Global Health Watch: Restructuring PEPFAR, Political Control Over Science; FDA + African Medicines Agency MoU

Issue 73

June 22, 2026

This week, the US Administration continues to move to consolidate control over science, restructure the systems that underpin PEPFAR and global health security, and redefine US global health engagement through regulatory influence rather than long-term public health partnerships.

Restructuring PEPFAR and Weakening the US CDC

The US Administration is moving forward with its plan to significantly reduce the US Centers for Disease Control and Prevention’s (CDC) vital role in PEPFAR and global health programs, shifting much of the authority and funding to the US Department of State, which many argue, does not have the expertise or capacity to manage the programs. In contrast to CDC’s historical role in implementing PEPFAR in-country programs, the plan would require countries to “purchase” CDC technical assistance services (ranging from disease surveillance to laboratory support) through new bilateral agreements in a “fee-for-service” public health model. The future of in-country CDC offices and technical staff is uncertain under this new plan.

The Administration already significantly weakened PEPFAR’s infrastructure by shutting down USAID last year and delaying HIV funding in an interagency transfer to CDC. This new proposal could further undermine the CDC from much of the work that helps deliver HIV services and supports disease detection around the world. As eight former CDC directors – appointed by both Republican and Democratic presidents – warned previously, the proposed restructuring could disrupt not only HIV services but also the laboratory networks, surveillance systems, trained workforce and trusted relationships with ministries of health that support outbreak detection and response worldwide.

IMPLICATIONS: “This will completely destabilize HIV work abroad,” former CDC official Michele Montandon told the New York Times. “We’ve seen service disruptions, deaths and babies born with HIV after shuttering USAID, and we can expect more to come if CDC is also shut out of this work.” The rapid restructuring of PEPFAR could decimate HIV programs, complicate the transition to country ownership, and fracture global disease surveillance and outbreak-response systems built through decades of US investment. While there is broad stakeholder agreement about the importance of increasing country ownership and transitioning away from donor dependence, the accelerated pace and structure of the proposed changes makes technical expertise and relationships precarious before sustainable alternatives are in place. These changes come at a time of a rapidly unfolding Ebola epidemic in Central Africa, complicating current crises and creating doubt in response capacity for future epidemics.

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Political Control Over Science Moves Ahead

The proposed new regulations that would significantly expand political interference in federal funding decisions across all US government grants by the White House’s Office of Management and Budget (OMB) remains at the center of current controversy. In a recent New England Journal of Medicine editorial, editors warned that this Administration is increasingly using budgetary and regulatory tools to bypass longstanding scientific peer-review and congressional processes, including withholding appropriated funds, restructuring federal agencies, and proposing rules that would give political appointees greater influence over research funding decisions. At the same time, Hal Duncan, the nominee to serve as the Deputy Director of the OMB, defended the “pocket rescission” strategy during his confirmation hearings this week in front of Senate leaders. This strategy would allow the Administration to use additional spending cuts through “pocket rescissions,” which would allow funds to expire before Congress has an opportunity to act.

IMPLICATIONS: The moves by OMB signal increasing efforts to shift decision-making authority away from Congress and scientific peer review and toward the Executive Branch, giving the President more control over how federal money is spent and what research and programs get funded in alignment with ideology. For the last 18 months, the question of who gets to decide what scientific research and public health programming are funded and whether Congress’s decisions are carried out as intended continues to be raised, and the answer increasingly appears to be the White House rather than Congress or the broader scientific and public health community.

Scientists Issue Bethesda Declaration: One Year Later

Nearly 40 former and current staff at the National Institutes of Health (NIH) authored a new report, The Bethesda Declaration One Year Later, Continuing Harms to the NIH Mission, which outlines nine deepening concerns at the NIH over the last year along with proposed solutions. This report comes one year after hundreds of NIH employees accused the Administration of politicizing biomedical research through the original Bethesda Declaration. The new report notes that the Administration is slowing medical research, disrupting international collaborations, weakening ethical safeguards, driving away experienced staff and undermining public trust in science. Approximately 24% fewer NIH research projects were funded in 2025 than in 2024 and more than 5,500 peer-reviewed grants were terminated. The report also warns that the White House’s proposed Office of Management and Budget (OMB) rule, which would subject federal grants to greater political review and require alignment with presidential priorities, would institutionalize many of the changes researchers have opposed in the last year.

IMPLICATIONS: The updated Bethesda Declaration shows growing concern from the scientific community about the politicization of science. The NIH has served as the foundation of HIV research, from supporting basic science, vaccine development, implementation of new prevention technologies and global research partnerships. As political oversight expands and international collaboration is deconstructed, the US risks undermining the scientific infrastructure that has fueled decades of innovation and partnership.

US FDA and African Medicines Agency Enter Into New Partnership

The US Food and Drug Administration (FDA) and the African Medicines Agency (AMA) have signed a new Memorandum of Understanding (MoU) to create a shared framework for information sharing and regulatory cooperation. The agreement could allow African regulators to draw on FDA assessments and regulatory decisions when evaluating medical products, while also facilitating greater cooperation on inspections, scientific reviews and regulatory capacity building.

IMPLICATIONS: This agreement between two stringent regulatory authorities (SRAs) is another example of the Administration’s evolving approach to global health and in-line with the US government’s recent “America First” global health strategy. This partnership could be interpreted as a regulatory harmonization effort that would allow for the rapid influx of American-made health technologies for emerging markets in Africa. The expansion and procurement of US-made health commodities is a central feature to the US government’s new transactional approach to global health. However, this comes in stark contrast as the US cuts funding for global health programs, reduces the CDC’s international role and restructures PEPFAR, it is replacing long-term public health partnerships with narrower bilateral agreements focused on regulation and innovation. The disconnect between developing new health technologies and supporting the health systems needed to deliver them complicates the vision for greater regulatory cooperation between SRAs that is required for scale-up and access to the latest treatment and prevention modalities.

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A ‘perilous moment’ for the response to HIV

A new UNAIDS report released ahead of next week’s United Nations General Assembly’s High-Level Meeting on HIV/AIDS shows that external funding cuts, a strong push back on human rights and under investment and under prioritization of HIV prevention and community services are threatening to reverse years of gains in the AIDS response. Read AVAC’s UN High-Level Meeting on HIV/AIDS: What to Watch.

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