Science reports on new guidance issued May 5 in which the US Department of State indicates plans to end the US Centers for Disease Control and Prevention (CDC) support for PEPFAR programs in most countries by September 30, 2026, the end of the current fiscal year. This guidance notes that countries would receive PEPFAR funding directly and have the option to decide whether to contract CDC for technical assistance in a “fee for service” model for support, such as HIV surveillance, laboratory quality assurance and specimen transport. Countries receiving more than $125 million in annual US assistance would be required to pay fees for a minimum of six CDC support services out of 30 services offered.  

This development further advances the US “America First Global Health Strategy,” which is built on bilateral health Memoranda of Understanding (MoUs)—five- to 10-year agreements intended to transition from US-supported health programs to country-owned models, but often require co-investment and include provisions on data sharing, pathogen access and more. The Administration’s move to end technical leadership from CDC would dismantle the long-standing integration between CDC technical staff, ministries of health and implementing partners that many credit as central to PEPFAR’s effectiveness over the past two decades—all a year after the Administration’s dismantling of USAID, the other key pillar to the past two decades of PEPFAR’s success. 

IMPLICATIONS: This proposed restructuring of what is left of PEPFAR marks a major transition in its architecture and may complicate future success of the program. While greater country ownership of health and health systems has been a long-standing goal of previous and current administrations, rapid removal of the CDC technical support on top of the erasure of USAID, could weaken HIV surveillance, laboratory systems, program oversight and outbreak response capacity for HIV services, and also the broader public health infrastructure. As mike Reid explained to Science, “What if we hand over PEPFAR in a haphazard, unthoughtful way, at rapid speed, and then everything implodes? Then in 5 years, people turn around and say, ‘Look, we invested $115 billion into HIV and it never worked, we’re never doing this again.’ I think that’s the wrong story that could end up being told.”  

READ: 

• Trump administration cuts CDC’s key role in global program to stop HIV—Science  
• House Democrats Press Trump Administration Over Withholding Foreign Assistance Funds and Defying Congressional Intent—Congresswoman Lois Frankel 
• This Is What Happened When Trump Abandoned the World’s Poorest Children—New York Times 
• The Hidden Risk in the State Department’s Bilateral Health Agreement Era—Lights. Camera. Equity! Substack 
• America First Global Health Strategy Documents Pertaining to Plans for "State" Capture of Global Health—Emily Bass Substack 

An exclusive New York Times report reveals that US Health and Human Services Secretary (HHS) Robert F. Kennedy (RFK) Jr. is overseeing an initiative to examine possible links between vaccines and chronic disease. Martin Kulldorff, a former member of RFK Jr.’s restructured Advisory Committee on Immunization Practices (ACIP) and now HHS chief science and data officer is purportedly leading the effort across agencies. The initiative is reportedly focused on already disproven and unconfirmed claims linking autism and vaccines, neurological and autoimmune disorders, vaccine timing and exposure patterns and the preservative thimerosal, which is no longer used in vaccines. HHS officials defended the initiative as an effort to conduct “gold-standard vaccine research”. The cost of the initiative is unknown.  

IMPLICATIONS: This new initiative will continue to advance vaccine skepticism and possibly legitimize scientifically discredited theories. The report notes, “As part of the new effort, Mr. Kennedy has tasked some government scientists with studying the health status of vaccinated children compared with those who were not vaccinated.… Researchers say that such comparison studies would be riddled with pitfalls. Vaccinated children are more likely to receive medical care than those who are unvaccinated, and are thus more likely to receive additional medical diagnoses that could be wrongly attributed to vaccines.” This initiative and its outcomes have the potential to redirect limited research funding and priorities toward questions that decades of evidence have already addressed.  

READ: 

• Kennedy Is Driving a Vast Inquiry Into Vaccines, Despite His Public Silence—New York Times 
• RFK Jr.’s War on Science Is Really a War on Scientists—The xxxxxx 
• As public vaccine criticism quiets, RFK Jr. keeps safety inquiries running in background—Fierce Pharma 

Additional Andes hantavirus cases linked to the cruise ship outbreak earlier this month continue to emerge. News reports highlight concerns about transmission, outbreak response, public health guidance and global coordination. MedPage Today highlighted uncertainty over how passengers from the cruise ship were monitored and managed after disembarking and travelling home to multiple countries, as well as the limited ability of the US to coordinate with global partners following funding cuts, the dismantling of health architecture and reduced participation in multilateral health systems. Meanwhile, a viewpoint in The Atlantic suggests that airborne transmission in shared indoor spaces may play a larger role in hantavirus spread than current public health messaging focused on “prolonged close contact” suggests. 

IMPLICATIONS: The hantavirus outbreak is showing the growing challenge of public health communication, outbreak preparedness and response and international coordination in a polarized environment. Inconsistent messaging about transmission risks could undermine public trust and delay actions. At the same time, the outbreak highlights how weakened relationships between the US, WHO and international surveillance networks may hinder rapid information sharing and coordinated response during emerging infectious disease events.  

READ: 

• The Hantavirus Isn’t the Biggest Threat We’re Facing—The Nation 
• Hantavirus outbreak should reset WHO’s default approach to airborne risk—BMJ  
• Hantavirus cluster linked to cruise ship travel, Multi-country—WHO  
• Hantavirus: Anatomy of a Fractured Global Response—MedPage Today 
• The Close, Prolonged Contact Myth—The Atlantic 
• The first US case of Andes hantavirus is confirmed. Here are answers to the next questions.—Inside Medicine 

Author and advocate Emily Bass reports that the US Department of State is working toward a September 20, 2026 deadline to close out the Global Health Supply Chain–Procurement and Supply Management (GHSC-PSM) mechanism, which has been implemented by a consortia led by Chemonics and is responsible for end-to-end procurement and delivery of HIV, TB and malaria commodities. In a draft timeline received by Bass, most countries’ technical activities would end by September 30, 2026, despite State Department officials previously noting that transitions would be phased and supported by “failsafes.” This would leave countries with just four months to transition procurement, forecasting, warehousing, distribution and last-mile delivery functions to other systems or providers. This comes after 250 civil society organizations signed on to a letter to the US Secretary of State calling for immediate reversal of the April announcement that GHSC-PSM would be terminated by May 30, 2026 and calls to extend the Chemonics contract through 2027 as Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, Jeremy Lewin previously noted. 

IMPLICATIONS: While the leaked timeline offers four months to transition and aligns with the scheduled end date (end of FY2026) of the GHSC-PSM contract, it still represents an extraordinarily compressed transition for one of the world’s largest and most complex health supply chain systems. As the 250 civil society organizations wrote, “We support countries taking up the procurement and supply chain management tasks GHSC-PSM currently carries out, but quality transition takes time and real planning.” Whether countries, implementing partners and donors can realistically replace critical end-to-end functions—including forecasting, storage, shipment coordination and last-mile delivery—without major disruptions to HIV, TB and malaria programs is highly unlikely. And the absence of dedicated funding for transition planning heightens risks of stockouts, treatment interruptions, weakened surveillance and laboratory systems, and, ultimately, poorer health outcomes and epidemic resurgence. 

READ:

• New GHSC-PSM Closeout Timeline Sets FY2026 End for Most Countries—Emily Bass Substack