A new analysis from Public Citizen and Partners In Health finds that the US Administration’s bilateral (government-to-government) health agreements would drastically reduce US global health funding and foreign assistance to 18 recipient countries by 59 percent ($2 billion) by 2030 compared to pre-2025 funding. This is despite the US Congress maintaining relatively stable global health appropriations. The organizations analyzed 18 available memoranda of understanding (MoU) noting that the Administration “has kept the public in the dark about the full details of its plans for the future of US support for global health...” and “the MOUs warn of a disturbing potential underspend of congressionally appropriated global health dollars.” The agreements require countries to increase domestic health spending as US support declines. However, in 11 of the 18 countries, those domestic resource mobilization commitments would not fully replace the planned reductions in US funding.

IMPLICATIONS: The analysis raises significant questions about whether the Administration’s “America First” global health strategy toward “country ownership” and “self-reliance” is actually achievable. Instead, the analysis posits that the accelerated transition to sustainable domestic financing actually constitutes a rapid withdrawal of critical US support that these countries may not have the fiscal capacity to replace. The analysis further conveys that many of these deals contain worrisome conditionalities and performance metrics tied to funding, which may not be attainable as bilateral funding to support in-country programs are greatly diminished to begin with. The authors also exposed a disconnect between the global health funding Congress has appropriated and the substantially lower spending envisioned by the Administration under the bilateral agreements, with potential consequences for HIV, TB, malaria, Ebola and other health programs. The Department of State said it intends to spend all congressionally-appropriated global health funds, but where and how funding not included in the bilateral agreements will be spent is the outstanding question. 

READ:  

• Secretive deals may cut billions from U.S. global health spending, analysis shows—Washington Post 
• Defunding Freedom – Impacts of U.S. Foreign Aid Cuts on LGBTIQ People Worldwide—Outright International  
• Namibia Rejects US Demands For Data And Pathogen-Sharing—Health Policy Watch 
• Trump’s Bilateral Agreements Reshape Global Health Funding—Public Citizen  
• Trump Administration Agreements Reshape Global Health Funding—Public Citizen  

Members of the US House of Representatives on both sides of the political aisle voted to pass a continuing resolution (CR) for fiscal year 2027 (FY 27) appropriations. This CR was previously approved by the Senate in early August, which authorizes government spending until December 11, delays a government shutdown on September 30 (the end of the US fiscal year), and, at least for now, delays implementation of the White House Office of Management and Budget’s (OMB) controversial proposal to give political appointees greater authority over federal grantmaking. Last month, in a stopgap spending bill released by Senate appropriators, Democrats and Republicans joined in adding a provision that would prevent the OMB rule from taking effect until at least December 11, while Congress negotiates broader government funding measures. The proposal was originally slated to go into effect on October 1, but opposition from both Democratic and Republican appropriators slowed the path forward. 

IMPLICATIONS: This temporary delay is important, allowing more time for advocacy and for potential litigation to formulate. However, if implemented in December (or any time), the rule would fundamentally reshape the US research enterprise by injecting political considerations into grantmaking, weakening peer review and undermining the international collaborations that drive progress against HIV, TB, emerging infectious diseases and other global health challenges. The Senate’s actions last month and the bipartisan agreement on the CR suggest that the months of public opposition and advocacy from the advocacy and scientific community may be beginning to influence policymakers. The Senate’s intervention is one of the first signs that resistance to the OMB proposal extends beyond the scientific community and into both parties in Congress.  

READ: 

• House passes funding bill to avoid shutdown before midterms—The Guardian  
• House passes bill to avert a government shutdown ahead of midterm elections—Washington Post  

As the WHO-hosted Joint Task Force on Global Health Architecture Reform meets in person for the first time this week, the Health Architecture Reimagined (HEAR) CSO Steering Committee issued a letter urging the Task Force to put equity and meaningful community and civil society leadership at the center of reform, while also strengthening regional platforms and protecting access as financing shifts. Meanwhile, a new Council on Foreign Relations analysis of 67 health architecture reform proposals finds consensus around shifting decision-making to countries and regions, aligning donor funding with country priorities, strengthening national health systems, expanding regional roles and diversifying financing. 

IMPLICATIONS: While the analysis and civil society advocacy show agreement on the direction of global health architecture reform, the outstanding question of how to get there remains. The CFR analysis highlights the key challenges around who pays versus who decides, what is gained or lost by moving from disease-specific programs to integrated health systems, and which functions belong at global versus regional levels. As these decisions are made, HEAR CSO argues that reform must be judged not only by efficiency, but by whether it advances equity, protects access and gives affected communities meaningful power. Moreover, these processes are all unfolding in the midst of leadership transitions at WHO, the Global Fund, Unitaid and the Medicines Patent Pool, amongst others. 

READ: 

• The Future of Global Health: Themes and Thorny Questions—Think Global Health 
• Who Should Lead the Global Fund? Let the Candidates Make Their Case—Health Policy Watch 
• The Future of Global Health: Themes and Thorny Questions—Think Global Health
• Kenya offers a blueprint for civil society in the 'America First' era—Devex  
• Stand with Communities: Endorse the NGO Delegation’s Position on the Future of UNAIDS—NGO Delegation to the UNAIDS PCB