Global Health Watch: Billions in Question, NIH + America First Plans, WHO + Global Fund Leadership & PPPR Rejection

October 2, 2026

The US fiscal year ended this week amid questions about the billion dollars in Congressionally-appropriated foreign assistance, while new strategies for HIV research at the National Institutes of Health (NIH) and the America First Global Health strategy theoretically move into implementation phases. Also, the Global Fund announced five candidates for its Executive Director, and six candidates were shared as possible leaders of the World Health Organization (WHO), just after the US rejected the UN pandemic preparedness declaration at the end of last week.  

Fiscal Year Ends with Billions in Global Health Funding in Question 

The US 2026 fiscal year ended Wednesday, September 30, and it is not at all clear how billions of dollars of Congressionally-appropriated global health funding were actually spent – and even if it was spent. Lawmakers, including Senate Appropriations Committee Chair Susan Collins (Republican from Maine, who is up for re-election), pressed the Administration to release all funds and raised concerns that some global health and development assistance resources were instead being redirected toward costs associated with closing USAID. According to Devex, “not all foreign aid money will be used as originally intended by Congress.” The State Department moved $2.5 billion previously slated for global health and development assistance into a miscellaneous, non-expiring account, preventing the funds from immediately expiring. However, the Administration has indicated that those funds will be used toward closing out USAID.  

Separately, the Administration tried to cancel $810 million of other Congressionally-appropriated funds via a so-called “pocket rescission,” submitting the request just days before the end of the year. These are funds Congress approved, but the Administration is seeking to withhold as the fiscal year ends. The US Government Accountability Office (GAO) concluded that it is not legal for the President to withhold these appropriations beyond the end of the fiscal year without Congress approving their rescission. 

IMPLICATIONS: These year-end actions bring a sense of déjà vu. One year ago, at the end of the US 2025 fiscal year, the Supreme Court ruled in their “shadow docket” in litigation brought by AVAC and the Global Health Council (GHC) and partners that allowed the Administration to continue withholding billions in Congressionally-appropriated foreign assistance funding. In a new development this week, Judge Amir Ali who oversees the GHC and AVAC’s case, suspended the September 30 expiration date for any disputed funds that State or USAID failed to obligate, meaning those funds remain available while the court examines what happened. As AVAC Executive Director Mitchell Warren said this week, “the issue extends beyond foreign assistance or the HIV response; it is fundamentally about Congress’s constitutional power of the purse.” Congressional appropriations mean little if funding approved for HIV, TB, malaria, maternal and child health and other programs is delayed, redirected or allowed to expire before it can reach programs and people. Delays in transferring funding to programs force them to re-budget or stop or limit certain functions, until funding is received. A year after AVAC and GHC went to court over the withholding of foreign assistance, the same fundamental fight over whether the executive branch can decline to spend funds Congress has appropriated remains unresolved. 

READ:  

• Unspent healthcare funding faces do-or-die cliff—The Hill  
• The State Department is Dumping Billions of Global Health Dollars Into Sole Source Awards—Health Security Policy Academy 
• What Is a ‘Pocket Rescission’? Inside Trump’s Move to Cancel $810 Million in Federal Funding—TIME  
• Boyle Statement on Trump Administration’s Pocket Rescission—House Committee on the Budget 
• Sen. Collins Urges Administration to Spend Global Health Programs Funding—US Senate Committee on Appropriations  
• Federal watchdog says Trump’s $810M funding cancellation is unconstitutional—Politico 

New 5-Yr NIH Plan Released and America First Global Health Plans Said to Begin 

October 1 marked the start of the new US fiscal year and, in theory, two new strategies are beginning to be implemented. The US National Institutes of Health (NIH) released its FY2026–2030 Strategic Plan for HIV and HIV-Related Research, which describes priorities for the next five years across the HIV research continuum. At the same time, the US Department of State planned the start of country implementation plans under the America First Global Health Strategy, which is reshaping how the US funds and delivers global health assistance across 35 countries. Yet according to Devex, as implementation begins, those country plans have not been publicly released or provided to Congress, even as the Administration moves ahead with new bilateral agreements and greater government-to-government financing. 

IMPLICATIONS: The NIH’s new HIV research strategy calls for strengthening research capacity and infrastructure and moving discoveries across the “research-to-practice continuum”, including an emphasis on implementation. However, it is released just as a restructuring of NIAID is proposed, including plans to do away with its Division of Clinical Research and redistribute some core clinical research functions across the Institute. Meanwhile, the America First Global Health Strategy is reshaping how US-supported programs are financed and delivered in countries. These changes from preclinical work to develop new innovative products to ensuring they get to the people who need them most, is in a major transition, which makes implementation very hard to plan for.   

READ:

• NIH Strategic Plan for HIV and HIV-Related Research—NIH  
• NIH Employees Lived in a Culture of Fear, So They Started Keeping Receipts—Association for Psychological Science  
• NIH Censors Crucial Research in Alzheimer’s, Kidney Disease, and More, Researchers Share—ACLU  
• Disruption of global research at NIH is endangering people in the United States and around the world—27UNIHTED 
• Policy Research At The National Institutes Of Health: An Imperative In Peril—Health Affairs  
• From Standoff to Shutdown: Trump’s Diplomatic Failures Would Trigger Collapse of Healthcare Systems and Services in Zimbabwe—Health Gap  
• What we know — and still don’t — about the US global health deals—Devex  
• US to launch global health plans Congress hasn’t seen—Devex  
• Despite the Deadline, US Bilateral Health Deals Are Not Ready for Implementation—Health Policy Watch  
• From Discovery to Impact: A New Strategic Plan for NIH HIV Research—NIH  

Global Fund and WHO Leadership

The Global Fund for AIDS, TB and Malaria named five finalists to take over as Executive Director after Peter Sands steps down at the end of the year. The Global Fund Board will engage with the finalists over the coming weeks and is scheduled to appoint the next Executive Director at its October 28–30 meeting. The World Health Organization (WHO) also identified six prospective candidates to succeed Director-General Tedros Adhanom Ghebreyesus. The complete official slate will not be announced until on or after October 29, with a candidates’ forum beginning November 18 and the final election at the World Health Assembly in May 2027.  

IMPLICATIONS: These leadership changes come amid much uncertainty as the global health architecture is being reshaped by many factors including reduced assistance, calls for greater country ownership and domestic financing, institutional reform and the US withdrawal from the WHO. WHO is already reducing its staff significantly after the US refused to support it, and the Global Fund is facing difficult decisions about where and how to invest its smaller Grant Cycle 8 budget. These new leaders will face immediate decisions that will shape how these institutions define their roles in an evolving architecture. 

READ:

• At least five candidates vie to become the next WHO leader, as questions over U.S. role loom—STAT  
• Global Fund Executive Director Selection Moves to Final Phase with Five Finalists—The Global Fund 
• Here are the contenders fighting to lead the Global Fund—Devex  
• As WHO Nominations For Next Director-General Close, Six Contenders Emerge – But More May Remain Under Seal—Health Policy Watch 

US Rejects UN Pandemic Preparedness Declaration

Last Friday at the UN General Assembly’s (UNGA) High-Level Meeting, the United States declined to support a new UN Political Declaration on Pandemic Prevention, Preparedness and Response (PPPR), which breaks consensus around a declaration intended to demonstrate global political commitment to prepare for future pandemics. The US cited “divisive ideologies that lack definitional consensus” and objected to references to the ongoing negotiations over pathogen access and benefit sharing (PABS). The European Union raised separate objections around intellectual property and technology transfer; Italy also rejected the declaration; and India and Germany expressed reservations. The declaration is expected to be voted on by the General Assembly where it could still be adopted.   

IMPLICATIONS: The fact that consensus was not reached shows a major divide over the architecture being built to prevent and respond to the next pandemic. As Georgetown University’s Lawrence Gostin wrote, “UN high-level meetings are designed to showcase uniform geopolitical alignment against universal threats like pandemics. By breaking consensus, the US has signaled that domestic sovereignty outweighs collective diplomatic solidarity on global health architecture.” 

The declaration is important in that it helps outline who pays, who gets access to vaccines, diagnostics and treatments, how technology and pathogen information are shared and the role of multilateral institutions. As this system for pandemic preparedness is being updated, it’s happening alongside the uncertainty of financing, institutional leadership and mandates and national commitments that would make it operate.  

READ:

• U.S. Rejects U.N. Declaration on Preparing for Future Pandemics—New York Times 
• US response to UN pandemic talks ‘severely weakens’ global planning, says leading health expert—The Guardian  

What We’re Reading

• ‘Zombified’ C.D.C., Hobbled by Cuts, Struggles to Fulfill Scientific Mission—New York Times 
• CDC Funding for Community-Based HIV Prevention Is Vital to End the U.S. Epidemic—amfAR  
• Where to Put the CDC’s Monkeys—Politico  
• NACA tasks journalists with accurate HIV PrEP reporting—Nigerian Tribune 
• Dr. Fauci ‘honored to be part of’ LGBTQ history—Washington Blade  
• Would homegrown LEN cost more? Why SA should still make the HIV prevention jab—Bhekisisa 
• Kenya to manufacture HIV-prevention drug—Daily Nation (Kenya)  
• One Drug, Two Products: The Supply Chain Challenge of Scaling Lenacapavir—Root to Rise 
• State Extends Malaria Supply Chain Contract to Avert Stock-Outs—To End a Plague Again…Substack 
• PAHO’s Annual Meeting Opens Amid Political Tension and Calls for Stronger Regional Cooperation—Health Policy Watch  
• Ebola Is Hollowing Out Basic Health Care as Congo’s Outbreak Surpasses 8,000 Cases—Bloomberg 
• United States Pledges Additional Life-Saving Health Assistance in Response to Ebola Outbreak—US Department of State 
• The Trump administration said it would prioritize ending mother-to-child HIV transmission. Health workers say it cut services—CNN  
• RFK Jr. Just Exposed a Fraudster — And It Is Him—Washington Sun