Devex CheckUp: US pivots to market-first health approach in Africa

When it comes to America’s role in Africa, the Trump administration doesn’t want to focus on responding to emergencies. Instead, it wants to support American companies in introducing innovations to sell to African governments.

This is according to State Department official Jeff Graham, speaking at the Global Health Supply Chain Summit in Kigali this week. “We’re not abandoning global health leadership,” Graham said. “We’re transforming it.”

He pointed to Zipline, an American company that delivers medical supplies via drone to remote areas, as an example. The U.S. government has made a $150 million investment in the company, but Graham said payment for Zipline will come from African governments.

It’s worth listening to what Graham says. He is part of one of the two U.S. teams currently negotiating bilateral health agreements with 16 African nations. In a change of pace, the American officials are leaning more heavily on channeling future global health funding through governments rather than on implementing partner NGOs.

Africa Centres for Disease Control and Prevention Director-General Dr. Jean Kaseya is encouraging countries to share what takes place in their negotiations, so they might reach the best possible deals. It’s expected these agreements will require countries to make a series of commitments, including increased domestic resource investments and the sharing of information on disease surveillance with the U.S. government.

Read: US health strategy aims to position African governments as customers

Plus: US has begun bilateral health negotiations with 16 African nations

Do more with less

A presentation to World Health Organization member states Wednesday broke the bad news: The result of the agency’s reorganization means that from January 2025 to June 2026, WHO will lose 2,371 people.

WHO Director-General Tedros Adhanom Ghebreyesus said it could have been worse — massive funding cuts could have meant hundreds more jobs lost, and those let go will be prioritized to fill new vacancies, he said.

Still, one senior WHO official described the cuts in one word: “CHAOS.”

Read: WHO to lose nearly 2,400 jobs by mid-2026

CIFF not now, when?

One of the largest global philanthropic foundations, the Children’s Investment Fund Foundation, recently announced that it would pause its funding to U.S.-based NGOs because of questions around the rules that guide foreign funders. But the changes don’t stop there.

CIFF’s executive director for sexual and reproductive health and rights, Miles Kemplay, says the philanthropy is moving away from project-based funding and service delivery programs that don’t align with national strategies.

In turn, the philanthropy intends to increase its direct investments in countries outside the U.S., particularly in West and Central Africa.

And while it will preserve its standing areas of focus — SRHR, family planning, safe abortions, HIV prevention, and sexual and gender-based violence — CIFF is also expanding some of those fields. Kemplay says, for instance, there is an opportunity for CIFF to work on masculinity and men’s SRHR.

Read: Here's what CIFF says it will do more, and less of (Pro)

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IAVI out

CIFF isn’t the only donor reimagining its future funding.

After two decades of support, the Danish government plans to cut its funding for the International AIDS Vaccine Initiative. Denmark had invested $23.3 million in IAVI since 2001.

The loss of Danish investments comes at a bad time for IAVI, which lost $22 million as a result of U.S. aid cuts. That forced the organization to lay off at least 15% of its workforce and delayed an HIV vaccine clinical trial.

Read: Denmark to cut IAVI funds, prioritizing multilaterals over smaller grants

Top up

The Global Fund to Fight AIDS, Tuberculosis and Malaria’s highly anticipated replenishment event will take place Friday in Johannesburg, on the margins of the G20 summit. It’s the eighth replenishment of the multilateral fund, which has set an ambitious target of $18 billion to fund its work between 2026 and 2029.

There have been some early pledges. The United Kingdom, which has been the third largest public donor, committed £850 million, which is 15% less than its previous replenishment pledge.

One of the big question marks is what the U.S. government will commit. America has been the largest donor to the Global Fund, accounting for 33% of the organization’s funding.

An American law prevents the U.S. from contributing more than $1 for every $2 that other donors contribute — which, when maxed out, equals 33%. But earlier this year, the Trump administration released its fiscal year 2026 budget request, which didn't specify a funding amount for the fund but noted it aimed to reduce the percentage it contributes as compared to other organizations.

It’s unclear when there will be a final tally of what was raised on Friday, but we will bring you the latest information from the event. During the last replenishment, pledges continued to take place after the event.

Background reading: Global Fund launches $18B replenishment in tough fundraising landscape

Hot in here

A warming planet brings with it an increase in illnesses caused by higher temperatures — but also a spike in vector-borne diseases, food insecurity, and flooding.

Now there’s a plan to help prepare for all of those problems.

Brazil’s Ministry of Health collaborated with WHO to launch the Belém Health Action Plan last week at the 30th U.N. Climate Change Conference, or COP30.

The idea is to boost surveillance and monitoring systems, improve technical capacities, and spur innovation that can help health systems adapt to these growing problems. It will take political commitment and some funding, though, to actually help countries to localize the plan to their own needs.

Read: Brazil, WHO launch pioneering climate adaptation road map for health

+ Don’t miss out on the big stories from COP30. Check out our focus page to stay updated!

Who’s counting?

That’s how many girls Gavi, the Vaccine Alliance has immunized against the human papillomavirus, or HPV – fulfilling a goal for this year that it set at the end of 2022. The organization estimates that could help avert 1.4 million deaths, since HPV can cause cervical cancer.

Gavi’s effort came with unique challenges. The HPV vaccine is intended for girls between the ages of 9 and 14, not at the younger ages when children traditionally get immunizations. So that meant building specific campaigns to reach the right populations.

It also meant overcoming a global shortage of the vaccine and bringing prices way down to make the campaign affordable.

Now, Gavi is working to expand vaccine access even further to reach girls who haven’t yet been immunized.

Read: Gavi and partners reached HPV vaccine goal, immunizing 86 million girls

What we’re reading

Will artificial intelligence help end the rise of antimicrobial resistance by helping identify new antibiotics? [BBC]

Cuts to international aid by the United States and European countries could cause 22.6 million deaths by 2030, including 5.4 million children under 5, according to new research. [France 24]

There are three confirmed and three suspected deaths so far in the Marburg outbreak in Ethiopia. [The BMJ]

Sara Jerving contributed to this edition of Devex CheckUp.