February 20, 2026
This week, researchers, advocates, and policymakers are reflecting on the escalating war on science. Two recent pieces in Think Global Health and in The Nation illustrate how budget decisions and policy priorities are reshaping US scientific and global health leadership and undermining the stability of programs relied on by hundreds of millions of people – in the US and around the world. This week’s GHW newsletter also tracks the consolidation of power across US health agencies, mounting uncertainty in vaccine regulation, and the Global Fund’s ongoing replenishment.
Leadership Changes at US CDC Raise New Concerns about Scientific Independence
US National Institutes of Health (NIH) Director, Jay Bhattacharya, was also named acting director of the US Centers for Disease Control and Prevention (CDC). This represents the administration’s fourth leadership change at the agency in just over a year and a move widely seen as further centralizing federal public health authority. Many are critical of this appointment and fear scientific independence given Bhattacharya’s public alignment with Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and his negative views on pandemic response and public health governance.
IMPLICATIONS: Concentrating leadership across NIH and CDC blurs lines between research, surveillance, and public health practice, while raising the risk that evidence-based decision-making will be deprioritized to political priorities. Together, these events point to a coordinated re-shaping of US health agencies that could weaken regulatory stability, disrupt research pipelines, and further undermine confidence in public health guidance around the world.
READ:
- N.I.H. Director Will Temporarily Run C.D.C. in Leadership Shake-Up—New York Times
- Erasing the Biodefense Era: Inside the 2026 Restructuring of NIAID—CRV Science
- Experts warn NIH director now leading CDC will push ‘RFK Jr’s agenda’—The Guardian
- Jay Bhattacharya named acting CDC director—Politico
Global Fund Concludes Replenishment Falling Short of Target
The Global Fund to Fight AIDS, Tuberculosis and Malaria concluded its 8th Replenishment with US$12.64 billion in total pledges, which was endorsed by its board last week. Shifts approved by the Board move toward a longer-term, rolling replenishment approach and emphasizing country transitions to reinforce sustainability.
IMPLICATIONS: The US$12.64 billion outcome falls short of the original US$18 billion target for this replenishment cycle, showing ongoing vulnerability in global health financing amid broader donor retrenchment. Key pledges, including France’s, have yet to be confirmed. Flat or reduced support from major donor countries compared with previous cycles reflects a trend among wealthy nations to re-prioritize or constrain foreign health investments. Reliance on scaled domestic resource mobilization, private philanthropy, and public-private partnerships is unlikely to fill funding gaps quickly enough to prevent disruptions in HIV, TB, and malaria services or to repair damage already inflicted by abrupt aid terminations. Without robust, predictable commitments from major donors, the gains against the three diseases and the goal of ending them as public health threats remain at risk.
READ:
- Global Fund Board Welcomes Final Eighth Replenishment Outcome of US$12.64 Billion, Backs Strategic Shifts to Advance Countries’ Path to Self-Reliance—Global Fund
- A Radically Simplified Global Fund to Meet the Moment—CGD
Uncertainty at the US Food and Drug Administration (FDA)
The US FDA reversed its decision and agreed to review Moderna’s mRNA-based influenza vaccine after initially refusing to consider the application last week. They cited concerns about the clinical trial design, specifically the choice of the comparator vaccine used in studies of adults over 65. This decision drew much criticism across industries, leaving many questioning what seemed like a shift from regulatory standards.
Additionally, this reversal occurs amid a debate within the FDA about the role of randomized clinical trials in drug approvals, with the FDA reconsidering the long-time standard of requiring two rigorous studies. The FDA Commissioner wrote in the New England Journal of Medicine (NEJM) that the “default position” would be to require only one trial, upending decades of regulatory science and practice.
IMPLICATIONS: These developments deepen concerns about unpredictability and politicization in US vaccine regulation. The FDA’s initial refusal to review Moderna’s flu vaccine followed by a rapid reversal shows regulatory chaos as agency leaders are publicly questioning the long-standing expectation of multiple randomized trials for new medicines. While flexibility in trial requirements can be appropriate in some circumstances, shifting the “default” to a single study risks blurring standards and weakening confidence. The broader pattern of reversals, public disputes, and narrowing vaccine recommendations continues to erode trust.
READ:
- F.D.A. Reverses Decision and Agrees to Review Moderna’s Flu Vaccine—New York Times
- FDA reverses course on Moderna flu shot—NPR
- Vaccine Makers Curtail Research and Cut Jobs—New York Times
- One Pivotal Trial, the New Default Option for FDA Approval — Ending the Two-Trial Dogma—NEJM
- FDA will drop two-study requirement for new drug approvals, aiming to speed access—Associated Press
- Top Republican eyeing FDA overhaul—The Hill
- Poll: Trust and Confidence in the CDC Remain at Low Point After Changes to Recommended Childhood Vaccines; More Say the Changes Will Hurt than Help Children’s Health—KFF
- Upcoming meeting of federal vaccine panel may be postponed after HHS missed deadlines—STAT
A Year of Crisis and Promise
2025 tested global health like few years before it. Funding freezes, political disruption, and rising misinformation collided with historic scientific breakthroughs. Read how AVAC protected progress and pushed prevention forward.
What We’re Reading
- What $50 Billion for U.S. Foreign Affairs Changes for Global Health—Think Global Health
- The Scientists Groveling to Trump Are Kidding Themselves—The Nation
- After leaving WHO, Trump officials propose more expensive replacement to duplicate it—Washington Post
- WHO Welcomes US States to its Global Disease Outbreaks Network—Health Policy Watch
- What’s behind US states joining WHO’s outbreak response system—Devex
- Is the United States Planning to Replace WHO Prequalification?— To End a Plague…Again Substack
- WHO Pandemic Agreement is only the beginning: strengthening implementation to protect global health—The BMJ
- Africa’s future depends on investing in women, children, adolescents—Devex
- Kenya receives first batch of Lenacapavir HIV drugs—The Citizen
- After US aid cuts, South Africa’s HIV response strains to hold the line—Devex
- Botswana health crisis as diamond trade drains the country’s finances—The Telegraph
- Ex-NATO chief warns against boosting defense budgets at expense of aid—Devex
Resources
- Costs, Chaos and Corruption: 1 Year of Robert F. Kennedy, Jr.’s Disastrous Leadership—Senators Angela Alsobrooks and Ron Wyden
- FCAA Resource Tracking, Funders Concerned About AIDS