Presented by International Monetary Fund
The United States has lost its seat on the board of Gavi, the Vaccine Alliance after failing to pledge funding. The House of Representatives has now approved money, but it needs Senate and presidential sign-off. The freeze reflects vaccine skepticism inside the Trump administration — claims Gavi strongly rejects.
Also in today’s edition: Will Trump use foreign aid money? Plus, how lower-income countries will use AI for health, and making the case for global south-south cooperation.
Money, not medicine
After decades as a major backer of global immunization, the United States has lost its seat on Gavi, the Vaccine Alliance’s board — a quiet but telling signal of how far U.S. support has slipped under the Trump administration.
The change is visible on Gavi’s own website. In 2025, Trump administration official Mark Kevin Lloyd joined the board as the U.S. representative, taking one of five seats reserved for donor countries. He’s now gone — and according to Gavi, the explanation is straightforward: Funding hasn’t materialized.
A Gavi spokesperson tells Senior Reporter Jenny Lei Ravelo, “Gavi’s donors are a self-organizing group that determines Board seat representation based on financial commitments for each strategy period. As the United States government has not yet pledged to Gavi it is currently not on the Gavi Board.” In other words, no pledge, no seat.
There may be a path back. The U.S. House of Representatives recently approved $300 million for Gavi in the fiscal year 2026 budget bill — money the organization says, if disbursed, “would help Gavi protect millions of lives in the coming years.” The funding now awaits Senate approval and, ultimately, sign-off from President Donald Trump.
That congressional move is a sharp reversal from the White House budget request, which included no funding for Gavi at all. It also comes amid lingering uncertainty: Gavi declined to say whether it has received any U.S. funding appropriated by Congress in fiscal year 2025.
Historically, the U.S. has been one of Gavi’s largest donors, accounting for roughly 13% of its funding.
The pullback traces back to skepticism from U.S. Health and Human Services Secretary Robert F. Kennedy Jr., who said at Gavi’s 2025 replenishment summit that the U.S. would not contribute until the alliance could “re-earn the public trust” and take “vaccine safety seriously.” Gavi has pushed back forcefully, saying its “utmost concern is the health and safety of children” and that its vaccine decisions are guided by independent scientific experts reviewing all available data.
Scoop: US loses Gavi board seat after withholding funding
Rescission decisions
Even if Congress comes back with a spending bill for foreign assistance signed by Trump, there’s nothing to say the president won’t simply turn his back on it down the line.
That’s exactly what he did with two rescission packages last year that clawed back billions in aid funding previously approved by Congress.
The prospect looms large again, said experts at a Devex Pro Briefing moderated by Senior Reporter Adva Saldinger on Wednesday. “What if there are a ton of rescissions? What if there's just a lack of implementation?” asked Jim Kunder of the international development consulting firm Kunder/Reali Associates.
“It's one thing to pass the bill. It's one thing to set the funding levels, but after its performance in the last year, is the Congress really going to insist that the U.S. foreign aid program looks like what's in the bill? To me, that's the big operative question,” he added.
Certainly, there is room for cynicism given the epic budgetary impasses of this Congress, with lawmakers often resorting to “continuing resolutions” that just carry funding levels over from previous years. Not to mention the fact that Republican lawmakers have shown little appetite to challenge Trump, especially when it comes to foreign aid.
But hope springs eternal — and the mere presence of this $50 billion bill is enough to cling to it.
“We had all hoped for this result,” said Lisa Bos of InterAction. “Maybe we thought that was overly optimistic to get to this place, but here we are, and it took a lot of hard work by both sides of the aisle on [Capitol] Hill.”
Read: Congress may pass a $50B foreign aid bill. Will Trump spend the money? (Pro)
+ Tomorrow makes it exactly a year since the Trump administration’s global stop-work order that brought the entire U.S. foreign aid system to a standstill. Our special Saturday edition of the Devex Pro Insider led by Senior Reporter Michael Igoe will break down the behind-the-scenes of the upheaval of the aid sector and dissect the way forward — if any — with the new budget.
Not yet gone Pro? Sign up to Devex Pro with a free 15-day free trial now to get your copy of the newsletter directly in your inbox tomorrow — and also gain access to all our Pro content and events.
Care, not hype
The Gates Foundation and OpenAI unveiled a $50 million initiative to bring artificial intelligence into 1,000 primary health care clinics across Africa by 2028, starting in Rwanda and later expanding to Kenya, South Africa, and Nigeria.
At the World Economic Forum in Davos, Bill Gates joined Paula Ingabire, Rwanda’s minister of information and communications technology, and Peter Sands, the executive director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, to argue that AI’s biggest payoff in health in low-resource settings will come on the delivery side of care. “I would say it's even more important that AI will be used on the delivery side,” Gates said. “This is the first year that we're really going to see horizontal application.”
Rather than focusing on flashy diagnostics, the Horizon1000 initiative aims to work across the spectrum of a patient’s experience with the health care system, while also working to reduce burdensome paperwork for overstretched health care workers. “Taking away the paperwork that needs to be done, organizing the resources so the patient knows what's available, and when to come for their appointments,” Gates said.
Rwanda, Ingabire said, is ready to scale up its use of AI. “With limited natural resources, I think technology becomes a natural go-to and not an afterthought,” she said, adding that AI can ease administrative burdens so community health workers can focus on care. Sands said AI adoption may move faster in poorer countries because the need is urgent and resistance is lower. In refugee camps in Chad, he said, AI-powered tuberculosis screening fills a void.
“The question is not replacing any radiologists — there were no radiologists,” he said. “If you want the screening to be interpreted, there is no alternative.” But he cautioned that scale will depend on solving basics such as connectivity and training. “The whole thing has to be framed around problems needing solutions, as opposed to a whole bunch of tools needing a problem to fix,” he said.
Read: Low-resource nations may leapfrog wealthier ones in using AI for health (Pro)
Listen: In the latest episode of our This Week in Global Development podcast, Devex’s Rumbi Chakamba, Raj Kumar, and Elissa Miolene dig into this new partnership and other top development stories from Davos.
From aid to investment
Salah Ahmed Jama is making the pitch development experts keep talking about: shift from humanitarian aid to climate investment.
The deputy prime minister of Somalia told Devex President and Editor-in-Chief Raj Kumar at Davos that climate change keeps creating cycles that displace people and undermine development. His solution: investment in adaptation infrastructure, not more humanitarian response.
“There are fundamental structural problems arising from climate change,” said Jama, who leads his country’s climate response. “We get cycles of droughts that turn blessed people in our countryside into displaced people.”
It's a familiar argument. What makes it urgent: Traditional aid is disappearing while millions face crisis. U.S. and European donors — once major supporters — are shifting priorities. Somalia hasn’t received its share of climate finance promised at U.N. climate change conferences. Jama is betting on blended finance and de-risking mechanisms to bridge the gap.
As such, Somalia is testing a key question the sector is wrestling with: Can investment models actually work for the world’s most fragile, climate-vulnerable states?
South-south moment
Everyone talks about global south-south cooperation. Juliana Uribe Villegas thinks now’s actually when it takes off.
The Movilizatorio founder — who won the Schwab Foundation Social Innovation Award this week — told Raj at Davos that the world’s shifting in ways that create new openings for global south organizations to lead.
“There’s now a big opportunity to create new ways of collaboration,” said Uribe Villegas, an Ashoka and Acumen fellow. “Groups need to believe their locally rooted methods work better than imported models.”
As “my country first” rhetoric spreads and aid budgets shrink across North America and Europe, traditional funding models are breaking. Colombia — once one of USAID’s biggest recipients — is facing significant cuts.
Movilizatorio diversified early — working with bilaterals, multilaterals, philanthropy, private sector, and peer organizations. The group fed 2 million people during the pandemic, mobilized after Colombia’s peace referendum failed, and organized a fossil fuel funeral at the COP30 U.N. climate summit that brought 70,000 Brazilians into the streets. It now supports 20 million Indigenous people across four continents.
“You shouldn’t depend on just one partner,” Uribe Villegas said.
As aid budgets continue shrinking, more groups may have no choice but to test Uribe Villegas’ thesis.
+ Check out all our on-the-ground reporting from the World Economic Forum in Davos and keep an eye out for our Davos wrap-up newsletter hitting your inbox later today..
In other news
The Trump administration plans to expand the Mexico City Policy, also known as the global gag rule, to block some $30 billion in U.S. foreign aid from organizations linked not only to abortion services but also to gender and diversity initiatives. [Reuters]
ActionAid UK plans to rethink its child sponsorship model, moving toward more community-led funding as part of efforts to decolonize its aid work. [The Guardian]
The United Nations has taken over management of the al-Hol camp for families linked to the Islamic State after unrest forced aid agencies to suspend work in Syria. [BBC]
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About the author
Helen Murphy
Helen is an award-winning journalist and Senior Editor at Devex, where she edits coverage on global development in the Americas. Based in Colombia, she previously covered war, politics, financial markets, and general news for Reuters, where she headed the bureau, and for Bloomberg in Colombia and Argentina, where she witnessed the financial meltdown. She started her career in London as a reporter for Euromoney Publications before moving to Hong Kong to work for a daily newspaper.
