Breakthroughs Blog: Congress

Congress is advancing a six-bill spending package that would maintain significant global health assistance and increase funding for medical research, demonstrating continued bipartisan support for areas the administration previously targeted for cuts. The package also includes important provisions to limit recent changes to biomedical research grant policies, strengthen oversight of global health programs, and establish, for the first time, a new global health research and development (R&D) initiative at the State Department, a significant milestone consistent with longstanding GHTC advocacy. Last Thursday, the House approved the fiscal year 2026 (FY26) package, which still needs to clear the Senate and be signed by the President before the January 30 deadline to avert another government shutdown. While initially this process appeared on track, the timeline for final passage has now become uncertain. Stalled negotiation surrounding the bill’s funding for the Department of Homeland Security, combined with severe winter weather limiting Senators’ ability to return to Washington, DC, may delay action. As a result, the United States could be headed to a partial government shutdown, with only half of the twelve appropriations bills passed by the deadline.  Major wins for global health R&D at State Department despite topline reductions The FY26 budget package provides $9.4 billion for Global Health Programs, now housed at the State Department following the July integration of programs at the US Agency for International Development (UASID) into State. This represents a reduction of $615 million from fiscal year 2025 (FY25) enacted levels. While a cut is rarely ever good news, the funding remains $5.6 billion above the President’s Budget Request (PBR) and includes resources for areas targeted for elimination by the administration, including reproductive health, neglected tropical diseases, and a US contribution to Gavi, the Vaccine Alliance. Although the overall Global Health Programs budget declined, the bill contains several significant victories for the global health R&D community and opportunities to shape the State Department’s expanding role in global health going forward. A new $50 Million Prevention, Treatment, and Response InitiativeThe bill establishes for the first time a $50 million Prevention, Treatment, and Response Initiative for the prevention and treatment of HIV/AIDS, malaria, and other infectious diseases in alignment with the America First Global Health Strategy. This new initiative, which is intended to support the research, development, and delivery of technologies, closely mirrors a GHTC-led proposal to create a disease-agnostic global health R&D fund at USAID that was taken up in bipartisan legislation introduced in fall 2023. Given the termination of almost all USAID’s R&D work early last year, Congress’s decision to direct funding to State to explicitly support global health R&D activities is a major win.Guardrails and oversight for the Innovation Fund and bilateral agreements  The package also introduces key guardrails, consistent with priorities long advanced by GHTC, to inform the State Department’s implementation of a newly proposed Innovation Fund supporting biomedical and health systems innovation, in alignment with the America First Global Health Strategy. While the fund concept remains in a nascent stage, Congress is already exercising oversight to ensure funds are administered through a transparent, competitive process, approved by Congress, that includes a broad range of partners. Budget directives require a briefing from the Secretary of State outlining planned activities for the fund and encourage partnerships with both private companies and nonprofit organizations.  The inclusion of nonprofit organizations, who bring deep expertise as implementors of USAID global health R&D programs and a firm commitment to global access, is key to ensuring that technologies and approaches supported by the Innovation Fund are globally relevant and accessible.  To ensure visibility into the new bilateral country agreements being actively negotiated under the new global health strategy, the bill directs the State Department to report to Congress on the structure and content of the agreements and on all activities funded under Global Health Programs, safeguarding transparent and robust implementation of the strategy. Strengthening coordination across the US government and multilaterallyFinally, the bill reinforces the importance of global health collaboration across the US government and with global partners. There are strong budget directives supporting State Department collaboration with the US Centers for Disease Control and Prevention (CDC) and other relevant agencies to ensure strong technical components in the implementation of the global health strategy.  Beyond the United States, the bill includes funds for US contributions to the Pandemic Fund and the Coalition for Epidemic Preparedness Innovations, the latter to advance vaccines to counter pandemic threats, and requires the department to brief Congress on its plans to maintain essential multilateral health engagement activities like disease monitoring and data sharing, among others. These provisions will hopefully help ensure that the State Department’s global health activities are coherent, technically grounded, and not duplicative of other US government or multilateral efforts. Medical research and global health funding protected at HHS In contrast to the administration’s funding proposal and the sweeping policy changes it has implemented across the Department of Health and Human Services (HHS) that have reshaped the US biomedical and public health apparatus, the funding package includes increased funding for HHS agencies to support medical research and global health technical assistance, as well as new budget directives to limit changes to the grantmaking process.  The package provides a one percent increase to the National Institutes of Health (NIH) budget from FY25, which also represents a $21.21 billion or 77 percent increase from the PBR. The NIH National Institute of Allergy and Infectious Diseases, which supports critical research to advance technologies to address longstanding and emerging global infectious disease threats, also received a modest 0.35 percent boost, which represents a $2.41 billion or 58 percent increase from the PBR. The Fogarty International Center, which advances international research training and collaborations; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which supports critical advancements in reproductive and women’s health technologies; and the Office of Research on Women’s Health, which supports research and cross-cutting approaches to advance the health of women—all of which were absorbed into other entities or outright eliminated in the PBR— received flat or increased funding from FY25. The Office of Research on Women’s Health saw a significant $30 million or 39 percent increase from FY25.  At the CDC, the spending package maintains flat funding for the Global Health Center, which provides critical technical assistance in implementing global health programs and tracking emerging threats. It was eliminated entirely in the PBR and cut significantly in the House’s health spending bill. It also provides a 3 percent boost to the National Center for Emerging and Zoonotic Infectious Diseases, which supports the development of diagnostic technologies.  Finally, the Biomedical Advanced Research and Development Authority, which supports the development of medical countermeasures against emerging pandemic and epidemic threats, received a 3 percent increase from FY25, which is more than 50 percent above the budget proposed in the PBR. It is encouraging to see that congressional appropriators are still strongly supportive of these offices and centers that lead and fund critical research on global health and women’s health. Bill language provides some guardrails on new funding limitations, hiring practices, and grant terminations The package also introduces new guardrails to preserve the integrity of the research grantmaking process at NIH. During the funding negotiations, congressional appropriators raised concerns about a practice NIH deployed last year to forward fund grants by providing all funds for multiyear grants up front rather than on a yearly basis, which had the effect of reducing total awards made. In the conferenced bill, Congress limits NIH spending on forward funding to the percentage spent in 2025, which was 39 percent. This issue was a sticking point in negotiations, and the language ultimately represents a compromise outcome, with the Senate wanting stricter prohibitions on forward funding and the House more responsive to pushback from the administration. The conferenced bill text also prohibits the administration’s attempts to implement blanket changes on indirect cost rates, which support overall research infrastructure on which individual projects rely. The language highlights the importance of indirect costs in sustaining US scientific leadership and urges the agency to work with Congress to reform the indirect cost process. Similarly, the JES includes language responding to the large number of grant terminations that have taken place over the past year, directing HHS to consult with Congress prior to terminating grants and calling attention to the significant consequences of these actions. Looking ahead This spending package creates the foundation for restoring US leadership in global health innovation. If enacted, GHTC is eager to build on this momentum and will continue working closely with department officials and congressional appropriators to ensure these provisions and funding translate into meaningful action. While many unanswered questions remain as these new provisions take shape, utilizing the groundwork that has been laid out in this FY26 package to inform the road ahead in fiscal year 2027 will be essential. 

Earlier this week, the Global Health Technologies Coalition (GHTC) and partners brought more than 25 innovative global health technologies to Capitol Hill to highlight how US government investments in global health research and development (R&D) are saving lives in the United States and around the world. Each technology displayed—whether a vaccine, diagnostic, drug, device, or nutrition solution— demonstrate how these investments not only protect the world’s most vulnerable people but also strengthen America’s own health security, help prevent pandemics, and fuel high-quality US jobs and economic growth. The exhibit offered a snapshot of a larger story of how the United States is doing well by doing good. Between 2007 and 2022, the US government invested just under $46 billion in global health R&D. These investments helped drive the development of 67 new technologies approved since 1999 for neglected and (non-COVID-19) emerging diseases. At the same time, they created 600,000 new US jobs and yielded knowledge expected to generate more than $255 billion in long-term benefits for the American economy—a six-fold return on investment. This exhibit showcased what’s possible when science, purpose, and smart policy align. Explore the exciting US-backed breakthroughs displayed below. VACCINESSingle-dose vaccines for Sudan and Marburg viruses on the rVSV vaccine platform IAVI, a nonprofit based in New York and New Jersey, is advancing single-dose vaccines for the Sudan and Marburg viruses using the proven rVSV vaccine platform, the same technology behind an Ebola vaccine that has helped contain recent outbreaks. Sudan and Marburg viruses continue to spark deadly, Ebola-like outbreaks, yet no approved vaccines or treatments exist, underscoring the urgency of this work. These vaccine candidates are being developed with critical support from the Defense Threat Reduction Agency at the US Department of Defense (DoD) and the Biomedical Advanced Research and Development Authority (BARDA). Novel oral polio type 2 (nOPV2) vaccine PATH, a nonprofit developer based in Washington state with an office in the District of Columbia, alongside the University of California, San Francisco; the Washington-based Gates Foundation; and global partners, developed nOPV2, a next-generation oral polio vaccine. nOPV2 maintains the same advantages of the original oral vaccine but has been specifically engineered to be less likely to seed vaccine-derived polio outbreaks in communities with low immunization coverage. This breakthrough, which is accelerating global efforts to end polio, also benefitted from critical development support from the US Centers for Disease Control and Prevention (CDC).Next-generation malaria vaccines PATH and the University of Oxford are developing next-generation malaria vaccines designed to overcome key limitations of the currently available options and help turn the tide of this longstanding global health challenge. This work has received vital US government support from the US Agency for International Development (USAID), the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), and the DoD Walter Reed Army Institute of Research and Naval Medical Research Command. Additional US-based partners, including Johns Hopkins University in Maryland, the Scripps Research Institute in California, and the University of Texas at Austin, alongside a constellation of international collaborators, also played a critical role in advancing this research.DRUGSPretomanid, a novel tuberculosis (TB) drugTB Alliance, a New York-based nonprofit, developed pretomanid, a groundbreaking drug for treating highly drug-resistant TB. As part of a six-month combination regimen, it has drastically reduced treatment duration and complexity for patients compared to previous regimens that required up to 20 or more pills a day—as many as 14,000 total over the course of 18 months or more of treatment. This work was backed by US federal funding from USAID and NIAID and advanced in partnership with a broad coalition of American companies, nonprofits, and universities, including AbbVie Inc. in Illinois, Advancing Clinical Therapeutics Globally for HIV and Other Infections in the District of Columbia, the Gates Foundation, Harvard University in Massachusetts, Johns Hopkins University, Johnson & Johnson in New Jersey, RTI International in North Carolina, Texas A&M University, the University of Illinois Chicago, and the University of North Carolina at Chapel Hill.Child-friendly TB medicinesTB continues to infect millions of people worldwide each year, with children facing a heavy burden—an estimated 1.3 million new pediatric cases were reported in 2023. For decades, children with TB were treated with crushed adult pills, a practice that was difficult for caregivers and often led to inconsistent dosing. TB Alliance developed child-friendly TB medicines that are palatable, fast-dissolving in water, and precisely dosed for children, ensuring young patients finally have access to safe, appropriate, and easy-to-administer therapies. This work received vital funding from USAID and was advanced in partnership with other international donors and organizations, as well as US-based partners, including Management Sciences for Health in Virginia and Baylor College of Medicine in Texas.Inhaled oxytocin for the prevention and treatment of postpartum hemorrhage Postpartum hemorrhage, or excessive bleeding after childbirth, is the leading cause of maternal deaths globally. To address this urgent challenge, Monash University has developed an investigational heat-stable, inhaled powder formulation of oxytocin designed to provide the same protection as the injectable gold standard treatment. By eliminating the need for refrigeration and trained providers to administer injections, this innovation could greatly expand access to lifesaving care for mothers in low-resource settings. This work received funding from USAID and support from US-based partners, including the Gates Foundation and Johnson & Johnson, alongside other international collaborators. Monoclonal antibody therapy to prevent and treat Nipah virus (MBP1F5) The Coalition for Epidemic Preparedness Innovations, whose US headquarters are in the District of Columbia, is supporting the development of a monoclonal antibody therapy being advanced by California-based Servare GMP and Mapp Biopharmaceutical to prevent and treat Nipah virus, a highly lethal zoonotic disease with no approved treatments or vaccines. This work received support from the DoD Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense and Uniformed Services University, as well as USAID.Tafenoquine, a single-dose therapy for relapse prevention of P. vivax malaria & long-acting injectable malaria prophylaxisThe Medicines for Malaria Venture and GSK—whose US headquarters are in Pennsylvania— developed tafenoquine, a single-dose treatment to prevent the difficult-to-treat relapses characteristic of Plasmodium vivax malaria. By replacing multi-day regimens, tafenoquine simplifies care for patients and helps malaria-endemic countries accelerate progress toward elimination. Its development received crucial support from USAID, the DoD Walter Reed Army Institute of Research, and the US Food and Drug Administration through its Priority Review Voucher Program.The Medicines for Malaria Venture, Oregon Health & Science University, and the California-based Calibr-Skaggs Institute for Innovative Medicines are co-developing a long-acting injectable malaria prophylaxis designed to provide combination protection against both Plasmodium falciparum and blood-stage P. vivax malaria. This next-generation approach aims to offer durable, simplified prevention for people in high-risk areas. The work received important support from USAID and the Department of Veterans Affairs.Injectable lenacapavir for HIV prevention Gilead Sciences, a California-based biopharmaceutical company, developed lenacapavir, a groundbreaking new HIV prevention drug requiring twice-yearly injections. In pivotal Phase 3 trials, lenacapavir demonstrated remarkable efficacy across key populations, including historically underserved groups. Developed using evidence from NIH-funded research, it offers discreet, long-acting protection, providing an alternative to daily pills or bimonthly injections and making HIV prevention more accessible and easier to sustain.  DEVICESEllavi Uterine Balloon Tamponade for postpartum hemorrhage As noted earlier, postpartum hemorrhage is the leading cause of maternal deaths worldwide. The Ellavi Uterine Balloon Tamponade is a low-cost, easy-to-use inflatable device placed inside the uterus that uses pressure to rapidly slow or stop bleeding. Designed specifically for use in low-resource settings, it offers a simple, lifesaving intervention where advanced care is not always available. The device was developed by PATH and Sinapi Biomedical, with support from USAID, the Gates Foundation, and other partners.Anne® One continuous wireless vital sign monitoring platform Life-threatening pregnancy risks can too often go undetected in areas with limited resources and health care workforce. The Anne® One continuous, wireless vital-sign monitoring platform, developed by Illinois-based Sibel Health, Inc. and supported by the Gates Foundation and the Steele Foundation for Hope in New Hampshire, helps identify complications in real time, helping improve care for both mothers and babies. The technology can also enhance monitoring and care for patients of all ages, whether at home or in hospital settings. The work received key US government support from the Small Business Innovation Research program and the NIH RADx for Maternal Health Challenge, BARDA, and the DoD Medical Technology Enterprise Consortium.Monthly dapivirine vaginal ring for HIV prevention The dapivirine vaginal ring, originally developed by the Maryland-based International Partnership for Microbicides and now advanced by the Population Council in New York, is a flexible silicone ring that users self-insert, which reduces the risk of HIV infection. The ring provides one month of protection by slowly releasing the antiretroviral drug dapivirine, offering a discreet, user-controlled prevention option. Its development received critical support from NIH, USAID, the Gates Foundation, and other international donors and partners.Microarray needle-free “button” for vaccine and drug delivery Micron Biomedical, based in Georgia, developed a microarray needle-free “button” that could one day be used for delivering vaccines and pharmaceuticals without the need for traditional injections. This innovative, pain-free solution could be self-administered, reducing barriers to vaccination and treatment. It also limits or eliminates the need for refrigerated storage, simplifies transport and storage, and produces no sharps waste, making it especially valuable for low-resource settings. This technology received US funding support from CDC and BARDA (through the New York-based Global Health Investment Corporation) and was developed in partnership with other US-based groups, including the Gates Foundation, PATH, and Emory University in Georgia.Nifty Cup Millions of babies are born each year who are unable to breastfeed because they were born prematurely or have conditions such as cleft lip or palate. In low-resource settings, commonly used feeding tools can be impractical or difficult to keep hygienic. To address this challenge, PATH partnered with Washington-based collaborators, The University of Washington School of Dentistry and Seattle Children’s Hospital, with support from USAID and Laerdal Global Health, to develop the Nifty Cup. This low-cost silicone feeding cup is durable, gentle, easy to disinfect and simple for caregivers to use—a great example of a frugal, high-impact innovation designed specifically for low-resource environments.  HEATmarker™ vaccine vial monitor Most vaccines require continuous refrigeration to remain effective, which can be a significant challenge in remote and low-resource settings worldwide. Breaks in the cold chain can lead health workers to discard perfectly good vaccines because they suspect heat damage or, worse, unknowingly administer doses that have lost potency. To solve this, PATH and New Jersey-based Temptime (later acquired by Illinois-based Zebra Technologies) developed the vaccine vial monitor, a small sticker placed on vaccine vials that changes color when exposed to too much heat, clearly indicating whether a vaccine is still safe to use, preventing waste and saving lives. This simple, low-cost innovation reduces waste, improves safety, and helps ensure lifesaving vaccines reach the people who need them. The work received crucial support from USAID.BD Uniject™ auto-disable prefillable injection system Injectable drugs and vaccines have saved countless lives, yet administering them safely in low-resource settings presents challenges—health workers require appropriate training and if reused, syringes can spread dangerous infections. With funding from USAID, PATH designed the Uniject™ system, now manufactured by New Jersey-based BD. It’s an inexpensive, pre-measured and -filled syringe that automatically disables after a single use. This technology enables health workers with minimal training to safely deliver correctly dosed injections, prevents syringe reuse, reduces product waste, and ultimately saves lives and costs.BD SoloShot™ auto-disable syringeBD and PATH also partnered on the SoloShot™ auto-disable syringe, with support from USAID, which locks after injection, also helping prevent reuse and bloodborne disease transmission. Interceptor® G2 dual-insecticide bednetAs rising insecticide resistance threatens progress against mosquito-borne diseases such as malaria, Zika, and dengue, the Interceptor® G2 dual-insecticide treated bednet represents an important evolution of one of global health’s most essential prevention tools. Developed by BASF, whose agriculture division is based in North Carolina, the Interceptor® G2 uses two insecticides to improve effectiveness against resistant mosquito populations. Its development was supported by the President’s Malaria Initiative, USAID, and CDC, as well as the Gates Foundation, the Innovative Vector Control Consortium, and other international partners.  DIAGNOSTICSLumify AI-assisted handheld ultrasoundLife-threatening risks during pregnancy can go undetected in areas with limited health care resources, leading to deaths, as well as complications for both mothers and their babies. But a portable, artificial-intelligence-powered ultrasound developed by Philips Healthcare, whose North America offices are located in Massachusetts, with support from BARDA and the Gates Foundation, is addressing this challenge head on by helping improve access to screening for pregnant mothers in low-resource settings.Determine™ Antenatal Care Panel; Determine™ HIV Early Detect, Determine™ HBsAg 2, and Determine™ Syphilis TP rapid testsIllinois-based company Abbott developed a rapid panel test capable of simultaneously detecting HIV, hepatitis B virus, and syphilis, three major infections that pose serious risks to maternal and newborn health. The combination platform, which could simplify testing for health systems and patients and improve testing coverage, builds on individual in vitro rapid tests for each virus, which were developed by Abbott and later procured and scaled with support from the US President’s Emergency Plan for AIDS Relief (PEPFAR).OraQuick™ Ebola Rapid Antigen Test, Investigational Marburg rapid antigen test, and OraQuick™ HIV Self-TestOraSure Technologies, a Pennsylvania-based diagnostics company developed the OraQuick™ Ebola Rapid Antigen Test, a point-of-care tool that enables fast, presumptive diagnosis of Ebola virus disease. By providing results in minutes, the test supports health workers in rapidly isolating patients, initiating potentially lifesaving treatment, and ensuring safe and dignified burials that reduce transmission risk. The test was developed with support from BARDA.With support from BARDA, OraSure is also advancing a similar rapid antigen test for Marburg, a related virus to Ebola that also causes sever and often fatal disease.OraSure also has an oral HIV self-test, built on the same platform as its Ebola and Marburg tests. As the first US Food and Drug Administration-approved HIV self-test, it provides discreet, rapid testing for patients at home in as little as 20 minutes. The US government has supported scale-up of this product globally through PEPFAR.Co-Dx PCR Pro™ for on-site PCR testingThe PCR Pro™ molecular diagnostic platform from Utah-based Co-Diagnostics is designed to enable health care professionals to conduct on-site PCR testing, expanding access to fast, accurate testing outside traditional laboratory settings. With test panels available for flu, COVID-19, and RSV as a multiplex test and, separately, HPV and TB, the platform—developed with support from the NIH RADx program, as well as from PATH and the Gates Foundation for specific applications—has the potential to transform decentralized testing globally.NUTRITION INNOVATIONSReady-to-use therapeutic food for the treatment of severe acute malnutrition Nearly one third of children under five worldwide suffer from malnutrition. But a ready-to-use therapeutic food Plumpy’Nut has been a game changer. Developed by scientists at Washington University in St Louis and the French Institut de Recherche pour le Développement, manufactured by Georgia-based Mana and New Hampshire-based Edesia Nutrition, and scaled up with support from USAID and now the Department of State, this essential mix of vitamins, milk, and peanut butter allows severely malnourished children to recover and stay recovered with just a few servings.  Vitamin A biofortified corn Vitamin A deficiency is the leading cause of preventable child blindness worldwide. It impairs growth and immunity, increasing the risk of severe illness from common childhood infections such as diarrhea and measles. Corn biofortified with Vitamin A, developed by the District of Columbia-based Harvest Plus program at the International Food Policy Research institute, with support from USAID’s Feed the Future program, has been a transformative innovation. When consumed regularly, it can provide up to half of daily vitamin A needs for women of reproductive age and children. Thanks to our partners the American Society for Microbiology, the American Society of Tropical Medicine and Hygiene, Research!America, the Innovative Vector Control Consortium, IAVI, Monash University, Philips, Co-Diagnostics, HarvestPlus, Micron Biomedical, BASF, the Medicines for Malaria Venture, TB Alliance, Abbott, Mana, BD, Zebra Technologies, Sibel Health, the Coalition for Epidemic Preparedness Innovations, PATH, Gilead Sciences, OraSure Technologies, and the Global Health Investment Corporation for supporting this event. 

2025 has been a whirlwind year for global health. In the United States, we've seen the integration of the US Agency for International Development (USAID) into the Department of State, transformation at the Department of Health and Human Services (HHS), and a complicated and prolonged budget process. Globally, we've seen setbacks and progress in HIV and malaria, an evolution at the World Health Organization (WHO), a multilateral win with the Pandemic Agreement adoption, and African partners stepping up to boost autonomy.As the year draws to a close, GHTC is reflecting on the innovations, policy shifts, and pivotal moments that defined 2025 and what they signal for the years to come.US global health leadership in transitionOn day one of his second term, President Donald Trump initiated an effort to realign US foreign assistance programs with the goal of making America safer, stronger, and more prosperous. This effort started with an overhaul of USAID, triggering a series of layoffs, stop-work orders that turned into award terminations, and withdrawals from multilateral partnerships, culminating in the agency’s official integration into the State Department on July 1.While this suspension and termination of USAID programs disrupted critical research projects and health services worldwide earlier this year, in September, the State Department unveiled the America First Global Health Strategy, which outlines a plan to reshape the US government’s global health programming, presenting opportunities for global health research and development (R&D).The new strategy centers multiyear bilateral agreements with countries while reducing ties with nongovernmental organizations and narrowing health focal areas. While critical questions remain on implementation—including on whether the agency still retains needed expertise and how it will coordinate with interagency technical partners like the US Centers for Disease Control and Prevention (CDC)—the strategy’s focus on integrating aid more directly into national health systems is a step forward in improving sustainability and self-reliance. The strategy also raises the exciting possibility that funds could be used to support “innovative, breakthrough technologies.”  Building on USAID’s successes and shortcomings in that space, the department has a clear opportunity to establish a centralized R&D fund—in complement to bilateral agreements—to invest in innovative tools that could leapfrog global health progress. Through collaboration with global health stakeholders and interagency partners, State could reshape US global health programs to continue to save lives; foster funding beyond US government resources, including through partner nations; and promote shared security and prosperity.Overhaul of US scientific and public health infrastructureThe United States has long been a leader in global health R&D and science more broadly, with American researchers, universities, companies, and patients benefiting. In 2025, sweeping changes at HHS reshaped America’s public health and research infrastructure. These far-reaching reforms aimed to advance administration priorities of promoting “gold standard science,” improving efficiency, transparency, and oversight and realigning investments to match administration objectives. At the National Institutes of Health (NIH) and CDC, these changes have included significant staff departures, among them seasoned leaders, and the appointment of many officials who were previously critics of these agencies. It has also included new policies to overhaul oversight of foreign awards and cap indirect costs, changes to longstanding vaccine guidance, and the terminations of numerous awards, including a wind-down of mRNA vaccine development activities. The speed and scale of these changes have raised concerns across the biomedical research and public health communities. While thoughtful reforms could yield benefits, experts warn that current actions risk driving US scientists abroad, disrupting promising clinical trials, weakening the pipeline of new tools, eroding trust in public health guidance, and weakening the structures that have sustained US scientific leadership. US budget swings and shutdowns2025 began with a race to fund the government, with President Trump signing the fiscal year 2025 budget into law in mid-March. While the budget maintained global health R&D-relevant funding lines at prior levels, it funded a government that now looked significantly different after sweeping layoffs and restructuring. Months later, the administration issued its budget request, proposing significant cuts and a restructuring of global health and research programs, reflecting far-reaching changes it had already begun to enact.In June, the administration proposed a request to rescind billions in funding for foreign aid. Though Senators stepped in to remove cuts to global programs for HIV/AIDS and several other health areas, the package ultimately became law, cancelling $500 million in previously appropriated global health funds and raising the possibility that this administration will continue to use rescissions as a tool to withdraw funding.  By late summer, Senate and House appropriators advanced interim funding bills that included higher-than-expected funding for global health and medical research, maintaining funding proposed for elimination by the administration. But then stalled negotiations triggered the longest-ever government shutdown, during which the administration implemented unprecedented furloughs and layoffs that affected critical staff at public health and health research agencies.While the shutdown ended on November 12, pushing the funding fight until January, and most associated layoffs were reversed, uncertainty about future funding for global health R&D persists, especially with a deeply divided Congress and the potential of further recissions.A year of setbacks and breakthroughs in HIV and malaria effortsGlobal HIV/AIDS and malaria efforts faced major setbacks in 2025 as declining US and international donor support has threatened decades of hard-fought progress. Funding cuts could lead to millions of additional HIV and malaria cases in the coming years and has already stalled promising research advancing new HIV and malaria tools.Amid these challenges, the June approval by the US Food and Drug Administration of lenacapavir, a twice-yearly injectable drug for HIV prevention, marked a major milestone and a reminder of the incredible progress possible through strong support for research. Developed by Gilead and supported by NIH-backed research, the drug offers an alternative to daily pills or bi-monthly injections, making prevention more accessible and easier to maintain. Global partners are stepping up to expand access, and Phase 3 trials of a once-yearly version are planned.In November, Medicines for Malaria Venture and Novartis shared Phase 3 trial results for GanLum, a new drug found to be highly effective at treating malaria, including drug-resistant cases, and capable of blocking disease transmission. Pending approval, it could help counter rising resistance to current treatments.Other notable R&D advances in 2025 also targeted the growing threat of antimicrobial resistance, including a Phase 3 trial for a novel antibiotic targeting a dangerous antibiotic-resistant pathogen, support for what could be the first-ever vaccine for Escherichia coli, and efforts to harness artificial intelligence to transform antibiotic discovery. These breakthroughs underscore the importance of sustained R&D investment and the efforts to ensure new tools reach those who need them.WHO restructures amid budget shortfallFacing a severe budget crisis and pressure from member states to reprioritize programs, WHO launched a sweeping overhaul in 2025, cutting staff, slashing its budget, and reorganizing core functions. At its February Executive Board meeting, member states approved a $1.1 billion budget reduction, leaving a remaining $1.7 billion shortfall for 2026 and 2027, despite a recent increase to membership dues and appeals for voluntary contributions.In late April, WHO announced a plan to halve its senior leadership team and consolidate departments. Infectious disease and climate and health programs remain relatively well-resourced, and merging several disease-specific initiatives into a new division could strengthen certain programs. However, neglected tropical diseases and health emergency preparedness and response programs face sharp cuts, while reductions in regional and in-house expert posts may weaken global lab and surveillance networks and delay critical guidance, raising concerns about WHO’s outbreak response capacity.One core R&D function spared from the worst cuts was WHO’s prequalification (PQ) program, which evaluates medical products to support regulatory approval and rollout in countries with less advanced regulatory authorities. The program has marked some important achievements this year, launching a new portal to improve transparency for developers, introducing a new streamlined review and guidance process for TB diagnostics, and prequalifying lenacapavir for HIV prevention through a compressed process completed in just 36 days. As WHO and the broader United Nations system grapple with financial strain and diminished donor support, questions remain about the capacity to deliver on their mandate. A major outbreak could test the limits of this leaner system.Pandemic Agreement provides hope in challenging year for multilateralismAt the World Health Assembly in May, delegates adopted the Pandemic Agreement, a milestone win for global health after three years of complex negotiations. However, consensus on a pathogen and access-benefit sharing system was not reached, requiring member states to return to the negotiating table to finalize an annex for adoption at next year’s assembly. Persistent disputes over the voluntary or legally binding nature of participation signal tough negotiations ahead.While the Pandemic Agreement is a huge win, pushback from key countries and declining pandemic preparedness investments raise concerns about global readiness. Annex negotiations and the 2026 United Nations High-Level Meeting on Pandemic Prevention, Preparedness, and Response will further test international unity on this crucial topic.Meanwhile, 2026 brought notable R&D advances to strengthen our defenses against pandemic threats. The Coalition for Epidemic Preparedness Innovations launched the first-ever adjuvant library of 25 immune-boosting substances to improve vaccine effectiveness and awarded $17.3 million for Phase 2 trials of a promising Nipah vaccine, among the first candidates targeting the priority virus to reach this critical stage. IAVI’s vaccine candidate for Lassa virus, another virus with pandemic potential, was also found to be safe and effective in a first-in-human Phase 1 trial, marking further R&D progress against concerning disease threats.Partners step up to fill gaps and boost autonomyAmid steep foreign aid funding losses, African nations are accelerating efforts to boost manufacturing and laboratory capacity on the continent and reduce reliance on external partners. At October’s Conference on Public Health in Africa in Durban, South Africa, thousands of participants endorsed The Durban Promise, a roadmap for Africa’s health sovereignty, urging action on manufacturing, financing, workforce and capacity development, and regulatory strengthening, a signal of growing continental unity.This momentum was echoed by the Accra Reset, led by Ghanaian President John Mahama, to forge further progress toward greater sovereignty and more equitable global cooperation. At the continental level, the Africa Centres for Disease Control and Prevention launched a new biomanufacturing fellowship to help meet the goal of producing 60 percent of Africa’s vaccine dose needs locally by 2040.South Africa held the G20 presidency this year, culminating in the first G20 summit held on African soil and a declaration focused on priorities for Africa and the Global South. The summit was punctuated by the absence of the United States, underscoring the imperative for greater African autonomy as international aid declines and health threats rise. With the United States assuming the G20 presidency next year, its priorities will be closely watched. Looking ahead to 2026If 2025 has taught us anything, it’s that global health is unpredictable and constantly evolving, so we won’t speculate on exactly what 2026 may bring. But a truth remains clear: global health R&D is a strong investment that pays off—saving lives, strengthening economies, and fueling scientific progress. As the United States redefines its approach and role in the broader global health ecosystem, it remains to be seen how it, and others, will step up to ensure that promising technologies in the pipeline are advanced to improve lives around the world.For other fascinating global health news delivered to your inbox weekly and to stay abreast of developments in 2026 and beyond, sign up now to receive GHTC’s R&D News Roundup newsletter.

On Thursday, Senate appropriators advanced out of committee a fiscal year (FY) 2026 spending bill for the Department of Health and Human Services (HHS) that rejects billions in health spending cuts proposed by the Trump Administration and protects programs vital to global health innovation.The bill increases or flat-funds global health research-relevant agencies, including the National Institutes of Health (NIH) and Biomedical Advanced Research and Development Authority (BARDA), and slightly reduces funding for the US Centers for Disease Control and Prevention (CDC) compared to FY25 enacted—an outcome that is in stark contrast to the President’s Budget Request (PBR), which proposed deep cuts across all three. Funding at this level will enable these agencies to continue to advance medical breakthroughs and operate programs that deliver better health outcomes for people around the world and fortify our defenses against disease threats.Funding highlightsThe legislation allocates $48.7 billion in funding for NIH, which is a $400 million (.8 percent) increase compared to FY25 enacted and nearly $22.2 billion (77 percent) above the PBR, and $1.015 billion for BARDA, which represents level funding from FY25 but $361 million (55 percent) more than the White House request. While the legislation unfortunately cuts funding for CDC by $72 million, or 1 percent, this allocation is $4.8 billion or 112 percent greater than the President’s request.While advocates expected the Senate to reject the steep cuts proposed by the Trump Administration, many still anticipated significant reductions. It is therefore both welcome and surprising that Senate appropriators advanced a spending package that maintains strong funding for many programs the President aimed to slash or eliminate.Beyond topline funding for agencies, the bill and accompanying report also diverge from the PBR in other crucial ways. While the President proposed eliminating the CDC Global Health Center (GHC), this spending bill keeps the center intact, maintaining level funding from FY25. The bill also maintains flat funding for the NIH Fogarty International Center—which supports global health research partnerships and training—and provides a 0.5 percent increase to the NIH’s National Institute of Allergy and Infectious Diseases (NIAID). This stands in sharp contrast to the White House’s proposal to eliminate Fogarty entirely and cut NIAID’s budget by 58 percent. Additionally, it provides level funding to the Advanced Research Projects Agency for Health (ARPA-H), a new agency established under the Biden Administration to support high-risk, high-potential health research, rejecting the President’s proposal to reduce its funding by $555 million.Beyond  funding numbers, the bill’s accompanying report includes welcome directives affirming the Senate’s support for research activities critical to global health, including across health areas like neglected tropical diseases, malaria, tuberculosis, emerging infectious diseases, antimicrobial resistance (AMR), and more, and underscores the importance of international health research partnerships and training programs supported by the Fogarty International Center and global health activities undertaken by CDC GHC and NCEZID.  Taken together, the funding and directives can be viewed as a strong rebuke of the president’s efforts to downsize and dismantle US global health efforts and a strong affirmation of the Senate’s support for programs that save and improve lives around the world and protect Americans from disease threats. The report also dictates stricter reporting requirements to Congress for HHS, indicating bipartisan concern by lawmakers as to whether the agency is dispersing funding as directed and making scientifically-drive decisions.The report also conveys Senate appropriators’ desire to see BARDA devote robust funding to developing countermeasures against emerging infectious diseases, AMR, and pandemic influenza, and directs BARDA to spend no less than $10 million on advancing countermeasures against “Disease X,” which is a term to denote priority viral pathogens that could cause the next pandemic. Despite an overall positive picture, the bill does include some decreases to subaccounts relevant to global health, including an 80 percent cut to  the CDC-wide Infectious Disease Rapid Response Fund, which was a fund originally created to provide flexible funds for the agency to rapidly respond to pandemic and epidemic threats. See the chart below for a more detailed comparison of funding in the Senate bill and percent changes compared to FY25 enacted and the PBR.What comes nextThe bill’s passage out of committee is just an initial step in a lengthy political process. It will next go to the full Senate for a vote, the House of Representatives will need to advance its parallel bill, and then the two bills will need to be conferenced to work out their differences before going back to both chambers for a vote and then to the President for signature.It is anticipated that the House will propose lower spending levels for health programs than the Senate, so these numbers are a likely high watermark where negotiations begin between the two chambers. Nonetheless, if one reads the House’s spending bill on global health as a tea leaf of what’s to come, it’s unlikely the House will cut as deep as the President wishes , so if the two chambers can reach a compromise and pass a budget, we could see funding levels land somewhere below the Senate but still substantially above the PBR. In the House bill, we are likely to see stronger relative numbers for NIH over CDC, given heightened criticism for the latter agency among Republican lawmakers.For many advocates, this bill is welcome news that Congress is reasserting its power of the purse in opposition to the president, yet significant concerns remain. Will the two chambers actually reach a promising compromise? And even if Congress appropriates strong funding for FY26, given all the recent moves by the Administration to rescind, halt, or slow the disbursement of federal spending, will this money actually reach researchers and health implementers to deliver impact? While we can’t predict for certain, GHTC and other advocates will continue to keep a close watch on what’s to come and activate where we can in order to protect vital funding for global health and medical research.