Global Health Watch: Responding to new cuts, new losses and new data

Issue 7: March 14, 2025

March 14, 2025

This week’s issue covers the latest developments in the AVAC vs. Department of State lawsuit, NIH’s termination of vaccine hesitancy research, new data revealing the deadly impact of foreign aid cuts on HIV, and renewed calls for African-led, sustainable health funding. Read on for more.

AVAC vs. Department of State

On Monday, US District Court Judge Amir Ali issued a 48-page ruling in AVAC vs. Department of State and Global Health Council vs. Trump, the twin lawsuits against the foreign aid freeze. The ruling orders the government to pay for work already completed and to spend congressionally appropriated funds for foreign assistance. However, Judge Ali’s order did not reinstate the mass cancellations of aid grants, leaving thousands of lifesaving programs in limbo. Lauren Bateman, lead counsel on AVAC’s case with Public Citizen Litigation Group, said “Today’s decision affirms a basic principle of our Constitution: the president is not a king. But we are painfully aware that, without unwinding the mass termination of foreign assistance awards, winning on the constitutional issues does not avert the humanitarian disaster caused by the Trump Administration’s freeze on foreign assistance. And it does not undo the damage that the freeze has already inflicted on millions of vulnerable people across the world. Deaths will continue to mount. While the courts have an important role to play in standing up for the rule of law, Americans need more than just the courts. We need Congress, which has always supported foreign aid on a bipartisan basis, to assert itself.”

IMPLICATIONS: Secretary of State Marco Rubio confirmed that 5,200 USAID programs—about 83% of the agency’s overall work—have been terminated, citing “tens of billions of dollars” spent in ways that allegedly “did not serve US interests”. The new administration will retain about 1,000 programs under the State Department’s oversight. Even if some contracts are eventually reinstated, the State Department has already eliminated a significant majority of USAID’s work and tens of billions of dollars in Congressionally approved spending. It is unlikely implementing partners and programs will receive the funding they need to start back up and continue their critical work.

FOLLOW ALONG: Visit our updated page summarizing the lawsuit.

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NIH Cancels Grants on Vaccine Hesitancy

In a sweeping move, the National Institutes of Health (NIH) is terminating or scaling back dozens of grants focused on vaccine hesitancy and boosting vaccine acceptance, citing “misalignment with NIH funding priorities.” It is unclear whether new Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy Jr. directed the cuts—his longstanding anti-vaccine views are concerning, especially since the Centers for Disease Control and Prevention (CDC) was recently instructed to revisit the debunked link between vaccines and autism. The NIH is also canceling grants tied to transgender issues, diversity, equity, and inclusion, and research involving Chinese institutions, reflecting the administration’s broader push to cut spending and reshape federal research priorities. 

IMPLICATIONS: Defunding these projects comes at a perilous time, given the reemergence of measles and declining immunization rates. By terminating research on vaccine hesitancy and acceptance, the NIH undermines efforts to build trust and increase uptake of essential prevention strategies, particularly among marginalized communities. This short-sighted approach risks widening existing health disparities and eroding decades of global progress toward equitable HIV prevention. 

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Reforming PEPFAR

Researchers are proposing strategic reforms to PEPFAR, which is up for reauthorization later this month. The recommendations would trim PEPFAR program costs by 20% in five years, and transition financial responsibility to local governments in high-burden regions. They focus on ramping up long‐acting PrEP as a key component of HIV prevention. As highlighted in the opinion piece by Jirair Ratevosian, PEPFAR has evolved far beyond its original “emergency plan,” becoming indispensable to global HIV prevention and treatment. Embracing these reforms, he writes, would ensure PEPFAR remains resilient and impactful amid rising infections, geopolitical strains, and domestic political uncertainty. 

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The Impact of Funding Cuts and Frozen Aid

Nearly two months into the dismantling of foreign aid and the research enterprise, the scale of the threat to vulnerable populations and global health is coming into sharper focus. New modeling data presented at CROI shows that nearly one in five children under one with HIV who experienced a treatment interruption in 2024 died, based on a review of over half a million children in US-funded PEPFAR programs. With major challenges to sustaining access to treatment since the new administration froze PEPFAR funds, the findings from this modeling study are a dire warning of the toll on lives to be expected from these policy changes. Meanwhile, clinical trials for new prevention tools, such as long-acting injectables and HIV vaccines, have been halted or scaled back, while organizations that built local research capacity and trust with communities now face staff layoffs and funding shortfalls.  

IMPLICATIONS: The loss of data from these canceled projects will undermine governments’ ability to sustain the HIV response, with or without U.S. support, and reduced investment in infectious disease research could drive up costs in the long run. 

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Africa and Sustainable Health Funding 

Global health leaders are joining calls from civil society for African nations to break free from donor dependency by building self-sufficient, locally-driven health systems that prioritize their own needs and strategies. A rethinking of traditional aid models in favor of sustainable, equitable investments in health infrastructure and local research is needed and holding donor countries accountable for supporting true development rather than perpetuating reliance on external funding is imperative.  

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ICYMI, PxWire Special Edition

In case you missed it, check out the special edition of PxWire, which dives into the assault on global health and its devastating impact on HIV prevention—from crippling existing PrEP delivery to threatening the rollout of LEN for PrEP and paralyzing R&D.

Read PxWire

What We’re Reading

Resources

Many researchers and advocates are on their way home from San Francisco where the Conference on Retroviruses and Opportunistic Infections (CROI) just wrapped up. The science showcased the great promise and importance of research and made clear just how much is at stake. You can read more about the promise of scientific advances against the backdrop of the US government’s priorities here and here.