This week covers the significant turmoil at the US National Institutes of Health (NIH), including a close look at the NIH deputy director’s role in disruptions in leadership and funding cuts, and a lawsuit filed by the former Director of the National Institute of Allergy and Infectious Diseases (NIAID). It also covers urgent civil society pushback against efforts to sunset UNAIDS, the rapid expansion of US “America First” bilateral health agreements across Africa, and what’s next for STI research, prevention and diagnostics.

NIH Leadership Turmoil

A new investigation by The Atlantic’s Katherine Wu examines the central role of the Deputy Director of the National Institutes of Health (NIH), Matthew Memoli, in recent leadership changes and funding cuts across the NIH, including the firing of former NIAID Director, Jeanne Marrazzo, and the reassignment of Carl Dieffenbach, longtime director of NIAID’s Division of AIDS, to another NIH center. The Atlantic’s reporting shows how these decisions have significantly weakened NIAID, with particularly acute impacts on HIV prevention and vaccine research, where programs, expertise, and long-term scientific capacity are being eroded amid broader restructuring and budget shifts.

In addition, this week, Dr. Marrazzo, the newly appointed chief executive officer of the Infectious Diseases Society of America (IDSA), filed a lawsuit against the US federal government. The lawsuit alleges that Marrazzo was illegally fired from her position and seeks to be reinstated as head of NIAID and to receive formal declarations that her rights were violated. The suit argues that her firing was retaliation for a whistleblower complaint she filed on September 3, in which she raised concerns about anti-vaccine positions held by newly appointed NIH officials; demands to halt clinical trials; and requests to cut international research collaborations. Twenty-two days after filing the complaint, Marrazzo was fired by Health and Human Services Secretary, Robert F. Kennedy Jr.

IMPLICATIONS: The developments at the NIH show instability at its leadership level and severe consequences for infectious disease research, particularly vaccine research. This comes at a time when sustained R&D investment is most critical. Without robust research support, future advances in next-generation options could stall. See the new People’s Research Agenda, which calls for a balanced HIV prevention portfolio that is optimized for impact. However, Marrazzo’s new role at the IDSA, which represents clinicians, scientists and public health experts who are driving policy and advocacy to address critical issues in combating infectious disease, will be pivotal in ensuring rigorous science, inclusion and equity in research, community engagement, and evidence-based communications remain central to tenors in global health discourse and debate.

READ:  

• AVAC Board Member Jeanne Marrazzo named CEO of IDSA—AVAC  
• The Most Feared Person at the NIH Is a Vaccine Researcher Plucked From Obscurity—The Atlantic  
• Fired NIH institute head sues Trump administration—Science  
• IDSA selects next CEO—Infectious Diseases Society of America 

Future of UNAIDS 

Member states and civil society convened at the 57th meeting of the UNAIDS Programme Coordinating Board (PCB) in Brazil this week to discuss urgent decisions about the future of the global HIV response amid deep funding cuts and a shifting global health landscape. They reviewed and approved the Global AIDS Strategy 2026–2031 and assessed the impact on communities from disruptions to services for HIV prevention and treatment. Civil society representatives on the PCB shared comments, and African women leaders and other civil society groups issued statements (and sign-ons) denouncing efforts to sunset UNAIDS by the end of 2026: “Any move to sunset UNAIDS before ending AIDS as a public health threat is premature and unacceptable. No sunsetting until we finish the job. AIDS is not over.”  

The PCB also held a special thematic session on long-acting ARVs for treatment and prevention. See this clip from Yvette Raphael where she included AVAC’s latest blog in her remarks about the current context: “We cannot let cruel international policy allow historic gains to collapse, just as a few highly effective prevention options arrive. That is why rolling out LEN to all countries that need it with speed, scale and equity must be our uncompromised, uncompromising priority. If we do this, we can change the trajectory of the epidemic, but only if we act at the pace that data and science demand.”

IMPLICATIONS: As the world moves toward the June 2026 High-Level Meeting on HIV, and the rollout of the new Global AIDS Strategy, the strong pushback by civil society at the PCB underscores that any reform must preserve UNAIDS’ core mandate and ensure that the global HIV response remains centered on those most affected — especially women, girls, and key populations — rather than being quietly dismantled at a moment of crisis.

READ:  

• African Women Leaders Condemn Any Move to Sunset UNAIDS: AIDS is Not Over—African Women Prevention Community Accountability Board 
• Deputy Secretary-General, Addressing UNAIDS Programme Coordination Board, Highlights Transition Strategy, Legacy as United Nations Success Story—Press UN 
• The Future of HIV Prevention Depends on Speed, Scale and Equity—AVAC  
• UNAIDS Must Be Retained as a Distinct, Independently Mandated Joint Programme within UN Reform—KP-TNC Statement 
• The HIV Response Orphaned: At the Cost of Women Living with HIV—ICWEA  

Eswatini and Mozambique Join Growing List of African Countries to Sign “America First” Bilateral Health MoUs

Mozambique and Eswatini are the latest countries to sign the bilateral health Memorandums of Understanding (MoUs) with the United States under the America First Global Health Strategy, adding to earlier agreements with Kenya, Liberia, Rwanda and Uganda. These agreements provide 5 to 10 years of funding and health support in exchange for co-financing, health data, pathogen-specimens, and national health system data, marking a major shift in how global health cooperation is structured under US leadership.   

IMPLICATIONS: The pace of these agreements shows how quickly the Administration is moving to reshape US global health with little time for discussion and debate on transparency, consultation, and how civil society fits within this evolving framework. As the landscape shifts, civil society and non-governmental organizations must quickly reassess their roles in the hope of preserving aid delivery, accountability, and equity. 

READ:  

• NGOs must prove relevance to survive in ‘America First’ health strategy—Devex  
• Far from over—Forsaken Substack 
• US-Africa Health Agreements Targets Don’t Add Up—To End a Plagues … Again Substack 

What We’re Reading

• Reimagining HIV prevention programmes: the time is right, but what needs to be done?—The Lancet HIV
• Is science diplomacy still possible?—The Lancet
  2025 Broke the System. 2026 Decides the Future of Global Health.—Lights.Camera.Equity Substack
• When politics Trumps science: Why the US isn’t giving South Africa LEN—Financial Mail
• Will New US Aid Strategy Improve Countries’ Self-Reliance?—Medscape
• World leaders adopt a historic global declaration on noncommunicable diseases and mental health—WHO 
• Forget quiet quitting, the State Department appears to be quiet hiring—Devex 
• Trump Officials Celebrated With Cake After Slashing Aid. Then People Died of Cholera.—ProPublica 
• Exclusive: Senate Democrats introduce bill to protect UN Population Fund—Devex 
• California Hires Former C.D.C. Officials Who Criticized Trump Administration—New York Times
• Update on Lives Lost from USAID Cuts—CGD
• U.S. Global Health Country-Level Funding Tracker—KFF

STIs Spotlight

AVAC’s STI program looks back at 2025—and ahead to 2026—tracking rising STI rates, major HPV vaccination gains, slow but promising diagnostics, the growing role of self-care, and what’s next for STI research, prevention and diagnostics.

Read More

Decisions and actions this week further weaken the global HIV response — from the exclusion of communities in the new PEPFAR US global health strategy negotiations to a Global Fund replenishment that falls short of what’s needed to deliver emerging HIV, TB, and malaria innovations at scale. Major disruptions at the US CDC and NIH – including halted non-human primate research, politicized vaccine messaging, leadership changes that jeopardize HIV research, and “skipping” World AIDS Day — continue the erosion of accountability, trust, and the integrity of the public health system. 

US Global Health Strategy Negotiations Leaving Communities Behind 

African advocacy partners including Eastern Africa National Networks of AIDS and Health Service Organizations (EANNASO) and the Coalition to build Momentum, Power, Activism, Strategy & Solidarity in Africa (COMPASS) have been taking stock of the ongoing country negotiations around the US government’s Memorandums of Understanding (MoUs) as part of its new “America First” global health strategy. They are finding that communities are being systematically excluded from the “government-to-government” negotiations for new 5-year PEPFAR MoUs, a direct reversal of the community engagement that has defined decades of the HIV response. Efforts to ensure program effectiveness, implementer accountability, programs for key populations, and commodity security are all at stake. The new framework would also require partner countries to share pathogens and patient data, potentially with US commercial interests, without privacy safeguards or assured access to resulting products — for decades longer than the life of the actual MOUs. With an MoU signing deadline of December 12, there is a great need to mobilize to demand transparency, inclusion and fair terms for all parties. 

IMPLICATIONS: The exclusion of communities from the new MoU negotiations is an abrupt shift away from the community-centered model that has been at the center of PEPFAR’s success for decades. These closed-door, government-to-government negotiations undermine the hard-won progress on reaching key populations, protecting data privacy, and delivering services that are responsive to the real-life needs of communities. Sidelining communities threatens the effectiveness, and legitimacy of the next phase of the HIV response and without immediate transparency and meaningful engagement, these MoUs risk weakening impact and trust. 

READ: 

• No seat at the table—Forsaken Substack 
• First look: Full Text of America First Global Health Strategy Specimen Sharing Agreement—To End A Plague Again Substack  
• Will African nations lose their leverage in an ‘America first’ health plan?—Devex  
• South Africa May Be Excluded From Future US Grants for HIV Amid Political Row—Health Policy Watch 

Global Fund Replenishment Support, But Falls Short of Target 

Last Friday, donors pledged just over $11 billion at the Global Fund’s 8th Replenishment in Johannesburg. This was an important show of support, especially given the challenging political and economic climate, but well short of the $18 billion target needed to fully harness today’s unprecedented scientific advances against HIV, TB and malaria. The US pledged $4.6 billion, a decrease from the previous cycle, even as it reaffirms the 1:2 matching commitment, placing renewed pressure on Congress to fully appropriate funds, and on other donors to step up.  

IMPLICATIONS: As long-acting HIV prevention, new malaria tools and improved TB treatments enter the market, this shortfall threatens the speed, scale and equity of their rollout. And with communities already facing service disruptions, this shortfall could cost millions of lives and squander a historic opportunity to turn innovation into impact. 

READ: 

• Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States—Health Policy Watch
• Global Fund raised $11.34 billion with a surprising US pledge—Devex  
• Control of HIV, TB and malaria at risk after global health fund donations fall—The Guardian  
• Friends statement on the U.S. commitment to the Global Fund—Friends of the Global Fight  
• The ONE Campaign Applauds American Leadership on Global Fund, Highlights Need for Full Funding—One Campaign 
• AVAC Statement on the 8th Replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria—AVAC      

Big Disruptions at US CDC and NIH – and World AIDS Day

In the last week, decisions and actions at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health’s (NIH) Division of AIDS (DAIDS) further jeopardize the future of HIV research and confidence in vaccines. The CDC abruptly ordered an end to all non-human primate research, including critical macaque studies that have long supported HIV prevention science. The agency also altered language on its website implying a link to vaccines and autism and contradicting established scientific consensus. At the NIH, long-time DAIDS Director, Carl Dieffenbach, was reassigned to the Fogarty International Center, a move that removes a trusted leader who played a central role in guiding HIV research. See AVAC’s resource, HIV Prevention R&D at Risk, which tracks the impact of all this and more. Also, just ahead of December 1, the US administration announced that it will no longer commemorate World AIDS Day. 

IMPLICATIONS: Together, these actions continue the decline in US global health leadership, unraveling decades of scientific progress and trust in vaccines and public health institutions. Halting essential preclinical research in macaques, politicizing vaccine messaging and sidelining experienced leadership weakens the pipeline of innovation and threatens the integrity of HIV science at a moment when sustained investment and credibility are most needed. As for World AIDS Day, Congressman Mark Pocan, who leads the Congressional HIV/AIDS Caucus, said the administration’s refusal was “shameful and dangerous.” But it’s important to remember that World AIDS Day is not decided by the US government; it belongs to everyone – and the new UNAIDS report provides the theme: Overcoming disruption, transforming the AIDS response. Or as the International AIDS Society says: Rethink. Rebuild. Rise. 

READ: 

• Kennedy Says He Told C.D.C. to Change Website’s Language on Autism and Vaccines—New York Times   
• Exclusive: CDC to end all monkey research—Science 
• NIH shake-up to grant decision-making draws concerns of political meddling—Science 
• Trump Administration Will No Longer Commemorate World AIDS Day—New York Times 
• The United States Cancels World AIDS Day—Substack To End a Plague … Again 

What We’re Reading

• What Africa Lost Under Trump: At least $5 Billion. What It Got In Return: “True Chaos.”—Veza from the Center for Collaborative Investigative Journalism (CCIJ) 
• The 2025 HIV Market Report: The state of the HIV market in low- and middle-income countries—Clinton Health Access Initiative
• China pledges $3.5 million for South Africa’s HIV response—Reuters  
• UNICEF, Gavi deal slashes malaria vaccine price to $2.99 per dose—Devex  
• Ex-top USAID official details wish list on health and funding fixes—Devex 
• G20 summit in South Africa adopts declaration without the US—Devex
• DOJ Tries To Block Elon Musk Testimony In USAID Lawsuit—Forbes 
• HHS rehiring some people fired through reduction-in-force efforts—Politico
• Video: We Have a Chance to End the AIDS Pandemic—Public Citizen 
• “Miraculous” HIV drug to be rolled out after overcoming aid cuts threat—BMJ

This week’s newsletter publishes just as the Global Fund’s 8th Replenishment Summit in South Africa is taking place. The Global Fund represents one of the strongest symbols of global solidarity in the fight against HIV, TB, and malaria, but, despite early pledges from several European Union member states and private partners, key donors (including the UK, Germany and France) appear to be stepping back, with smaller or uncertain pledges at this critical moment, and it is not yet clear what the US will do. A budget-constrained Global Fund raises serious concerns about losing ground against all three diseases and failing to seize opportunities to scale up new innovations in all three, including long-acting injectable PrEP for HIV. This Global Fund Advocates Network (GFAN) tracker tallies pledges, and this resource for scenario building shows how potential donor pledges could impact the funds available for health programs. Be sure to watch AVAC’s channels for the latest on the pledges.  

Read on for more including the arrival of injectable lenacapavir for PrEP in Eswatini and Zambia, the uncertain future of US health funding post-shutdown, and new research exposing the impact of NIH clinical trial cuts.

Lenacapavir Arrives in Eswatini and Zambia  

The first doses of injectable lenacapavir for PrEP (LEN) arrived in Eswatini and Zambia. These initial deliveries mark a historic acceleration in PrEP access, moving faster than we’ve seen with past introductions (see  AVAC’s new graphic comparing the rollout of LEN to past PrEP products) and signaling momentum and an ability to apply lessons from past delays. With additional regulatory reviews underway across the region, this early action represents a promising step forward. 

IMPLICATIONS: While these first shipments are worth celebrating, they’re just a down payment on what’s needed to deliver LEN at scale with equity. The joint Global Fund and PEPFAR commitment to reach two million people in the first three years is far more ambitious than past introductions, but falls short of delivering the impact that is needed. For LEN to have maximum impact, global donors and governments must align on transparent volume commitments, prioritize high-need markets and ensure that rollout strategies are rooted in community-led approaches. While South Africa is slated to receive LEN with Global Fund support, the fact that they are excluded from PEPFAR’s program is a huge, missed opportunity. If we really want to build a sustainable market as quickly as possible, one that will drive volume up and prices down and deliver real impact, South Africa must be THE center of the market and needs PEPFAR and Global Fund both to work with the South Africa government. AVAC’s full LEN resource library, including infographics on supply and demand, is designed to support advocates working to make that vision real. 

READ: 

• First doses of HIV prevention drug lenacapavir delivered to Zambia, Eswatini—Reuters  
• A ‘breakthrough’ drug to prevent HIV, an ‘unprecedented’ rollout—NPR Goats & Soda 
• Trump HIV prevention plan shuts out South Africa — the nation most affected—Washington Post 
• South Africa is urged by advocates to issue a compulsory license for Gilead’s HIV prevention drug—STAT
• Trump Takes Credit for Lenacapavir Deal after His Administration Decimated U.S. International AIDS Prevention Programs—Public Citizen 
• Access Uncertain for New Injectable PrEP as the Affordable Care Act’s (ACA) Open Enrollment Begins—KFF    

US Government Reopens, Health Funding Remains Uncertain 

The US Congress officially reopened the federal government after the longest shutdown (43 days) in the country’s history. Funding for most agencies is now extended until January 30, and three appropriations bills were passed to cover several departments through all of fiscal year 2026 which ends next September. However, key health initiatives remain vulnerable: the deal keeps major health programs, including the nation’s HIV response, on a short-term continuing resolution only through January, and does not address spiking US health insurance costs. 

IMPLICATIONS: HIV prevention, treatment, and care programs will continue at last year’s levels through January 30, which avoid devastating cuts for the time being, with the fight to increase investments ongoing. The broader budget agreement also sidesteps major reforms demanded by lawmakers that threaten to gut these programs. It’s not clear if or when future disruptions might further impact public health programs and US global health engagement. 

READ: 

• The government has reopened, but Congress must protect HIV funding for 2026—The Hill  

Clinical Trials Affected by NIH Research Grant Terminations 

A new study published in the Journal of the American Medical Association (JAMA) shows that more than 74,000 clinical trial participants were affected when 383 clinical trials lost funding from the National Institutes of Health (NIH) between February 28 and August 15, 2025. These cuts disrupted research across a range of diseases, but most of the targeted trials were outside of the US and were testing preventive or behavioral interventions, primarily in infectious diseases. “Those findings suggest that there’s a bias towards termination of grants that have nothing to do with the quality of research being conducted,” the authors wrote.  

IMPLICATIONS: This is one of the first studies to officially document the impact of the Presidential Administrations’ hostile policies and funding cuts to science. The political willingness to gut science without warning erodes trust in public health institutions and undercuts the foundation of long-term innovation. The impact is being seen across geographies, industries, communities, and diseases. 

READ: 

• Clinical Trials Affected by Research Grant Terminations at the National Institutes of Health—JAMA   
• NIH grant cuts have disrupted hundreds of clinical trials, study finds—Fierce Biotech 
• Trump slashed spending on clinical trials. The toll is starting to become clear.—Washington Post  
• NIH funding cuts have affected over 74,000 people enrolled in experiments, a new report says—Associated Press 

What We’re Reading

• US health strategy aims to position African governments as customers—Devex 
• Could an HIV miracle drug actually reach people like my parents?—STAT 
• Lenacapavir Plus Broadly Neutralizing Antibodies Maintains Viral Suppression—POZ 
• MacArthur Foundation awards $100M to outbreak surveillance network, a boost amid global health cuts—Associated Press 
• Global Aid Cuts Could Reverse Decades of Progress in Health and Development—ISGLOBAL  
• Amid aid cuts, these countries have ramped up global health cooperation—Devex  
• DOGE Man Drives US Bilateral Health Agreements With African Countries—Health Policy Watch
• N.I.H. Worker Who Criticized Trump Health Policies Says She Is on Administrative Leave—New York Times 
• A Small Texas Think Tank Cultivated Covid Dissidents. Now They’re Running US Health Policy.—KFF 
• State department to cut 38 universities from research program over DEI policies—The Guardian 
• Senator Murray Slams Outrageous Political Retaliation at NIH, Demands Answers from Trump Administration—Senator Patty Murray 

Resources