Global Health Watch: Zambia’s Bilateral MoU, NIH Budget Cut, LEN Pricing & Access, New HIV Prevention Access Framework

Issue 62

April 3, 2026

This week, the global health world lost a true leader, Stephen Lewis, whose life was defined by an unwavering commitment to creating a better, more just world. Lewis’ unwavering passion and fearless advocacy continue to set the standard, reminding us that global health demands urgency, equity and accountability. This week’s issue follows that charge. It covers growing calls for transparency: from Zambia’s bilateral MoU, to the anticipated proposal to cut 20% cut from the US National Institute of Health’s 2027 budget, and the pricing and access negotiations around lenacapavir, as well as the Global HIV Prevention Coalition’s new Prevention Access Framework.

Advocates Challenge US Plan to Tie HIV Funding to Zambia Minerals Negotiations

In response to a leaked draft memo, more than 100 civil society organizations sent a letter to the US Secretary of State urging him to reject reports that the US may withhold Zambia’s HIV and health funding if the country does not agree to a critical minerals deal as part of the America First Global Health Strategy. Advocates warned that “threatening these programs — and the lives of those reliant on them — to gain leverage in trade negotiations is ethically indefensible…[withholding] these vital medicines would only deepen poverty and suffering in Zambia and the surrounding region, creating a ripple effect of instability that could have unforeseen impacts on US interests over the short, medium and long term.” The State Department dismissed the letter, characterizing the signatories as partisan advocacy groups and questioning their credibility rather than addressing the substance of their concerns.

IMPLICATIONS: Angola became the 27th country overall and 22nd in Africa to sign an agreement this week. Linking HIV and public health funding to broader economic negotiations is a coercive model of global health security and diplomacy. It undermines trust, country ownership and the stability of programs. As more countries sign-on to these agreements, the precedent being set raises urgent questions about equity, sovereignty and the long-term sustainability of the HIV and larger global health response.

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A Proposed 20% Cut to US NIH 2027 Budget

The US Administration is expected to propose a 20% cut to the National Institutes of Health (NIH) in the President’s fiscal year 2027 (FY27) budget request, which is a significant reduction from the agency’s current $47.2 billion budget. Congress already rejected deep cuts to the FY26 NIH budget and instead increased funding to the agency. The new proposal revives earlier efforts to scale back investment in biomedical research and may include restructuring elements – and highlights the concern that the Administration will make budget decisions, irrespective of Congress’s constitutional power of the purse. This all comes amid the instability of the US health and research infrastructure with delays in grant disbursement, cancellations and ongoing funding uncertainty.

IMPLICATIONS: Even before any formal cuts are enacted, the combination of proposed reductions, funding delays and policy shifts is already slowing research and destabilizing what is left. Researchers warn that prolonged uncertainty risks stalled studies, layoffs and a growing “brain drain,” threatening the US’s long-standing leadership in biomedical innovation and global health. Multi-year cuts of this scale could also have cascading economic and public health consequences, weakening the pipeline of discoveries that drive prevention, treatment and global health security.

Lenacapavir Access Dispute: Where is the Transparency?

Médecins Sans Frontières (MSF) issued an open letter to Gilead Sciences, criticizing its refusal to sell lenacapavir for HIV PrEP (LEN) directly for use in MSF’s programs. The issue comes amid limited public information on pricing, volumes and supply timelines. Gilead has been channeling all LEN supply through the Global Fund’s procurement mechanism, with PEPFAR also procuring via this route. Gilead’s current production of LEN for LMICs is based on orders from Global Fund for approximately 600,000–700,000 person-years for 2026. While Gilead earlier said they could manufacture larger volumes, they have a 6-9 month manufacturing lead time, meaning that it is hard to secure additional product this year. MSF, which is already accessing limited supply of LEN through the Global Fund, is seeking additional doses to reach populations beyond the early adopter countries. Gilead told MSF that increased LEN supply would not be available until 2027 and only through existing procurement channels.

Meanwhile, new modeling research suggests that the investigational MK-8527 once-monthly oral PrEP pill “could be manufactured at extremely low cost, suggesting that intellectual property and licensing arrangements, rather than production feasibility, will determine equitable access in LMICs.”

IMPLICATIONS: These issues hit on the main challenge: closing the gap between scientific breakthroughs and the systems needed to deliver them with speed, scale and equity to deliver public health impact. Constraining LEN access to limited procurement channels and timelines risks slowing its uptake and excluding populations outside of government-led programs. At the same time, as advocates have been saying for decades, we need to plan for accelerated, equitable access from the start. Products can be produced at large scale and low prices, if policy choices like pricing, licensing, volumes forecasting, market shaping and transparency are prioritized.

HIV Prevention 2030 Global Access Framework 

The Global HIV Prevention Coalition shared a new Access Framework outlining how, by 2030, countries can ensure that 90% of people in need of HIV prevention services have access and that 90% of people living with HIV are virally suppressed. This, in combination, would lead to a 90% reduction in new HIV infections globally. 

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