Devex CheckUp: What to expect when you’re expecting new global health agreements

Negotiations are officially underway. The United States has started discussions with some partner countries on bilateral agreements that will guide America’s health financing beginning as early as next April.

These agreements were first introduced in September’s “America First” global health strategy. They are at the heart of the document’s proposal to bypass most nongovernmental organizations to directly fund governments, while promoting American products and countering Chinese influence.

So what exactly is on the table? My colleague Sara Jerving got some insight when she obtained a copy of a template that could guide these agreements:

• Washington is offering to fund health care workers to be part of a country’s permanent workforce, so long as domestic governments commit to taking over their salaries.

• The template also sets obligations for domestic government financing and requires officials to draw funds from their own budgets, rather than from other donors or multilateral organizations.

• Countries would be required to detect outbreaks in seven days and then alert America within one day of that determination. In return for collaborating with Washington, U.S. officials would assist with the immediate assessment and elimination of the outbreak, as well as the longer-term job of building laboratories to address biosecurity.

• The agreement would require countries to send America data on any pathogens found within their borders, including the genetic sequences, within five days. This is a controversial suggestion, since it would bypass part of the global Pandemic Agreement that is still under negotiation.

That’s not all that’s contentious. The template threatens to decrease funding if countries don’t hit specific targets or if they fail to provide access to requested data or information. We’ll be keeping an eye on these discussions to see how closely they hew to this template.

Read: US template for bilateral health deals bypasses WHO pandemic negotiations

Plus: ‘America First’ in global health — oxymoron or opportunity?

+ICYMI, we launched a new series on The Future of Global Health. It explores the consequences of cuts to foreign aid and the efforts to find a new direction for global health. Catch up on our coverage.

Doctors’ orders: Fix the planet

Also underway? The “adaptation COP” in Belém, Brazil. As Day 2 wrapped up, thousands of health workers flooded the streets of Belém for the Global March for Health and Climate — a rare sight at recent COPs, where host governments had restricted such demonstrations. Before that, the pandemic had halted them entirely.

Doctors, nurses, and health activists walked the milelong route from the Embassy of Peoples to the COP30 venue, carrying placards reading “I prescribe a healthy planet” and “No health on a dead planet.” The message: The climate crisis is a health emergency.

Organizers said the march was as much about solidarity as it was about visibility. “Loneliness is the kryptonite of a changemaker,” Dr. Courtney Howard of the Global Climate and Health Alliance told Devex contributing reporter Cheena Kapoor, noting that the event was designed to bring together the climate and health community after years of silence. She added that Brazil’s health community played a crucial role in reaching out to Indigenous leaders — a recognition of the courage Indigenous land defenders have shown around the world.

Adding to the momentum, 35 philanthropies used COP30 to launch a new $300 million Climate and Health Funders Coalition, aiming to scale solutions on extreme heat, air pollution, and climate-sensitive diseases while strengthening climate-resilient health systems.

The coalition includes heavy hitters such as Bloomberg Philanthropies, the Gates Foundation, Wellcome, The Rockefeller Foundation, IKEA Foundation, and the Children’s Investment Fund Foundation.

Read: Philanthropies commit $300M for climate-health solutions at COP30

+ Join us on Nov. 19 for a Devex Pro Briefing with World Resources Institute President and CEO Ani Dasgupta. He will discuss which climate financing mechanisms are actually delivering results, where the climate finance is flowing, what are proven strategies in advancing climate goals, and more. Save your spot now.  

Choking

But any efforts that might emerge from COP30 may come too late for many in India, where the country has not adapted quickly enough to stem some of the most insidious forms of air pollution.

That includes the fine particulate known as PM2.5, which can be drawn deep into the lungs, and was linked to at least 1.7 million deaths in 2022. At times during the year, the level of PM2.5 in some parts of India can be four times higher than the World Health Organization’s standards for a daily permissible level.

But urgently needed adaptation measures have not been put in place, and there does not appear to be the funding needed to rush them into place. And those are not the only problems. Experts say data collection is still lagging, making it harder to target adaptation efforts.

Read: As COP30 spotlights adaptation, India’s toxic air demands action

+ Check out our focus page for all our COP30 coverage, including our reporters’ notebooks and special edition newsletters.

New approaches

The latest WHO global tuberculosis report reveals 1.23 million people died because of TB in 2024, a 3% reduction from 1.27 million in 2023. And for the first time, since the onset of COVID-19 in 2020, the absolute number of people who fell ill with TB decreased. However, these positive trends are at risk of being reversed if U.S. funding cuts to TB are not restored or replaced.

Here’s why: The U.S. government contributed about 50% of all international funding for TB from 2015 to 2024. That money was given bilaterally by USAID, as well as through the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The impact of the funding loss is already being felt in countries. Some countries have reported fewer people diagnosed with TB in the first six months of 2025 compared to the same period in 2024, as well as disruptions to staffing, procurement of diagnostic supplies, and the conduct of national TB surveys.

Modelling studies estimate that if U.S. government funding for TB is not restored or replaced, and service disruptions continue, up to 2 million additional people could die from TB, and 10 million more could fall ill from the disease between 2025 and 2035.

And the news keeps getting worse. The United Kingdom announced that it is reducing its commitment to the Global Fund by 15% —  from £1 billion during the last three-year funding cycle to £850 million during the current replenishment.

That prompted Frontline AIDS to warn that “reducing its contribution risks sending a message to other countries that they can back out of their commitments at such a critical moment for global health.”

To offset those cuts, TB programs might need to start getting creative. That was the message out of the latest Stop TB Partnership board meeting in the Philippines.

Indonesian Health Minister Budi Sadikin urged countries to look to nontraditional TB funders, including development finance institutions. And the secretariat is looking at how it might drive down costs — and its own expenses — so that the money that is available will stretch a little further.

Meanwhile, Nigeria’s coordinating minister of health and social welfare, Muhammad Pate, said his government will invest more in its response, to the tune of $54 million.

In a press conference launching the WHO report, Yogan Pillay, director for HIV and TB delivery at the Gates Foundation, acknowledged that more domestic financing is crucial.

“Even as funding comes back, or some funding increases, we need to change the way in which we do things so that we can sustain the gains that we've seen in the 2024 data, notwithstanding any funding cuts,” he said.

Read: How the Stop TB board plans to future-proof tuberculosis finance

Finally, some good news

Confirmed resistance to artemisinin, the drug that serves as the backbone of most malaria treatment, in several countries has fueled the search for alternatives. So the news this week that Novartis has a promising new treatment candidate has energized the global health community.

New results from a Phase 3 clinical trial showed that Ganaplacide-lumefantrine, or GanLum, is highly effective in treating uncomplicated malaria. Even better? It can kill parasites that have developed partial resistance to the current antimalarials.

Read: Novartis’ new malaria treatment shows promise against resistant parasites

+ Devex Pro members can read about how innovative financing mechanisms could help close financing gaps for neglected disease R&D. Not a Pro member yet? 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 Pro members.

Landmark

Malawi’s High Court has ruled: Survivors of sexual violence should have access to safe abortion services.

Though the country is a signatory to the Maputo Protocol, which recognizes that women have the right to comprehensive sexual and reproductive health services that include safe abortions, the service remained illegal in Malawi except under very rare circumstances, such as if the procedure is meant to preserve the mother’s life.

Advocates hope the ruling will reduce the number of women who attempt to terminate their pregnancies through unsafe methods. That is a leading cause of death for women in Malawi and costs the country $314,000 per year in postabortion care treatment.

The court may have decided, but that does not automatically wipe away the cultural and religious objections to abortion that may continue to prove an impediment to survivors of sexual violence accessing the service.

Read: Could Malawi’s landmark abortion ruling save lives — and public funds?

What we’re reading

Countries can overcome foreign aid cuts by improving their debt management, leveraging potential health sector profits, and tapping into technology. [Devex Opinion]

The long-awaited launch of the African Medicines Agency raises hopes that the continent will soon see strong regulatory capacity and more harmonized national frameworks. [Nature]

In a long-expected decision, Canada has lost its measles elimination status. That means all of the Americas region has, as well. [Stat]

Jenny Lei Ravelo and Cheena Kapoor contributed to this edition of Devex CheckUp.