Global Health Watch: NIH-DoD Deal & NIAID Restructuring, Ebola Vaccine Progress, Gavi Funding Resumes, New US Foreign Aid Leadership

Issue 85

September 11, 2026

The US National Institutes of Health (NIH) signs a 10-year agreement that could move significant NIAID research funding to the Department of Defense, as NIAID separately proposes a major restructuring of its clinical research infrastructure. CEPI advances efforts toward a Bundibugyo Ebola vaccine amid funding gaps, while US funding for Gavi resumes and medical groups step in on vaccine guidance. And new leadership at the Department of State brings further change to the US foreign assistance system.

NIAID Funding and Research Infrastructure Uncertain

The US National Institutes of Health (NIH) signed a 10-year agreement with the US Department of Defense (DoD) to allow the transfer of NIH funds to DoD for projects that would “support the advanced development of medical countermeasures against pandemic influenza, chemical, biological, radiological, and nuclear (CBRN) threats, and emerging infectious diseases.” Funding will come out of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) budget and has the potential to shift hundreds of millions of NIAID-funded research into the military biodefense program. According to an NIH spokesperson interviewed by Nature, “This partnership will only take place on a project-by-project basis, and all research will be within the scope of NIH’s mission. There is no blanket transfer of funds.” Nature reports that NIAID is identifying projects that could move under the arrangement, while congressional Democrats have raised concerns that the agreement could give DoD access to money Congress appropriated for biomedical research at NIH. The agreement was signed last month but went largely under the radar until this week, when Representative Rosa DeLauro (D-CT) – ranking chair of House Appropriations – raised the issue during a hearing.

The agreement comes as NIAID is also proposing a significant restructuring of its clinical research infrastructure. Under a reorganization announced in late August, NIAID would do away with its Division of Clinical Research (DCR), which helps facilitate and coordinate NIAID research programs in the US and internationally, and redistribute clinical operations and oversight across other parts of the Institute. The proposal follows months of delays in renewal notices for NIAID’s HIV clinical trial networks and Centers for AIDS Research (CFARs), raising concerns about the future of the research networks and infrastructure that has supported major advances in HIV, TB and other infectious diseases.

IMPLICATIONS: While the NIH-DoD agreement is supposedly designed to support biomedical countermeasure research, there is substantial discretion over which projects move and how the money is ultimately used. If this agreement shifts infectious-disease research away from NIAID, it risks fragmenting an infrastructure built around peer review, scientific expertise, clinical research networks and long-term public-health priorities. The fact that this agreement was unilaterally executed by the Administration a month ago, without public knowledge or Congressional notification, points to a strong need for policymaker oversight of this process to ensure that Congressionally-appropriated biomedical research funding for NIAID is used for its intended scientific purposes and that changes to the Institute do not undermine or diminish the research capacity and leadership that was built over decades through bipartisan support.

These concerns extend beyond individual grants and institutions. A March Health Affairs analysis highlights how decades of US investment in international HIV research have generated scientific advances and research capacity that also benefit Americans—underscoring that global HIV research infrastructure is not separate from US health and scientific leadership. And a recent Think Global Health analysis of the Administration’s proposed budget cuts at NIH highlights the threaten to essential HIV research.

IDSA and HIVMA have separately warned that NIAID’s research infrastructure is already being destabilized by delayed renewals and a proposed restructuring of its clinical research program. Beyond an initial chart posted to the NIAID’s website, very little detail has been shared on the proposed reorganization, as advocates are monitoring for additional insight to be revealed on the restructuring in an uncharacteristically short deadline for public comment from September 9-18.

READ:

Vaccines Depend on More than Science

Nearly 100 days into the Bundibugyo Ebola response, there is still no approved vaccine, and the Coalition for Epidemic Preparedness Innovations (CEPI) says another $128 million is needed to prevent delays in later-stage trials of vaccine candidates. But CEPI also points to the response as evidence of how investments made before an outbreak can accelerate vaccine development: six pre-positioned research and response networks were activated within three days; three vaccine developers received funding within two weeks; and two experimental vaccines entered Phase 1 trials within 11 weeks. (There are now at least five vaccine candidates in clinical trials.) The experience underscores that rapid vaccine development depends on scientific breakthroughs and on sustained investment in the research networks, financing, partnerships and infrastructure needed to move quickly when a crisis emerges. Meanwhile, the US Administration announced it will release $600 million in Congressionally-appropriated funding for Gavi after more than a year of uncertainty, saying Gavi had committed to transitioning away from vaccines containing the preservative thimerosal—even though Gavi was already moving toward newer vaccines for broader public health benefits.

And in the US, leading medical organizations issued their own recommendations for COVID-19, flu and RSV vaccines as litigation over federal vaccine policy has disrupted the usual Centers for Disease Control and Prevention (CDC) recommendation process.

IMPLICATIONS: The speed of the Bundibugyo response was possible because research networks, manufacturing partnerships, regulatory preparation and vaccine platforms were established before the outbreak, but financing gaps could still slow the next stage. At the same time, the Gavi funding dispute and US medical societies stepping in to provide independent vaccine guidance demonstrate how political interference and instability in public health institutions can affect financing, recommendations, trust and ultimately access. Rapid scientific progress requires sustained investment in the institutions, expertise, partnerships and infrastructure that make it possible long before a crisis begins.

READ:

New Leadership for US Foreign Assistance

This week, Dr. Becky Bunnell, Principal Deputy Assistant Secretary of State for PEPFAR – and a distinguished HIV research and program leader for decades – announced her intention to step down from PEPFAR leadership. No one individual – or organization or policy maker or politician – is responsible for PEPFAR’s tremendous success. But Becky epitomizes all that has made PEPFAR great and impactful – commitment to evidence, data and, most importantly, the individual staff, partners, participants and clients that matter. Her retirement leaves a huge void.

At the same time, Andrew Veprek is the new political appointee leading the US Department of State’s foreign assistance, humanitarian affairs and religious freedom bureau. He replaces Jeremy Lewin, who moved to lead the Department’s policy planning office. Veprek previously led the Bureau of Population, Refugees, and Migration working to align humanitarian programs with the Administration’s immigration priorities. He has criticized “forever aid” and argued that foreign assistance should have a “clear and direct connection” to US foreign policy goals.

IMPLICATIONS: These leadership changes are another important development in the ongoing restructuring of US foreign assistance, as the State Department assumes greater control over programs previously managed through USAID and global health remains one of its three principal foreign-assistance pillars. Veprek has advocated for limiting open-ended assistance, increasing contributions from other countries and more closely aligning funding with Administration priorities. For global health programs, including PEPFAR, this new leadership raises new questions about how much Congressionally-appropriated funding is ultimately released, where it flows and what conditions may be attached.

READ:

The Impact Report: Two Decades of Good Participatory Practice in HIV Research

AVAC’s new Impact Report illustrates how meaningful participation – driven by Good Participatory Practices (GPP) – strengthens both the research process and the global impact of HIV prevention innovations.

Read the Report

What We’re Reading