Global Health Watch: Global Governance Shifts, ACIP Charter + Vaccine Policy, PEPFAR Transition

Issue 75

July 3, 2026

As many in the United States pause to commemorate Independence Day – and, hopefully, re-commit to the fundamental principles of democracy – the global health community continues to navigate the far-reaching effects of US policy decisions. Institutions are changing, governance is being redefined and the systems that have underpinned the global HIV response are being reshaped. This issue covers developments in global health governance, the continued restructuring of US vaccine policy and growing concerns that PEPFAR’s transition is outpacing the systems needed to sustain it.

Global Governance Shifts

The last two weeks, and the week ahead, mark key moments for global health governance with implications for the HIV response. Last week, for the first time in 25 years, UN Member States adopted a new Political Declaration on HIV/AIDS with a vote (with the US voting no), as opposed to the historic consensus of all past declarations. This week, both the UNAIDS Programme Coordinating Board (PCB) and the Unitaid Executive Board met against the backdrop of financial strain and uncertainty. Conversations and debates about their future roles continued, including questions about UNAIDS’ future structure within the UN system. Next week, the Global Fund Board will meet as it prepares to select its next Executive Director who is expected to shape the Fund’s strategic direction during one of the most challenging periods in its history.

IMPLICATIONS: In all these meetings, there is a reassessment of each entity and a reenvisioning of how global health organizations will coordinate, finance and sustain the HIV response in an era of constrained resources and shifting geopolitical priorities. As countries work toward the 2030 goal of ending AIDS as a public health threat, the decisions made by these governing bodies in the coming weeks will help determine whether and how the HIV response maintains the leadership, financing, accountability, collaboration and civil society engagement needed to carry the response forward.

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US HHS Rewrites ACIP Charter, Further Reshaping US Vaccine Policy

The US Department of Health and Human Services (HHS) issued a new charter for the CDC’s Advisory Committee on Immunization Practices (ACIP), broadening the Committee’s mandate and reducing the qualifications required for membership. Previously, vaccine expertise was a requirement, but the revised charter states that members should collectively represent a “balanced range of scientific, clinical, and public health expertise”. The new charter also expands the Committee’s focus beyond reviewing vaccines to considering alternative approaches to disease prevention.

IMPLICATIONS: This is the latest step in the restructuring of ACIP. By broadening the Committee’s remit and redefining membership qualifications, vaccine policymaking is further politicized and vaccine confidence continues to erode. This creates further instability and uncertainty for vaccine manufacturers, healthcare providers and immunization programs worldwide.

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PEPFAR In Transition

Two commentaries this week recognize the breaking point to which PEPFAR is nearing. The Health Security Policy Academy argues that despite the temporary extensions, which have kept and continue to keep parts of PEPFAR operating, the US Department of State has not yet built a viable implementation system to keep HIV treatment, supply chains, laboratories and community programs working. At the same time, Emily Bass, Yvette Raphael, Nono Eland and colleagues at Physicians for Human Rights argue in Think Global Health that the planned phase-out of all US PEPFAR support for South Africa by early 2027 is not a routine transition to country ownership, and caution that this accelerated withdrawal risks severed disruption to HIV prevention, surveillance, research and community programs that have long depended on US partnership.

IMPLICATIONS: Without a clear implementation strategy and carefully managed country transitions, these abrupt changes to PEPFAR threaten essential HIV services. A more deliberate, evidence-based approach that preserves critical infrastructure while supporting long-term country ownership is needed. “The dismantling of USAID showed what happens when the Administration destroys an operating system before a replacement exists. That chaos was not an accident, but it was sudden,” writes the Health Security Policy Academy. It remains even less clear what happens next with leadership transitions at the State Department: Jeremy Lewin who has led the State Department’s foreign aid bureau for the last year is heading to the National Security Council, and is being replaced by Andrew Veprek, who has pushed immigration and refugee restrictions at the State Department – and confirmation hearings are yet to be scheduled for Johnny Figueroa as the ambassador-at-large for global health security and diplomacy and PEPFAR.

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What We’re Reading