This week, researchers, advocates, and policymakers are reflecting on the escalating war on science. Two recent pieces in Think Global Health and in The Nation illustrate how budget decisions and policy priorities are reshaping US scientific and global health leadership and undermining the stability of programs relied on by hundreds of millions of people – in the US and around the world. This week’s GHW newsletter also tracks the consolidation of power across US health agencies, mounting uncertainty in vaccine regulation, and the Global Fund’s ongoing replenishment.

Leadership Changes at US CDC Raise New Concerns about Scientific Independence

US National Institutes of Health (NIH) Director, Jay Bhattacharya, was also named acting director of the US Centers for Disease Control and Prevention (CDC). This represents the administration’s fourth leadership change at the agency in just over a year and a move widely seen as further centralizing federal public health authority. Many are critical of this appointment and fear scientific independence given Bhattacharya’s public alignment with Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and his negative views on pandemic response and public health governance.
 
IMPLICATIONS: Concentrating leadership across NIH and CDC blurs lines between research, surveillance, and public health practice, while raising the risk that evidence-based decision-making will be deprioritized to political priorities. Together, these events point to a coordinated re-shaping of US health agencies that could weaken regulatory stability, disrupt research pipelines, and further undermine confidence in public health guidance around the world.

READ:  

• N.I.H. Director Will Temporarily Run C.D.C. in Leadership Shake-Up—New York Times
• Erasing the Biodefense Era: Inside the 2026 Restructuring of NIAID—CRV Science
• Experts warn NIH director now leading CDC will push ‘RFK Jr’s agenda’—The Guardian 
• Jay Bhattacharya named acting CDC director—Politico  

Global Fund Concludes Replenishment Falling Short of Target

The Global Fund to Fight AIDS, Tuberculosis and Malaria concluded its 8th Replenishment with US$12.64 billion in total pledges, which was endorsed by its board last week. Shifts approved by the Board move toward a longer-term, rolling replenishment approach and emphasizing country transitions to reinforce sustainability.

IMPLICATIONS: The US$12.64 billion outcome falls short of the original US$18 billion target for this replenishment cycle, showing ongoing vulnerability in global health financing amid broader donor retrenchment. Key pledges, including France’s, have yet to be confirmed. Flat or reduced support from major donor countries compared with previous cycles reflects a trend among wealthy nations to re-prioritize or constrain foreign health investments. Reliance on scaled domestic resource mobilization, private philanthropy, and public-private partnerships is unlikely to fill funding gaps quickly enough to prevent disruptions in HIV, TB, and malaria services or to repair damage already inflicted by abrupt aid terminations. Without robust, predictable commitments from major donors, the gains against the three diseases and the goal of ending them as public health threats remain at risk.

READ:  

• Global Fund Board Welcomes Final Eighth Replenishment Outcome of US$12.64 Billion, Backs Strategic Shifts to Advance Countries’ Path to Self-Reliance—Global Fund 
• A Radically Simplified Global Fund to Meet the Moment—CGD

Uncertainty at the US Food and Drug Administration (FDA) 

The US FDA reversed its decision and agreed to review Moderna’s mRNA-based influenza vaccine after initially refusing to consider the application last week. They cited concerns about the clinical trial design, specifically the choice of the comparator vaccine used in studies of adults over 65. This decision drew much criticism across industries, leaving many questioning what seemed like a shift from regulatory standards. 

Additionally, this reversal occurs amid a debate within the FDA about the role of randomized clinical trials in drug approvals, with the FDA reconsidering the long-time standard of requiring two rigorous studies. The FDA Commissioner wrote in the New England Journal of Medicine (NEJM) that the “default position” would be to require only one trial, upending decades of regulatory science and practice.  

IMPLICATIONS: These developments deepen concerns about unpredictability and politicization in US vaccine regulation. The FDA’s initial refusal to review Moderna’s flu vaccine followed by a rapid reversal shows regulatory chaos as agency leaders are publicly questioning the long-standing expectation of multiple randomized trials for new medicines. While flexibility in trial requirements can be appropriate in some circumstances, shifting the “default” to a single study risks blurring standards and weakening confidence. The broader pattern of reversals, public disputes, and narrowing vaccine recommendations continues to erode trust.

READ:  

• F.D.A. Reverses Decision and Agrees to Review Moderna’s Flu Vaccine—New York Times 
• FDA reverses course on Moderna flu shot—NPR  
• Vaccine Makers Curtail Research and Cut Jobs—New York Times 
• One Pivotal Trial, the New Default Option for FDA Approval — Ending the Two-Trial Dogma—NEJM  
• FDA will drop two-study requirement for new drug approvals, aiming to speed access—Associated Press 
• Top Republican eyeing FDA overhaul—The Hill 
• Poll: Trust and Confidence in the CDC Remain at Low Point After Changes to Recommended Childhood Vaccines; More Say the Changes Will Hurt than Help Children’s Health—KFF  
• Upcoming meeting of federal vaccine panel may be postponed after HHS missed deadlines—STAT 

A Year of Crisis and Promise

2025 tested global health like few years before it. Funding freezes, political disruption, and rising misinformation collided with historic scientific breakthroughs. Read how AVAC protected progress and pushed prevention forward. 

What We’re Reading

• What $50 Billion for U.S. Foreign Affairs Changes for Global Health—Think Global Health
• The Scientists Groveling to Trump Are Kidding Themselves—The Nation
• After leaving WHO, Trump officials propose more expensive replacement to duplicate it—Washington Post
• WHO Welcomes US States to its Global Disease Outbreaks Network—Health Policy Watch
• What’s behind US states joining WHO’s outbreak response system—Devex
• Is the United States Planning to Replace WHO Prequalification?— To End a Plague…Again Substack
• WHO Pandemic Agreement is only the beginning: strengthening implementation to protect global health—The BMJ
• Africa’s future depends on investing in women, children, adolescents—Devex
• Kenya receives first batch of Lenacapavir HIV drugs—The Citizen
• After US aid cuts, South Africa’s HIV response strains to hold the line—Devex
• Botswana health crisis as diamond trade drains the country’s finances—The Telegraph
• Ex-NATO chief warns against boosting defense budgets at expense of aid—Devex

Resources

• Costs, Chaos and Corruption: 1 Year of Robert F. Kennedy, Jr.’s Disastrous Leadership—Senators Angela Alsobrooks and Ron Wyden
• FCAA Resource Tracking, Funders Concerned About AIDS

“In this moment of crisis and possibility, AVAC did what it has done for 30 years: We showed up, spoke out and worked with partners to push the field forward.” — Mitchell Warren, Executive Director

In a year marked by funding freezes, political disruption and historic scientific breakthroughs, we are proud to share our 2025 Year in Review — one defined by crisis and resilience.   

The last year tested global health in unprecedented ways. AVAC showed up: helping protect hundreds of millions of dollars for global health; defending HIV programs and research; delivering trusted data, tools and analysis; and accelerating equitable access to innovations, like long-acting PrEP.  

None of this would have been possible without you — our partners, our donors, and our community. 

Inside the report, you’ll find:

• How AVAC equipped advocates, researchers, and partners with the context and tools needed to understand and act in a volatile environment. 
• How our legal action and advocacy helped unlock global health funding – and hold the US Administration accountable.
• What it took to move lenacapavir for PrEP (LEN) faster into the market than any prevention product before it. 
• Why defending global health requires sustained vigilance, strong leadership and robust partnerships. 

AVAC — like the field at large — enters 2026 in transition. We stand ready for the future: supporting African leadership, strengthening bridges from R&D to delivery, and preparing for a new chapter as we move forward into our fourth decade as an organization. 

As we look ahead, challenges remain. But the science is strong, new options are in the pipeline, and, with smart analysis, rigorous science, good policies and global partnerships, progress is possible — and essential. Thank you for standing with AVAC and helping to shape what’s next for HIV prevention, R&D and global health. 

The annual Conference on Retroviruses and Opportunistic Infections (CROI), taking place February 22–25, 2026, in Denver, Colorado, will once again kick off the year as the premier scientific convening for our field.   

AVAC will be tracking the HIV and STI science at CROI 2026, including advances in long-acting HIV prevention, evolving science around cure, and important discussions on the impact of the global funding crisis on research, development, and delivery. Here we share ways to follow and join in the conversation, in-person or virtually. 

Share the Latest Data: AVAC infographics

For those presenting at CROI (as well as anyone interested in tracking the field), AVAC’s latest infographics on HIV R&D and the delivery pipeline, the current landscape of prevention options, and the impact of US funding cuts are available here in an easy-to-use slide format. We hope these visuals are useful for presentations and discussions at the conference and beyond.

Join the Conversation: Community Breakfast Clubs

Each day during CROI, AVAC, EATG, Fiocruz, TAG, and other partners will host virtual webinars called Community Breakfast Clubs featuring researchers and advocates breaking down important prevention, treatment and cure science presented at CROI and the implications for the field. Registration is open to all.

Follow Along: News from the conference

AVAC will be tracking news and developments from the conference. Be part of the conversation by following AVAC on BlueSky at @hivpxresearch.bsky.social, and sign up for our Advocates Network newsletters if you were forwarded this email. And be sure to follow our partner, Aidsmap, as they report from the conference.

Sessions of Interest: What to watch

Check out the CROI program for sessions of interest. Some of the things we’re watching include:  

Sunday, February 22 

• Scott Hammer Workshop for New Researchers 

• Clinical Trial Design and Analysis Workshop 
• Opening Session with Named Lectures by Sharon Lewin, Peter Staley and Linda-Gail Bekker

Monday, February 23 

• Plenaries on Meeting the Moment: HIV Treatment and Prevention and Structure, Function, and Inhibition of the HIV Capsid 
• Sleepless in Denver: Impact of Funding Changes on HIV Care 
• Strategic and Resilient Responses to the Funding Crisis Across Africa 

Tuesday, February 24 

• Plenary on Cutting-Edge Issues in Sexually Transmitted Infections
• HIV Reservoirs and Cure Strategies 
• Counting and Caring for Transgender and Gender-Diverse Individuals 

Wednesday, February 25 

• Manipulating the HIV Immune Response for Prevention and Treatment 
• From Good to Great: Advancing Treatment and Prevention 
• Test and Tell 
• Harnessing B-Cells and Antibodies for HIV Control 
• Some Assembly Required: Self-Blood Collection and Testing 

This week marks one year since AVAC and the Global Health Council filed their lawsuits over the sweeping foreign assistance freeze — cases that challenged the Administration’s withholding of Congressionally appropriated funds and underscored the stakes for global health and HIV programs. That broader dispute over executive power and federal spending continues to reverberate, as four US states sued the administration this week over its decision to withhold $600 million in public health grants supporting disease surveillance, emergency preparedness, vaccination, and HIV prevention. This Global Health Watch issue also examines ongoing signs of erosion in vaccine confidence and regulatory stability and calls for early global access planning for Merck’s investigational monthly oral PrEP candidate. 

Four US States Sue HHS Over $600 Million in Public Health Grants 

Last week, the US administration announced it would withhold approximately $600 million in previously allocated public health grants for disease surveillance, emergency preparedness, vaccination programs and HIV prevention from states it argues are not aligned with administration priorities. In response, these states, which are led by Democrats: California, Colorado, Illinois and Minnesota, filed a lawsuit against the US Department of Health and Human Services (HHS), seeking to block the cuts. The funding is primarily distributed through the US Centers for Disease Control and Prevention (CDC) and the states argue that the administration cannot retroactively impose new conditions on congressionally appropriated funds or withhold them based on policy disagreements.

IMPLICATIONS: This case mirrors broader disputes over executive authority and federal spending, including AVAC’s lawsuit, that have surfaced repeatedly over the past year. Beyond the immediate budget impact, the decision to withhold public health funds risks destabilizing prevention and preparedness systems that rely on sustained, predictable financing. For HIV and other infectious diseases, interruptions in surveillance, community outreach, and prevention programming can quickly translate into increased transmission and weakened response capacity. While $600 million in funding is on the line, so is the principle that public health infrastructure cannot function effectively if appropriated funds are subject to shifting political leverage. 

READ:  

• Four States Sue Administration Over Loss of Public Health Funds—New York Times 
• Four states sue Trump administration over cuts to public health funding—Reuters  
• ‘Sanctuary’ States Get Judge to Pause Trump’s Public Health Cuts—Bloomberg  
• Save HIV Funding Campaign Denounces Cancellation of Vital HIV and STI Funding, Urges the Administration to Immediately Restore Grants

Vaccine Confidence Continues to Be Undermined 

Vaccine confidence continues to be undermined across multiple fronts this week. The US Food and Drug Administration (FDA) declined to review Moderna’s mRNA seasonal influenza vaccine candidate, raising questions about the regulatory pathway and timeline for review and introduction of new flu products. At the same time, the American Medical Association (AMA) announced its plans for its own independent vaccine safety and effectiveness review initiative, which signals growing concern about trusted scientific assessment processes. And a survey found declining public perceptions of the safety of COVID-19, influenza, and MMR vaccines, underscoring persistent erosion of vaccine confidence. 

IMPLICATIONS: This week’s developments signal mounting stress on the scientific and governance systems that underpin vaccine confidence and access and risk fragmenting systems that were grounded in evidence and transparency. At a moment when routine immunization rates remain fragile and misinformation continues to spread, sustained regulatory clarity, transparent scientific review, and stable engagement in multilateral vaccine processes are essential to maintaining public trust and global health security.

READ:  

• F.D.A. Refuses to Review Moderna Flu Vaccine—New York Times 
• Vinay Prasad’s Vaccine Kill Shot—Wall Street Journal 
• Prasad overruled FDA staff to reject Moderna’s flu vaccine application—STAT  
• AMA launching its own vaccine safety, effectiveness review system—The Hill 
• Study Finds Declining Perceptions of Safety of Covid-19, Flu, and MMR Vaccines—Annenberg Public Policy Center of the University of Pennsylvania  
• Mexico state steps up health screening in schools as measles cases grow nationwide—Associated Press 
• FDA’s rejection of Moderna threatens to stifle broader vaccine industry—STAT  
• US participating in influenza vaccine meeting: WHO—The Hill

Advocates Urge Early Access Planning for MK-8527 

More than 170 groups representing people living with HIV, advocates and providers across 30 countries called on Merck to commit now to a global access strategy for its investigational monthly oral PrEP candidate, MK-8527. Signatories argue that early decisions on pricing, licensing, and regulatory pathways will determine whether the product becomes a transformative addition to the HIV prevention toolkit or follows the slow, inequitable rollout patterns seen with the rollout of oral PrEP. The groups urged Merck to build on the momentum of Gilead’s accelerated work on lenacapavir and pursue regulatory pathways through the European Medicines Agency and the World Health Organization to accelerate approvals in low- and middle-income countries; seek registration in at least 10 high-burden African countries within six months of a major regulatory approval; commit to pricing at or near generic oral PrEP levels (under $40 per person per year); and negotiate non-exclusive voluntary licenses before approval to enable timely generic production.

IMPLICATIONS: This moment reinforces a lesson the HIV field has learned repeatedly: that access needs to be embedded in the design and development of new products. Decisions made during product development around pricing, licensing, regulatory strategy, and manufacturing shape whether innovation translates into impact or inequity. We are already seeing how early, proactive access planning with lenacapavir for PrEP can accelerate timelines, align donors and regulators, and drive what is now the fastest rollout of a new prevention product since oral PrEP. Advocates are pressing Merck to apply those same principles to MK-8527 now, before trials have results, to avoid the delays and disparities that have historically limited uptake of new prevention options in low- and middle-income countries.  

READ:  

• Merck is urged by patient groups to ensure widespread access to an HIV prevention pill being tested—STAT  
• Letter: Ensuring Equitable Global Access to MK-8527 for HIV Prevention 
• Speeding Up Access to PrEP: Time from efficacy results to key milestones—AVAC  
• The Gears of Lenacapavir for PrEP Rollout—AVAC 

What We’re Reading

• Four States Sue Administration Over Loss of Public Health Funds—New York Times
• EU To Pledge ‚700 Million To Global Fund, Less Than Previous Years—Health Policy Watch
• Will Africa’s health care reset leave patients footing the bill?—Devex
• As The Aid Model Collapses, Africa Is Rewriting Its Health Future Through The ‘African Leadership Meeting’—Health Policy Watch
• Dozens of researchers will move to France from US following high-profile bid to lure talent—Nature
• Malawi struggles to fill development gaps after US aid cuts—Devex
• One year after USAID’s shutdown, Ethiopian aid workers are still struggling—Devex
• UN presses for clarity on nearly $4 billion owed by US as financial crisis looms—France 24
• Zimbabwe’s youth pay the price of US funding drawdown—Devex
• WHO director-general calls plans for US-funded vaccine trial ‘unethical’—STAT
• Kenya second-largest Africa vaccine trial hub—The Star (Kenya)
• By Slashing Foreign Aid, Trump is Fueling the Spread of HIV in Uganda—The Intercept
• UN presses for clarity on nearly $4 billion owed by US as financial crisis looms—France 24
• US Global Health Spending Watch—PIH 

This week a $50 billion US foreign affairs spending bill was signed into law, averting severe proposed cuts; a new modelling analysis projects millions of additional preventable deaths by 2030 if global aid cuts continue; and the financial crises facing the UN and WHO continue. We are also following plans to transition or close the Oregon National Primate Research Center, a leading research institution that has contributed enormously in biomedical and HIV research.

US Signs Foreign Affairs Spending Bill Amid Ongoing Uncertainty 

The US Congress passed the $50 billion foreign affairs spending bill and the President signed it into law Tuesday, ending a brief government shut-down. The appropriations bill restores billions in foreign assistance, along with companion bills that restore critical support for biomedical research at the NIH and domestic HIV programs, that had been at risk of deep proposed cuts, though it still represents a reduction from previous years and questions remain about how fully the administration will implement the funding and priorities laid out by lawmakers.

IMPLICATIONS: While this bill averts the most severe proposed cuts and sends a strong signal for continued engagement by Congress, the reduced funding level and uncertainty of whether global health and humanitarian programs will receive the funding Congress appropriated leave many reluctant to celebrate. Coordinated advocacy and sustained Congressional oversight will be needed to ensure all appropriated funds are obligated and spent. 

READ: 

• US Congress passes $50 billion foreign affairs bill—Devex  
• UPDATE: Final Passage of FY26 Spending Package Protects Funding for Domestic & Global HIV Programs after Hard Won Fight, Concerns about Funding for DHS Persist—Save HIV Funding 
• Devex Newswire: Foreign affairs spending bill becomes law after shutdown—Devex

New Modelling Quantifies the Impact of Aid Cuts 

A new modelling analysis published in The Lancet Global Health finds that ongoing cuts to official development assistance, particularly from long-time donors like the US, UK and Germany, could lead to between 9.4 million and 22.6 million additional deaths by 2030 across 93 low- and middle-income countries. This includes more than 5 million children under age five. 

IMPLICATIONS: This analysis reinforces the need to sustain strategic investments now to avoid deaths and setbacks on all fronts, from HIV to maternal and child health to chronic diseases. 

READ: 

• Impact of two decades of humanitarian and development assistance and the projected mortality consequences of current defunding to 2030: retrospective evaluation and forecasting analysis—The Lancet Global Health 
• Global aid cuts could lead to 9.4 million deaths by 2030, study projects—Washington Post 
• Aid cuts could cause 22m avoidable deaths by 2030, study finds—The Guardian

UN and WHO Face Deepening Financial Crisis

Global health and humanitarian institutions are facing an escalating financial and political crisis. UN Secretary-General António Guterres warned that the United Nations risks “imminent financial collapse” if member states, specifically the US, do not pay their dues on time, or fail to agree to revise the financial rules, which require the UN to repay governments hundreds of millions of dollars in credits for programs, even ones that were never implemented. At the same time, the World Health Organization (WHO) launched its 2026 emergency appeal amid its biggest financial decline in a decade and while the US withdrawals and other countries question their engagement.  

IMPLICATIONS: While WHO and the UN pursue reforms toward more sustainable and flexible financing, failure by member states to stabilize funding and modernize governance could strip capacity from global institutions at a moment when they are needed most with major implications for health security, equity, and trust in the global response system. 

READ: 

• US retreat from WHO harms global health and the HIV response—Positively Aware  
• US funding pledge insufficient to avert UN financial woes—Devex  
• Global health systems ‘at risk’ as funding cuts bite, warns WHO—UN News  
• Building healthy bridges towards peace: WHO launches $1 billion appeal—UN News  
• Days After US Leaves WHO, Israel Warns It Faces Pressure To Withdraw—Health Policy Watch 
• What kind of leader does WHO need next?—Devex

NIH to Transition Primate Research Center Amid Broader Shift Away from Animal Testing

In the last week, NIH Director, Jay Bhattacharya, confirmed plans to transition the Oregon National Primate Research Center at Oregon Health & Science University (OHSU) into an animal sanctuary. This is the first of possibly seven of the NIH’s National Primate Research Centers to close or transition and is part of a broader national push to reduce animal testing. The NIH said last year it would spend $87 million to develop a standardized alternative to animal testing. OHSU’s board of directors will meet Monday to consider negotiations with the NIH. They previously estimated it would cost $241 million over eight years to close.

IMPLICATIONS: This move reflects a broader pattern of policy decisions that risk eroding the foundational research systems underpinning early-stage biomedical science, including HIV prevention, treatment, and cure research. While developing alternatives to animal research is important, rapidly dismantling animal research—particularly nonhuman primate capacity at these centers and at the CDC—without validated replacements could weaken the early-stage pipeline that has been critical to breakthroughs such as HIV PrEP, PEP, long-acting prevention, vaccine and cure research and development.

READ:  

• NIH looks to turn primate research center into a sanctuary—Politico  
• As US officials move to reduce animal testing in research, focus may shift to restrictions on imports—STAT

What We’re Reading

• ‘Biblical Diseases’ Could Resurge in Africa, Health Officials Fear—New York Times
• What Will HIV Funding Look Like in 2026?—Bhekisisa
• By-disease investment trends for the first 15 American global health agreements—To End a Plague…Again Substack
• Thanks, but no thanks—The Forsaken Substack
• Gates doubles down on goals in a world weighed down by crisis, CEO says—Devex
• Q&A: How Can Humanitarians Navigate The New Expanded Global Gag Rule?—Health Policy Watch
• Good health is the world’s best investment – and the key to economic resilience—Gavi
• Whose ethics govern global health research?—Nature Medicine
• FDA Commissioner Marty Makary tries to soothe staff concerns over voucher program—STAT
• We asked whether principal investigators have plans in place for how research can continue without them—STAT
• The Only Thing That Will Turn Measles Back—The Atlantic
• Trump Administration to Make It Easier to Fire 50,000 Federal Workers—Wall Street Journal
• Evaluation of an Artificial Intelligence Conversational Chatbot to Enhance HIV Preexposure Prophylaxis Uptake: Development and Usability Internal Testing—Journal of Medical Internet Research
• A Year of Disruption: 5 Resources to Understand Foreign Aid Cuts—Partners in Health
• NIH rolls back red tape on some experiments — spurring excitement and concern—Nature
• Conflicts and Vaccine Hesitancy Undermine Global Immunization Efforts—Health Policy Watch

New this week: resources on the impact of harmful US policies on the HIV response; updated infographics on the ups and downs in PrEP; and an opportunity to apply for the US HIV Cure Academy in North Carolina this April.

The US withdrawal from WHO has made Americans less safe, further damaged diplomatic relationships and will ultimately make America less healthy, writes AVAC Executive Director Mitchell Warren in Positively Aware.

Milestones for access to injectable lenacapavir for PrEP (LEN) are being met faster than any other PrEP product before it. Learn how and why.

The PEPFAR stop-work order resulted in major declines in initiations of PrEP. Between January–September 2024 and January–September 2025, PrEP initiations dropped by 13-66% in high-volume countries, with the steepest declines occurring in PEPFAR-dependent programs disrupted by stop-work orders.

From Devex’s The AID Report, this article features the voices of veteran HIV advocates including AVAC’s Maureen Luba and HEPS-Uganda’s Kenneth Mwehonge. The article traces the impact of the US foreign aid freeze, illuminating how outreach, prevention and monitoring systems are fraying across four African countries critical to the HIV response.

This Bhekisisa piece explores how HIV programs must adapt after US funding cuts. AVAC’s Mitchell Warren argues that survival requires consolidation, new partnerships, boosting domestic government contributions, and sharply refocusing on HIV prevention.

The US HIV Cure Research Academy: April 22-24, 2026 

The US HIV Cure Research Academy brings together researchers and community members from across the United States to learn about HIV cure science and translation. This two and a half-day intensive training program includes interactive discussions, skill-building workshops, and networking sessions. Full scholarships will be awarded for up to 15 attendees. Applications close February 13 at 11:59pm ET. Apply here: US HIV Cure Research Academy 2026!  For further information please contact [email protected].

As this issue goes to publication, the US fiscal year (FY26) budget remains unresolved in the Senate, adding to uncertainty for global health funding. A short-term funding deal reached last night would delay, but not resolve, a potential government shutdown, as negotiations over the administration’s deadly mass deportation efforts continue. For global health programs already under strain, this limbo continues to carry serious consequences. This week’s issue tracks the expansion of the Global Gag Rule under the new “Promoting Human Flourishing in Foreign Assistance” (PHFFA) policy, the US’s formal withdrawal from the World Health Organization (WHO), growing pushback on concerning vaccine policy, and the new finding that nearly half of US CDC surveillance databases have been paused or stopped.

Weaponizing Foreign Aid with the Expanded Global Gag Rule

Last Friday, the US administration expanded the harmful Global Gag Rule (GGR), also known as the Mexico City Policy, under a new Promoting Human Flourishing in Foreign Assistance policy, which broadens restrictions on US foreign aid. Originally enacted in 1984, the GGR barred non-US organizations receiving funding for global health from providing or promoting abortion services (even with their own, separate resources). Each Republican president enforced the GGR, while each Democratic president rescinded it. Now, this administration’s restrictions are being drastically expanded and extend to programs that engage in what the administration labels “gender ideology” and diversity, equity, and inclusion initiatives. It now applies not only to non-governmental organizations (NGOs) based abroad, but US NGOs, multilateral organizations and direct aid to foreign governments. Many organizations, including AVAC, Global Health Council, PAI, Planned Parenthood, Health GAP, and others called for the immediate rejection of the policy as weaponizing US foreign assistance and imposing political ideology at the expense of improving global health and international cooperation.   

IMPLICATIONS: As this Think Global Health editorial from Stephanie Psaki states, “PHFFA applies not just to global health funding but to all non-military US foreign assistance, approximately $30 billion annually—or 50 times more than what was covered by the original Mexico City Policy… At best, the rules will waste US taxpayer dollars and impede the administration’s ability to implement its America First Global Health Strategy. At worst, the policy will cost lives, stall progress against key global health challenges including HIV/AIDS, and further damage US credibility with key partners—particularly across Africa.” Our colleagues at KFF, provide a very useful analysis of this latest expansion here.  

READ:  

• Trump expands policy banning aid to groups abroad that discuss or provide abortions—NPR  
• The Trump Administration’s Latest Expansion of the Mexico City Policy: A Funding Analysis—KFF 
• Latest US Restrictions On Aid ‘Bully’ Recipients To Accept ‘Extremist Ideology’—Health Policy Watch 
• New US funding rules tie aid to abortion, gender ideology, DEI bans—Devex  
• Expanding the Mexico City Policy Undermines Global Health—Think Global Health 

US Formally Notifies WHO of its Withdrawal 

As this issue was going to publication last week, the US formally notified the World Health Organization (WHO) of its decision to withdraw. This triggered responses from WHO and the United Nations noting that the US was a founding member in 1948 and a central partner in major global health gains ever since, and warning that the US departure makes the US and the world less safe.  

IMPLICATIONS: The US withdrawal from the WHO underscores a deeper shift in global health governance where health is a bargaining chip for a new imperialistic ideology around foreign policy and national interest. This move heightens, rather than diminishes, the importance of multilateral cooperation. As Chatham House Fellow, Ebere Okereke, writes in Think Global Health, the “US withdrawal from the WHO increased the relevance of multilateral cooperation for Africa. The WHO remains the primary source of global health norms and coordination, even in its weakened state. Disengagement would leave African countries more exposed to power-based bargaining during crises.” 

READ: 

• WHO statement on notification of withdrawal of the United States—World Health Organization 
• US withdrawal from WHO ‘risks global safety’, agency says in detailed rebuttal—United Nations 
• Joint Statement by Secretary of State Marco Rubio and Secretary of Health and Human Services Robert F. Kennedy, Jr.—US Department of State 
• What U.S. Withdrawal From the World Health Organization Means for Africa—Think Global Health 
• As the U.S. bids adieu to the World Health Organization, California says hello—NPR 
• The Trump administration says it won’t pay what it owes WHO—Devex  
• Withdrawing From the WHO: America Is Not First in Isolation—Medscape   

American Academy of Pediatrics Issues its Own Immunization Schedule

As US policy shifts and vaccine mis- and dis-information fuels mistrust and confusion—including this week’s chair of the CDC’s Advisory Committee on Immunization Practices (ACIP) shockingly questioning longstanding recommendations for polio vaccination—many organizations are stepping up to defend vaccine science and evidence. The American Academy of Pediatrics issued its own 2026 immunization schedule, continuing to recommend routine vaccination against 18 diseases, a broader program of vaccine protection than the new schedule of vaccines released by the US administration a few weeks ago. The AAP’s recommendations are backed by numerous professional groups including the American Medical Association and National Medical Association. The Center for Infectious Disease Research and Policy (CIDRAP) also launched an effort to boost evidence-based vaccine information by partnering with communicators and rapid-response teams to counter misinformation and clarify vaccine safety and effectiveness.

IMPLICATIONS: The AAP’s decision to publish its own comprehensive vaccine schedule, and the broad coalition endorsing it, signals a powerful pushback and commitment to evidence over ideology. This mixed guidance with the medical and scientific community differing from federal recommendations will continue to erode trust and will undermine routine immunization and confidence in public health, ultimately threatening the gains achieved against vaccine-preventable diseases such as measles, influenza, and polio. 

READ:  

• American Academy of Pediatrics departs from CDC with childhood vaccine revisions—The Hill 
• CIDRAP launches new effort to boost evidence-based vaccine information—CIDRAP  
• Rejecting Decades of Science, Vaccine Panel Chair Says Polio and Other Shots Should Be Optional—New York Times

Nearly Half of US CDC Surveillance Databases Stopped Updating 

New research published in the Annals of Internal Medicine shows that nearly half of US Centers for Disease Control and Prevention (CDC) data systems have been paused. Of 82 databases meant to update monthly, 46% show unexplained pauses, most lasting six months or more, and of those paused, approximately 87% track vaccinations. 
 
IMPLICATIONS: As Infectious Diseases Society of America (IDSA) CEO Jeanne Marrazzo writes in an accompanying editorial, “Until the United States restores the CDC and its partner agencies to their former stature, we are not only flying blind in the face of emerging and reemerging threats to human health and well-being—we are being deprived of effective weaponry.”

READ:

• CDC Stopped Updating Key Vaccine, Infectious Disease Databases in 2025—Medpage Today 
• Nearly Half of Once Frequently Updated CDC Databases Are Now Outdated—The Scientist 

What We’re Reading

• The anti-HIV jab Buhle trusts — and 456 000 South Africans can soon get for free—Bhekisisa
• Transformative’ HIV PrEP shot slowly overcomes cost hurdles—The Hill
• One year after US aid freeze, HIV care in Africa is in retreat—Devex
• Zambia US Talks Tie Medical Aid to Mining—Lusaka Times
• US gives 5 weeks for 5-Year Aid Plans—To End A Plague…Again Substack
• US loses Gavi board seat after withholding funding—Devex
• US Freezes All Funds to Gavi Over Vaccine Preservative Thimerosal—Health Policy Watch
• Pandemic Agreement on Hold: Can Countries Bridge the Divide on Pathogen Access and Benefit Sharing—Health Policy Watch
• Lessons From William H. Foege, A Global Health Legend—Forbes
• Kennedy Plan to Test a Vaccine in West African Babies Is Blocked—New York Times
• Trump and allies at odds over COVID shots—Axios

Last week marked one year since the US president took office and began systematically dismantling global health and equity. Below is a roundup of essential conversations and resources summarizing the past 365 days and what’s at stake as we move forward.

READ: One Year Later: Global Health Chaos and Disruption 

AVAC shared a series on the impact of the past year on five key areas of global health and development: the erosion of US foreign aid; the assault on vaccine science and policy; the dismantling of the research enterprise; the cruel irony of funding cuts in the context of the breakthrough technology of long-acting lenacapavir for PrEP; and the profound shifts underway in global health architecture. These original articles by AVAC show how the field navigated a year defined by disruption and resilience—and how policy decisions reverberate through science, programs, and communities. 

WATCH: The People’s Research Agenda

Last week, hundreds joined AVAC for a conversation about The People’s Research Agenda for Speed, Scale and Equity, with Jeanne Marrazzo, former NIAID Director, CEO of the Infectious Diseases Society of America (IDSA), and AVAC Board member. Watch the recording to hear what it will take to deliver science that meets the moment and how advocates can use the People’s Research Agenda, which offers a people-led framework that tracks the science, highlights where investments align with community priorities and identifies critical gaps to ensure the prevention pipeline meets the needs of diverse populations in a reimagined HIV response.

LISTEN: One year after Trump: The day HIV funding changed forever — and what came next 

One year ago, Donald Trump was inaugurated as president of the United States and, overnight, US policies on HIV funding for countries like South Africa changed. Bhekisisa’s Mia Malan speaks with AVAC Executive Director Mitchell Warren to find out how international aid has changed.

READ: Fighting for Billions: The legal battle to keep US foreign aid alive 

Devex’s in-depth retrospective chronicles how legal action became a critical line of defense against the dismantling of lifesaving programs by the US administration — including the ongoing cases by AVAC, the Global Health Council and partners challenging the foreign aid freeze. The piece highlights where we are with the case and why the outcome still matters.

READ: Expansion of the Global Gag Rule 

Late on Friday, the US Administration dangerously expanded the Global Gag Rule, which further restricts the ability of organizations to engage in advocacy, education programs, discrimination protections, and legal reform, anywhere in the world, in any program, with anyone’s funding. 

Download: The Latest Infographics from AVAC

Check out three essential infographics on the HIV vaccine clinical trials pipeline, PrEP products currently available and in late-stage clinical trials and lenacapavir regulatory approvals—to visualize where the field is today and what lies ahead.

Since first established in 1984 by President Ronald Reagan, the Global Gag Rule has harmed global health and disrupted sexual and reproductive health and HIV programs. Reports on the dangerously expanded rules likely to be issued today would move beyond the assault on women’s health and bodily autonomy and lay bare the US administration’s broader war on gender, diversity, equity and inclusion, underscoring their relentless agenda of control over people and programs. 

The expanded Gag Rule restricts the ability of organizations to engage in advocacy and education programs, discrimination protections, and legal reform, anywhere in the world, in any program, with anyone’s funding. This will silence healthcare providers, undermine civil society, and deny people access to essential information and services. The expansion of this policy threatens the very integrity of evidence-based care and foreign assistance. 

“This cruel Gag Rule is bad politics and bad policy,” said AVAC Executive Director Mitchell Warren. “Expanding it represents further weaponization of US funding to impose ideology at the expense of lives and livelihoods. Restricting information and activities that providers deem necessary puts individuals, communities and especially women, girls, LGBTQI+ people, and others at higher risk of poor sexual health outcomes including HIV and other infections. It also weakens the very systems required to respond to global health emergencies and prepare for future pandemics.” 

People’s needs—not politics—must be at the heart of what drives US investments, programs, and global engagement. The Global Gag Rule plays politics with people’s health and lives. AVAC calls for the immediate rejection of the Global Gag Rule and any expansion of it and urges US lawmakers to uphold science, human rights, and public health.