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AVAC Advocates' Network Logo November 21, 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’s newsletter publishes just as the Global Fund’s 8th Replenishment Summit ([link removed]) in South Africa is taking place. The Global Fund represents one of the strongest symbols of global solidarity in the fight against HIV, TB, and malaria, but, despite early pledges from several European Union member states and private partners, key donors (including the UK ([link removed]) , Germany and France ([link removed]) ) appear to be stepping back, with smaller or uncertain pledges at this critical moment, and it is not yet clear what the US will do. A budget-constrained Global Fund raises serious concerns about losing ground against all three diseases and failing to seize opportunities to scale up new innovations in all three,
including long-acting injectable PrEP for HIV. This Global Fund Advocates Network ([link removed]) (GFAN) tracker ([link removed]) tallies pledges, and this resource for scenario building ([link removed]) shows how potential donor pledges could impact the funds available for health programs. Be sure to watch AVAC’s channels for the latest on the pledges.

Read on for more including the arrival of injectable lenacapavir for PrEP in Eswatini and Zambia, the uncertain future of US health funding post-shutdown, and new research exposing the impact of NIH clinical trial cuts.


** Lenacapavir Arrives in Eswatini and Zambia
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The first doses of injectable lenacapavir for PrEP (LEN) arrived in Eswatini and Zambia. These initial deliveries mark a historic acceleration in PrEP access, moving faster than we’ve seen with past introductions (see  AVAC’s new graphic ([link removed])  comparing the rollout of LEN to past PrEP products) and signaling momentum and an ability to apply lessons from past delays. With additional regulatory reviews underway across the region, this early action represents a promising step forward.

IMPLICATIONS: While these first shipments are worth celebrating, they’re just a down payment on what’s needed to deliver LEN at scale with equity. The joint Global Fund and PEPFAR commitment to reach two million people in the first three years is far more ambitious than past introductions, but falls short of delivering the impact that is needed. For LEN to have maximum impact, global donors and governments must align on transparent volume commitments, prioritize high-need markets and ensure that rollout strategies are rooted in community-led approaches. While South Africa is slated to receive LEN with Global Fund support, the fact that they are excluded from PEPFAR’s program is a huge, missed opportunity. If we really want to build a sustainable market as quickly as possible, one that will drive volume up and prices down and deliver real impact, South Africa must be THE center of the market and needs PEPFAR and Global Fund both to work with the SA government. AVAC’s full LEN resource
library ([link removed]) , including infographics on supply and demand, is designed to support advocates working to make that vision real.

READ:
* First doses of HIV prevention drug lenacapavir delivered to Zambia, Eswatini ([link removed]) —Reuters
* A 'breakthrough' drug to prevent HIV, an 'unprecedented' rollout ([link removed]) —NPR Goats & Soda
* Trump HIV prevention plan shuts out South Africa — the nation most affected ([link removed]) —Washington Post
* South Africa is urged by advocates to issue a compulsory license for Gilead's HIV prevention drug ([link removed]) —STAT
* Trump Takes Credit for Lenacapavir Deal after His Administration Decimated U.S. International AIDS Prevention Programs ([link removed]) —Public Citizen
* Access Uncertain for New Injectable PrEP as the Affordable Care Act’s (ACA) Open Enrollment Begins ([link removed]) —KFF


** US Government Reopens, Health Funding Remains Uncertain
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The US Congress officially reopened the federal government after the longest shutdown (43 days) in the country’s history. Funding for most agencies is now extended until January 30, and three appropriations bills were passed to cover several departments through all of fiscal year 2026 which ends next September. However, key health initiatives remain vulnerable: the deal keeps major health programs, including the nation’s HIV response, on a short-term continuing resolution only through January, and does not address spiking US health insurance costs.

IMPLICATIONS: HIV prevention, treatment, and care programs will continue at last year’s levels through January 30, which avoid devastating cuts for the time being, with the fight to increase investments ongoing. The broader budget agreement also sidesteps major reforms demanded by lawmakers that threaten to gut these programs. It’s not clear if or when future disruptions might further impact public health programs and US global health engagement.

READ:
* The government has reopened, but Congress must protect HIV funding for 2026 ([link removed]) —The Hill


** Clinical Trials Affected by NIH Research Grant Terminations
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A new study published in the Journal of the American Medical Association (JAMA) shows that more than 74,000 clinical trial participants were affected when 383 clinical trials lost funding from the National Institutes of Health (NIH) between February 28 and August 15, 2025. These cuts disrupted research across a range of diseases, but most of the targeted trials were outside of the US and were testing preventive or behavioral interventions, primarily in infectious diseases. “Those findings suggest that there's a bias towards termination of grants that have nothing to do with the quality of research being conducted,” the authors wrote. 

IMPLICATIONS: This is one of the first studies to officially document the impact of the Presidential Administrations’ hostile policies and funding cuts to science. The political willingness to gut science without warning erodes trust in public health institutions and undercuts the foundation of long-term innovation. The impact is being seen across geographies, industries, communities, and diseases.

READ:
* Clinical Trials Affected by Research Grant Terminations at the National Institutes of Health ([link removed]) —JAMA
* NIH grant cuts have disrupted hundreds of clinical trials, study finds ([link removed]) —Fierce Biotech
* Trump slashed spending on clinical trials. The toll is starting to become clear. ([link removed]) —Washington Post
* NIH funding cuts have affected over 74,000 people enrolled in experiments, a new report says ([link removed]) —Associated Press

What We're Reading

• US health strategy aims to position African governments as customers ([link removed]) —Devex
• Could an HIV miracle drug actually reach people like my parents? ([link removed]) —STAT
• Lenacapavir Plus Broadly Neutralizing Antibodies Maintains Viral Suppression ([link removed]) —POZ
• MacArthur Foundation awards $100M to outbreak surveillance network, a boost amid global health cuts ([link removed]) —Associated Press
• Global Aid Cuts Could Reverse Decades of Progress in Health and Development ([link removed]) —ISGLOBAL
• Amid aid cuts, these countries have ramped up global health cooperation ([link removed]) —Devex
• DOGE Man Drives US Bilateral Health Agreements With African Countries ([link removed]) —Health Policy Watch
• N.I.H. Worker Who Criticized Trump Health Policies Says She Is on Administrative Leave ([link removed]) —New York Times
• A Small Texas Think Tank Cultivated Covid Dissidents. Now They’re Running US Health Policy. ([link removed]) —KFF
• State department to cut 38 universities from research program over DEI policies ([link removed]) —The Guardian
• Senator Murray Slams Outrageous Political Retaliation at NIH, Demands Answers from Trump Administration ([link removed]) —Senator Patty Murray

RESOURCES
• Open science in a closed world – lessons and opportunities for securing openness and equitable access in R&D collaborations ([link removed]) , DNDi
• 24 Hours to Save HIV Research marathon recordings ([link removed]) , AVAC
•

HIV Prevention R&D at Risk: Tracking the Impact of US Funding Cuts ([link removed]) , AVAC

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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