Global Health Watch: White House Drops NIH Review Plan, NIAID Reorg Moves Fwd, Prep for Generic LEN Access, Accra Reset

September 25, 2026

There is no shortage of global health news this week. Against the backdrop of the UN General Assembly (UNGA 81), this issue covers efforts to reshape the global health architecture through the Accra Reset, proposed and withdrawn Executive Orders affecting NIH grant making, NIAID restructuring developments, and preparations to expand access to generic lenacapavir for PrEP.

White House Drops NIH Review Plan and NIAID Reorganization Moves Forward 

In response to significant opposition from advocates, researchers, scientific institutions and members of the US Congress, the White House withdrew plans to issue an Executive Order (EO) that would have created an ‘external review committee’ with decision-making power over billions of congressionally-appropriated biomedical research dollars. The EO would have marked a significant overstep by politicizing NIH grantmaking review to fit ideology and in opposition of a process historically based on scientific merit and rigor. The review committee would have included political appointees, including Office of Management and Budget (OMB) Director Russell Vought.  

The reversal of this plan came just as the NIAID Council and AIDS Research Advisory Committee (ARAC) met Wednesday to discuss the proposed reorganization of NIAID that would eliminate the Division of Clinical Research and redistribute clinical research functions across the Institute. This proposal to fundamentally change the US biomedical research enterprise under which federally funded HIV research occurs was open for public comment for a mere five days. AVAC delivered a public comment at the meeting, raising concerns about the potential disruption to HIV research, global research partnerships and community engagement, and urging NIH to withdraw the proposal, provide greater transparency and meaningful opportunities for community input, and immediately release delayed funding opportunities for the HIV Clinical Trials Networks and Centers for AIDS Research. 

IMPLICATIONS: The White House’s decision not to move forward with the EO to establish an external review committee is one step in reducing greater political control over NIH grantmaking, and an example of advocacy and bipartisan congressional oversight in pushing back against political interference. However, the NIAID reorganization, delays in critical HIV research funding opportunities and disputes over how NIH grants are reviewed and funded are continuing. As US Senator Patty Murray (D-WA) and ranking member on Senate Appropriations said, “Whether lifesaving medical research gets funded or not should be determined by experts at the NIH—not a panel of lackeys…,” as she underscored the need for stronger statutory protections against political interference in research funding.

READ:

• White House backing down from NIH grant order—The Hill 
• White House Backtracks on Plan to Exert New Control Over N.I.H. Grants—New York Times 
• The NIH budget should be $100 billion per year—STAT  
• The End of the War on Biomedical Science?—NEJM  
• I’m a Republican senator. America needs more science, not less.—Washington Post 
• Senator Murray on Trump’s Latest Plan to Politicize Lifesaving NIH Research—US Senator Patty Murray 
• Keep politics out of medical research—IDSA  
• Russel Vought will reportedly be given veto power over all NIH grant—ARS Technica 
• White House Moves to Take Control of N.I.H. Grants—New York Times 
• Trump administration backing off NIH grant order amid pushback—Semafor 
• Stand Up for Science Warns of Trump And Vought’s Backdoor Plan to Seize Control of Entire NIH Grant Budget—Stand Up for Science

Global Fund Prepares for Generic Lenacapavir for HIV PrEP

The Global Fund announced Thursday that it is preparing for an expansion of lenacapavir for HIV PrEP (LEN) as milestones for generic introduction approaches. This builds on the two new agreements announced last week from Gilead Sciences, the developer of lenacapavir – one with the Pan American Health Organization (PAHO) to expand access to LEN in Latin America (although no clear volume or price was named) and the other to expand the six generic licenses to include the potential once-yearly option still in development (in addition to the current every six-months)—see last week’s Global Health Watch for more details.  

The Global Fund says it anticipates initial generic supply in late 2026 and wide scale availability in 2027, when it expects a significant acceleration in access to LEN. It also reiterated the goal, shared with PEPFAR, of reaching 3 million people with LEN by the end of 2028, and pointed to its existing expedited review and pooled procurement mechanisms as pathways for generics.  

IMPLICATIONS: While the announcement underscores growing demand for LEN and the importance of combining Gilead supply with generics to meet it beginning in 2027, it offers few new details about how or when that expansion will happen, including which generic manufacturers will supply product, expected volumes, pricing or specific next steps. Early implementation is already illustrating strong demand for LEN, which is outpacing available supply. AVAC previously forecasted that there could have been up to 1.5 million LEN users in 2026 in the top 16 LMIC PrEP markets – IF enough product had been procured – including 1.3 million in the 12 Global Fund and PEPFAR early adopter countries. And while the goal of reaching three million people over three years with LEN moves the rollout faster than previous PrEP options, as AVAC documented in July 2025, it does not meet the true demand for PrEP, nor will it deliver population-level impact. AVAC is pushing to accelerate orders and deliveries now, so that the three million LEN user target is achieved in two years, instead of three, in order to increase volumes, reduces price, build a durable market and sustain impact. Additionally, it is essential to build and strengthen prevention platforms now that can more quickly and efficiently integrate new products beginning in late 2027 and 2028 and avoid an innovation pile-up with the pipeline.  

READ:

• Global Fund Prepares for Major Expansion in Access to Lenacapavir as Generic Supply Approaches—Global Fund 
• Is Aspen betting on the right HIV prevention product?—Spotlight (SA)  
• Where We Are Now with LEN for PrEP—AVAC  
• Now What with Injectable LEN for PrEP—AVAC  
• PAHO, Gilead deal expands lenacapavir access for 14 countries—Devex  

The Accra Reset Shares Blueprint for a New Global Health Architecture 

On the sidelines of the UN General Assembly (UNGA) this week, a High-Level Panel of the Accra Reset launched its report, A Sovereign Future for Health – a 10-point blueprint for restructuring global health financing and governance. The Accra Reset, an initiative launched by Ghanaian President, John Dramani Mahama in 2025, calls for moving from aid dependence toward country-led financing and systems. The new blueprint makes the case for global health cooperation to be organized around priorities and capabilities defined by countries themselves rather than separate donor institutions and funding streams. The report’s ten recommendations include aligning partners behind one national health plan, budget and coordination platform; increasing domestic and pooled financing; strengthening regional research, manufacturing, regulatory and procurement capacity; and reforming global health institutions under a framework of “Commit, Collaborate, Consolidate and Close”. This includes potentially sunsetting institutions when their functions can be transferred elsewhere. Importantly, the report calls for a managed transition rather than abrupt withdrawal of international support. 

IMPLICATIONS: This blueprint comes as some organizations who have historically been at the center of the current global health architecture look ahead to their future. UNAIDS is considering significant reform, the Global Fund is determining its future with significantly reduced funding and selecting its next Executive Director, and Gavi is looking at ways for countries to finance more of their own health priorities. Notably, Global Fund Executive Director Peter Sands and Gavi CEO Sania Nishtar participated in the Accra Reset launch at UNGA, alongside the WHO and the Pandemic Fund. 

READ: 

• As Global Pandemic Approach Flounders, Experts Offer Blueprint to Protect All Citizens—Health Policy Watch 
• Offline: The tragic fallacy of global health reform—The Lancet  
• America Announces End to All Health Funding in Zimbabwe—New Zimbabwe  
• Accra Reset Unveils 10-Point Plan to Shift Global Health Towards Country-Led Systems—Voice of Africa 
• Healthcare in Africa ‘under growing strain’ after US withdrawal from aid programs, report warns—The Guardian  
• One year after Accra Reset launch, panel lays out next steps—Devex  
• Accra Reset’s Plan for Health Sovereignty Includes Closing Some Global Health Bodies—Health Policy Watch  

What We’re Reading

• Putting the Public Back In Public Health—With & For Substack 
• Ervebo vaccine trial kicks off in Ebola-ravaged DR Congo—CIDRAP   
• WHO Africa chief: DRC Ebola outbreak could surpass West Africa crisis—Devex
• Local, state public health officials overwhelmingly faced serious backlash during pandemic, report reveals—CIDRAP 
• Beyond Protecting HIV Programs: Building the Public-Health System We Need Part 2—POZ
• HHS unveils new initiatives to reduce animal testing in drug development—STAT 
• Why self-care is becoming a health systems issue—Devex
• UK Commits £254 Million to Expand Global Maternal Healthcare Access—Streamline
• Wellcome CEO calls for rethink of global health institutions’ mandates—Devex 
• These 6 charts show how NIH research funding has been reshaped under Trump—NPR
• Kennedy Keeps Finding New Ways to Undermine Trust in Vaccines—New York Times
• “Secretary of Measlesland”: Dr. Paul Offit Slams RFK Jr.’s Handling of Deadly Measles Outbreak—Democracy Now