Global Health Watch: NIH Challenges, PEPFAR uncertainty & the battle over foreign aid

March 7, 2025

This week’s issue covers challenges confronting the US National Institutes of Health under the new administration, the uncertain future of PEPFAR, continued legal battles over the foreign aid freeze and urgent efforts in Africa to secure sustainable health funding amid drastic aid cuts. Read on for more.

AVAC vs. Department of State

On Wednesday, in response to the US government’s request, the Supreme Court ruled that the administration must release up to $2 billion in frozen foreign aid funding for work completed before February 13. This overturned a temporary stay granted by the Chief Justice last week. This was a small victory along the way. And on Thursday, the case was back in the District Court for a four-hour hearing where the judge ordered from the bench that the government must pay AVAC, the Global Health Council and other plaintiffs the outstanding balances they are owed by Monday evening.

IMPLICATIONS: Thursday’s ruling is a “concrete step” forward, said the judge overseeing the case, but it does not rule on or indicate the fate of the $2 billion in payments owed to other aid organizations. Even if some contracts are eventually reinstated, the State Department has already cancelled 90% of USAID’s work and tens of billions of dollars in Congressionally approved spending, so it is unlikely implementing partners and programs receive the funding they need to continue this critical work.

FOLLOW ALONG: Track progress on the case here.

READ: Trump administration ordered to pay select USAID partners by Monday—Devex

Threats to US-Funded Research

At a March 5 congressional hearing on threats to US-funded research, representatives debated strategies to counter security threats while investing in the US scientific enterprise. Republican committee members focused on restricting international students and researchers from US institutions, whereas Democrats focused on the threats from within. Specifically, administration and Congressional attacks on federal agencies, which jeopardize US leadership in discovery and innovation, and cuts to “indirect costs”, which are essential for maintaining research infrastructure and administrative overhead. “The money has to come from somewhere. The result [of these cuts] will be less research, driving many out of business. The impacts are potentially huge,” said MIT’s Maria Zuber who gave testimony at the hearing.

In a related and unprecedented move, the NIH on Wednesday initiated mass terminations of active research grants that no longer align with its new “agency priorities.” Internal documents reveal that NIH staff are required to review projects for ties to diversity, equity, and inclusion—especially those involving transgender issues, or research in China—and to classify them into categories for easier cancellation decisions.

And further, the NIH announced that it will centralize peer review of all grant and cooperative agreements, and research and development contracts within its Center for Scientific Review.

IMPLICATIONS: Forcing federal grants and programs to adhere to partisan ideology is anti-science and anti-evidence. Subjecting funding decisions to political tests will undermine essential research and jeopardize long-term research and future discovery. Further excising key populations from research ultimately limits the benefits and interventions that result from publicly funded biomedical research for those most vulnerable to HIV and other diseases.

READ: Exclusive: NIH to terminate hundreds of active research grants—Nature

The Future of the NIH: Jay Bhattacharya’s Confirmation Hearing

At his confirmation hearing to become NIH Director, nominee Jay Bhattacharya faced tough questioning on future NIH priorities, and how he would balance scientific integrity and political pressures. When questioned about the proposed indirect cost rate cuts and their ramifications, Bhattacharya defended the policy, saying it would enhance research efficiency while sustaining vital infrastructure. Bhattacharya pledged to focus the NIH on chronic diseases, rebuilding public trust in science through transparency and debate, and undergoing structural changes to support innovative research.

IMPLICATIONS: Despite concerns over Bhattacharya’s vaccine skepticism, AIDS denialism and racist views of immunology, his confirmation appears likely with a full Senate vote imminent. If confirmed, Bhattacharya would serve under Health and Human Services (HHS) Secretary Robert F Kennedy Jr. (RFK Jr.), who controls funding, administration and how science is communicated via the US CDC, NIH, FDA and other important health agencies. As the potential lead for NIH, Bhattacharya will be tasked with carrying out elements of RFK Jr.’s agenda of ‘Making America Healthy Again’. RFK Jr. was confirmed in February despite concerns over his vaccine skepticism, AIDS denialism, and racist views of immunology.

READ: Trumps’s pick to head NIH avoids major controversy at Senate hearing—Science

Undermining NIH Public Engagement

HHS Secretary Kennedy issued a policy statement rolling back a 1971 policy that requires public comment on rules related to grants, loans, public property and benefits. This policy shift veils the decision-making process and could enable controversial changes to be imposed without public discussion or debate.

IMPLICATIONS: This new directive will inalterably transform how NIH operates and significantly restrict the research community’s ability to engage in policymaking. It guts a critical mechanism established nearly 50 years ago for public and expert scrutiny of policy and stifles collaboration between scientists and government that has long driven scientific innovation and progress in public health. Moreover, this move further limits community engagement in NIH processes and research, losing valuable perspectives and insights that are necessary to enrich the impact of publicly funded biomedical research.

READ:

RFK Jr. Kills Policy on Public Comment for Health Regulations—Axios
RFK Jr.’s Limits on Rule Comments Have Risk for Medicaid, Grants—Bloomberg Law

PEPFAR in Jeopardy

Advocates continue to fight for the PEPFAR program. On Wednesday, AVAC, the Global AIDS Policy Partnership (GAPP) and The U.S. Congressional Caucus on Black Women & Girls Co-Chairs Representatives, Robin Kelly (D-IL), Yvette Clarke (D-NY), and Bonnie Watson Coleman (D-NJ) hosted, the congressional briefing, The State of PEPFAR. The briefing featured a broad panel with AVAC’s Senior Policy Manager John Meade, Jr. serving as co-moderator. Panelists included Friends of the Global Fight’s Chris Collins, Desmond Tutu HIV Center Director and AVAC Board member Linda Gail Bekker, Angeli Achrekar of UNAIDS and Jirair Ratevosian of the Duke Global Health Institute. They offered insightful analysis on how recent administrative decisions threaten global progress in HIV.

“The hardest hit are key populations—Black gay men, sex workers, transgender people, people who inject drugs and Adolescent girls and young women—those already on the margins of society. Their clinics are shutting down, their communities are losing access to PrEP and HIV treatment,” noted AVAC’s John Meade, Jr. “Congress must act immediately to restore and protect funding for PEPFAR and global HIV programs. This is not a partisan issue—PEPFAR has enjoyed strong bipartisan support for over two decades because it works. It has saved lives, strengthened economies, and reaffirmed America’s role as a leader in global health.”

READ:

Africa and Sustainable Health Funding

The foreign aid freeze, dismantling of USAID and many other US actions under the new administration are accelerating discussions on how African governments will tackle the immense challenges ahead. At this week’s Africa Health Agenda International Conference (AHAIC) in Kigali, African leaders, advocates, and delegates confronted the funding crisis head-on, exploring urgent, innovative financing models to ensure the long-term sustainability of essential health programs. While some see this moment as an opportunity to build capacity and reduce dependence on external aid, others warn that without significant domestic reforms, the sudden loss of aid will intensify poverty, strain resources, and further impede development across the continent.

READ: Why Some Africans See Opportunity in Foreign-Aid Cuts—The Economist