African governments confirmed support for a multilateral Pandemic Accord under the World Health Organization (WHO) even as they face significant pressure to sign bilateral or government-to-government global health aid agreements with the US. These controversial agreements would require countries to share pathogen data, omit HIV prevention metrics, including PrEP and products like LEN, sideline civil society and key populations by removing requirements for community engagement, and bypass multilateral coordination, ignoring WHO and regional public health institutions. Advocates warn that bypassing the WHO Pandemic Accord negotiations risks repeating the inequities of COVID-19, forcing countries to share pathogen data without securing fair access to the medical countermeasures developed from them, leaving lower-income nations without the leverage needed to protect their own populations. 

IMPLICATIONS: This shift toward government-to-government support and conditional health assistance is shifting global health engagement into more transactional, equity‑challenging territory. Without indicators, community input, guaranteed reciprocity or multilateral coordination, countries may be locked into deals that deprioritize their interests. 

READ: 

• African Countries Affirm Support for Multilateral Pandemic Agreement Amid Pressure to Make Bilateral Deals with US—Health Policy Watch 
• US template for bilateral health deals bypasses WHO pandemic negotiations—Devex  
• Bilateral deals would undermine pandemic preparedness, multilateralism is the only answer—The Independent Panel for Pandemic Preparedness & Response 
• State Department Plans New Framework to Advance America First Global Health Strategy—Bloomberg  

The United Kingdom announced that it will reduce its upcoming pledge to the Global Fund by approximately 15% for the 2026‑2028 replenishment cycle, down from £1 billion in the previous cycle to £850 million. This news comes just two weeks ahead the Global Fund’s replenishment summit, which takes place November 21 in Johannesburg—which the UK and South Africa are co-hosting. The Global Fund proposed a target of $18 billion in its Eighth Replenishment Investment Case to save an estimated 23 million lives and prevent hundreds of millions of infections between 2027 and 2029. “It took the world 18 years to halve the combined death toll from AIDS, TB and malaria; with the right resources we can more than halve it again in only six years.” 

IMPLICATIONS: The cut from a longstanding major donor and summit co-host sets a worrying precedent, potentially signaling a retreat from multilateral leadership. Coupled with US cuts to global health funding generally, falling short of the Global Fund’s replenishment goal would increase disparities in access and likely shift resources and power away from communities and civil society.  

READ: 

• UK set to slash aid funding to fight deadly diseases – putting 250,000 lives at risk—The Independent  
• African HIV services face double blow of cuts from both Trump and UK—The Independent 
• UK cuts to HIV funding is a major blow to ending AIDS by 2030—Frontline AIDS 
• Flash quote: MSF UK reaction to UK's Global Fund pledge—MSF  
• Eighth Replenishment background materials—Global Fund 

Rwanda is now the 7th African country to receive a regulatory submission for lenacapavir for PrEP (LEN), which was recently approved in South Africa and Zambia, in addition to the US and European Union. For a full regulatory update, see here). The pace of progress for PrEP rollout continues to accelerate reflecting lessons learned from previous PrEP rollouts and signaling growing capacity and urgency to act. As AVAC’s new infographic below shows, the global community can learn and apply lessons, can move with speed, scale and equity, and might actually seize a PrEP opportunity instead of squandering it. 

IMPLICATIONS: Regulatory submissions and approvals are only one piece in the complex process. Turning regulatory milestones into public health impact depends on aligned global funders, transparent pricing and volume commitments, and community-engaged introduction strategies. Without this, innovation risks stagnation. 

READ: 

• Gears of Lenacapavir for PrEP Rollout—AVAC   
• Cruel Ironies: Scientific advances collide with major infrastructure upheaval—AVAC  
• Access Strategy for Lenacapavir for PrEP in Low- and Middle-Income Countries—Gilead Sciences