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AVAC Advocates' Network Logo October 31, 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. 

This week, South Africa became the first African nation to register injectable lenacapavir (LEN) for PrEP. The US released a draft global health “Memorandum of Understanding” (MoU) with serious omissions related to HIV prevention and community engagement; and a leaked document indicates that the European Union may cut future funding to Gavi and the Global Fund. And just as this issue was being published, The Lancet issued a new series, Innovations in Sexual and Reproductive Health ([link removed]) .


** South Africa Registers Injectable Lenacapavir for PrEP
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South Africa has become the first African country to register the twice‑yearly injectable lenacapavir for PrEP (LEN). The approval by the South African Health Products Regulatory Authority (SAHPRA) is the fastest Africa approval of PrEP ever and opens the door for a national rollout beginning in early 2026. Additional regulatory approvals are pending in Kenya, Malawi, Zambia and Zimbabwe ([link removed]) . In addition, earlier in October, the WHO pre-qualified both the oral and injectable forms of LEN using an expedited process.

IMPLICATIONS: LEN’s registration in South Africa is significant progress, and reflects one of several milestones in product introduction that have happened faster for LEN than for any previous PrEP product. See AVAC’s comparative graphic on Moving PrEP Options to the Real World ([link removed]) . At the same time, so much more needs to happen to translate this option into public impact, including securing price and volume transparency, aligning global funders, and enabling rapid country-level introduction. A robust and accelerated global rollout will create a foundation for further reduced pricing, greater choice, and real momentum in HIV prevention. See AVAC’s report, Getting PrEP Rollout Right This Time ([link removed]) , which can support countries in the early stages of LEN planning. And visit AVAC’s LEN page ([link removed]) for a range of resources and graphics,
and PrEPWatch.org to track the rollout ([link removed]) of all long-acting PrEP.

READ:
* SA becomes the first African country to register the twice-a-year anti-HIV jab — at record speed ([link removed]) —Bhekisisa
* Access Strategy for Lenacapavir for PrEP in Low- and Middle-Income Countries ([link removed]) —Gilead Sciences


** US Global Health MoU Template Raises Urgent Concerns
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This week, US government country teams at embassies and missions around the world received a draft memorandum of understanding (MoU) template and guide that will shape bilaterial US global health investments. These MoUs between the US and individual countries are being developed for PEPFAR but will also extend across other US global health foreign assistance programs, establishing a framework for how the US engages partner governments on health priorities. The bilateral agreements, which the Administration is aiming to finalize by mid-December, outline process and outcome metrics focused on treatment, such as ART coverage and viral suppression. However, the draft template omits HIV prevention indicators, including any reference to PrEP or new products such as injectable lenacapavir, and also also bypasses multilateral coordination, ignoring institutions like WHO or regional public health agencies, and suggests that policies favoring US commercial interests would factor into funding
decisions, while providing no framework for civil society or key population engagement.

IMPLICATIONS: The shift to direct government-to-government MoUs sidelines the community and erodes decades of progress grounded in data-driven, inclusive approaches—violating the core principle of “nothing about us without us.” The exclusion of key populations and civil society voices from these negotiations raises serious concerns about accountability and equity. Equally alarming is the fact that the US government has not released any PEPFAR data this year, leaving advocates, partners, and decisionmakers without the basic transparency needed to evaluate impact or guide decisions. These omissions must be challenged immediately by in-country advocates and Congress.

READ:
* Breaking: First Look at the USG Draft Memorandum of Understanding for Global Health ([link removed]) —To End A Plague Again Substack
* How will America's new global health strategy change PEPFAR? ([link removed]) —Devex
* Devex CheckUp: ‘America First,’ but what about PEPFAR? ([link removed]) —Devex
* PEPFAR’s Missing Data: Why Transparency Matters More Than Ever ([link removed]) —Center for Global Development (CGD)
* PEPFAR Has No Plan for World AIDS Day Data Release ([link removed]) —Emily Bass Substack


** European Commission May Shift Away from Gavi and the Global Fund
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The European Commission (the executive body of the European Union) plans to potentially phase out funding to Gavi, the Vaccine Alliance, and the Global Fund by 2030 according to a leaked document, which was prepared for the European Union’s Commissioner for International Partnerships. The document makes the case for concentrating EU support on initiatives where the bloc can “truly shape governance.”

IMPLICATIONS: This signals a dramatic pivot away from institutions that have helped save 90+ million lives through vaccine access and disease prevention. While no formal decision has been made, this move mirrors similar cuts by the US under the new administration, and underscores growing skepticism in major donor governments about traditional multilateral aid. Global health financing is already under significant strain, with donors prioritizing national interests and public-private investments over long-term, predictable health aid. A shift away from core multilateral partners may leave critical gaps in vaccine delivery, HIV prevention and response to emerging disease threats.

READ:
* EXCLUSIVE: EU mulls copying US with end to aid for global health funds ([link removed]) —Euractiv


** Launch of The Lancet’s Innovations in Sexual & Reproductive Health series
October 31 at 8:00am ET
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Fenway Health will help launch The Lancet's five-paper series on sexual and reproductive health, edited by Profs. Kenneth Mayer and Linda-Gail Bekker.
Stream ([link removed])
What We're Reading

• How HIV research drives health innovation in multiple diseases ([link removed]) —Nature Medicine
• Transforming HIV Prevention in 2025 ([link removed]) , AVAC
• Gates Foundation skews global health agenda after US retreat, study says ([link removed]) —Financial Times
• Trump Revives Foreign Aid, Helping Needy Billionaires ([link removed]) —New York Times
• Private donors gave more than $125M to keep foreign aid programs going after US cuts ([link removed]) —Associated Press
• Ritshidze report spotlights ‘system-wide slide’ in basics for health facility standards after Pepfar cuts ([link removed]) —Daily Maverick
• Global security is impossible without sufficient support for global health— ([link removed]) STAT
• African Public Health Conference Calls for ‘Health Sovereignty’ and Prioritizing Primary Care Ahead of G20 ([link removed]) —Health Policy Watch
• African Center for Economic Transformation tries to humanize debt ([link removed]) —Devex
• John Roberts Is a Threat to the Health of Every American ([link removed]) —The Nation
• Behind the Dismantling of the C.D.C.: Reform or ‘Humiliation’? ([link removed]) —New York Times
• Her refusal to approve a dangerous drug changed medical history ([link removed]) —19th News
• How Moderna, the company that helped save the world, unraveled ([link removed]) —STAT

AVAC RESOURCES
• Vaccine-Preventable Disease: A Global Tracker ([link removed]) , Think Global Health
• PEPFAR’s Missing Data: Why Transparency Matters More Than Ever ([link removed]) , CGD
• Getting LEN Rollout Right: Resources and Tools ([link removed]) , AVAC
• Do Not Check That Box – Impacts From the Assault on Transgender Communities and DEI + Strategies to Sustain and Rebuild ([link removed]) , AVAC
Webinar
November 17, 2025 at 10:00am ET
[link removed]


** We Declare—Turning “The People’s Declaration” Demands into Actions and Accountability on HIV
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Register Now ([link removed])

In solidarity,

AVAC
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AVAC Global Advocacy for HIV Prevention
+1 212 796 6423 [email protected] (mailto:[email protected]) www.avac.org ([link removed])
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