August 22, 2025
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.
READ:
- US Non-profits Vow to Fight on After Court Rules They Can’t Challenge Trump Aid Freeze—Health Policy Watch
- Foreign Aid Groups Continue Their Fight Against the Trump Administration — In Court—NOTUS
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.
READ:
- Trump budget officials claim sweeping spending power from Congress, records show—Washington Post
- Trump Budget Office Is Withholding H.I.V. Funds That Congress Appropriated—New York Times
- OMB Just Dropped the FY2026 US Global HIV Budget by 50 percent—To End a Plague Substack
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.
READ:
- NIH director orders new review of grants in outline of top research priorities—Science
- Grant Terminations in the US Threaten HIV Research and Future Progress—JAMA
- Advancing NIH’s Mission Through a Unified Strategy—NIH statement
- Supreme Court allows Trump to gut DEI-linked NIH grants—The Hill
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.
READ:
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.
READ:
- After the CDC shooting, federal workers demand more protections from RFK Jr.—NPR
- The CDC shooting was public health’s Jan. 6—STAT
- Credible scientists can’t hold up Kennedy’s charade for much longer—The Hill
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.
What We’re Reading
- Exclusive: CVS holds off adding Gilead’s new HIV prevention shot to drug coverage lists—Reuters
- Is global development decolonizing or recolonizing?—Devex
- A time of rethink and restructure for aid organizations—Devex
- Cancelling mRNA studies is the highest irresponsibility—Nature
- America Is Abandoning One of the Greatest Medical Breakthroughs—New York Times
- Why Jay Bhattacharya agrees with RFK Jr. on defunding mRNA technology—Politico Pro
- The Most Damaging RFK Jr. Decision Yet—The Bulwark
- State Department’s new human rights reports are silent. We refuse to be—Washington Blade
- The Efficiency Myth—Reimagining Global Health Substack
- Here’s What Real Pro-Family Policy Looks Like—TIME
- LEN Is Not a Silver Bullet—Reimagining Global Health Substack
Resources
- Getting PrEP Rollout Right This Time: Considerations for LEN for PrEP Introduction, AVAC
- PEPFAR Program Status, amfAR
- Long-Acting PrEP Market Assessment for Key Populations, AVAC, GBGMC
- The Global Need for Long Acting PrEP Among Key Populations: Forecasts of Global Demand 2025-2030, AVAC, Avenir Health, GBGMC