As U.S. Agency for International Development programs get integrated into the State Department, here’s our key question: Which global health programs will continue to be supported under this new arrangement?
An Excel sheet and PowerPoint slides — dated April 8 — obtained by Devex has some answers, identifying some of the priorities that will still receive support from the State Department. And some that won’t.
This is a preview of Devex CheckUp
Sign up to this weekly newsletter for exclusive global health news and insider insights in your inbox every Thursday.
So, “what’s in”? Among other things, the REACH program, which is the U.S. President’s Malaria Initiative’s flagship service delivery project and is slated to end in 2028. Another is the ACHIEVE project, which is aimed at preventing and controlling the spread of HIV among pregnant and breastfeeding women, adolescents, infants, and children. U.S. support will also continue for USAID’s massive global health supply chain project, led by Chemonics, which procures and delivers lifesaving products such as anti-HIV and malaria drugs.
Programs left out include the DREAMS project, which helps girls and young women stay HIV free across 15 countries, mostly in sub-Saharan Africa. Projects on antimicrobial resistance, non-emergency infectious diseases, and expanding data systems for research, trials, and community monitoring are also no longer getting funded.
Take all this with a key caveat: In recent weeks, the Trump administration has backtracked on some terminations — and hacked through programs previously thought safe at the last minute.
Read: 'What’s in' and 'what’s out' in USAID’s global health programming
ICYMI: Trump administration admits lifesaving aid was accidentally cut
A ‘major milestone’
On Saturday, countries negotiating the pandemic treaty reached a breakthrough after three years — though of course, the discussions didn’t end until the wee hours of yesterday. As expected with any contentious negotiations, many, including member states, civil society representatives, and independent experts, still feel the text is far from perfect.
But Rachael Crockett, senior policy advocacy manager for DNDi, points out that attaching conditions to publicly funded research and development grants and contracts in order to promote equitable access to pandemic-related health products is a potentially “massive” development. “This has never been done in an international health agreement before, ever,” she says.
The agreement includes assurances that technology transfers will be done on “mutually agreed terms” with the owners of the tech, but that countries could resort to compulsory licensing if they deem it necessary, a compromise between high-income countries concerned about repressing innovation and lower-income nations that want to avoid a repeat of the vaccine hoarding seen during the COVID-19 pandemic.
Countries still need to work on the details of the pathogen access and benefit-sharing system, which will serve as an annex to the agreement — and, of course, road-test the treaty via real-life implementation.
Thus, while the conclusion of the treaty negotiations — which now must be adopted at next month’s World Health Assembly — is a “major milestone,” Nina Schwalbe, CEO and founder at Spark Street Advisors, tells me: “We can’t declare victory and walk away at this stage.”
Read: Countries reach historic pandemic treaty deal after prolonged stalemate
Early exit
U.N. Population Fund Executive Director Dr. Natalia Kanem is stepping down from her role in July, three months ahead of the end of her term, after nearly eight years at the helm.
Her departure comes amid turmoil for the United Nations agency, which lost hundreds of millions in funding for reproductive health and anti-violence programs in February when the U.S. terminated all 48 of its grants. Some were reinstated later, but then another round of cancellations hit, leading one U.N. official to describe it as a “roller coaster.”
Read: UNFPA chief to step down months before term ends
WHO knows?
With a massive hole in its budget, the World Health Organization has implemented several cost-saving measures, including limiting the renewal of fixed-term contracts and offering early retirement for staff approaching 55 years old. But it appears it will need to further slash its workforce.
In a Devex Pro briefing, Elaine Fletcher, editor-in-chief of Health Policy Watch and former WHO staffer, said there’s a need for WHO to ensure these cuts are strategic and merit-based, and that the agency can do that by being more transparent about staff positions and costs.
Fletcher said knowing the cost of each position could help the organization figure out where it can cut more and where it can save. She also said it would be helpful to know how many administrative staff, professional staff, directors, down to senior advisers are in each WHO department — something that WHO has not published since 2019.
“I would say that would be another really important thing to create inclusion, and it doesn't come off the back of any of the power of the administration to make clear and tough decisions. It's simply sharing what's the state of play right now, and then what do we have to get to,” she said.
“None of us know what is the state of play right now, not member states and not staff,” she added.
Between 2017 and 2024, WHO's staff ballooned significantly, with the number of senior directors at D2 level nearly doubling, as Fletcher revealed in an analysis of WHO human resources during this period. Her estimates found that those positions, including assistant directors-general, are costing the organization some $92 million a year in compensation and benefits such as relocation and education allowances.
Read: As WHO lays off staff, why is transparency more crucial than ever? (Pro)
+ Not yet a Devex Pro member? Start your 15-day free trial today to access all our expert analyses, insider insights, funding data, events, and more. Check out all the exclusive content available to you.
What we’re reading
South Africa faces an epidemic of children getting addicted to vaping, according to a study that surveyed over 25,000 learners across eight provinces in the country. [Mail & Guardian]
U.S. Health Secretary Robert F. Kennedy Jr. contradicted health experts by stating that autism “has to be” caused by environmental factors and vowed to begin a series of studies on toxins within weeks. [NBC News]
Patients from Myanmar are often required to pay a deposit before receiving medical care, including emergency care, in Thai hospitals despite Thailand’s constitution guaranteeing patients’ rights to medical care without discrimination to their nationality and status. [Radio Free Asia]
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.
