Global Health Watch: State Dept. diverts millions for contraception, who’s leading US global health, new Global Fund ED, UNAIDS’ future

October 30, 2026

For nearly two years, the US Administration has ignored Congress and denied women and couples of life-saving sexual and reproductive health commodities. So this week’s breaking news that the US Department of State is shifting millions of dollars appropriated by Congress for contraception to “stem some of the bleeding they’ve caused by starting a reckless war and creating a global energy crisis” is perhaps not surprising. But it is appalling, nonetheless. With the US midterm elections happening next week, all members of Congress, irrespective of party or ideology, should be speaking up and taking back their power of the purse.

At the same time, global health leadership continues to change across the US global health agencies, with new departures at the Department of State and the Centers for Disease Control and Prevention (CDC). Meanwhile, Mark Dybul was appointed Executive Director of the Global Fund, the UNAIDS Board has rejected plans to sunset the Joint Programme, and new modeling highlights the investments needed to achieve global HIV targets by 2030. Also, this week, promising advances in mRNA cancer vaccines contrast with growing uncertainty around US vaccine policy and access.

Who Is Leading US Global Health? 

The revolving door of leadership and staffing changes across US agencies continues. Jeremy Lewin is leaving the Department of State, while Jennifer Shuford is leaving her leadership role at the Centers for Disease Control and Prevention (CDC). Also, a new Devex report provides a “who’s who” of the officials shaping and implementing the America First Global Health Strategy. It highlights the experience that remains and the significant gaps left by departing technical experts. Among those remaining is Dr. Mamadi Yilla, whose decades of experience with PEPFAR and country-level implementation are increasingly valuable; as AVAC’s Mitchell Warren told Devex, “She knows what it takes to deliver a program.” 

IMPLICATIONS: The US mid-term elections take place next week, and with further leadership changes likely post-elections, major questions remain about whether the Administration can sustain the expertise and capacity needed to translate its strategy into effective programs and ensure uninterrupted access to lifesaving services. Additionally, as the US Department of State takes on more responsibility for programs previously run by USAID and CDC, the loss of institutional knowledge and country-level experience threatens to undermine program effectiveness, continuity, oversight and accountability. This is significant as countries begin implementing their new bilateral health agreements, which require technical expertise, strong partnerships and an understanding of complex health systems.  

READ:  

• Meet the team behind the America First Global Health Strategy—Devex  
• He resigned from CDC leadership. Now now he’s fighting RFK Jr. from the outside—Washington Post  
• A 28-Year-Old DOGE Operative Gutted USAID. HR Had No Record of Him Working There—Wired  
• The future of US global health aid comes slowly into focus—Devex  
• C.D.C. Deputy Director Resigns After Four Months in the Job—New York Times 

Mark Dybul Appointed ED of Global Fund

Mark Dybul was appointed Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) at a pivotal moment for global health, as funding pressures, political threats and persistent inequities threaten hard-won progress against the three diseases. Dybul previously held the position from 2013 to 2017, when he oversaw the introduction of a new evidence-based funding model and expanded the Fund’s procurement operations. He also previously led PEFPAR from 2006 to 2009. As a member of the Accra Reset high-level panel, Dybul has advocated for greater health sovereignty and changes to the international aid system. As Devex reports, he inherits unresolved questions about the Global Fund’s evaluation function, a proposed new financing mechanism and its next strategy, among many issues. As AVAC’s Suraj Madoori said in its statement, Dybul’s “global health leadership, experience and deep and durable partnerships are needed now more than ever to translate political commitments and resources into lifesaving impact, especially as the Global Fund heads into its 9th Replenishment and the organization develops its next strategy for the future beyond 2028.”  

IMPLICATIONS: The introduction of transformative new tools to prevent and treat HIV, TB and malaria provides unprecedented opportunities to accelerate progress, but it all comes in the midst of significant political and economic challenges which Dybul will need to navigate. This will require ambitious targets, affordable prices, re-commitment to community leadership and human rights, and coordinated actions to ensure these innovations reach the people and communities that need them with speed, scale and equity. As the Global Fund develops its strategy beyond 2028, Dybul will also need to define its role within a changing global health architecture, strengthen coordination with bilateral and multilateral partners, and ensure that efforts to increase country ownership do not undermine community leadership, accountability or access to lifesaving services.  

READ: 

• Global Fund Board Appoints Mark Dybul as Next Executive Director—The Global Fund 
• The hard work of health sovereignty starts now—Devex  
• Global Fund Appoints Mark Dybul as Executive Director Amid Mandate and Funding Challenges—Health Policy Watch  
• Mark Dybul makes a comeback as new Global Fund chief—Devex  
• AVAC Applauds Appointment of Mark Dybul as Executive Director of the Global Fund—AVAC  

New HIV Modeling Highlights the Stakes of UNAIDS Transformation

A new study published in PLOS Global Public Health estimates that achieving UNAIDS’ 2030 global HIV targets could reduce annual new HIV infections by 77%, from 1.3 million in 2023 to 300,000 in 2030. However, $21.9 billion annually would be required to reach these targets in low- and middle-income countries by 2030. The findings come as the UNAIDS Programme Coordinating Board (PCB) rejected a proposal to sunset the Joint Programme by the end of 2026, and instead endorsed UNAIDS’ transition to a smaller, more focused program. The proposed structure would retain a streamlined Secretariat, or hub, responsible for leadership, coordination, data and accountability, and community engagement, but would shift more technical and implementation responsibilities to UNAIDS’ UN cosponsors. A transition team is in the process of developing a fully-costed implementation plan. 

IMPLICATIONS: This new modeling data and the evolution of UNAIDS show the challenge of achieving global HIV targets as resources and institutional capacity reduce. Specifically, the transition of UNAIDS raises critical questions about whether a smaller institution can maintain the coordination, independent accountability and meaningful community leadership needed to support countries in achieving the 2030 targets.  

READ: 

• The impact and cost of reaching the UNAIDS global HIV targets—PLOS Global Public Health 
• UNAIDS Must Continue, and African Women’s Rights and Leadership Must Shape Its Future—African Women Prevention Accountability Board  
• UNAIDS Board Rejects ‘Sunsetting’, Opting Instead for Transformation—UNAIDS  

Vaccine Innovation Advances as US Policy Creates New Barriers

As vaccine science continues to advance, changes to US vaccine policy continue to create major barriers to access. In the last week, new data from an experimental personalized mRNA cancer vaccine when used alongside immunotherapy, showed that the technology reduced the risk of melanoma recurrence or death by 42% over approximately two years. This demonstrates the potential of mRNA technology beyond infectious diseases, but comes as The Guardian reports sweeping changes by US Health Secretary Robert F. Kennedy Jr. that left the Advisory Committee on Immunization Practices (ACIP) unable to issue recommendations for newly approved vaccines.  

IMPLICATIONS: As science demonstrates the potential of mRNA technology, uncertainty in US vaccine policy raises broader questions about whether the institutions responsible for evaluating, recommending and delivering new vaccines can keep pace with scientific progress. Without ACIP recommendations, vaccines that have been approved by the US Food and Drug Administration (FDA) face uncertainty around insurance coverage and availability. The recently approved mRNA influenza vaccine is affected, with some patients already facing out-of-pocket costs. 

READ:

• ‘It’s a mess right now’: RFK’s sweeping changes place new vaccines in limbo—The Guardian  
• NIH’s new vaccine injury center has broad goals beyond RFK Jr.’s focus on shots—STAT  
• First-of-Its-Kind Vaccine Ushers in New Hope for Cancer Patients—New York Times 

What We’re Reading

• State Dept. To shift Millions in Contraceptive Funding to Cover Energy Costs—New York Times
• HIV service delivery after the PEPFAR and USAID HIV funding withdrawal in Uganda and Zimbabwe: an interrupted time-series study—Lancet Global Health  
• Sustaining South Africa’s Progress in the Next Phase of the HIV Fight—CSIS  
• First participant vaccinated in pivotal Phase 2/3 Bundibugyo vaccine trial in DRC—CEPI  
• The Trump administration is funding an experimental Ebola vaccine—Politico Pro 
• Ebola Outbreak in Africa Reaches Widest Expansion Ever—New York Times 
• New TB vaccines are coming. How are countries preparing for the rollout?—GAVI
• Kennedy to select MAHA-aligned researcher to head mental health institute, overruling NIH director—Science  
• “Voting is just the first step”—27UNIHTED Substack  
• Recommitting to the eradication of measles—BMJ 
• Ben Plumley & Emily Bass on PEPFAR, UNAIDS, Russian Microbes, and More—A Shot in the Arm 
• The global health reset has consensus. But can it deliver?—Devex  
• When PrEP Options Are Equally Attractive, Should Their Carbon Footprint Tip the Balance?—TheBodyPro