Devex CheckUp: Is it curtains for UNAIDS?

Is the end coming for UNAIDS?

It sure seems like it could be, though maybe not anytime too soon. My colleague Jenny Lei Ravelo got access to a report that UNAIDS will be discussing at next week’s program coordinating board meeting. The proposal lays out how the program will reduce its footprint in the coming years, before potentially closing down in 2030.

A UNAIDS spokesperson would only confirm that the issue will be discussed at the upcoming board meeting.

Change was already coming for UNAIDS. Amid widespread funding cuts, the program is reducing its staff by more than 55%. According to an organizational chart that Jenny saw, most people who do remain will move out of Geneva to Johannesburg, Nairobi, Bangkok, or Bonn. Country offices are also disappearing, with many being consolidated into multicountry outposts.

It also looks like only one of the two current deputy executive directors will survive the downsizing, since the chart shows only one assistant secretary-general leading UNAIDS global practice.

There are still a lot of unanswered questions raised by the proposal, including why Afghanistan and Egypt, two countries that face an increase in HIV infections, are missing from the organization chart.

The biggest question, though, is whether the leadership will decide to actually move toward shutting down the agency by 2030. The document calls on the executive director to have a plan in place by 2027 to “further transform, consolidate and integrate the Joint Programme with a view to closing down the UNAIDS Secretariat by 2030.”

Read: Will UNAIDS sunset by 2030?

Who will stay at WHO?

UNAIDS is not the only U.N. agency undergoing serious changes. The World Health Organization is also slashing jobs amid questions about its long-term funding. And some staffers aren’t happy with the way the process is playing out, warning that management is favoring people with longevity over merit, according to Jenny’s reporting.

A committee established to review recommendations for positions in the new organizational structure will prioritize longer-term staff who are eligible for reassignment. Other steps are also in place to protect people who have been with the agency for a while. And some staff say these efforts go beyond what is necessary.

There is a suspicion that WHO wants to hang on to long-standing employees because it does not want to pay higher indemnities.

WHO says this is not the case. They are simply trying to follow staffing rules while ensuring they fill the positions that do remain with the most qualified employees.

Read: Is WHO’s restructuring process fair? Some staff aren’t so sure

Related: As WHO lays off staff, why is transparency more crucial than ever? (Pro)

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Moving forward

Lenacapavir, the injectable antiretroviral that has been nearly 100% effective at preventing HIV infections in clinical trials, scored U.S. Food and Drug Administration approval this week.

This will translate into the availability of lenacapavir in the United States, but what about in the countries where most of the 1.3 million annual new HIV infections are happening? Though FDA approval doesn’t mean immediate access there, advocates say it is still an important step, signaling to their own regulators the importance of approving lenacapavir.

At the same time, there may be bigger hurdles. Gilead, which controls access to lenacapavir, has not named a price for low- and middle-income countries, but advocates worry it will come in too high for many countries to afford. Meanwhile, they’re not certain what kind of commitments donors might make, particularly with the U.S. government withdrawing its support for HIV prevention.

The situation has the potential to turn lenacapavir “into a medical breakthrough and a public health disaster at the same time,” one researcher tells me.

Read: FDA approves new HIV prevention tool, though access questions linger

Take it back

And just like that, the U.S. House of Representatives voted to rescind $8.3 billion in previously approved foreign assistance, including $900 million in previously approved global health spending.

The Senate must also approve the rescission package, which would codify those cuts.

The Trump administration has already moved to slash international aid, including support for the President’s Emergency Plan for AIDS Relief, or PEPFAR. The law seeks to claw back that previously allocated spending.

Some of the Republicans who voted in favor of the bill late last week have rejected evidence of people dying as a direct result of these funding cuts. But Devex is among the many publications that have documented deaths that are linked to the canceled programs. That includes Lydia Nabirye, who stopped taking her antiretroviral medication and died in March, just months after the administration eliminated a program to assist families with orphans and vulnerable children in Uganda.

It's not certain the bill, which only narrowly passed the House, will have enough votes to clear the Senate. Senators have until July 18 to pass the bill.

Read: House approves Trump’s $8.3 billion clawback of US foreign aid

Plus: 'No children are dying on my watch,’ says Rubio

Also: Following PEPFAR cuts, vulnerable Ugandans are dying, providers say

One big number

That’s how much the Coalition for Epidemic Preparedness Innovations and the European Union’s Horizon Europe program are investing in a new vaccine that could protect against many different filoviruses, including two different strains of Ebola and Marburg virus disease.

Denmark’s Adaptvac will head a consortium of researchers attempting to unlock a single immunization against some of the world’s deadliest diseases — most of which do not have an existing vaccine. The process will start by using AI to identify immunogens that might protect against a range of filoviruses. They’ll then get added to a vaccine platform Adaptvac has developed and get run through clinical trials.

Background reading: CEPI launches ambitious biosecurity strategy at UNGA

 What we’re reading

South Africa was a beacon for medical research, with scientists involved in developing new drugs and vaccines. Following U.S. funding cuts, that research infrastructure is crumbling, and the impact will be felt globally. [The New York Times]

With massive mpox vaccine shortages across sub-Saharan Africa, advocates are calling on vaccine manufacturer Bavarian Nordic to drop its prices. [Health Policy Watch]

Lawmakers in the U.K. have voted to decriminalize abortion for women looking to terminate their pregnancies outside existing rules in England and Wales. [BBC]