Devex CheckUp: New faces, but familiar challenges in global health in 2026

Happy 2026, CheckUp readers. We’re looking forward to another year of keeping you up to date on all of the latest developments in global health. And if you thought 2025 wasn’t disruptive enough, just wait until you consider what we already know this year is going to bring. It starts with some key leadership changes.

Peter Sands was supposed to be out of a job in March. That’s when his second term as the head of the Global Fund to Fight AIDS, Tuberculosis and Malaria originally expired, but the board gave him an extension until the end of the year.

Sands has gotten kudos for keeping the Global Fund afloat despite shrinking global financing over his eight years in office. And he is just wrapping up a nail-biting replenishment effort that saw him raise $11.34 billion for the fund’s work through 2029 against a goal of $18 billion.

His successor, expected to be announced by mid-2026, will take over efforts to transition responsibility for managing and financing health systems to partner countries.

Meanwhile, the jockeying has already started to replace World Health Organization Director-General Tedros Ghebreyesus, whose term doesn’t actually expire until 2027. The first African to hold the position, Tedros has endured two tumultuous terms asWHO chief, which included the COVID-19 pandemic and, more recently, the decision by the United States to withdraw from the agency.

Whoever replaces Tedros will inherit a slimmed-down WHO, following a reorganization prompted by the loss of U.S. funding. Though that person won’t be named until next year, expect campaigning to heat up at the World Health Assembly in May.

And Philippe Duneton is entering his last year as head of Unitaid, where he has pivoted the agency to respond to emergencies since taking over in 2020. His successor, like any leader in the global health space in 2026, will have to contend with critical funding challenges.

Read: 3 key global health leadership changes to watch (Pro)

+ Catch up on our reporting on The future of global health — a new series that explores the consequences of cuts to foreign aid and the search for a new path forward.

Winding down?

It’s not just leaders who are leaving. The entire UNAIDS could shut down this year if United Nations Secretary-General António Guterres gets his way. He surprised the world in September with a report calling for the agency to sunset by the end of this year.

The UNAIDS board agreed at the end of 2025 to set up a working group to guide the process of transitioning the agency’s work into the broader U.N. system. But that does not mean the board intends to comply with Guterres’ timeline, particularly since this is the first year of a new Global AIDS Strategy that they just adopted.

Instead, the board’s idea is to propose an alternative timeline as early as June of this year, offering a revised plan for closing the agency.

Read: UNAIDS board launches new process for transition amid sunset calls

Hangover

Even as we dive into 2026, communities around the world are still dealing with the consequences of last year, particularly the cuts to foreign aid enacted by the Trump administration.

In Kenya, the networks of community health workers that helped connect people to services, including HIV treatment and mental health programs, are in tatters. As a result of cuts to U.S. aid, thousands of CHWs abruptly lost support. That has destabilized health programs across the country.

The Kenyan government is trying to absorb the programs, but payment is less than what CHWs were making before, and has been irregular.

In Botswana, the government is not even attempting to pick up the outreach services for voluntary medical male circumcision, which also fell victim to the U.S. aid cuts. VMMC can reduce a man’s risk of HIV infection by 60% from a female partner.

The program in Botswana was buoyed by a local organization that provided support to men as they underwent and recovered from the procedure. That funding came entirely from the United States. It disappeared completely in 2025.

As a result, VMMC has fallen off dramatically: UNAIDS reports that VMMC services in Botswana declined by 88% in the first five months of 2025.

Read: ‘I can’t just leave them’ — Kenya’s health workers carry on without pay

Plus: US retreat stalls Botswana’s HIV prevention outreach

These stories are part of The Aid Report, a Gates Foundation-funded, editorially independent initiative to track and document the on-the-ground impacts of the U.S. aid cuts with firsthand reporting and curated news coverage. You can go to https://www.theaidreport.us for more information.

Quid pro quo

Even as countries contend with the consequences of America’s aid cuts, more than a dozen sub-Saharan African countries have struck bilateral agreements with the United States for new funds that could help address those gaps. But the transactional nature of those deals is coming into focus.

Washington is looking for a return on its investments, whether it’s a competitive edge over China, securing minerals, strengthening military alliances, or accessing health data. As my colleague Sara Jerving reports, two cases really stand out: Nigeria and Zambia.

The five-year deal that the United States reached with Nigeria will see Washington send $2.1 billion in health assistance to the West African country. In return, the United States wants Nigeria to take steps to protect Christians from violence, even as Abuja disputes claims that Christians are persecuted in the country.

The Zambia negotiations are still ongoing, with the United States explicit about looking to exchange health financing for mining sector reforms. Washington also wants to counter two decades of Chinese involvement in the Zambian mining sector.

As the details of these agreements have rolled out, the United States has been accused of pursuing an extractive, neo-colonial strategy, while others think Washington is pursuing a rational, if not particularly subtle, approach.

Read: Alarm bells ring as US rolls out transactional strings for health deals (Pro)

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Time to act

The climate crisis is a health crisis. But as a warming planet gives rise to zoonotic spillover, antimicrobial resistance, and heat-related illnesses, the countries that are most affected by all of this have the fewest resources to respond.

In an opinion piece for Devex, veterinarian and U.K. parliamentarian Danny Chambers offers three steps to help mitigate these challenges:

1. Strengthen global tax cooperation to keep more resources in countries

2. Take a “One Health” approach to strengthening health systems

3. Let local leaders guide the path to addressing these crises

Opinion: Rising climate shocks threaten health in 2026 – here’s how to respond

What we’re reading

Ugandan regulators have approved the twice-yearly injectable form of HIV prevention, lenacapavir, for use in the country. [UGDiplomat]

Against the advice of experts, the United States has pared down the list of recommended pediatric immunizations from 17 to 11. [Stat]

Israel has ordered Médecins Sans Frontières to end operations in Gaza, even as the humanitarian medical group provides direct care or support for 20% of all remaining hospital beds. [The New York Times]