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If you’re just coming back from the holidays, here’s the latest in global health: The United States Congress just released its foreign assistance appropriations bill, spelling out what it aims to spend in 2026 — including $9.4 billion for global health. The House of Representatives approved the bill on Wednesday, but it must still pass the Senate before it heads to U.S. President Donald Trump’s desk for approval.
Here are some highlights:
• $5.9 billion is allocated for HIV programming. Malaria, tuberculosis, and polio also get $795 million, $379 million, and $85 million, respectively.
• The Global Fund to Fight AIDS, Tuberculosis, and Malaria, which has been praised by Trump administration officials, was allocated $1.25 billion — and lawmakers have asked Secretary of State Marco Rubio to settle debts to the fund from previous U.S. funding commitments.
• UNAIDS — which faces an uncertain future — gets $45 million, matching 2021 levels.
• Global health security gets $615.6 million, including contributions to the Pandemic Fund and the Coalition for Epidemic Preparedness Innovations, or CEPI. And in the event of a public health emergency of international concern, Congress allocated up to $200 million for the response.
• Gavi, the Vaccine Alliance, gets $300 million, despite U.S. health secretary Robert F. Kennedy Jr.’s comments that the U.S. won’t contribute to the organization until it works to “re-earn the public trust.”
• Family planning and reproductive health programs were allocated at least $575 million — $523.9 million under global health and $51 million under national security. Neglected tropical diseases also received an allocation of $109 million. Neither had been included in the White House's proposed budget.
• Congress also allocated $32.5 million for the United Nations Population Fund. But the agency can’t use it in China, and should keep U.S. funding in a separate account. However, the bill states that if this funding cannot be made available to the organization due to any laws, it should be transferred to other global health programs for family planning, maternal, and reproductive health activities.
Read: Unexpected global health wins in the US foreign aid bill
Plus: US Congress backs Gavi, the Vaccine Alliance, despite Trump admin cuts
Who would?
The congressional appropriations bill comes on the heels of bilateral health agreements that the U.S. State Department signed with over a dozen countries. As parties hash out the details of implementing those agreements, former staff and officials at the U.S. Centers for Disease Control and Prevention wonder what the agency’s role will be in their execution.
For decades, CDC staff have supported countries in health program implementation, from HIV to helping build countries’ capacities for outbreak response. But that capacity now faces constraints, after firings and workforce reductions over the past year. Some people left because of instability, and a federal hiring freeze meant some contracts weren't renewed and vacant roles weren’t filled. One former employee tells Devex Senior Reporter Sara Jerving that there might be more layoffs coming in April for those working on global HIV.
Former and current employees are concerned governments won’t lean as heavily on the U.S. if it’s unreliable. The Trump administration’s cutting and reinstating staff doesn’t help that perception.
“Who would choose to work with somebody who might be there and might not?” says Dr. Barbara Marston, who was deputy director for science and program in the Division of Parasitic Diseases and Malaria, before she retired from CDC in 2022.
Read: After a year of chaos, US CDC’s global health work hangs in the balance
+ 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.
‘The devil is in the detail’
We’ve written a lot about the conversations on the future of global health over the past year. But for Gavi CEO Sania Nishtar, it’s time to “get down to the specifics.”
“Every paper will tell you sovereignty matters and that countries should transition. But the devil is in the detail. How is that going to happen? You have to make those nuts and bolts implementation choices that will put countries in the driving seat. You have to actively demonstrate what a graduation looks like,” she said during a recent Devex Pro Briefing.
That’s what Nishtar says Gavi has done. Over the past year, the organization was preoccupied not just with fundraising, but also putting the systems and policies in place to simplify its processes and reduce the burden on countries, and give them the choice on what vaccines to roll out and which partners to work with in delivering them.
Read: Gavi reforms put countries in the driver’s seat (Pro)
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If wishes were policy
“Maybe if you ask me my wish instead of my feeling, I hope the U.S. will reconsider its decision and rejoin WHO.”
— Tedros Adhanom Ghebreyesus, director-general, World Health OrganizationAfter a tumultuous year that left the World Health Organization in chaos and resulted in the loss of more than 2,000 of its staff — the consequence of significant donor funding cuts, most notably the U.S. government — Tedros said he still wishes for the United States to reconsider its decision to withdraw from the United Nations agency.
He said leaving WHO is a loss for the U.S. and the rest of the world.
“It's not really the right decision. I want to say it bluntly. Because I believe that there are many things that are done through WHO that benefits the U.S. … especially the health security issues. That’s why I said the U.S. cannot be safe without working with WHO,” he said during the agency’s press briefing this week.
By law, the U.S. can withdraw from WHO if it meets two conditions: a one-year notice of withdrawal and once it settles its outstanding financial obligations in the current year. The one-year notice is coming up next week, but the U.S. has not yet paid its 2024 and 2025 dues. The agency also got zero funding from the U.S. Congress’ foreign assistance appropriations bill.
Steve Solomon, the agency’s principal legal officer, said member states will be discussing whether the conditions for withdrawal have been fulfilled at the executive board meeting in February, and he expects that discussion to continue in May at the World Health Assembly.
But Tedros said it’s not all about the money, and added that WHO has about 75% of the budget it needs for the 2026-2027 biennium.
“I’m not saying money doesn'’t matter. But what matters most is solidarity, cooperation, and for the whole world to prepare itself for any eventualities to a common enemy, like a virus, like COVID, that we have seen,” he said.
ICYMI: WHO to lose nearly 2,400 jobs by mid-2026
Background read: Trump orders US exit from WHO. Can it survive the financial hit? (Pro)
New year, new goals
People love coming up with New Year’s resolutions. For global health expert and activist Nina Schwalbe, it’s running for Congress — as a Democrat in New York's 12th Congressional District — and championing national and global health needs.
“Along with dismantling our democracy, the administration is dismantling the systems that keep us safe and healthy. From destroying our domestic vaccine programs to defunding HIV prevention overseas, it’s bonkers. And their logic and decisions fly in the face of all the science and evidence,” Schwalbe tells me. “There is currently no accountability.”
But she’s determined “to hold the administration to account — with facts, evidence, and the rule of law.”
“Congress — even when in the minority — has real tools to stop the madness, including forcing votes the administration would rather avoid and, where warranted, impeaching officials, including RFK, for unlawful conduct that harms Americans,” she says.
But what does this all mean for her global health work?
“Running for Congress is not a departure from global health work. It’s a continuation of it,” she says, explaining that global health needs a “stronger, unwavering voice in Congress” that will champion the likes of Global Fund, Gavi, and PEPFAR, and advance pandemic prevention, preparedness, and response in the U.S. and around the world.
Your next job?
Associate, Health System Efficiencies
Clinton Health Access Initiative
Malawi
What we’re reading
Germany is halving its funding for the WHO Hub for Pandemic and Epidemic Intelligence based in Berlin. [Health Policy Watch]
Health facilities run by Médecins Sans Frontières are at risk of shutting down after an Israeli ban preventing the organization from bringing in aid and international staff to Gaza. [NPR]
U.S. cuts to HIV programs in sub-Saharan Africa pose global risks, including the development of drug resistance. [CIDRAP]
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
