Devex Newswire: Trump severed a $17B lifeline. Can it be resurrected?

One of the most closely watched global health projects in the history of U.S. foreign aid quietly met an end last year. Can the ambitious NextGen mega-venture be reincarnated in 2026?

Also in today’s edition: The 2007 emergence of voluntary medical male circumcision as a way to prevent HIV infection was unprecedented at the time. Today, while the sheen has worn off, circumcision remains a highly effective intervention. Aid cuts could change that.

+ How is one of the world’s largest philanthropic foundations approaching global development at a time of shifting aid priorities? Join us today for a Devex Pro Funding Briefing with Novo Nordisk Foundation’s Rikke Johannessen to unpack how the foundation structures and deploys its global development and humanitarian funding. Register now.

Next please

In virtually no time at all, five years’ worth of labor prep, legal review, and procurement box-checking went down the drain last year with the dismantling of USAID. Now everyone is asking: What’s next after NextGen — the $17 billion bundle of contracts that represents a major rethink of how the U.S. government procures and distributes lifesaving health commodities such as HIV/AIDS medicines around the world.

“I think the administration only has a couple of choices before it,” says a former senior USAID official.

One of the more obvious choices, my colleague Michael Igoe writes, would be to ask another major global health supply chain player — The Global Fund for AIDS, Tuberculosis and Malaria — to step in and expand its own coverage through some kind of partnership with the U.S.

For other commodities, the former senior USAID official predicts the administration might look to the private sector — possibly by collaborating with the U.S. International Development Finance Corporation to expand market access for American companies.

In November, the State Department announced a grant of up to $150 million to the U.S.-based drone company Zipline to boost operations in five African countries — part of the administration’s broader “America First” global health strategy that emphasizes private sector partnerships and cost-sharing agreements.

But the Zipline deal is a drop in the bucket compared to the billions of dollars associated with NextGen.

“Zipline is supposed to take care of the last mile, but what about all the other miles before that?” says a source with direct knowledge of NextGen.

That mammoth task now falls to a slimmed-down, overworked State Department. Hopes aren’t high that it will unveil a well-formulated alternative any time soon.

“I worry that we don’t know the answer because they don’t know the answer,” a source tells Michael.

Read more: What will replace USAID’s largest project? No one seems to know (Pro)

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Protection racket

Some of the primary commodities NextGen was responsible for moving were condoms and HIV/AIDS medicines. While the administration has ostensibly said its health strategy will preserve efforts to combat HIV infections, doubts are plentiful after many effective programs were axed.

In Gaborone, Botswana, one of those programs educated men about voluntary medical male circumcision, or VMMC, which studies show can reduce a man’s risk of being infected by a female partner by around 60%. It also reduces the risk that a female partner will become infected or develop cervical cancer.

After learning about the benefits, Thatayaone Rampe became a convert, undergoing the procedure and then becoming an advocate for it, recruiting thousands of men as a volunteer for the African Comprehensive HIV/AIDS Partnerships, or ACHAP.

Funding from PEPFAR went directly to local organizations such as ACHAP to extend clinical services to the community — but that was terminated, and Rampe was laid off along with the rest of the team.

It’s a sign of how narrowly the administration is interpreting HIV/AIDS treatments. In fact, it has eliminated support for most of Botswana’s HIV prevention and community-based activities, outside of programs targeting pregnant or breastfeeding women, writes Devex contributing reporter Andrew Green.

That’s a loss, VMMC supporters say.

“It’s very much a success in the shadows,” says Jason Reed, who helped build PEPFAR’s VMMC program. So much so that advocates put together a call in 2024 for donors to reinvest in VMMC, emphasizing that it remained a cost-effective strategy for reducing HIV incidence in more than two-thirds of settings across Africa.

No one really stepped up to supplement PEPFAR funding, which is itself now gone.

Although he is still eager to help, Rampe no longer has a job. “When there’s no outreach, it will be difficult because [men] need to be encouraged,” he says.

Read: US retreat stalls Botswana’s HIV prevention outreach

+ This story is 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. We’ll be featuring The Aid Report in the Newswire this week. You can also go to https://www.theaidreport.us for more information.

Matchmaker

A fundamental premise behind U.S. President Donald Trump’s health strategy is that countries need to contribute their fair financial share. The United Nations Population Fund — itself on the receiving end of U.S. aid cuts — has been pioneering this model since 2022 with its UNFPA Match Fund.

The idea is that UNFPA provides $2 worth of commodities for every $1 a country spends on reproductive health products, including contraceptives and essential items to help mothers during pregnancy and childbirth, my colleague Jenny Lei Ravelo writes.

Since its launch, the fund has provided $56 million in commodities to 36 countries. These countries — even some of the lowest-income ones — in turn contributed an additional $33 million of their own resources.

Emma Foster of the UNFPA Supplies Partnership’s technical division says the agency hopes to expand the model in 2026, despite the bleak aid landscape.

“I think it’s one of those … tried and tested solutions that we’re really excited to scale, particularly within the current funding context,” she says.

Read more: How UNFPA’s Match Fund spurs additional domestic funding (Pro)

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On trial

That’s the paltry proportion of clinical trials hosted on the African continent in 2023 — despite the fact that Africa is home to 25% of the global disease burden. But that could be changing.

The African clinical trials market, valued at $910 million in 2023, is projected to grow to $1.68 billion by 2032, according to Dr. Mansoor Saleh, founding chair of hematology-oncology at Aga Khan University in Nairobi. “This growth reflects increasing recognition of Africa’s potential in clinical research,” he writes in an opinion piece for Devex.

He cites a study of breast cancer in Black South African women that found new genetic variants linked to cancer risk — variants never seen in European populations. “It’s yet another reminder that if we only study one group of people, we’re missing crucial pieces of the puzzle,” he writes, urging pharma and investors to step up.

“We need pharmaceutical partners who recognize that African populations offer not just large patient pools, but genetically distinct populations that could unlock new therapeutic approaches,” he writes. “We need investors who understand that the return on investment in African clinical research extends far beyond financial metrics — it’s about building the foundation for precision medicine that works for all humanity.”

Opinion: Our work is redefining cancer care in Africa. Now we need global partners

Read the room

Millions of children in low- and middle-income countries are stuck in a reading crisis because schools aren’t using proven methods to help them. That’s the conclusion of a new report grounded in the “science of reading" and draws on more than 150 studies across roughly 170 languages.

The research reframes what effective literacy instruction looks like outside wealthier countries, writes Devex contributing reporter Sophie Edwards.

“Most evidence has historically come from high-income settings that hold limited contextual relevance to education systems in LMICs. This paper changes that and updates the definition of what the ‘science of reading’ is,” says Ben Piper of the Gates Foundation.

The stakes are high: Up to 70% of 10-year-olds in these regions cannot read a simple sentence.

Read: New research shows how to tackle literacy crisis in developing nations

In other news

Yemen’s humanitarian response is nearing collapse, with its 2025 aid plan only 25% funded, forcing deep cuts to health, protection, and food services, even as conflict and climate shocks leave millions increasingly vulnerable. [UN News]

Schools in parts of Nigeria’s Niger state will begin reopening from Jan. 12 after a mass abduction forced closures in November 2025. [BBC]

The U.N. Security Council is set to scrutinize the legality of the U.S. capture of Venezuelan President Nicolás Maduro, as legal experts warn the operation likely violated international law. [Reuters]

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