Members of the US Congress reconvened this week following their extended August recess. They now face a looming deadline of the end of the fiscal year on September 30 to avert a government shutdown if they cannot agree to a bipartisan fiscal year 2026 (FY26) federal budget by then. In this context, the FY26 appropriations process, the President’s request for “pocket rescissions” to claw back Congressionally appropriated funds, AVAC’s court case (AVAC v. State Department), and PEPFAR’s reemergence to rollout long-acting PrEP take on heightened urgency.

PEPFAR Reemerges to Support Rollout of LEN for PrEP

The President’s Emergency Plan for AIDS Relief (PEPFAR) and Gilead Sciences yesterday announced plans to procure injectable lenacapavir for PrEP (LEN) in “countries with the largest HIV/AIDS epidemics…with a focus on preventing mother-to-child transmission.” This is not new news, since PEPFAR and the Global Fund had already announced an ambition to reach two million people with LEN in the first three years – and the Global Fund recommitted to the ambition in their July announcement with Gilead. But given the past seven months and PEPFAR’s absence from planning, it is good to see PEPFAR committing to prevention and PrEP again. 

IMPLICATIONS: Yesterday’s announcement at least gets PEPFAR back, but there are still many questions to be answered and critical work to be done to ensure this initiative achieves impact for all populations in need of prevention: which countries and which populations; what volumes and what prices; and how to invest in this important innovation when PEPFAR budgets are being slashed by the Office of Management and Budget (OMB)? But “it’s a step forward from where we’ve been in a fairly paralytic state for the last seven months, and I hope that this breaks the logjam and at least can get prevention back on the agenda,” AVAC’s Mitchell Warren told NPR. 

READ: 

• Why the medical community is thrilled by U.S. support for a ‘breakthrough’ HIV drug—NPR Goats & Soda 
• PEPFAR’s Support of American Innovation to Reach up to 2 Million People by 2028 with Breakthrough HIV Drug Lenacapavir—US Department of State  
• Gilead Announces Partnership With PEPFAR to Deliver Twice-Yearly Lenacapavir for HIV Prevention for up to Two Million People in Primarily Low- and Lower-Middle-Income Countries—Gilead Sciences  
• PEPFAR aims to complete “Bridge Planning” sprint and a “Self-Reliance Strategy” by September 30—To End a Plague Again Substack 

NIH Budget Preserved Under Appropriations Bill, But for How Long?

The House Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee (LHHS), which oversees NIH funding, issued its draft FY26 spending bill and summary. It notably preserves NIH funding at approximately $48 billion. Significantly, this bill reflects the Senate version, which rejects the President’s proposed 40% cut and retains all 27 NIH institutes and centers. Next week, the committee will issue a report detailing how the money should be spent, setting the stage for a broader spending debate across Congress. Meanwhile, the action to terminate nearly 800 NIH grants was ruled “illegal and potentially racially discriminatory” by a federal judge, triggering talks of a settlement to restore funding that could conclude later this week. 

IMPLICATIONS: While NIH funding levels in Congressional bills reflect continued bipartisan support for biomedical and implementation research, proposed deep cuts to the Centers for Disease Control and Prevention (CDC) and broader Health and Human Services (HHS) have the potential to further dismantle public health infrastructure in the US. And what happens after next week’s appropriations Committee report will shape not only the stability of NIH and CDC, but the future of US global health commitments. As FY26 appropriations move forward, the House and Senate bills will need to be reconciled with agreement on final spending levels between the two chambers. Perhaps more importantly, though, is whether the President and the OMB will spend Congressionally appropriated funds next year, given their current attempts to usurp Congress’s power of the purse. 

READ: 

• House bill cuts HHS budget but excludes RFK Jr.’s reorganization, maintains NIH funding—STAT  
• House GOP keeps NIH funding Trump wanted to cut—Axios  
• House Republicans add to support for maintaining NIH budget in 2026—Science  
• A closely watched legal battle over NIH funding cuts could settle soon—STAT  

The Latest in Foreign Aid

Earlier this week, the US President issued a “pocket rescission” request, a questionable budget maneuver, which would effectively run down the clock without disbursing nearly $4.9 billion in Congressionally appropriated FY25 foreign assistance funding. This week, advocates rallied in Washington, D.C., to demand the release of global AIDS funding warning that a “pocket rescission” defies the law, sabotages programs like PEPFAR, and jeopardizes lives. See AVAC’s statement condemning the President’s pocket rescissions request.  

Then on Wednesday night, the US District Court issued a new preliminary injunction in AVAC v Department of State and Global Health Council v Trump, blocking the US government from withholding funds that Congress has already appropriated. Of importance, this is the first case to explicitly reject the legality of a “pocket rescission.” The government immediately filed yet another appeal of this ruling to the US Circuit Court of Appeals. 

IMPLICATIONS: These developments underscore both the urgency and the stakes. On one hand, the District Court’s injunction in AVAC and GHC affirms that the “pocket rescission” is unlawful, protecting billions in global health funding from executive overreach. On the other, the Administration’s ongoing maneuvers in the courts reveal its intent to undermine Congress’s constitutional “power of the purse” and strip away resources from foreign assistance programs. AVAC and partners will continue to press in court, in Congress, and with communities to ensure that funds flow as appropriated, because at stake is not only the survival of HIV prevention and treatment programs worldwide but also the fundamental balance of powers in US governance. 

READ: 

• New Preliminary Injunction Issued in Foreign Assistance Lawsuit Is a Victory for Rule of Law—Public Citizen 
• Donald Trump Suffers Major Legal Blow Over Billions in Foreign Aid Cuts—Newsweek  
• Protesters demand release of HIV funds ‘illegally’ withheld by Trump—The Guardian  
• The Pocket Rescission Gambit: Trump’s Strategy to Cut Foreign Aid Without Congressional Approval—Center for Global Development 
• AVAC Condemns US Administration’s ‘Pocket Rescission’ Request to Withhold Billions in Foreign Aid—AVAC  
• Republicans dismayed by Trump’s decision to use pocket rescission—The Hill 
• Appeals Court Declines to Block Trump From Freezing Foreign Aid—New York Times

Vaccines Unraveling

New developments that have been building to further undermine vaccine policy and scientific expertise in the US are coming to a head. This week, Paul Offit, a pediatrician and co-inventor of the rotavirus vaccine, was removed from the FDA’s Vaccines and Related Biological Products Advisory Committee; Florida rolled back its mandate requiring pediatric vaccines for entry into the public school system; the President publicly challenged pharmaceutical companies to prove that their COVID‑19 vaccines still work; and HHS Secretary Robert F. Kennedy Jr. continued to muddy the waters regarding vaccine safety and efficacy. Meanwhile, two leading NIH scientists filed whistleblower complaints, stating they were stripped of leadership roles after objecting to the Trump administration’s efforts to undermine vaccines. 

IMPLICATIONS: These developments signal a dangerous escalation in the US government’s ongoing assault on vaccine science and policy. The politicization of vaccines in the US threatens to reverberate internationally, fueling disinformation and destabilizing decades of progress in immunization and epidemic preparedness.  

READ: 

• Whistle-Blower Complaints Detail Tension Over Vaccines at N.I.H.—New York Times 
• Kennedy faces off with senators, defends firing CDC director at hearing—STAT  
• Trump says CDC is ‘being ripped apart’ over Covid products, calls for drugmakers to prove their benefits—STAT  
• Trump Wants Proof That Covid Vaccines Work. It’s Easy to Find.—New York Times 
• FDA Pulls RFK Jr. Critic Off Its Vaccine Advisory Panel—MedPage Today 
• Unraveling the arc of vaccine progress—Science 

Join us September 16-17

AVAC and partners are hosting a 24-hour livestream event with scientists, researchers and advocates from around the world to share insights, answer questions, and inspire action!

Learn More

What We’re Reading

• Changes at NIH Give Political Appointees Greater Power To Fund or Block Research—KFF
• Watching the Chaos at the CDC — with Sadness and Alarm—Jwatch
• Modeling the fallout: projecting the global impact of donor funding cuts on HIV prevention, treatment, and care—Current Opinion in HIV and AIDS
• Trump’s aid cuts in east Africa led to unwanted abortion and babies being born with HIV – report—The Guardian
• Joint statement calling for Secretary Kennedy resignation—Infectious Diseases Society of America
• WATCH: RFK Jr. testifies on Trump’s health care agenda before the Senate Finance Committee—PBS NewsHour
• Philanthropic initiative launches long-term fund to replace USAID stopgap—Devex
• The Real-World Impact of Defunding STI Research—TheBodyPro

Resources

• A Resource Round Up Covering Funding Fights & A New Generation of PrEP, AVAC
• US Investments in the Global Fund Strengthen the US Economy, One Campaign
• HIV Research on Pause: Impacts of US government cuts on HIV R&D, AVAC
• Getting PrEP Rollout Right This Time: Considerations for LEN for PrEP Introduction, AVAC

The news is moving fast, and the need for advocacy is moving even faster. AVAC is providing resources, updates on its fight against the US government on the foreign aid freeze, documenting impacts on STI prevention, and sharing new opportunities for education and advocacy in HIV prevention.

AVAC Condemns US Administration’s ‘Pocket Rescission’ Request to Withhold Billions in Foreign Aid

The latest move by the US Administration to undermine congressional checks and balances and gut funding for foreign assistance involves a so-called “pocket rescission” whereby the President asks Congress to approve the cancellation of funds late in the fiscal year. Read AVAC’s statement and NPR’s coverage, White House goes after more foreign aid cuts for more context.
 
And late last night, the US District Court issued a preliminary injunction blocking the government from withholding funds Congress has already appropriated. Most significantly, the judge addressed the illegality of “pocket rescissions”.

The Real-World Impact of Defunding STI Research

The impact of US funding cuts on STI research and prevention remains largely overlooked—even as the consequences grow dire. These cuts are devastating STI surveillance, prevention, diagnostics and research and development. In a new piece for TheBodyPro, AVAC’s Alison Footman documents these losses through the voices of seven leading researchers whose work—and communities—are directly at risk. Read it on TheBodyPro.

Resources

• HIV Prevention R&D at Risk: Tracking the Impact of US Funding Cuts highlights the impact of US cuts to the pipeline of HIV prevention R&D. And learn about the Impact of PEPFAR Stop Work Orders and Why STI Funding Matters in AVAC’s other trackers of the impacts and consequences of the Administration’s actions.
• Track the progress of AVAC’s court fight against executive overreach on our dedicated page: AVAC v. United States Department of State
• Our weekly Global Health Watch newsletter to keep advocates informed, prepared, and connected. Subscribe here.

Events

Will Lenacapavir be a Lever or a Let-Down? Lessons, Resources and Considerations for Implementation in the United States

Hosted by The Choice Agenda and the HIV BLUPrInt team, this webinar will explore what’s next for rolling out injectable lenacapavir for PrEP (LEN) in the US, and the advocacy to increase HIV prevention access, empowerment, and reach. Find additional resources on rolling out LEN globally, how to achieve impact on the epidemic, and an overview of the efficacy trials here. 

Register here.

South Africa AIDS Conference (SAAIDS), September 8-11

Attending the 12^th annual SA AIDS conference in Johannesburg, South Africa, next week? Don’t miss the Advocates’ Corner, a keynote plenary where AVAC’s Mitchell Warren shares perspective on the future of HIV prevention, and an important satellite on Wednesday, Bridging the Gap and Identifying Opportunities: Innovative Strategies to Accelerate HIV Prevention, Treatment, and Care for Key and Vulnerable Populations in South Africa.

Learn more.

24 Hours to Save AIDS Research!

AVAC and partners are hosting a 24-hour livestream event with scientists, researchers and advocates from around the world to share insights, answer questions, and inspire action! 

Join us on YouTube, and track the conversation on Bluesky (@saveaidsresearch.bsky.social‬) and Instagram (@saveaidsresearch). Starting on September 16 at 11am ET and continuing for 24 hours!

For busy advocates, we hope these resources and opportunities will support your work in the fight to save investment in research, to speed access to choices in HIV & STI prevention, and to bolster the HIV response in this time of transition.

This week, political overreach that is destabilizing global health programs and policy was on full display with the political interference and departure of leaders at the US Centers for Disease Control and Prevention (CDC) and the US Administration’s emergency appeal to the Supreme Court in AVAC v. Department of State case.

US CDC Leadership Departs Citing Weaponization of Public Health 

The CDC Director and several senior leaders were removed or resigned from the agency this week. The White House announced that Director, Susan Monarez was fired after a month into her new position, saying that she is “not aligned with the president’s agenda”.  

In protest, three senior CDC leaders, including Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases, and former director of the Division of HIV Prevention in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, and Debra Houry, chief medical officer, resigned. Daskalakis’ resignation letter, which he made public, warned that the actions of Health and Human Services (HHS) Secretary, Robert F. Kennedy Jr. pose dire risks to vulnerable communities and undermine scientific credibility. “I am unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt rather than to improve the public’s health.” Houry wrote in her resignation, “For the good of the nation and the world, the science at CDC should never be censored or subject to political pauses or interpretations.” 

US Senator Patty Murray, Democrat from Washington called for the immediate termination of HHS Secretary, RFK Jr. in a statement. Separately, Sen. Bill Cassidy, a Louisiana Republican who chairs the Senate Committee on Health, Education, Labor and Pensions, called on HHS to “indefinitely postpone” its vaccine advisory committee meeting next month amid the slew of departures from the CDC and growing anti-vaccine sentiment and intentional misinformation from the administration. 

IMPLICATIONS: These developments at the CDC continue the dangerous shift to ideology over evidence under the current HHS leadership. And they also show how difficult scientific independence can be in the face of political overreach. These shifts are destabilizing trust, credibility and leadership in the US public health system and undermining vaccines and vaccination programs. “If the [vaccine advisory committee] meeting proceeds, any recommendations made should be rejected as lacking legitimacy given the seriousness of the allegations and the current turmoil in CDC leadership,” Cassidy said in a statement. 

READ:  

• White House fires CDC director who says RFK Jr. is ‘weaponizing public health’— Washington Post 
• CDC official in resignation letter says HHS policies ‘do not reflect scientific reality’—STAT  
• CDC director refuses to leave after White House order—BBC  
• CDC in Turmoil as Director Is Ousted, Top Leaders Resign—POZ  
• The Resignation Letter of Dr. Demetre C. Daskalakis  
• RFK Jr. Could Blow Up the Vaccine Industry With One Simple Move—The Bulwark 
• Vaccine misinformation led to an officer’s murder at the CDC – politicians’ silence is deafening—The Guardian  
• I Was Inside CDC During the Shooting. I Can Still Hear the Bullets.—MedPage Today 

Updates in AVAC v Department of State Case 

Thursday evening, the DC Circuit Court of Appeals denied AVAC’s petition to rehear the AVAC v Department of State case on the foreign aid freeze in front of the full panel of judges (“en banc”). This comes just two days after the US government filed an emergency application to the Supreme Court of the United States (SCOTUS) seeking to “stay” (i.e., suspend) the injunction that is compelling the US government to pay out congressionally-appropriated funds as the case continues to be litigated. While this decision is a setback, the Appeals Court panel modified its previous opinion agreeing that the plaintiffs – AVAC and the Global Health Council and their co-plaintiffs – do, indeed, have legal standing to bring their cases back to the District Court for further consideration. The District Court issued the original temporary restraining order and preliminary injunction earlier this year.

As AVAC’s Mitchell Warren shared with Politico after the Government’s emergency application to SCOTUS, “Time and again, this administration has shown their disdain for foreign assistance and a disregard for people’s lives in the United States and around the world. But even more broadly and dangerously, this administration’s actions further erodes Congress’s role and responsibility as an equal branch of government. The question being put to SCOTUS is whether they will be complicit in further eroding the constitutional commitment to checks and balance.”  

IMPLICATIONS: While the lower DC District Court of Appeals’ ruling moots the governments emergency application to SCOTUS, the fight is far from over. AVAC and partners commit to accountability and will defend global health and the principle of separation of powers.  

READ:  

• Trump Administration Asks Supreme Court to Allow Freeze on Foreign Aid—New York Times 
• Justice Department asks Supreme Court to allow Trump to withhold foreign aid—Politico  
• Trump administration asks US Supreme Court to halt foreign aid payments—Reuters  
• Appeals Court Declines to Block Trump From Freezing Foreign Aid—New York Times

What We’re Reading

• SA plans anti-HIV jab roll-out at 300+ clinics by April. By 2027 the government will be buying generics— Bhekisisa
• In Malawi, the fight to get HIV services back on track post-USAID cuts—Devex
• We surveyed hundreds of biomedical researchers about the instability in federal funding. Here’s what they said—STAT
• Inside the USAID Fire Sale—The Atlantic
• Donald Trump’s Big Gay Government—New York Times
• HHS moves to strip thousands of federal health workers of union rights—Associated Press
• NIH Publisher Fee Cap Plan ‘Not Comprehensive Enough,’ Critics Say—Inside Higher Ed
• Prasad’s return to FDA comes with fewer titles and a seemingly lower profile—EndPoints News
• Gates Foundation Quietly Cuts Ties With Firm Linked to Democrats—New York Times
• As MAHA turns 1, a fired-up movement is still figuring out how to fulfill its promises—STAT
• SWEAT Secures a National Moratorium on Sex Worker Prosecutions—Sex Workers Advocacy & Education Taskforce

Resources

• Title X Restrictions Harm the U.S. HIV Response, amfAR
• Next Up: A monthly pill for PrEP?, AVAC
• PEPFAR Program Status, amfAR
• Long-Acting PrEP Market Assessment for Key Populations, AVAC, GBGMC

Save the Date!

In response to the US government’s August 26 emergency application to the US Supreme Court seeking to stay the preliminary injunction in the AVAC v Department of State legal case against the foreign aid freeze, AVAC’s Executive Director, Mitchell Warren wrote:

“It is no surprise that the administration has taken our case directly to the Supreme Court, especially after the District Court’s very clear and firm denial of their request yesterday to suspend the requirement to obligate Congressionally appropriated funding for foreign assistance. Time and again, this administration has shown their disdain for foreign assistance and a disregard for people’s lives in the United States and around the world. But even more broadly and dangerously, this administration’s actions further erode Congress’s role and responsibility as an equal branch of government. The question being put to SCOTUS is whether they will be complicit in further eroding the constitutional commitment to checks and balance.”

This week brought another round of threats and attacks on US global health policy including troubling court rulings over the foreign aid freeze, deepening cuts to the fiscal year 2026 (FY26) global health budget, and troubling developments at NIH, where new research priorities and another agency-wide review could disrupt HIV and global health research. We also track new signals of a US pullback at UN General Assembly (UNGA).

AVAC and Plaintiffs Challenge Rulings on the Foreign Aid Freeze

Last week, a three-judge panel of the DC Circuit Court sided with the Administration in the AVAC vs. Department of State case. See AVAC’s press release for details. The full Circuit Court has not yet issued its mandate, which means the preliminary injunction that requires the US government to obligate appropriated funds remains in effect. Judge Amir Ali of the District Court has now scheduled a status conference for August 25, explicitly reminding the government that it remains obligated to comply with the preliminary injunction. Judge Ali directed the Department of State to be prepared to detail steps already taken and future plans to ensure compliance. 

IMPLICATIONS: The ruling underscores the precarious balance between ongoing litigation and urgent global health needs. While the injunction remains in force, giving temporary protection to life-saving programs, the Administration continues to resist full compliance. 

READ:  

• US Non-profits Vow to Fight on After Court Rules They Can’t Challenge Trump Aid Freeze—Health Policy Watch 
• Foreign Aid Groups Continue Their Fight Against the Trump Administration — In Court—NOTUS  

FY26 US Budget Anticipated to be Cut in Half, Aligning with Administration, Not Congress 

The US Office of Management and Budget (OMB) quietly released an “apportionment approval” for a legally binding approval for federal agencies to spend funds. The OMB approval shows that the Fiscal Year 2026 (FY26) budget for global health has been slashed in half. Of the $6 billion available for programs, such as PEPFAR, global health security, and TB, malaria and polio programs, only $3.1 billion has been allocated. This cut is aligned with what the Administration proposed in its original budget request rather than congressional levels.  

IMPLICATIONS: This decision is unprecedented and heightens uncertainty and instability already created by the foreign aid freeze and abandonment of US global health commitments. By forcing through the Administration’s lower proposed budget rather than Congress’s higher levels, OMB is undermining Congressional authority over federal spending and undermining trust in US commitments. The cuts could lead to HIV treatment interruptions, stalled prevention efforts, and lost lives, while setting a dangerous precedent for politicizing global health funding in the years ahead. 

READ: 

• Trump budget officials claim sweeping spending power from Congress, records show—Washington Post 
• Trump Budget Office Is Withholding H.I.V. Funds That Congress Appropriated—New York Times
• OMB Just Dropped the FY2026 US Global HIV Budget by 50 percent—To End a Plague Substack

NIH Director Releases New Research Priorities and Orders Another NIH-Wide Review

National Institutes of Health (NIH) Director, Jay Bhattacharya, released a list of twelve new “research priorities,” including AI, autism, chronic disease, and select work on health disparities. The list is not surprising, but also includes a shift in HIV research, away from basic and clinical research and towards implementation science to expand access. Alongside the announcement, Bhattacharya ordered an internal review of all NIH grants, applications, and studies to ensure alignment with these priorities. While Bhattacharya framed the priorities as a unified, public-focused strategy, staff and outside experts expressed alarm at the lack of consultation, absence of clear timelines, and the risk of further delaying already delayed grant funding. 

In other, related and devastating news, late on Thursday the US Supreme Court, in a 5-4 ruling, enabled the Administration to cancel hundreds of millions of dollars in NIH grants linked to diversity, equity and inclusion initiatives. 

IMPLICATIONS: These actions will reshape NIH’s funding landscape, stifling scientific independence and slowing research. By forcing all grants to be assessed against partisan priorities (as opposed to rigorous scientific peer review, as has been NIH’s long-standing commitment), critical work will face further risks for termination and disruption, based on ideology. And the Supreme Court decision, which is not final yet, further enables the Administration to cancel important scientific work. For HIV and global health, these shifts threaten decades of progress by politicizing science, weakening trust in US research institutions, and destabilizing funding for projects that communities and scientists depend on.  

READ:  

• NIH director orders new review of grants in outline of top research priorities—Science 
• Grant Terminations in the US Threaten HIV Research and Future Progress—JAMA  
• Advancing NIH’s Mission Through a Unified Strategy—NIH statement 
• Supreme Court allows Trump to gut DEI-linked NIH grants—The Hill  

US May Pull Back from Global Health Leadership at UNGA

The US Administration is advocating for a “fundamental rethink” of US engagement at the United Nations General Assembly (UNGA) in September, according to an internal State Department memo, reported by Devex. The memo calls for a leaner global system that expects other donors to carry a greater share of responsibility in funding and carrying out global health and humanitarian aid.  

IMPLICATIONS: The new focus on three policy priorities—peace, sovereignty, and liberty—excludes any mention of development, which has always been a key pillar of the UN. Diminished US involvement in UNGA would further erode US leadership, leverage and investment in lifesaving programs, as multilateral institutions struggle to adjust. Strategic advocacy will be essential to rally other donors, preserve global health gains, and protect international cooperation.  

READ:  

• Exclusive: A first look at the Trump administration’s UNGA priorities—Devex 

US CDC Staff Demand Safety After Shooting

After the tragic shootings at the US Centers for Disease Control and Prevention (CDC) on August 8, more than 750 current and former staff from CDC, NIH, and other Health and Human Services (HHS) agencies signed a public letter demanding action from Secretary Robert F. Kennedy Jr. They called on him to stop spreading vaccine misinformation, reaffirm the CDC’s scientific integrity, and bolster emergency safety protocols. The signatories urged the removal of online “DEI watchlists” targeting staff and asked for enhanced security measures, given that the shooter was motivated by anti-vaccine conspiracy views.  

IMPLICATIONS: The CDC incident and the staff backlash it triggered underscore the tangible dangers facing public health workers amid rising disinformation and political erosion of trust.  

READ:  

• After the CDC shooting, federal workers demand more protections from RFK Jr.—NPR  
• The CDC shooting was public health’s Jan. 6—STAT 
• Credible scientists can’t hold up Kennedy’s charade for much longer—The Hill

What We’re Reading

• Exclusive: CVS holds off adding Gilead’s new HIV prevention shot to drug coverage lists—Reuters
• Is global development decolonizing or recolonizing?—Devex
• A time of rethink and restructure for aid organizations—Devex
• Cancelling mRNA studies is the highest irresponsibility—Nature
• America Is Abandoning One of the Greatest Medical Breakthroughs—New York Times
• Why Jay Bhattacharya agrees with RFK Jr. on defunding mRNA technology—Politico Pro
• The Most Damaging RFK Jr. Decision Yet—The Bulwark
• State Department’s new human rights reports are silent. We refuse to be—Washington Blade
• The Efficiency Myth—Reimagining Global Health Substack
• Here’s What Real Pro-Family Policy Looks Like—TIME
• LEN Is Not a Silver Bullet—Reimagining Global Health Substack

Resources

• Getting PrEP Rollout Right This Time: Considerations for LEN for PrEP Introduction, AVAC
• PEPFAR Program Status, amfAR
• Long-Acting PrEP Market Assessment for Key Populations, AVAC, GBGMC
• The Global Need for Long Acting PrEP Among Key Populations: Forecasts of Global Demand 2025-2030, AVAC, Avenir Health, GBGMC

This issue covers the Appeals Court opinion in AVAC v Department of State, a violent attack on the CDC fueled by vaccine disinformation, the continued dismantling of the NIH with a potential pendulum swing toward implementation science and away from basic science and clinical research, and a new executive order politicizing federal grants.

AVAC v Department of State Case – Decision Signals Grave Risks

The US Court of Appeals for the D.C. Circuit issued a 2–1 decision in favor of the Administration’s appeal in the AVAC v. US Department of State and Global Health Council v. Trump cases, which challenge the administration’s abrupt and unilateral freeze on foreign aid. The three-judge panel of the Circuit Court of Appeals overturned the lower court’s preliminary injunction, which ordered the Administration to release appropriated foreign aid funds. It didn’t rule specifically on whether the cuts to foreign assistance are constitutional, but instead ruled that the plaintiffs are not allowed to challenge the President’s freeze on Congressionally approved global health funding. In a statement, AVAC’s Mitchell Warren said, “The ruling hands the administration another victory in their intentional effort to destroy decades of progress in global development, diplomacy, public health and human rights. Time and again, this administration has shown their disdain for foreign assistance and a disregard for people’s lives in the United States and around the world. This decision, which we will appeal to the extent possible, further erodes Congress’s role and responsibility as an equal branch of government, and the majority opinion makes the court complicit.”  

IMPLICATIONS: This decision signals grave risks for global health and development and the larger role of Congress to maintain it’s Constitutional “power of the purse”. By allowing the executive branch to withhold Congressionally appropriated funds, the court’s ruling threatens millions of lives and sets a precedent for politicizing health assistance.  

READ:  

• AVAC Condemns Appeals Court Reversal of Order Directing Trump Administration to Spend Foreign Assistance Funds—AVAC statement 
• Trump Administration Can Withhold Billions in Aid, Appeals Court Rules—New York Times 
• President Trump can continue to withhold billions in foreign aid, court rules—NPR  
• US appeals court backs Trump in fight over foreign aid freeze—Devex  
• Appeals court says Trump officials can withhold billions in foreign aid—Washington Post  
• Appeals Court Reverses Order Directing Trump Administration to Spend Foreign Assistance Funds—Public Citizen statement

Shooting at the US Centers for Disease Control and Prevention

On Friday, a gunman fired shots at the Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, killing one responding police officer. Investigations revealed the shooter blamed the COVID-19 vaccine for his mental health struggles and had anti-vaccine writings in his home. No CDC staff were physically harmed, but the mental and emotional toll is significant. 

IMPLICATIONS: This shooting highlights the dangerous convergence of vaccine (and general health) disinformation and targeted violence. The erosion of trust fueled by anti-vaccine rhetoric, especially from political leaders in the Administration, directly endangers the people and programs working to protect communities.  

READ:  

• Suspect and Officer Are Dead After Shooting Outside C.D.C. in Atlanta—New York Times 
• CDC shooter thought COVID vaccine made him suicidal, his father tells police—AP News 

NIH Shift to Implementation Science and Further Takedown of the NIH

The dismantling of US support for global health R&D continues to accelerate. As Science magazine reported this week, the NIH is considering a dramatic shift in its HIV research budget away from basic science toward implementation science, with an emphasis on how best to use existing tools (including lenacapavir for PrEP) to end the epidemic in the US. This news follows the defunding of mRNA vaccine development under the Biomedical Advanced Research and Development Authority (BARDA) earlier this month and a dangerous overhauling of long-standing peer review processes for NIH grants (see more below). AVAC’s updated tracker of cuts to HIV R&D includes these latest developments. 

IMPLICATIONS: LEN for PrEP could have a critical role to play in ending the epidemic in the US and around the world, and implementation science is definitely needed to optimize its potential impact. But LEN is not the only intervention needed, and it will be critically important to embed any implementation science agenda into a comprehensive “R&D and delivery” research agenda that shows the appropriate balance of the overall HIV/AIDS research portfolio. The proposed shift comes at a particularly challenging time, with the President’s fiscal year 26 (FY26) budget request proposing an additional 40% cut to NIH. The field faces a tipping point—if the field doesn’t act now to define itself, the new Administration will. Advocates are pushing back with legal action, Congressional engagement, and an urgent focus on the People’s Research Agenda, a framework to ensure research is driven by communities and focused on equitable access and real-world impact. 

READ:  

• NIH ponders overhauling HIV budget to capitalize on prevention breakthrough—Science  
• HIV Prevention R&D at Risk—AVAC  
• RFK Jr has slashed vaccine research. You need to know how perilous that is for the world—The Guardian 

New Executive Order Gives Political Appointees Control Over Federal Grants 

The US President signed an executive order granting political appointees unprecedented control over federal research grants. This allows them to review funding decisions, terminate existing grants at will, and delay new solicitations. Historically, grants have been allocated through peer-reviewed processes, so this policy shift threatens to further entrench partisan political priorities in scientific funding. 

IMPLICATIONS: This new level of political control over research funding poses serious risks to HIV and broader global health R&D. Agencies are continuing to lose the ability to rely on predictable, science-driven funding streams. The new executive order severely disrupts decades of equitable and evidence-based research support.   

READ:  

• Trump signs order giving political appointees oversight of federal grants—The Hill 
• Trump executive order seeks to centralize control of grantmaking under political appointees—STAT  
• Donald Trump Announces Major Change to ‘Frivolous Grants’—Newsweek

What We’re Reading

• No One in the White House Knows How to Stop Ebola—The Atlantic
• Elton John AIDS Foundation plugging gaps in HIV funding—The Lancet
• WATCH: A Conversation on the Future of PEPFAR With One of Its Chief Architects—Tom Frieden Substack with Mark Dybul
• Is PEPFAR’s Data Going Dark?—To End a Plague Substack
• If We Want to Save Public Health, We Need to Get Out of Our Bubble—The Nation
• Exclusive: USAID officials tour missions worldwide as agency shutter—Devex
• How HIV funding cuts are undermining years of progress in Zimbabwe—Doctors Without Borders
• Inside SA’s multi-million rand plan to fill US funding void—Spotlight
• ‘Kennedy’s case against mRNA vaccines collapses under his own evidence—STAT
• Trump administration threatens to strip Harvard University of lucrative patents—The Guardian
• Vinay Prasad returns to the FDA, weeks after his ouster—STAT
• HHS revives child vaccine safety panel sought by anti-vaccine activists—Washington Post
• Breaking barriers, changing paradigms: Africa’s radical agenda for HIV sustainability—Frontiers in Reproductive Health
• ‘A whole body of health-equity research is being disappeared’ — why I resigned from the NIH—Nature

Updated Resources

• PEPFAR Program Status, amfAR
• Save PEPFAR, Save Lives: Rally & Civil Disobedience in DC, Housing Works
• Addressing Transgender Erasure in HIV Clinical Trials: The Scorecard for Transgender and Gender-Diverse Inclusion, American Public Health Association
• Long-Acting PrEP Market Assessment for Key Populations, AVAC, GBGMC
• The Global Need for Long Acting PrEP Among Key Populations: Forecasts of Global Demand 2025-2030, AVAC, Avenir Health, GBGMC

AVAC strongly condemns today’s decision by the U.S. Court of Appeals for the D.C. Circuit to overturn the District Court’s injunction that compelled the restoration of vital foreign aid funding in the lawsuit, AVAC v. United States Department of State, which challenged the Trump Administration’s funding freeze on foreign assistance, arguing that the mass termination of foreign assistance awards as unconstitutional, arbitrary and capricious, and contrary to law. 

This ruling, which allows the continuation of a Trump‑administration–imposed freeze on aid disbursements, poses profound threats to global health and HIV prevention efforts. By enabling the withholding of billions of dollars in funding, the court’s decision directly undermines the delivery of lifesaving HIV services and the ethical principles of equitable access. 

“Today’s Circuit Court ruling hands the administration another victory in their intentional effort to destroy decades of progress in global development, diplomacy, public health and human rights,” said Mitchell Warren, executive director of AVAC. “Time and again, this administration has shown their disdain for foreign assistance and a disregard for people’s lives in the United States and around the world. More broadly, this decision, which we will appeal to the extent possible, further erodes Congress’s role and responsibility as an equal branch of government, and the majority opinion makes the court complicit.” 

The Circuit Court panel of three judges decided in a 2-1 vote. The dissenting judge, Florence Pan, stated clearly what is at stake: “Today, a President defies laws enacted by Congress without any legal basis, and the court holds that he has merely violated a statute, that the Constitution is not even implicated, and that there is no judicially enforceable cause of action to challenge his conduct. By failing to rein in a President who ran roughshod over clear statutory mandates, the court evades its constitutional responsibility to delineate the obligations and powers of each branch of our government… At bottom, the court’s acquiescence in and facilitation of the Executive’s unlawful behavior derails the ‘carefully crafted system of checked and balanced power’ that serves as the ‘greatest security against tyranny—the accumulation of excessive authority in a single Branch.’” 

Lauren Bateman, an attorney with Public Citizen Litigation Group and lead counsel on this case, said “Today’s decision is a significant setback for the rule of law and risks further erosion of basic separation of powers principles. Our lawsuit will continue as we seek permanent relief from the Administration’s unlawful termination of the vast majority of foreign assistance. In the meantime, countless people will suffer disease, starvation, and death from the Administration’s unconscionable decision to withhold life-saving aid from the world’s most vulnerable people.” 

On February 10, Public Citizen filed suit on behalf of AVAC and the Journalism Development Network, Inc, seeking emergency relief from a funding freeze that was put in place by an executive order issued the day that the Trump Administration took office. 

The funding freeze ultimately led to the closure the US Agency for International Development (USAID) and decimated funding for global health, shattering relationships of trust with countries all over the world, upending decades of investment and development, and jeopardizing lives and livelihood. The case was among the first challenges to the Trump Administration’s executive orders to reach the Supreme Court. On March 5, in a 5-4 ruling, the justices rejected White House arguments that District Court judge, Amir Ali, lacked authority to direct payments to be unfrozen.  

In the following weeks, the government had been forced to bring back federal staff in order to issue nearly $2 billion in funds for contractual work completed by February 13 related to USAID programs. Judge Ali also directed the government to promptly restore grants and cooperative agreements that were terminated prior to February 13. But with the complete dismantling of USAID, for many of those programs it was too late. 

While the government has been forced by the court to issue these payments, which are ongoing, one USAID whistleblower has provided an eye-witness account and direct evidence alleging malfeasance by Trump Administration officials, including violations of the law and public trust, termination of contracts by individuals without legal authority to do so, and a so-called foreign aid grant review that was never more than a pretense, resulting in the illegal mass termination of contracts.  

AVAC commends USAID’s workforce, and leaders among them, who are taking a stand against these attacks on the US constitution, global health, foreign aid, and accountability in government. As Public Citizen’s Lauren Bateman said, “The Trump Administration has consistently—preposterously—claimed that its decision to terminate thousands of U.S. foreign assistance awards was legal because those terminations were based on an ‘individualized’ review. This internal agency document corroborates that there was no such individualized review. It also shows that the Administration has ignored both court orders and numerous communications from officials within USAID.” 

The global health ecosystem cannot afford further disruption. Data from a recent Lancet study estimate that the discontinuation of PEPFAR alone—one of the programs most directly impacted—could result in up to 10.75 million new HIV infections and 2.93 million HIV-related deaths by 2030. 

“This court decision exacerbates an already grave humanitarian crisis. AVAC stands unwavering in our commitment to ethical, evidence-based global health programs to develop and deliver HIV prevention, vaccine and contraceptive innovations,” said Warren. “We urge policymakers and the courts to act urgently to reverse this dangerous precedent. The health and lives of millions – not to mention the underpinnings of our democracy – hang in the balance.” 

This week the US administration cancelled $500 million in mRNA vaccine contracts (see AVAC’s statement) while a Government Accountability Office (GAO) investigation found the NIH grant freezes violated the law. The Gates Foundation committed $2.5 billion to women’s health R&D, and South Africa is investing to protect its national research capacity in the face of US funding cuts.

US Administration Cancels mRNA Vaccine Contracts

US Health Secretary Robert F. Kennedy Jr. announced plans to defund $500 million in grants issued by the Biomedical Advanced Research Development Authority (BARDA), which supports 22 mRNA vaccine development projects. He cited unvalidated and spurious concerns that mRNA technology lacks effectiveness against upper respiratory viruses such as COVID‑19 and influenza. The move was widely condemned by vaccine researchers, who expressed alarm that defunding this rapidly scalable vaccine development platform will leave the US more vulnerable to infectious disease outbreaks. This latest action also added to the litany of anti-vaccine decisions. “Actions to take apart the CDC’s Advisory Committee on Immunization Practices (ACIP), to cancel grants to the Consortia for HIV/AIDS Vaccine Development (CHAVDs), to cease contributions to Gavi, The Vaccine Alliance, and now to cancel BARDA support for mRNA vaccines are a red alert all around the world, signaling the US retreat from advancing vaccine development and delivery,” said AVAC’s Mitchell Warren in a statement.

IMPLICATIONS: This decision is part of a broader pattern to systematically decimate investments in vaccine development programs and delivery systems and continue to sow ideologically driven vaccine misinformation. These actions will bring harmful policies that threaten lives and undermine efforts to advance effective, evidence-based health interventions.
 
READ:

• Kennedy Cancels Nearly $500 Million in mRNA Vaccine Contracts—New York Times
• Why mRNA Vaccines Are So Revolutionary—And What’s at Stake if We Lose Them—Scientific American
• Watch: Federal mRNA funding cut is ‘most dangerous public health decision’ ever, expert says—PBS News Hour
• Call for Global Strategy to Counter ‘Vaccine Misinformation from the US’—Health Policy Watch
• AVAC Condemns Administration’s Further Actions to Dismantle and Deconstruct U.S. Government Vaccine Research and Delivery Infrastructure—AVAC statement

US Government Accountability Office Finds Cancellation of NIH Research Grants Illegal

A new report from the US Government Accountability Office (GAO) concluded that the US administration acted unlawfully when it ordered the National Institutes of Health (NIH) to cancel 1,800 research grants and delay funding decisions earlier this year. The GAO found that these actions violated the Impoundment Control Act, which prohibits the executive branch from withholding or canceling Congressionally appropriated funds without proper notification. This is one of at least seven investigations where the GAO has found legal violations by the executive branch, with nearly 50 additional cases under review.
 
IMPLICATIONS: A federal court ruled in June that the grant cancellations were illegal and this report from the GAO is not legally binding, but it does have the power to influence Congressional action. Advocates have continued to push to fully restore NIH grant funding. (See AVAC’s Research Matters resource for more.) As Senator Patty Murray noted, “The longer this goes on, the more clinical trials that will be cut short, labs that will shutter, and lifesaving research that will never see the light of day.”  
 
READ:

• NIH broke law by withholding funding: GAO—The Hill
• Trump administration violated impoundment law by canceling NIH grants, slowing new awards, GAO finds—STAT

Gates Foundation Commits to Funding $2.5 billion in Women’s Health R&D Through 2030

The Gates Foundation announced a five-year, $2.5 billion commitment to accelerate R&D focused exclusively on women’s health through 2030. The funds will support more than 40 initiatives across five critical areas: obstetric care and maternal immunization; maternal health and nutrition; gynecological and menstrual health; contraceptive innovation; and sexually transmitted infection (STI) solutions. According to the Foundation’s announcement, these investments are aimed at a “new era of women‑centered innovation,” particularly focused on low‑ and middle‑income countries where research gaps are most pronounced.
 
IMPLICATIONS: This major pledge is good news and may hopefully spark other donors to align with these priorities, but this commitment is still just a “drop in the bucket” given longstanding underinvestment in female-specific health research. Ensuring future innovations in women’s health are community-centered, equitable, and accessible across diverse settings will require advocates to help shape the R&D agenda, push for sustained funding, and promote integration with the broader HIV and STI landscapes.
 
READ:

• A $2.5 billion pledge makes women’s health a priority in Gates Foundation spend-down—Associated Press
• Watch: Gates Foundation pledges $2.5B for women’s health worldwide—PBS News Hour
• Why investing in women’s health is good for business—Fortune
• Gates Foundation to Invest $2.5 billion in Women’s Health Amid Debilitating US Funding Cuts—Health Policy Watch

South African Government Invests in National Health Research Enterprise

The South African government announced a 400 million Rand investment (approximately $22.5 million) over three years to protect its national health research enterprise. This is in response to the abrupt withdrawal of US funding to South African research and researchers, which is particularly devastating for HIV and TB research. Importantly, this investment will leverage an additional R200 million (approximately $11.3 million), split equally between the Gates Foundation and the Wellcome Trust. This collective funding will be used to support research programs threatened by the cuts, including those focused on HIV, TB, mental health, and maternal and child health. The South African Medical Research Council (SAMRC) has already this week issued a request for applications (RFA) for eligible research programs to maintain vital infrastructure, staffing, and academic capacity.
 
IMPLICATIONS: This emergency investment is a powerful example of local and global partners stepping in to stabilize essential health research amid destabilizing US policy shifts.
 
READ: South Africa and Global Partners Mobilis

What We’re Reading

• The funding scramble: countries desperately seek HIV finance solutions—aidsmap
• US Aid Cuts Could Trigger Global Health Setbacks—Newsweek
• The Trump Administration Is Promoting Its Anti-Trans Agenda Globally at the United Nations—ProPublica
• Harm reduction techniques being phased out under Trump—Rollcall
• Deep dive: The unraveling of USAID—Devex
• African Summit Looks for Solutions to Health Funding Crisis—Health Policy Watch
• The HIV/AIDS pandemic: where are we now?—AIDS
• New strategies for HIV prevention in a shifting funding landscape—Touch Infectious Diseases
• Addressing Transgender Erasure in HIV Clinical Trials: The Scorecard for Transgender and Gender-Diverse Inclusion—American Journal of Public Health
• What’s New & Next in HIV Prevention: Update on Research & Development AND Delivery—AVAC and Centers for AIDS Research

Join AVAC and partners next week for two important conversations on what’s needed to achieve equity and scale in the next era of PrEP.