Global Health Watch: PEPFAR, US foreign aid strategy, CDC turmoil, LEN for PrEP, vaccine policy

As the US government approaches its September 30 fiscal year deadline, the Supreme Court of the United States (SCOTUS) is weighing whether to uphold the District Court’s order in the AVAC v. Department of State lawsuit, which compels the US government to spend billions in congressionally-appropriated foreign aid, or allow the Administration to “run out the clock” as part of the “pocket rescission” maneuver. This ruling, alongside SCOTUS decisions on tariffs, could dramatically expand executive power over spending historically controlled by Congress. Coupled with CDC and vaccine policy turmoil, changes to PEPFAR’s planning process, and the State Department’s new “America First” global health strategy, these developments represent high stakes for HIV programs and the future of foreign aid for global health. 

New “America First” Strategy for Global Health Released

Under the plan, the US would initially cover 100% of commodity and frontline healthcare worker costs through the start of the next fiscal year but would shift an increasing share of expenses to partner governments over time. The plan also signals a reshuffling of which countries will receive US investments and may involve “third-country” allies in future agreements to reduce overlap. The plan does prioritize “innovation” and specifically names the importance of lenacapavir (LEN) for PrEP and the recent re-commitment of the Biden Administration first announced in December.  

IMPLICATIONS: This new strategy prioritizes US interests over traditional development goals and represents a fundamental overhaul of US global health assistance, with major consequences for HIV prevention and treatment programs worldwide. Moving toward bilateral agreements and compacts risks fragmenting coordination, intensifying the politicalization of assistance, slowing disbursements, and creating uncertainty for countries already grappling with budget shortfalls. While the new strategy appears to reaffirm US commitments to global targets for ending the HIV epidemic, there is concern whether current indicators will continue to be tracked and many unknowns in the details of pending bilateral agreements. For programs like PEPFAR, which have long relied on predictable, multi-year, large-scale US support, the new approach could mean sudden funding gaps and weaker negotiating leverage on pricing or access for new prevention tools. And while it is good (and smart) to see LEN prioritized, the continued unilateral focus on PrEP for mother-to-child transmission reflects a continued blind-eye to the epidemiology of HIV/AIDS and the need to provide LEN and prevention generally more broadly. 

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Where Are We With PEPFAR?

PEPFAR has initiated a “Bridge Plan” process to determine programming for a six-month stopgap funding period running from October 2025 to March 2026 and incorporating a 40% budget cut from previous allocations. For decades, countries and civil society have prepared Country Operational Plans (COPs) months in advance with clear budgets, targets and plans. Instead, this Administration began by freezing foreign aid and proposing a 40% cut to global health in the President’s fiscal year 2026 (FY26) Budget Request. In place of COPs meetings, PEFPAR instituted this temporary bridge plan process—with limited time and no stakeholder engagement. Country plans are due on September 24, leaving partner governments and civil society scrambling to meaningfully engage in decisionmaking with sharply reduced resources. Advocates warn that prevention services, key population programs, and the introduction of innovations like lenacapavir could all be delayed or excluded. The process also signals an attempt to go around Congress to enact the President’s requested FY26 budget cuts. 

IMPLICATIONS: The Bridge Plan keeps PEPFAR technically alive but with scaled-back funding, compressed timelines, and weaker accountability structures. If granular targets and community voices are sidelined, countries may lose hard-won gains in prevention and treatment and see stalled or reversed progress on HIV. Missing or delaying the rollout of LEN for PrEP, especially for key populations, would exacerbate the setback. Over the next six months, how these plans are finalized will shape the trajectory of global HIV programming for years to come.

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US CDC Recommends LEN for PrEP

After the departure of US Centers for Disease Control and Prevention (CDC) leadership in the last month and Senate testimony by its former Director a day prior (see below), the CDC issued new clinical recommendations endorsing injectable lenacapavir as a twice-yearly option for HIV PrEP, marking a major milestone in the expanding PrEP landscape. 

IMPLICATIONS: These recommendations are an important step forward, but equitable implementation remains a challenge in the US, especially the very high list price. This progress underscores the importance of strong policy protections like the Affordable Care Act, which requires most private health plans to cover PrEP, including visits and labs at no cost. However, ongoing legal threats to the ACA’s preventive coverage mandate could jeopardize access to LEN and all PrEP options. Tools alone don’t end epidemics; they must be delivered with equity. 

Given the political turmoil at CDC, these recommendations reflect – as so eloquently stated by Francisco Ruiz, former director of the White House Office of National AIDS Policy – “the tireless work of colleagues and partners who push science forward despite adversity. Their dedication underscores the need to keep investing in research, our workforce, and the infrastructure that ensures providers, communities, and people everywhere have access to proven HIV prevention tools. This is CDC in action … dedicated people, strong science, healthier communities.”

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CDC Turmoil as Former Director Testifies Before Senate Committee and ACIP Prepares Vaccine Recommendations 

Meanwhile, former CDC Director, Susan Monarez, testified Wednesday at the Senate HELP Committee hearing on her unjust firing. Monarez said she was forced out of the CDC after refusing to pre-approve vaccine recommendations and to fire career officials without cause. “He [HHS Secretary Robert F. Kennedy Jr.] just wanted blanket approval…Even under pressure, I could not replace evidence with ideology.” Monarez’s former chief medical officer, Debra Houry, who resigned shortly after Monarez was removed, echoed these concerns and called for RFK Jr.’s resignation warning that the upcoming Advisory Committee on Immunization Practices (ACIP) meeting could cement dangerous new policies.  

As this issue went to publication, the ACIP had just voted 8 to 3 to change the current recommendations that allow children under 4 to receive the combination vaccine for measles, mumps, rubella and varicella (MMRV). The ACIP is expected to vote today on shifting routine Hepatitis B vaccination (HBV) currently given at birth and to make recommendations on vaccines for COVID-19. These shifts raise important questions about sustainability, access, and equity moving forward. 

IMPLICATIONS: The testimonies of Monarez and Houry, their departures and the departures of other trusted CDC leaders are eroding confidence in the agency’s ability to make independent, evidence-based decisions. This raises serious questions about whether future CDC guidance will be evidence-based and can maintain credibility in an increasingly politicized environment. When public health decisions are perceived as politically pre-determined rather than evidence-based, public confidence in recommendations will erode and public health will be compromised. Departed leaders are encouraging individuals to seek advice of their medical professional over national recommendations. Health officials are warning that vaccine uptake will be lower, disease outbreaks will be more likely and health responses will be weaker.  

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24 Hours to Save AIDS Research

Earlier this week, nearly 5,000 scientists, researchers, advocates and members of the community came together for the online marathon to showcase and support decades of US investment in HIV research: what it has achieved and what’s now at risk. Since January 20, the US Presidential Administration has been making massive cuts to HIV research, dismantling the infrastructure for conducting research and spreading disinformation on the benefits of research. For 24 hours, more than 60 researchers from all over the world broadcast the facts, countered the lies and showed what HIV research has achieved. All recordings will be posted soon.

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Global Health Watch: SCOTUS decision keeps foreign aid frozen, US FY26 budget updates, Global Fund’s new report and shifting focus

Issue 33

This week Global Health Watch covers major developments from a Supreme Court decision stalling foreign aid disbursements (again), to the US House’s fiscal year (FY26) budget drafts, and the Global Fund’s updated report and shifting focus.

Supreme Court Pause in AVAC’s Foreign Aid Case 

The AVAC and Global Health Council cases against the US presidential administration on the foreign aid freeze continue to play out in the courts. Tuesday, US Supreme Court Chief Justice John Roberts issued a one-person decision, which granted the Administration a temporary administrative stay (or pause) on the recent District Court ruling. This temporary ruling means the government would not have to spend the congressionally appropriated funds by the September 30th fiscal year deadline despite the District Courts order last week that required them to do so.   

IMPLICATIONS: Chief Justice Roberts’ order effectively keeps the Administration’s “pocket rescission” strategy alive by temporarily suspending the District Court’s order. AVAC and its partners are preparing their Supreme Court brief due by Friday to make clear that allowing the Administration to “run out the clock” would not only devastate lifesaving programs but also set a dangerous precedent that erodes democratic oversight of federal spending. 

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US FY26 Budget Proposal Maintains NIH Budget, but Cuts CDC 

The US House Labor, Health and Human Services (LHHS) Appropriations Subcommittee released its fiscal year 2026 (FY26) draft spending bill, which allocates $184.5 billion, of which $108 billion is designated for Health and Human Services (HHS). This is approximately 6% less than the current year funding levels, and, notably, the proposal includes steady funding for the National Institutes of Health (NIH) at $48 billion. However, the bill includes deep cuts to the HIV prevention program at the Centers for Disease Control and Prevention (CDC) at 19-20% and eliminates the Title X family planning program. 

IMPLICATIONS: While NIH funding is preserved for now in the House bill, deep cuts to CDC, Title X, and key public health infrastructure pose a serious threat to HIV prevention, STI research, and community health programs. The upcoming full committee markup and potential amendments by Democrats will reveal where bipartisan opportunities remain, and where the fight for global health funding must focus next. 

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Global Fund Results and Shifting Focus 

The Global Fund released its 2025 Results Report, which shows increased access to HIV treatment and historic progress on TB and malaria prevention in countries where it invests. 

However, the Fund is facing serious funding shortfalls. As foreign aid declines, especially from major donors like the US, the Global Fund on Wednesday said it will prioritize funding “even more to the very poorest countries,” especially those facing conflict, high disease burden, and climate stressors, which have fewer alternative funding options.  

IMPLICATIONS: As we’ve been saying for months, gains in HIV, TB, and malaria could stall or reverse without urgent intervention. Prioritizing the poorest is necessary, but cuts could still undermine infrastructure, limit access, and exacerbate inequities globally. There is also a risk that countries dependent on Global Fund grants may face disruptions just when demand for prevention tools is growing and when new options (like long-acting PrEP) need stable funding to scale. 

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SA AIDS 2025 Highlights

The South African AIDS Conference spotlighted resilience across communities amid funding shocks and setback with advocates insisting that their work must intensify. AVAC and partners emphasized that products don’t end epidemics, programs do – and called for urgent, scalable, and people-centered approaches to turn innovation in research and development into options and choices that impact lives. The takeaway: protect prevention, invest in locally led systems, and keep communities at the heart of HIV response and research.

What We’re Reading

Resources

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!

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Join Us for ‘24 Hours to Save AIDS Research’

Join AVAC and partners as we host 24 Hours to Save AIDS Research on September 16-17. This all-day, online marathon will include more than 70 speakers from around the world sharing their work and experiences with HIV research. Registration is open and the interactive event will stream on YouTube.

Since January 20, the US Presidential Administration has been making massive cuts to HIV research, dismantling the infrastructure for conducting research and sharing misinformation on the benefits of research. The commitment and actions of the scientific and advocacy communities have been successful in reversing some of these actions and the pressure must continue. 

For more ways to make the case for sustained investments in biomedical research and development and to track the devastating impacts of recent cuts on HIV and STI research and development, visit Research Matters, which shares a toolkit for researchers, and see our impact trackers below. 

Impact Trackers

HIV Prevention R&D at Risk
Want to understand how the US policy shifts are endangering the future pipeline of HIV prevention tools? Check out our HIV Prevention R&D at Risk tracker.

Impact of PEPFAR Stop Work Orders
Want an in-depth look at how the PEPFAR stop work orders and contract terminations have disrupted PrEP access? Check out our PEPFAR PrEP impact tracker.

Why STI Funding Matters: Worldwide Prevention, Shared Protection
Want to know about the global threat posed by defunding STI research and programming? See our Why STI Funding Matters tracker.

Delivering Lenacapavir for PrEP

As the fight to protect HIV research from devastating cuts continues, we must also push to ensure that the breakthroughs it generates, like innovative new PrEP options, reach the populations most in need of prevention. 

PEPFAR Reemerges to Support Rollout of Lenacapavir for PrEP 

PEPFAR and Gilead Sciences 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” last week. 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. “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.

Resources to Deliver LEN with Speed, Scale and Equity

See AVAC’s in-depth resources to inform an equitable and effective rollout of LEN. 

The miracle of mRNA: What’s possible beyond SARS-CoV-2—understanding mRNA, its history and potential challenges for HIV vaccines

Thursday, September 11 at 9am ET
Approved in July, lenacapavir for PrEP has tremendous potential to increase access and engagement in the United States, reaching individuals who have been unable to embrace PrEP in its previous formulations. Please join the Choice Agenda and the HIV BLUPrInt team for a deep dive into rolling out LEN in the US.

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Global Health Watch: PEPFAR Reemerges, Budget Deadlines, Gov’t Shutdown Risks, Vaccine Policy Unraveling and What’s Next for FY26

Issue 32

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. 

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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. 

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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. 

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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.  

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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

Resources

A Resource Round Up Covering Funding Fights & A New Generation of PrEP

Policy Fights and Funding — From Further Cuts to Foreign Aid to Defunded STI Prevention

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

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 12th 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.

Global Health Watch: CDC leaders depart, updates in the AVAC v Department of State case on foreign aid

Issue 31

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. 

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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.  

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The EXPrESSIVE Trials Test a Monthly Pill for PrEP: Advocates Speak

Read a statement by advocates and tune into AVAC’s podcast to learn why these trials of a once-monthly PrEP pill matter, how communities shaped them through Good Participatory Practice and what this means for expanding choice in HIV prevention.

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What We’re Reading

Resources

Save the Date!

AVAC Responds to Government’s Emergency Appeal to SCOTUS

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.”

The EXPrESSIVE Trials Test a Monthly Pill for PrEP: Advocates speak

The drug maker Merck’s recent announcement at IAS 2025 of two new efficacy trials of a monthly PrEP pill, known as the EXPrESSIVE program, is welcome news. A long-acting PrEP pill would offer a unique new option that could transform the field, contributing significantly to expanding use of HIV prevention, especially to young women, key populations, and those navigating stigma, clinic fatigue, or other barriers to health services.

In addition, Merck’s robust commitment to stakeholder engagement to date contributes an important model of Good Participatory Practice (GPP) to the field, by putting global advocates at the forefront of planning for the program. Merck has expressed a commitment to sustain this vital engagement throughout the program and next steps, and advocates will be holding them to it. AVAC is pleased to share this statement, Global Advocates Welcome the Launch of Merck’s EXPrESSIVE Program, from numerous organizations and advocates who commend Merck “for this important investment in innovation, equity, and choice.”

“This is not just another trial; it’s a signal that the needs of young women and other key groups most affected by HIV really matter,” said Chilufya Kasanda Hampongo, Chair of the Young Women’s HIV Prevention Council (YWHPC). “A monthly pill will offer a new kind of freedom—something discreet, something manageable, something we can own on our terms.”

AVAC has produced several resources to explain and contextualize the EXPrESSIVE program and the monthly PrEP pill.

Now is the time for advocates to serve as both watchdogs and champions for the EXPrESSIVE program and additional options! Join AVAC in tracking this important development in prevention research.

Global Health Watch: Pullback at UNGA, foreign aid freeze litigation, FY26 budget cuts and new NIH research priorities

Issue 30

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. 

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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. 

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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.  

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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.  

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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.  

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HIV Prevention R&D at Risk

The entire HIV response — from basic research and clinical development to policy, programs, and global access to life-saving treatment and prevention — is under attack, and the world runs the risk of reversing the strides made to end HIV. This report highlights the impact of US cuts on the pipeline of HIV prevention research and development.

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Global Health Watch: NIH swings to implementation science, Court upholds foreign aid freeze, federal grants politicized & violence at US CDC

Issue 29

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.  

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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.  

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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. 

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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.   

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Getting PrEP Rollout Right This Time: Considerations for LEN for PrEP Introduction

This new resource shares insights and recommendations for the introduction of lenacapavir for PrEP building on lessons from over a decade of PrEP implementation.

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