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AVAC Advocates' Network Logo November 28, 2025
Global Health Watch is a weekly newsletter breaking down critical developments in US policies and their impact on global health. Tailored for our partners in the US and around the world, this resource offers a concise analysis of the week’s events, supporting advocates to respond to threats, challenges and opportunities in this critical period of change in global health. 

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
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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 ([link removed]) —Forsaken Substack
* First look: Full Text of America First Global Health Strategy Specimen Sharing Agreement ([link removed]) —To End A Plague Again Substack
* Will African nations lose their leverage in an ‘America first’ health plan? ([link removed]) —Devex
* South Africa May Be Excluded From Future US Grants for HIV Amid Political Row ([link removed]) —Health Policy Watch


** Global Fund Replenishment Support, But Falls Short of Target
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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 ([link removed]) —Health Policy Watch
* Global Fund raised $11.34 billion with a surprising US pledge ([link removed]) —Devex
* Control of HIV, TB and malaria at risk after global health fund donations fall ([link removed]) —The Guardian
* Friends statement on the U.S. commitment to the Global Fund ([link removed]) —Friends of the Global Fight
* The ONE Campaign Applauds American Leadership on Global Fund, Highlights Need for Full Funding ([link removed]) —One Campaign
* AVAC Statement on the 8th Replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria ([link removed]) —AVAC


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


** UNAIDS World AIDS Day report: Overcoming disruption, transforming the AIDS response
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UNAIDS’ new report shows that we were closer than in decades to ending AIDS by 2030, yet new HIV infections stayed flat in 2024, even before funding cuts, and resources were not enough to drive them down. We must double down with bolder, more strategic action to drive real decline.
read the report ([link removed])
What We're Reading

• What Africa Lost Under Trump: At least $5 Billion. What It Got In Return: “True Chaos.” ([link removed]) —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 ([link removed]) Health Access Initiative
•

China pledges $3.5 million for South Africa's HIV response ([link removed]) —Reuters
• UNICEF, Gavi deal slashes malaria vaccine price to $2.99 per dose ([link removed]) —Devex
• Ex-top USAID official details wish list on health and funding fixes ([link removed]) —Devex
• G20 summit in South Africa adopts declaration without the US ([link removed]) —Devex
• DOJ Tries To Block Elon Musk Testimony In USAID Lawsuit ([link removed]) —Forbes
• HHS rehiring some people fired through reduction-in-force efforts ([link removed]) —Politico
• Video: We Have a Chance to End the AIDS Pandemic ([link removed]) —Public Citizen
• “Miraculous” HIV drug to be rolled out after overcoming aid cuts threat ([link removed]) —BMJ

In solidarity,

AVAC
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AVAC Global Advocacy for HIV Prevention
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