget is an effort to embed into the formal budget process the cuts made by recent Executive Orders, which are being currently challenged in multiple court cases. If this proposed skinny budget is approved by Congress and becomes law, it would further decimate the infrastructure needed to accelerate science and innovation, hamper delivery of HIV prevention, stall progress on new tools like injectable PrEP, and weaken global preparedness for future pandemics. This is a profound retreat from science and equity.  

FIGHT BACK: Join us later today for a critical conversation, Science in the Crosshairs: Research Advocacy in a Time of Crisis where we will discuss the escalating threats to health research and equity-centered science. This webinar will explore the implications of the proposed FY26 budget and what these attacks mean for communities, researchers, and implementers, and will identify actionable advocacy strategies to fight back. 

READ:  

• Trump budget proposes unprecedented, ‘reckless’ cuts to foreign aid—Devex  
• Trump’s Reagan Moment on HIV/AIDS — Ratevosian Substack

Secretary of Health and Human Services will appear before Senate HELP Committee  

Secretary of HHS, Robert F. Kennedy Jr., will appear before the US Senate Health, Education, Labor, and Pensions (HELP) Committee on May 14 to discuss the FY26 budget proposal for the Department of Health and Human Services. 

AVAC and more than a dozen partners submitted a letter to the Senate HELP Committee for the record urging lawmakers to reject the cuts to NIH funding for HIV, TB, and STI research and highlighting the impact of these cuts on lifesaving innovation and research infrastructure. 

READ/WATCH:  

• Hearing on Fiscal Year 2026 Department of Health and Human Services Budget—Senate Help Committee 
• US Health Secretary Kennedy to testify before Senate panel May 14—Reuters

Potential Merger of UNAIDS and WHO

A confidential memo from the UN80 Initiative Task Force outlines proposals to restructure the UN system in response to budget pressures. This includes a potential merger of UNAIDS into the World Health Organization (WHO). The proposal frames this merger as a strategy to create a more “unified and efficient global health authority,” as UNAIDS faces deep financial uncertainty following the loss of US funding. In addition this week, UNAIDS announced that it will layoff more than 50% of staff in a massive restructuring. UNAIDS now plans to reduce the current number of staff from 608 to approximately 280 over time, according to a communique from the UNAIDS cabinet, seen by Devex. 

IMPLICATIONS: The merger would fundamentally reshape global HIV governance. It could shift the focus from civil society and multi-stakeholder advocacy and community leadership of UNAIDS to a more technocratic, health-systems-oriented approach under WHO. Such a move risks sidelining civil society voices and undermining the rights-based, equity-driven response that has been central to HIV progress for decades. 

READ:  

• Exclusive: Full Text of UN80 Task Force Pitch for Streamlined UN; UNAIDs Merger with WHO—Health Policy Watch 
• UNAIDS will lose more than 50% of staff in restructuring—Devex

Vinay Prasad to Lead US FDA Center for Biologics Evaluation and Research

Dr. Vinay Prasad, an oncologist and professor at the University of California, San Francisco, was appointed as the director of the US Food and Drug Administration’s (FDA) Center for Biologics Evaluation and Research (CBER). CBER oversees the regulation of vaccines, gene therapies, and other biologic products.  

IMPLICATIONS: Prasad has been critical of expedited reviews for vaccines and other biologics in the past. His appointment could slow approval of new innovations and shift the agency toward more ideologically conservative regulatory standards.  

READ:  

• Vinay Prasad tapped to run FDA center that regulates vaccines, gene therapies—STAT  
• FDA Commissioner Marty Makary taps Vinay Prasad to head up CBER—Fierce Pharma

New Plaintiff Joins AVAC vs. Department of State Lawsuit 

A new plaintiff, The Center for Victims of Torture, has joined AVAC’s lawsuit challenging the US government’s foreign aid freeze. Their inclusion underscores the urgent harm being caused to organizations as funding remains delayed or denied. Since April 23, the government has processed 59 payments for work completed before February 13. Seventy-nine payments remain outstanding. The government says these are more complex and is targeting May 15 as a deadline completion. They also note receiving 47 new payment requests from plaintiffs recently. 

READ: Center for Victims of Torture Joins Lawsuit Challenging Halt to Foreign Aid Funding—Center for Victims of Torture

What We’re Reading & Watching

• Inside the Bloodbath at the NIH—The Nation
• Trump’s NIH Axed Research Grants Even After a Judge Blocked the Cuts, Internal Records Show—ProPublica
• USAID Cuts Could Sever HPV Prevention—Think Global Health
• Borders on the Insane: New NIH policy on funding foreign scientists stirs outrage—Science  
• New NIH Foreign Subaward Structure Enhances Integrity, Accountability, Oversight, and National Security of NIH Funded Research—NIH
• HIV Testing and Outreach Falter as Trump Funding Cuts Sweep the South—KFF
• Europe Makes a Pitch to Attract Scientists Shunned by the US—The New York Times 
• The Road to Lenacapavir, a Breakthrough HIV Treatment—AAAS
• My New Deadline: 20 years to give away virtually all my wealth—The Bill & Melinda Gates Foundation
• Gender-Based Violence in Kenya and U.S. Foreign Aid—Think Global Health
• Surviving on Hope: Sex workers face HIV resurgence as ARVs, condoms vanish—Daily Nation (Kenya)
• In Historic First, the Global Fund Procures African-Made First-Line HIV Treatment—The Global Fund

Resources

• PxWire Volume 15, Issue 2—AVAC
• Worldwide Prevention, Shared Protection: Why STI Funding Matters—AVAC
• Politics and Global Health: The Need for a New, Resilient Architecture—AVAC
• Research Matters—AVAC, HIVMA, TAG
• The Trump Administration’s Foreign Aid Review: Status of PEPFAR—KFF  
• Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do—KFF
• Tracking the Freeze: Real-Time Impact on Key Populations—GBGMC
• The Best Investment You Didn’t Know You Made: How NIH Funding Fuels Innovation and Economic Growth—amfAR

In Case You Missed It

Long-time partner AND fierce advocate, Yvette Raphael, is being recognized as part of the AAAS Mani L. Bhaumik Breakthrough of the Year Award for lenacapavir.

Thanks to Yvette, the African Women Prevention Community Accountability Board and so many others, lenacapavir is now a real option for HIV prevention. Now we must translate this breakthrough and this award into action.

Learn more.

The threats and actions to decimate US biomedical research and global health continued this week as the world marked 100 days of the new administration. A proposed $9.3 billion rescission package would codify unprecedented cuts to NIH, USAID, and global health programs. At the same time, a draft NIH policy may halt funding for research outside the US threatening thousands of global collaborations.

As AVAC and partners push back—including at Wednesday’s Senate Appropriations Committee—this moment demands urgent advocacy to protect lives, science, and global stability. Read on for the latest, including new resources and opportunities for defending research, and watch and listen to a powerful new podcast, featuring AVAC’s Mitchell Warren on what it will take to rebuild prevention and global health leadership.

Rescission Package Looms

The US presidential administration is preparing to send Congress a rescission bill that seeks congressional approval to cancel $9.3 billion in already-appropriated funds, including massive cuts to the NIH, the State Department, and USAID. The bill would make recent cuts official—taking back congressionally approved government funding. (The process of “recission” in the US budget process is described in more detail here.) The impact would further dismantle critical programs, including support for HIV treatment and prevention, and vaccine delivery.  

Separately, leaked budget documents show plans by the administration to slash NIH’s FY2026 budget by more than 40%, consolidate or eliminate several institutes, and permanently eliminate grants tied to equity and transgender care. It was reported on Thursday that the President will release the full budget on Friday. At a Senate Appropriations Committee hearing this week (see below), Committee Chair Susan Collins, a Republican, called the proposed cuts “very troubling” and warned they would undermine US global leadership in biomedical research.

READ:  

• NIH under siege—Science  
• Collins says Trump’s research cuts ‘must be reversed’—Politico  
• Trump’s Rescissions Would Complete the Decimation of U.S. Global Health Leadership—Public Citizen

Research Matters: Senate Appropriations Committee and NIH Funding

At this week’s Senate Appropriations Committee hearing, Biomedical Research: Keeping America’s Edge in Innovation, lawmakers and witnesses, including the Chief Executive Officer of American Association for the Advancement of Science (AAAS) and Executive Publisher of, Science, Sudip Parikh, pushed back against the threats of further cuts and warned of the devastation of NIH cuts on US scientific leadership, health equity, and economic competitiveness. Democratic Senator Patty Murray, Vice-Chair of the Committee, stressed that slashing funding undermines efforts to develop cures, vaccines, and breakthrough therapies. AVAC and the Federal AIDS Policy Partnership (FAPP) Research Working Group submitted a written statement to the Committee, urging Congress to reject future funding cuts to the NIH and recognize the importance and impact investments in biomedical research have had on lives and livelihoods.

READ:  

• Collins and fellow GOP senators speak out in opposition to Trump’s cuts to biomedical research—STAT  
• Research Matters – Resources to Protect Research Funding—AVAC  
• Written Statement: US Senate Hearing on Biomedical Research—AVAC and FAPP 

WATCH: 

• Biomedical Research: Keeping America’s Edge in Innovation—Senate Appropriations Committee hearing

NIH Poised to Halt Foreign Research Funding

Internal memos suggest a new policy is expected from the NIH, which would suspend funding for research outside the US. Some NIH staffers have indicated that they have been instructed to pause funds on both new and renewing grants that include research outside the US. The policy could apply to all international collaborations—not just those in “countries of concern”, like China and North Korea—and would impact a wide range of research. According to an exclusive story in Nature, it is unclear when the policy would take effect, and whether it would apply to all research funds to non-US institutions or only ‘subawards’. In 2023, about 15% of NIH grants included foreign partners.

IMPLICATIONS:  

Former NIH Director Francis Collins warns the policy could have “tragic consequences,” given the shutdown of USAID and deep NIH budget cuts. Epidemics and diseases like HIV, TB and malaria require global data and partnerships. This new policy would decimate the US’ ability to conduct or support clinical trials and data collection in the countries and communities who need support the most. This would be a stark retreat from decades of US leadership in global science—and could cost millions of lives.

READ:  

• Exclusive: NIH to suspend funds for research abroad as it overhauls policy—Nature

What We’re Reading & Watching

• WATCH: Resilience and Realignment: Preventing Global Infectious Disease with AVAC’s Mitchell Warren—A Shot in the Arm
• Trump blew up the global fight against AIDS. Can it recover?—Nature
• The end of AIDS is in sight: don’t abandon PEPFAR now—Nature (editorial)
• Will US science survive Trump 2.0?—Nature
• How Trump’s HHS Cuts Are Another Attack On Trans People—Huffington Post
• Scientific Integrity Under Threat: The Role of the IDSA, PIDS, and SHEA Journals in an Evolving Political Landscape—Clinical Infectious Diseases
• How public health has been upended in Trump’s first 100 days—Washington Post
• RFK Jr.’s HHS Orders Lab Studying Deadly Infectious Diseases to Stop Research—Wired
• Bribes and Rationing of AIDS Medicine in Zimbabwe as Trump’s Aid Cuts Bite—Health Policy Watch
• How this Limpopo NGO prepared itself for Trump funding cuts—Bhekisisa
• Three ways to help the developing world survive the end of aid—The Guardian (opinion)
• Supreme Court Heard Arguments on Preventive Health Care Coverage. How’d It Go?—POZ
• KFF Health Tracking Poll April 2025: Public’s View on Major Cuts to Federal Health Agencies—KFF
• The Gates Foundation Grapples With the Age of Donald Trump—The New York Times

Resources

• Politics and Global Health: The Need for a New, Resilient Architecture—AVAC
• Research Matters—AVAC, HIVMA, TAG
• The Trump Administration’s Foreign Aid Review: Status of PEPFAR—KFF
• Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do—KFF
• Tracking the Freeze: Real-Time Impact on Key Populations—GBGMC
• The Best Investment You Didn’t Know You Made: How NIH Funding Fuels Innovation and Economic Growth—amfAR

This week saw a significant reorganization of the State Department and a delay in the foreign assistance “review process”. There were also new threats to PrEP programs, critical HIV services and health systems, and research in South Africa. Read on for key developments, implications, and resources for action.

Department of State Overhauled

The US administration initiated a significant reorganization of the US State Department, aiming to consolidate its 28 divisions into 15. This restructuring is part of a broader effort to streamline operations and reduce redundancy within the department. The plan situates the Bureau of Global Health Security and Diplomacy Office, which includes PEPFAR, under the undersecretary of State for economic growth and environment. This goes against the 2003 law that created PEPFAR, which placed PEPFAR and its Ambassador reporting directly to the Secretary of State.

​At the same time, the new Department of Government Efficiency (DOGE) implemented a “Defend the Spend” initiative, which imposes stringent new protocols on disbursing federal healthcare grants. The policy requires detailed justifications for each payment, effectively delaying or halting funding for programs such as salaries for healthcare workers at federal health centers. ​ 

IMPLICATIONS: The reorganization and funding constraints could affect the delivery of essential services, including those related to HIV prevention and treatment, both domestically and internationally and continue to raise concerns about potential disruptions to critical health services and the overall impact on public health infrastructure. And removing PEPFAR from the direct line to the Secretary of State potentially diminishes the program’s authority and visibility. 

READ:  

• Rubio unveils sweeping reorganization of State Department—Washington Post 
• How does butchering the State Department ‘make America great’?—The Hill 
• DOGE begins to freeze health-care payments for extra review—Washington Post 
• Rubio Downgrades PEPFAR in Proposed State Department Reorganization—Politico Pro

Foreign Aid Review Extended

The administration extended its supposed “foreign aid review” by an additional 30 days, pushing the conclusion to May 20. This follows the initial 90-day pause initiated by executive orders said to be assessing the alignment of US foreign assistance with the administration’s “America First” policy. An internal State Department email from Jeremy Lewin, the newly appointed Director of Foreign Assistance, indicated that the additional time would be used for further bureau feedback and to align recommendations with the upcoming budget proposal.​ 

IMPLICATIONS: This extension continues amid continued uncertainty around HIV and global health programs. Organizations reliant on this funding remain in limbo, hindering their ability to plan and deliver essential programs and services. The extension also raises concerns about the potential for further cuts or restructuring of foreign assistance. 

READ:  

• Trump administration extends foreign aid review for another 30 days—Devex

Federal Workers to be Reclassified (“Schedule F”) to Remove Their Protections

Approximately 50,000 federal employees will be reclassified under “Schedule F,” a designation that would strip them of longstanding civil service protections and render them “at-will” employees. These actions target career staff in policy-influencing roles across agencies like the Department of Health and Human Services (HHS), aligning with the administration’s broader agenda to reshape the federal workforce and consolidate executive control.  

IMPLICATIONS: This reclassification could undermine the nonpartisan expertise essential for effective governance, particularly in areas like health research and service delivery. The potential impact on global health initiatives is significant, as the loss of experienced personnel could disrupt programs critical to HIV prevention and pandemic preparedness. 

READ:  

• Thousands of federal workers would be easier to fire under Trump rule change—NPR  
• Trump imposes Schedule F to more easily remove federal workers—Fierce Healthcare

South Africa HIV Gains at Risk

Many news outlets and advocates this week are calling attention to South Africa’s HIV response, which is in crisis as the US funding freeze takes effect. Francois Venter argues in an opinion piece that key HIV services are collapsing, including community outreach, PrEP access, and clinic operations, leaving thousands without care. A pre-print journal article, The cost of the plunge, estimates that the termination of PEPFAR-supported services could result in over 13,000 additional deaths and more than 25,000 new infections each year in South Africa. The South African government’s response has been criticized for its lack of coordination and contingency planning, with civil society advocates calling for urgent action, increased transparency, and new domestic investments to prevent the collapse of two decades of progress against HIV.  

READ: 

• Our HIV programme is collapsing — and our government is nowhere to be seen—GroundUp   
• The cost of the plunge: The impact and cost of a cessation of PEPFAR-supported services in South Africa—medRxiv  
• Inside government’s confused response to the US funding crisis—Spotlight  

NIH Pauses HIV Research in South Africa

The US National Institutes of Health (NIH) has restricted research programs in South Africa from enrolling new participants in its major HIV clinical trial networks. South Africa is a leader in trial participation and lab analysis, has been a critical partner in advancing HIV prevention and treatment strategies and has one of the world’s largest HIV epidemics. Experts, including Glenda Gray of the South African Medical Research Council, warn that this action is “petty and punitive,” especially given South Africa’s longstanding contributions to US and global HIV guidance. 

IMPLICATIONS: This NIH decision, coupled with foreign aid cuts and the dismantling of USAID, risks sidelining one of the most capable research partners in the HIV field. It could slow progress in biomedical innovation, disrupt current trial pipelines, and further erode trust in US global health partnerships—at a moment when scientific collaboration and inclusive research are more critical than ever. 

READ:  

• NIH halts more collaborations with South Africa on HIV/AIDS trials—Science 
• We do the sums: The NIH funds $350-million (R6.65-billion) of research in SA—Bhekisisa

PrEP and Prevention at Risk in the US 

In the US, arguments just began in the Supreme Court on the Kennedy v. Braidwood Management case, which is challenging the Affordable Care Act’s (ACA) mandate that requires insurers to cover certain preventive services, including PrEP, at no cost. The case is brought by fundamentalist Christian business owners who oppose no-cost PrEP on religious grounds.  

IMPLICATIONS: If the Court strikes down the mandate, insurers may no longer be required to fully cover services recommended since 2010, including new long-acting PrEP options. This could severely limit access, raise out-of-pocket costs, and threaten hard-won public health gains in HIV prevention and beyond. 

READ:  

• What to know about the Supreme Court case that could take away your access to PrEP and other care—The Advocate  
• Use of No-Cost Preventive Services Jeopardized by Kennedy v Braidwood—JAMA

What We’re Reading

• After U.S. decimates PEPFAR and USAID, the struggle to save HIV services at one nonprofit in southeastern Africa—Positively Aware
• Researcher of 1918 flu virus takes over NIAID—Science
• New NIH director defends grant cuts as part of shift to support MAHA vision—Science
• Trump-Allied Prosecutor Sends Letters to Medical Journals Alleging Bias—The New York Times
• The U.S. needs an alternative organization to protect vaccine guidance from political interference—STAT
• Experts Say Abrupt and “Staggering” CDC Cuts Will Cost Lives—JAMA
• African leaders are rising to challenge of aid cuts, but debt holds them back—LinkedIn
• Fighting for funds: A new era of HIV activism—Bhekisisa
• More Than 220 Academic Leaders Condemn Trump ‘Overreach’—The New York Times
• NEJM Perspective: An HIV Vaccine in the Era of Twice-Yearly Lenacapavir for PrEP — Essential or Irrelevant?—NEJM
• Former Trump official warns president he’s at risk of ruining his legacy on ending HIV – STAT
• In a reversal, the Trump administration restores funding for women’s health study – NPR

Resources

• The Trump Administration’s Foreign Aid Review: Status of PEPFAR—KFF
• Analysis of USAID’s Active and Terminated Awards List: How Many Are Global Health?—KFF
• Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do—KFF
• Our Health ROI
• Tracking the Freeze: Real-Time Impact on Key Populations—GBGMC
• The Best Investment You Didn’t Know You Made: How NIH Funding Fuels Innovation and Economic Growth—amfAR

Just three months since the US presidential inauguration, and still more developments affecting the future of HIV prevention, global health leadership, and pandemic preparedness. From African women leaders demanding action to save HIV prevention, to escalating US foreign aid cuts and the fragile progress of WHO’s Pandemic Agreement, this issue break down what advocates need to know now. Read on.

Foreign Assistance Leadership in Flux

In another chaotic series of developments around foreign assistance, an internal State Department memo reports that Jeremy Lewin—a 28-year-old tech entrepreneur with no prior government or foreign assistance experience—has now been named Acting Director of the State Department’s Office of Foreign Assistance, following a few weeks as the Acting USAID Administrator—all in the wake of Pete Marocco’s brief, but devastating tenure in both positions. Lewin was a key figure in the Department of Government Efficiency (DOGE) and the dismantling of USAID. He is now overseeing what remains of US foreign assistance following USAID’s absorption by the Department of State.

IMPLICATIONS: Lewin’s inexperience and previous role raise serious concerns about the future of US global health and development, especially as so few staff remain with relevant expertise and relationships with governments and implementation partners.

READ:

• DOGE Staffer Takes Over at the State Department’s Office of Foreign Aid—Devex
• Trump Official Who Led Efforts to Dismantle USAID Exits State Department—The Hill

Further Cuts to Foreign Aid

The administration is advancing major efforts to continue cutting US foreign aid and dismantling USAID. A draft Fiscal Year 2026 budget proposes cutting the State Department by nearly 50%—over $30 billion—with foreign aid reduced by up to 75%, including the closure of at least 27 US diplomatic missions, primarily in Africa and Europe. At the same time, the White House is preparing a formal request to Congress to cut $9 billion of previously approved funds. The cuts are aimed at USAID, State Department and public broadcasting programs. A KFF analysis examined the implications of the cuts, and among other assessments, found HIV-related programs are disproportionately impacted.

IMPLICATIONS: If enacted, these cuts would deliver a major blow to US global health and development leadership, severely undermining programs focused on HIV and disease prevention, and further accelerating the administration’s efforts to dismantle USAID. As AVAC’s Mitchell Warren said in Science, “We are in the middle of a massive earthquake. And when buildings fall, we can’t just build back what we had before. We need a whole new global health funding architecture, but we won’t be able to build it fast enough to avoid significant harm.”

READ: 

• White House to Ask Congress to Cut $9B in Funds, Including for NPR, PBS, USAID—The Hill
• Trump Wants to Halve State Dept Budget, Slash Foreign Aid 75%—USA Today
• ‘What’s In’ and ‘What’s Out’ in USAID’s Global Health Programming—Devex
• Analysis of USAID’s Active and Terminated Awards List: How Many Are Global Health?—KFF
• Trump Has Blown a Massive Hole in Global Health Funding—And No One Can Fill It—Science

Restructuring HHS

A leaked HHS budget proposal this week outlines significant cuts to HIV programs in the US, including the elimination of the Ending the HIV/AIDS Epidemic Initiative (which was, ironically, started during President Trump’s first term and delivering results) and the Minority AIDS Initiative. The Ryan White Program under the new proposal would continue but with reduced funding, and the CDC prevention programs, including PrEP, face uncertainty due to consolidation. NIH’s HIV research funding could drop by 40%, jeopardizing progress in the fight against HIV.

READ:

• Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do—KFF
• Internal Budget Document Reveals Extent of Trump’s Proposed Health Cuts—Washington Post
• How Trump 2.0 is Slashing NIH-backed Research — In charts—Nature

WHO Warns of Budget Implications

At a press conference this week, WHO Director-General Tedros Ghebreyesus confirmed that health services in over 100 countries are being “severely disrupted” following the US’s withdrawal from the WHO and drastic cuts to foreign aid. He confirmed that there has been no formal dialogue yet between the new US administration and WHO. In his remarks, Tedros urged governments to protect the poorest and resist cutting public health funding. Moreover, WHO faces a $2.5 billion budget gap, which is forcing drastic downsizing and a massive restructuring of the agency.
 
IMPLICATIONS: In addition to the WHO, the US has also pulled out of pandemic treaty negotiations, citing false claims about sovereignty. This all points to reduced international pandemic preparedness, weakened surveillance systems, reduced access to vaccines, and growing health inequities—particularly in low-income countries most dependent on WHO support.

READ: 

• No Talks Between WHO and US Despite ‘Severe Disruption’ in Health Services Since Trump Slashed Aid—Health Policy Watch
• World Health Organization Reorganization Plan Developed with Boston-based Consultancy—Health Policy Watch

Pandemic Agreement Reached

Just over five years since the COVID-19 pandemic disrupted the world and after several years of negotiating, WHO member states finally reached agreement this week on a draft pandemic treaty that, if ratified, would be a legally binding accord that lays the foundation for future pandemic prevention and response, including real-time sharing of vaccines, treatments, and diagnostics. For three years member states negotiated critical issues, with pressure from civil society to embrace key provisions on equity and intellectual property. Some of those provisions have been addressed in the final text, with the precise language used remaining contentious. The agreement is expected to be adopted at the upcoming World Health Assembly (WHA) meeting in May. However, negotiations on an Annex detailing the new Pathogen Access and Benefit Sharing mechanism will continue with the aim of concluding at next year’s WHA. Sixty countries must adopt the Accord for it to be in full force.
 
IMPLICATIONS: The agreement marks a major step forward for multilateralism and health security—even as the US remains absent from negotiations. Advocates warn that without civil society input and sustained investment, including restored US funding, the agreement’s promise may fall short.

READ:

• Countries Say YES to Pandemic Agreement—Health Policy Watch
• The Pandemic Agreement is Here—Medicines Law & Policy
• MSF Welcomes Progress on Pandemic Agreement Negotiations: A step toward equity in future pandemics and health emergencies—MSF statement

NIH Indirect Costs and University Pushback

The administration’s proposal to cap indirect costs for National Institutes of Health (NIH) research grants at 15% is being challenged with lawsuits by universities and others. This week, several organizations representing research institutions announced efforts to develop alternative models for a streamlined, transparent approach to funding indirect costs that balance efficiency and sustainability. Specific proposals are still under discussion.

READ: Universities Begin Search for Indirect-cost Fix that Might Assuage Trump Administration—STAT

African Women Lead: A Call to Sustain HIV Prevention

The African Women Prevention Community Accountability Board (AWPCAB) issued a statement calling on global health institutions, African governments, donor countries, the private sector, and philanthropies to urgently address critical gaps to ensure a sustainable HIV response. AWPCAB is led by a number of AVAC partners and staff and represents a collective of women and girls committed to advancing HIV prevention.  The statement defines priority actions from local production to domestic financing and more. As they state clearly: “There is no ending AIDS by 2030 without prevention.”
 
READ: AWPCAB Calls for Urgent Action to Safeguard HIV Prevention and Centre Meaningful Community Engagement

What We’re Reading

• How the United States Became a Science Superpower — And How Quickly it Could Crumble—Nature
• NIH Cuts Triggered a Host of Lawsuits: Nature’s guide to what’s next—Nature
• HHS Systems Are in Danger of Collapsing, Workers Say—Wired
• Kennedy’s Deep HHS Cuts Threaten HIV/AIDS Response—The Hill
• At Harvard, Scientists Worry Over the Consequences of Resisting the Trump Administration: $2.2B in grants frozen—STAT
• R2.82-billion. That’s What We Need to Plug the US Funding Gap, For Now—Bhekisisa
• Zimbabwe’s HIV Crisis: US aid cuts leave millions at risk—Be In the Know

Resources

• The USAID List of Terminated Global Health Awards – What Does it Tell Us—KFF
• The Impact of Suspensions and Reductions in Health Official Development Assistance on Health Systems—WHO
• The Status of PEPFAR’s USAID Programming—amfAR
• Tracking the Freeze: Real-Time Impact on Key Populations—GBGMC
• The Impact of Suspensions and Reductions in Health Official Development Assistance on Health Systems—WHO
• The Best Investment You Didn’t Know You Made: How NIH Funding Fuels Innovation and Economic Growth— amfAR
• Quick Take: HIV Research Matters for America—O’Neil Institute and amfAR
• What Do Federal Staffing Cuts and HHS Restructuring Mean for the Nation’s HIV Response?—KFF
• Domestic Funding Contributions to Health: Comparing Changes in Domestic Financing in PEPFAR and Non-PEPFAR Supported Countries—amfAR

This week’s issue covers drastic cuts across the US Department of Health and Human Services (HHS), where a dramatic 20% downsizing effort is underway. On Tuesday, HHS began issuing reduction-in-force (RIF) notices across its agencies, triggering mass layoffs at the US Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and the US Food and Drug Administration (FDA). The ripple effects are vast—gutting HIV prevention, infectious disease research, and vaccine development, while threatening the stability and viability of the workforce that sustains US public health and biomedical research. Read AVAC’s statement on HHS here.  

This issue also covers growing legal, institutional, and global responses to these actions. 

Reduction-in-Force Notification at HHS

Tuesday, HHS began issuing reduction-in-force (RIF) notices across its agencies, with deep cuts at the CDC, NIH, and FDA. This effort is part of a sweeping reorganization announced by HHS Secretary Robert F. Kennedy Jr. last week, which aims to downsize HHS by 20%. Framed as a “painful period”, HHS leadership claim to be refocusing the agencies on rising chronic disease. Read more below for details.  

IMPLICATIONS: The dismissal of 20,000 public servants and leaders across every domain of global health research, policies and programs is absent of any clear plan to sustain life-saving work across these agencies. These ill-informed decisions dismantle the US capacity to advance and regulate science, medicine and health. They risk a resurgence of diseases like HIV and TB, reversing years of scientific advancement and bipartisan federal investment. They also mean the loss of an essential American brain trust in research and development, including the potential of a “chilling effect” in bringing in the next generation of young investigators.

CDC Developments

At the CDC, widespread layoffs have decimated critical divisions, including Reproductive Health, Population Health, and HIV and STD Prevention. Half of the employees at the Division of HIV Prevention received RIF notices. Jonathan Mermin, director of the National Center for HIV, Hepatitis, STD, and Tuberculosis Prevention (NCHSSTP), has been placed on administrative leave, and the Center has been cut, along with the tuberculosis elimination and research branches. The CDC is said to be among the agencies seeing the largest workforce cuts with 2,400 employees to be laid off. 

READ:

• The CDC Has Been Gutted—Wired
• These CDC Teams Were Hardest Hit by Trump’s Mass Layoffs—Medpage Today 

FDA Developments

Peter Marks, who led the FDA’s vaccine and biologics center and played a key role in COVID-19 vaccine approvals dubbed “Operation Warp Speed”, stepped down under duress. His resignation letter, which was made public, warned of dire consequences of the US government’s positioning on vaccines and the proliferation of misinformation, evidenced by the growing measles outbreak in Texas. Following his departure, HHS announced plans to cut about 3,500 full-time FDA positions. The agency stated that the layoffs will not impact drug, device, or food reviewers. The FDA has worked in conjunction with the CDC and the USDA to combat bird flu’s rapid spread. 

READ:  

• New FDA Commissioner Agreed to Oust Top Vaccine Regulator after Private Swearing-in—The New York Times

NIH Developments

Since Monday, directors of five NIH institutes, including NIAID’s Jeanne Marrazzo, and other senior leaders have received RIF notices, been placed on leave or offered reassignment. As the world’s largest funder of biomedical research, decades of NIH investments have driven the discovery and development of therapies and preventive interventions for HIV, tuberculosis, STIs, viral Hepatitis, other infectious and noncommunicable diseases. NIH-funded research contributed to the development of 354 of 356 drugs (99.4%) approved in the US between 2010 and 2019. 

The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN)—created in 2001—revolutionized research by generating data to develop and deliver life-saving HIV and STI interventions for adolescents, an often-excluded group in research. However, the ATN grant was terminated, undermining decades of investment by NIH and American taxpayers to advance healthcare for adolescents. 

An analysis by amfAR shows the cascading economic harm, which will affect all 50 states. “Each year the NIH awards over 60,000 grants that support over 300,000 researchers at more than 2,500 institutions across the US. For every $1 of NIH funding received, a state generates $2.46 on average in increased economic activity.”            

READ:  

• Five NIH institute directors and numerous lab heads ousted in unprecedented shake-up—STAT
• The Best Investment You Didn’t Know You Made: How NIH Funding Fuels Innovation and Economic Growth—amfAR 

Top Researchers Sound Alarm Over Federal Attacks on Science 

Nearly 2,000 top US scientists have signed an open letter condemning the administration’s attacks on science, including funding cuts, censorship, and pressure to alter research. The scientists—all elected members of the National Academies of Sciences (NASEM)—warn that the latest actions threaten both public health and America’s global scientific leadership. They describe a “climate of fear” in research, where scientists self-censor to avoid political backlash. 

READ:  

• Nearly 2,000 Top Researchers Call on Trump Administration to Halt ‘Assault’ on Science—STAT

Crisis and Cuts at WHO

At a global Town Hall meeting of World Health Organization (WHO) staff, Director General Tedros Adhanom Ghebreyesus announced major cost-cutting measures, including staff reductions starting with senior leadership, and a restructuring based on a “prioritization exercise.” WHO is facing a deepening financial crisis, with a $1.9 billion shortfall in its planned $4.2 billion budget for 2026–2027, and an additional $600 million deficit through 2025. The crisis is largely due to the US withdrawal from WHO, it also includes $130 million of obligations owed from 2024 dues.  

READ: 

• Faced with $600M Income Gap, WHO to Scale Back on Work, Staff, Budget—Devex
• WHO Budget Crisis Bigger Than Previously Thought – $2.5 Billion Gap for 2025-2027—Health Policy Watch 

New Lawsuit Challenges NIH Grant Terminations

Scientists and organizations including the ACLU, Center for Science in the Public Interest, Ibis Reproductive Health and Protect Democracy filed a lawsuit against the US administration arguing that the NIH’s rationale of “not supporting agency priorities” is vague, arbitrary, and illegal under the Administrative Procedure Act and the Fifth Amendment’s due process clause. Many canceled grants involved research on topics politically opposed by the administration, such as transgender health, LGBTQ+ issues, and workforce diversity. The lawsuit contends that the terminations violate congressional mandates, undermine scientific progress, and could ultimately endanger public health.  

READ:  

• Lawsuit Aims to Overturn Many NIH Grant Terminations—Science

What We’re Reading

• RFK Jr. Mimics AIDS Denier Thabo Mbeki—The Washington Post (opinion)
• The Quiet Way the NIH Is Stalling Some Research Before It Starts—Chronicle of Higher Education
• HIV Cases More Than Double in Middle East and North Africa—The Telegraph 
• As US Cuts HIV Help, South Africa Turns to Miners, Insurer—Bloomberg Law
• Millions of Women Will Lose Access to Contraception as a Result of Trump Aid Cuts—The New York Times
• Dropping U.S. Biodefenses: Why Cuts to Federal Health Agencies Make Americans Less Safe—Just Security
• Rollout of ‘Miracle’ HIV Prevention Drug is Threatened by Trump Cuts to Global AIDS Relief Program—STAT
• International Scientists Rethink U.S. Conference Attendance—Science

Resources

• Domestic Funding Contributions to Health: Comparing Changes in Domestic Financing in PEPFAR and Non-PEPFAR Supported Countries—amfAR
• Impact of US Funding Cuts on the Global AIDS Response—UNAIDS
• The USAID List of Terminated Global Health Awards – What Does it Tell Us—KFF  
• Impact of PEPFAR Stop Work Orders on PrEP—AVAC