Global Health Watch: NIH turmoil + a high-profile lawsuit, future of UNAIDS, more Countries sign “America First” MoUs with US

Issue 47

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.

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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.

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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. 

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The Future of HIV Prevention Depends on Speed, Scale and Equity

“Every funding cut can represent at minimum, a delay. Every delay in rollout is a missed chance to prevent infections. Every un- or underfunded clinic is a barrier to access. Every policy is a choice to be inclusive or leave someone behind…”

Read AVAC's New Blog

What We’re Reading

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

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.

Download

The Future of HIV Prevention Depends on Speed, Scale and Equity 

When the US Food and Drug Administration approved lenacapavir (LEN) fro PrEP, it offered something rare in public health: a genuine turning point. We now have one of the greatest opportunities and scientific breakthroughs that we’ve had in HIV in 44 years: a twice-yearly injectable that showed near-complete protection against HIV in major trials. Science has given us a breakthrough. What happens next is up to us. 

But as AVAC Executive Director Mitchell Warren recently noted on ABC News and CNN, this moment of possibility is colliding with a moment of profound danger. The US administration’s proposed cuts to HIV prevention programs could reverse decades of progress in research, care, and rollout of new options. If that happens, even the most powerful tools like LEN will fall short. This is not a theoretical concern. It’s a warning, and one we must urgently act on.

We cannot let cruel international policy allow historic gains to collapse just as a new, highly effective prevention option arrives. That is why rolling out LEN — to all countries that need it — with speed, scale, and equity must be our uncompromising priority. If we do this right, we can change the trajectory of the epidemic — but only if we act at the pace the science demands. 

  • Speed means national programs must approve, adopt, and distribute LEN now — not after years of bureaucratic drift or pilot-project hesitation. People at risk cannot wait. 
  • Scale means strengthening and funding the infrastructure to make LEN widely available — across entire systems and communities. 
  • Equity means ensuring LEN reaches the people most affected by HIV — including and prioritizing those historically sidelined, discriminated against, or left behind — not just the communities that are easiest to reach. 

Without speed, we lose momentum. Without scale, we limit impact. Without equity, we repeat the failures of the past.  

We are in a golden moment, where innovation, evidence and opportunity align. But proposed funding cuts could undo everything. These aren’t abstract numbers on a page. These cuts would shutter clinics, slow prevention, restrict treatment, and roll back the very systems that allow new tools like LEN to reach people. Watch this powerful call-to-action from APHA Executive Director and longtime AVAC partner Yvette Raphael at the recent UNAIDS meeting.

As Mia Malan recently reported in Bhekesisa, the US government recently announced that it would, join the Global Fund to buy LEN for African countries with high HIV infection rates. She reports, “the Trump administration revealed its support was a “market-shaping initiative” with the goal to increase LEN production and uptake, and, in effect, bring down the price of the jab as fast as possible, so that countries could eventually buy the medicine themselves. But they left South Africa — with the largest market for LEN, because it has the highest number of new HIV infections in the world — off the list.”

Warren spoke with Malan about this misguided decision, saying “If you want to build large volumes of a product, whether it’s lenacapavir or Coca-Cola — because we know that large volumes will lower prices — you make sure you start off with the biggest market, because that’s how you will shape the market the fastest and most meaningfully. So South Africa is the place where you’d want to be. Economically, because that’s how you will build the market the quickest. Epidemiologically, because that’s how you will prevent the most new infections. Practically, because that’s the country with the most mature HIV prevention medication market in the world.”

It makes no sense to celebrate the arrival of a breakthrough PrEP option while simultaneously dismantling infrastructure required to deliver it. We cannot allow ideology take over epidemiology. And we cannot end HIV with half-funded programs and half-hearted commitments. We cannot end HIV by retreating just as we need to push forward. We cannot end HIV if we abandon the global leadership that have made decades of progress possible. 

This is the paradox we face: extraordinary scientific promise shadowed by political short-sightedness. To realize LEN’s potential we need urgency, not hesitation. Governments must rapidly integrate LEN into national guidelines, commit domestic funding, and remove regulatory and logistical bottlenecks. Global donors, especially the US government, must protect and expand HIV investments, not shrink them. Scaling LEN requires resources, commitment, and sustained political leadership. Community organizations must lead rollout strategies, ensuring they are people-centered, stigma-free, and grounded in lived experience. And advocates must insist that LEN is rolled out now.  

If we get this right, LEN will be a global prevention pillar: accessible, trusted, and transformative. 

Let’s be clear. Every funding cut can represent at minimum, a delay. Every delay in rollout is a missed chance to prevent infections. Every un- or underfunded clinic is a barrier to access. Every policy is a choice to be inclusive or leave someone behind. No one should face risk of HIV simply because innovations didn’t move fast enough, weren’t scaled broadly enough, or weren’t delivered equitably.

We must act like the future depends on our choices, because it does. Science alone won’t get us there. Speed, scale, and equity will.  

Avac Event

Conference on Retroviruses and Opportunistic Infections (CROI 2026)

The annual Conference on Retroviruses and Opportunistic Infections (CROI) took place February 22–25, 2026, in Denver, Colorado.

Check out AVAC’s Summaries of Key Highlights from the Meeting

AVAC Infographics

AVAC’s visuals for presentations and discussions were seen across the conference. Access them here in an easy-to-use slide format.

Download the Slide Deck

Community Breakfast Clubs

Each day during CROI, AVAC, EATG, Fiocruz, TAG, and other partners hosted virtual webinars called Community Breakfast Clubs featuring researchers and advocates breaking down important prevention, treatment and cure science presented at CROI and the implications for the field.

Click here for the recordings

People’s Research Agenda

2025 Update

The People’s Research Agenda sets out a people-centered framework for equitable and accelerated R&D and product introduction. It tracks the science, shows where investments align—or fail to align—with community-defined priorities, and spotlights critical gaps in the pipeline of prevention options needed to meet the diverse realities of all populations.

Read the 2025 Update

The original 2024 report is also available.

At A Glance: The MPT R&D Pipeline

This graphic shows the status of products in development.

HIV Prevention Pipeline: Products to Watch

From the People’s Research Agenda, this graphic tracks the pipeline of potential new HIV prevention options across broadly neutralizing antibodies, preventive vaccines, pre-exposure prophylaxis, and multipurpose technologies.

An interactive version of this graphic is available.

People’s Research Agenda Pipeline Tracker

This tracker provides details on key HIV prevention trials to watch. It is updated on a quarterly and ad-hoc basis as developments occur.

If you would like to share additional information or corrections, please email Breanne at [email protected]. For more, visit the People’s Research Agenda.

View Tracker

Spotlight on MPTs Addressing STIs

This graphic outlines the development journey of multipurpose technologies (MPTs) that guard against STIs, including HIV, while also preventing pregnancy. It tracks the advancement of various potential products through different trial stages, emphasizing their combined protective roles.

PrEP Price Comparison

Comparing the annual price of oral TDF/FTC vs. the dapivirine vaginal ring and injectable cabotegravir. For product approvals, volumes, implementation, and price comparisons of long-acting PrEP, visit our dashboard on PrEPWatch.org.