Global Health Watch: WHA78, Misinformation at Congressional Hearings, Global Fund Cuts & More

Issue 17

The US Secretary of State and the Secretary of Health and Human Services appeared before Congress this week defending foreign aid cuts and the dismantling of USAID. Advocates are responding, including the Treatment Action Group (TAG) which issued a stark warning: US agencies are engaging in “unethical, dishonorable, and potentially law-breaking machinations” under new leadership, particularly at the NIH. Meanwhile, the US was absent from the World Health Assembly, where the WHO Pandemic Agreement was ratified and where a high-level dialogue on long-acting HIV prevention took place. All this plus looming Global Fund shortfalls, and new COVID-19 vaccine policy changes in this week’s issue. 

Misinformation and Controversy at Congressional Hearings 

The US Secretary of State Marco Rubio appeared in front of the US Congress this week defending radical cuts to foreign aid and a proposed State Department reorganization that deprioritizes global health programs. In front of the Senate Foreign Relations Committee (of which he was once a member), Rubio was corrected when he wrongly claimed that only 12% of US funding goes to direct services. In fact, 12% is the proportion of funds going directly to local NGOs, with 85% of total funding going towards direct services. He also claimed – without evidence – that 85% of PEPFAR beneficiaries were still receiving services and denied any deaths linked to the US cuts. The Secretary repeated these claims before the House Foreign Affairs Committee and Appropriations State and Related Programs subcommittee and ignorantly characterized voluntary male medical circumcision (VMMC) as wasteful spending. VMMC is proven to reduce transmission of HIV. Congressional members challenged Secretary Rubio on the legality of the foreign aid freeze and dismantling of USAID and highlighted reported deaths resulting from the cuts. Meanwhile, some Republican Senators, including Senate State, Foreign Operations, and Related Programs (SFOPs) Chair Lindsay Graham, expressed support for foreign assistance amidst calls for transparency and metrics to transition countries off US funding. 

Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy Jr. appeared before the Senate this week to defend cuts to public health programs and biomedical research. Similar to his appearance last week before the Senate Health, Education, Labor and Pensions (HELP) Committee, Kennedy’s remarks were controversial and contradicting.  

IMPLICATIONS: These hearings underscore the challenges facing US global health policy and programming amid shifting political priorities and leadership. Advocacy to counter mis- and dis-information, and a vision for this new era of global health financing, are more important than ever.  

READ:  

An Ethical and Legal Crisis

In a statement, TAG demands immediate action by the NIH to provide Congressionally appropriated and committed funding to the HIV clinical research networks (ACTG, HPTN, HVTN, IMPAACT). 

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World Health Assembly Updates 

The United States was notably missing from the World Health Assembly (WHA) this week, with no official delegation attending. This is a major change from previous years where delegations held leadership and diplomacy roles. In contrast, China sent more than 180 delegates and pledged an additional $500 million over the next five years to help stabilize the agency following the withdrawal of the United States, reinforcing its growing influence in global health governance. 

Meanwhile, the WHA formally voted to adopt the WHO Pandemic Agreement, a legally binding accord that lays the foundation for future pandemic prevention and response, including real-time sharing of vaccines, treatments, and diagnostics. For three years, member states negotiated critical issues, with pressure from civil society to embrace key provisions on equity and intellectual property. Some of those provisions have been addressed, but negotiations on an annex detailing the new Pathogen Access and Benefit Sharing (PABS) mechanism will continue with the aim of concluding at next year’s WHA. PABS refers to a proposed system where countries share genomic information about novel pathogens and share tools developed to combat those pathogens, regardless of which country discovered the pathogen or developed effective tools—it has been one of the most contested areas of negotiation. Though the treaty is less ambitious than earlier drafts, nations at the WHA have largely welcomed the agreement as a major achievement.  

Many events and discussions were held on the sidelines of the WHA, including Wednesday’s high-level dialogue organized by the Global HIV Prevention Coalition (GPC). The event, A New Era of HIV Prevention: Accelerating Access to Long-Acting Prevention Options, was co-hosted by UNAIDS, in collaboration with the United Nations Population Fund (UNFPA), United Nations Development Fund, (UNDP), WHO, the Federal Republic of Brazil and Kingdom of the Netherlands. AVAC’s Mitchell Warren, who also co-chairs the GPC, opened the session with urgency and optimism, calling it “one of our greatest opportunities in 44 years of HIV prevention,” even as global solidarity is waning. Dr. Lilian Benjamin Mwakyosi, a past AVAC Fellow and director of DARE in Tanzania issued a powerful reminder that “choice for HIV prevention is not a luxury. It’s a right,” stressing that adolescent girls and young women need accessible, discreet prevention options like long-acting PrEP. The dialogue underscored the need for political will, financing, and community-centered action to turn scientific breakthroughs like lenacapavir for PrEP into sustained prevention at scale. 

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Global Fund Financial Challenges 

More than 260 civil society advocates joined a conversation organized by the Coalition to build Momentum, Power, Activism, Strategy & Solidarity (COMPASS), Eastern Africa National Networks of AIDS and Health Service Organizations (EANNASO), CHANGE, and others to explore the financial constraints facing the Global Fund following its Board meeting earlier this month. Advocates learned unmet pledges and declining global health aid will mean that the current Global Fund Grant Cycle 7 will reduce allocations to countries to align with available resources, moving from pledge-based to cash-based allocations. Countries will receive reduced funding envelopes in mid-June 2025, which will trigger a two-week reprioritization process to focus on life-saving services like treatment continuity and community-led monitoring while deferring lower-priority items. 

IMPLICATIONS: These changes could jeopardize essential programs, especially those supporting key populations. And they also raise significant questions about the recently launched Global Fund replenishment for the next grant cycle. Civil society must prepare now to advocate for transparent processes, protect vital community interventions and support the Global Fund’s ambition to introduce injectable lenacapavir with speed, scale and equity. 

New US COVID-19 Vaccine Policy 

The US Food and Drug Administration (FDA) outlined in a new blueprint for COVID-19 vaccines, one that shifts from a recommended annual COVID vaccine for everyone 6 months and older, to adults over 65 and individuals with high-risk conditions, such as compromised immune systems. This shift requires vaccine manufacturers to conduct extensive clinical trials before approving vaccines for healthy individuals aged 6 months to 64 years, potentially delaying access for this group. Rather than proposing the new guidelines through the typical regulatory processes, including opportunities for public comment, this framework was devised and published by the head of the FDA along with the new head of FDA’s Center for Biologics Evaluation and Research (CBER).  

IMPLICATIONS: This unorthodox process could complicate future vaccine approvals, as well as leave interpretation and coverage decisions up to insurers, which would create major access barriers for many. 

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New Resources: Tracking the Impact of US Cuts to Foreign Aid, USAID, and Research

As the US administration continues to dismantle foreign aid infrastructure and retreat from its commitments to science and global health, AVAC is tracking the impacts and consequences. 

  • What Happened to PEPFAR? provides an in-depth look at the stop work orders and contract terminations disrupting HIV prevention access. 

What We’re Reading

Resources

Avac Event

100 Days In: How HIV Advocates are Meeting the Moment

In its first 100 days, the Trump administration proposed deep cuts to public health and HIV funding, attacked evidence-based healthcare, defunded scientific research, rolled back protections for LGBTQ+ people, and emphasized punitive criminal legal approaches. These moves pose serious threats to the future of HIV-related services, care, prevention, and the broader struggle for health equity and racial justice in our multiracial democracy.

Join CHLP for this moderated panel discussion focused on what the first 100 days of the Trump administration have meant for our communities, particularly people living with HIV, Black and brown people, LGBTQ+ people, and those impacted by criminalization, and how we are collectively shifting strategy to meet the current political moment.

Panelists

  • Michael Elizabeth, Equality Federation
  • Venita Ray, Black South Rising
  • John Meade, PrEP in Black America, AVAC
  • Chauncey McGlathery, American Academy of HIV Medicine
  • Jada Hicks & Sean McCormick, CHLP

HIV Prevention R&D at Risk

Tracking the Impact of US Funding Cuts

The US presidential administration is actively working to dismantle HIV research and demolish the architecture of global health. The entire HIV response — from basic research and clinical development to policy, programs, and global access to life-saving treatment and prevention — is now under attack, and the world runs the risk of reversing the strides made to end HIV.

AVAC has put together this report, highlighting the impact of US cuts on the pipeline of HIV prevention research and development. AVAC will continue to track these cuts and their impact, to amplify the damage they will cause, and to fight for their reversal.

Why HIV Prevention Must Not Be Left Behind

In this presentation at the INTEREST 2025 conference, Rhoda Msiska of Copper Rose Zambia emphasizes the urgency of protecting the progress made in scaling up PrEP and the need to act now to expand access to new HIV prevention tools like injectable lenacapavir (LEN) and the Dual Prevention Pill (DPP).

Advocates’ Guide: Understanding the President’s Proposed Fiscal Year 2026 (FY26) Budget and Its Implications for Science, Research and Global Health 

The US administration’s proposed Fiscal Year 2026 (FY26) budget marks a sweeping rollback of federal investment in health, research, and global development. For advocates, researchers, and implementers, this proposal demands urgent attention and action.  

This initial “skinny budget” is a proposal and not yet law. A more detailed proposal will be released by mid-to-late May and the US Congress will ultimately decide actual funding levels for FY26, which begins October 1. So, advocates must speak up now to protect funding for research and programming that saves lives and livelihoods. 

Here’s what advocates need to know and do: 

Big Picture: A Dramatic Retrenchment 

The budget proposes $163 billion in cuts to non-defense discretionary spending, including a 26% reduction to the Department of Health and Human Services (HHS)— the department that oversees the US National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA). These cuts are completely offset by an increase to defense spending and reflect a shift toward the elimination of science and programming tied to diversity, equity, inclusion (DEI), gender, and climate, and a redirection of funding toward defense and “America First” priorities—priorities that put the perceived interests of the US and its citizens over other national and global issues. 

Detailed Analysis and Implications

Health and Biomedical Research 

The proposed cuts to HHS would gut federal support for health and biomedical research, dismantling key programs at NIH and CDC. They threaten progress on infectious diseases, health equity, and pandemic preparedness—undermining decades of scientific gains and leaving communities vulnerable. 

NIH is Cut by $17.9 billion losing HIV and global health research 
  • Preserves $28 billion of the $46 billion for NIH overall, but excludes HIV prevention, global health, and health equity research.  
  • Reorganizes NIH into 5 “realigned” institutes, removing focus on climate, gender, racial equity. 
  • Eliminates the Fogarty International Center and the National Institute on Minority Health and Health Disparities. 
Centers for Disease Control and Prevention (CDC): Cut by $3.59 billion 
  • Eliminates Global Health Center and National Centers on environmental health, injury prevention and chronic disease prevention. 
  • Eliminates DEI programs and shifts the burden for pandemic prevention and response. 
Agency for Healthcare Research and Quality: Effectively eliminated 
  • Cited as redundant; targeted for work on climate and gender. 
National Science Foundation (NSF): Cut by $4.9 billion (56%) 
  • Eliminates funding for work seen as ideologically objectionable (e.g., broadening participation and racial equity in STEM). 

Global Health and Development

At a time when the USG should be expanding access to new technologies, the proposed FY26 budget guts foreign assistance funding, threatening pillars of the global HIV response: the President’s Emergency Plan for AIDS Relief (PEPFAR) and US contributions to multilateral initiatives, such as Global Fund and GAVI. The ideological targeting of family planning and gender-related programs will further weaken interventions to address HIV, which have been shown to work best within a comprehensive package of health and social services.  

Global Health Programs: Cut by $6.23 billion

  • Defunds NGOs providing family planning, impacting maternal and child health providers. 
  • PEPFAR preserved only for existing treatment programs and programs for the prevention of mother-to-child transmission (PMCT) , and specifically excludes primary prevention and PrEP, except for pregnant and lactating populations. 

USAID Development Aid: Cut by $8.33 billion 

  • USAID is eliminated with the limited number of existing programs moved into the State Department. 
  • Eliminates DEI, climate, and gender-related programming. 
  • Creates new “America First Opportunity Fund” to replace foreign assistance grants with loans that prioritize US interests over humanitarian needs. 

Centers for Disease Control and Prevention (CDC)

Health Resources and Service Administrations (HRSA): Cut by $1.73 billion

  • Ryan White HIV/AIDS Program activities not deemed core are eliminated. 

Substance Abuse and Mental Health Services Administration (SAMSHA): Cut by $1.065 billion 

  • Eliminates harm reduction and regional substance use program grants. 

Offices of Minority & Women’s Health 

  • Moved under a new, less visible structure. 

New Initiative: “Make America Healthy Again”

  • $500 million focused on lifestyle over treatment. 

What This Means

  • HIV Prevention R&D and global implementation is at risk. Cuts to NIH and USAID directly threaten support for clinical trials, community engagement, and biomedical innovation. 
  • Equity-centered research threatened. Eliminating institutes focused on minority and global health severely undermines inclusive science and jeopardizes future impact. Inclusion is not just a nice to have, it’s integral to achieving impact 
  • PEPFAR protections are narrow. Only existing beneficiaries are covered; scale up and innovation are excluded, compromising the imminent introduction and potential impact of injectable lenacapavir for PrEP. Funding for HIV prevention is also eliminated, except for pregnant and lactating populations. 

Advocacy Priorities

  • Monitor the full FY26 budget release for agency-level detail and justification. 
  • Engage Appropriations and other relevant Committees via coalition efforts (e.g., FAPP, GAPP, GHTC, SHF). 
  • Mobilize your community to contact your Senators and Representatives to let them know you oppose these cuts.  
  • Share your stories from researchers affected by cuts—particularly those whose work is globally focused or funded by NIH/USAID. 
  • Stay up to date with budget briefings and mobilization opportunities. See AVAC’s ‘Research Matters’ resource, which shares guidance and a toolkit for researchers to advocate for continued funding.

This budget is a threat to decades of progress in science, equity, and health—but it is also an opportunity to speak with clarity and urgency about what is at stake. Advocates must ensure that the future of HIV prevention, global health innovation, and equitable science is not written by politics, but by people, evidence, and impact. 

PrEP Delivery Imperiled

Programs for delivering PrEP have been shuttered all over the world by the withdrawal of the US government from global health. This graphic illustrates some of the severe measurable impacts of these cuts. Excerpted from PxWire.

PxWire Volume 15, Issue 2

The field of HIV prevention is confronted with two opposing forces; programs for delivering PrEP have been shuttered all over the world by the withdrawal of the US government from global health. At this same moment in history, next-generation long-acting products hold great promise to accelerate HIV prevention and help the world achieve epidemic control. Navigating these seismic developments requires unprecedented coordination, solidarity, and courage.

Global health champions can defy the hatred, fear, and greed that are dominating politics in so many places around the world. Together we can innovate, create, and protect the advance of HIV prevention and global health. This issue provides a snapshot on threats to delivering PrEP, the potential of injectable lenacapavir (LEN) for PrEP, and on the implications of upstream research and development of other long-acting PrEP.

Read below or download the PDF version.

Progress in PrEP Uptake: Threatened

  • PEPFAR documented 2.5 million new PrEP users in 2024, who could now lose access to PEPFAR- supported PrEP services. US Department of State issued a limited and inconsistently implemented waiver in February, allowing for continued provision of HIV treatment but restricting PrEP access to pregnant and lactating people only.
  • These actions will result in 3.5 million who identify as key populations (KPs) losing access to all HIV prevention programming under PEPFAR, according to 2024 PEPFAR data tracking KP use of PrEP. These groups have higher rates of HIV incidence and face additional barriers to accessing services now that targeted programs are suspended.
  • PEPFAR had a goal of 100,000 people initiating cabotegravir (CAB) for PrEP in 2025. But only 5,000 individuals had initiated by October 2024. The suspension of PEPFAR funding imperils scale-up of this long-acting product.
  • These figures represent just some of the disruptions that are decimating PrEP delivery. Learn more here: Impact of PEPFAR Stop Work Orders on PrEP
  • Overcoming this challenge, restoring, sustaining, and accelerating PrEP access is imperative and possible if the field works together.

For the last eight years, AVAC has proudly worked with PEPFAR to document PrEP uptake and its impact around the world. That stopped in January with a stop work order from the US government. But protecting access to PrEP is vital. Are you leading a PrEP program? Whether supported by PEPFAR or not, we invite you to work with us to ensure global data on PrEP is not lost. Find us at [email protected].

PrEParing for New Products

  • Approval by the US Food and Drug Administration (FDA) for injectable 6-month LEN for PrEP is expected in June, with WHO guidelines expected in July. See the full timeline.
  • Modelling data from South Africa demonstrate the potential of injectable PrEP to dramatically reduce HIV incidence by up to 90% by 2044, and potentially even sooner with more aggressive uptake. This potential goes beyond South Africa, lighting the way toward epidemic control the world over.
  • The field must be prepared for swift action once LEN is approved and recommended, to ensure this opportunity is not squandered. As AVAC’s interactive timeline, Tracking LEN Rollout, outlines, donors, ministries of health, manufacturers, regulators, and civil society all have a role to play to pave the way for swift, equitable and effective introduction of LEN for PrEP.

The Latest R&D in the Prevention Pipeline

  • The HIV prevention market is headed toward a period of significant opportunity—and possible congestion—as a slate of new products are on track for continued development and potential introduction to the market in 2027 and 2028.
  • Generics for 2-month CAB and 6-month LEN, along with ViiV’s 4-month CAB, Gilead’s 12-month LEN, and Merck’s monthly oral MK-8527 PrEP pill (if further development and approvals are successful) could all enter the market by 2028.
  • The possibility of so many products on the market, including four different formulations of injectable PrEP, means that it is imperative the field prepares for this future now.
  • Markets and policies must be built to support the products in the market already, so that new options can be rapidly deployed and deliver impact. Otherwise, the field will squander time and money, with epidemic control slipping further out of reach.
  • With US funding cuts to both HIV prevention R&D and delivery, communities must be engaged, supported, and informed about all prevention options, and the choices that all stakeholders will need to make. This means gathering and sharing data and information about cost-effectiveness, user acceptability, program feasibility, and impact. Communities empowered with the facts can advocate for the choices they need, and push ministries of health to make strategic investments and procure the prevention method mix that fits their context and delivers impact.

Prevention Playlist

AVAC develops a wide range of resources to inform decision making and action. Check out the latest:

Join

  • Subscribe to Global Health Watch: AVAC’s weekly newsletter dedicated to breaking down critical developments in US policies and their impact on global health, at avac.org/global-health-watch
  • CHANGE: In response to the unfolding crisis, more than 1,500 people from civil society organizations around the world have launched CHANGE—Community Health & HIV Advocate Navigating Global Emergencies—a coalition formed to support urgent action: [email protected]

Use

Watch/Listen

Read

An “Innovation Pile-Up” in Next-Generation LA-PrEP is Possible

The HIV prevention market is headed toward a period of significant opportunity—and possible congestion—as a slate of new products are on track for continued development and potential introduction to the market in 2027 and 2028. Markets and policies must be built to support the products in the market already, so that new options can be rapidly deployed and deliver impact. Otherwise, the field will squander time and money, with epidemic control slipping further out of reach. Excerpted from PxWire.

Avac Event

Science in the Crosshairs: Research Advocacy in a Time of Crisis

AVAC and partners had a critical conversation on the escalating threats to health research and equity-centered science. This webinar unpacked the implications of the proposed FY2026 US federal budget—which includes sweeping cuts to NIH, CDC, USAID, and the elimination of vital global and minority health research programs. Together, we explored what these attacks mean for communities, researchers, and implementers and identified actionable advocacy strategies to fight back.

Recording / Slides / Resources

Research Matters – Resources to Protect Research Funding 

For more than 30 years, AVAC and partners have worked to protect the infrastructure and funding that drives lifesaving HIV and biomedical research. Today, that mission is more urgent than ever. 

Funding from the National Institutes of Health (NIH) fuels innovation, drives the economy, and saves lives. Cuts to this support will make America—and the world—poorer, sicker, and less prepared for future health threats. 

Tomorrow (Wednesday, April 30), the US Senate Appropriations Committee will host a hearing on Biomedical Research: Keeping America’s Edge in Innovation at 10:30am ET. Click here to watch the hearing. 

And be sure to read the written statement to the Committee from AVAC and The Federal AIDS Policy Partnership (FAPP) Research Working Groups, which provides a strong, urgent appeal to Congress to reject future funding cuts to the NIH and shows the importance and impact investments in biomedical research have had on lives and livelihoods. 

Resources for Researchers 

In addition, AVAC, TAG and the HIV Medicine Association (HIVMA) co-created a new resource hub, Research Matters, to support researchers advocating for sustained NIH funding. These tools include an Advocacy Toolkit  to help move our collective efforts forward. Please share this link with any researchers who have received NIH funding—we will continue to update the hub with resources to support continued advocacy for biomedical research.  

Share Your Story 

Additionally, AVAC and partners are collecting stories of impact—if you know someone willing to share their story about how NIH cuts are affecting their work, contact John Meade Jr. at [email protected]. This Huffington Post piece by Katie Edwards at the University of Michigan is a terrific example of a researcher sharing the real-world toll on scientists, trial participants, communities, research and public health. 

Thank you for standing with us to protect science, health, and progress.