Breakthroughs Blog

In a surprising move, House appropriators advanced out of committee yesterday a fiscal year 2026 funding bill that codifies the closure of the US Agency for International Development (USAID) and cuts global health spending—yet delivers nearly $6 billion more than the White House requested, putting Congress on a collision course with the administration’s global health agenda.  Funding highlightsThe bill, covering National Security, State, and Related Programs, allocates $9.5 billion in funding for global health activities at the Department of State. This includes $5.9 billion for programs historically housed at State and $3.6 billion for programs formerly housed at USAID that have been absorbed into State following the administration’s official closure of the agency on July 1.This development is a glass-half-full or glass-half-empty outcome, depending on how advocates choose to view it. While this funding represents a $511.7 million (5 percent) cut to global health programs overall compared to fiscal year 2025 (FY25) enacted levels, it is also $5.7 billion above what was proposed in the President’s Budget Request, which would have represented a massive 62 percent cut.Many political observers had anticipated that the House would put forward a bill closely aligned with the President’s request, so it is both surprising and welcome news that House appropriators have advanced legislation maintaining substantial funding across many programmatic areas the administration has sought to drastically cut or eliminate. Beyond topline funding, the bill and accompanying report also diverge from the president’s proposal in other key ways. While the administration proposed eliminating funding for family planning and reproductive health, neglected tropical diseases, vulnerable children, nutrition, maternal and child health activities (except polio), and certain HIV/AIDS activities (formerly at USAID) and announced it would stop financial contributions to Gavi, the Vaccine Alliance, the House bill retains funding across each of these aforementioned areas.  Additionally, the bill and report include welcome language affirming that House appropriators believe—in agreement with advocates—that investments in global health make America safer, stronger, and more prosperous. They also included language advocated for by GHTC, allowing appropriated funds to be used to support research and noting that the committee “supports investments in research, development, and introduction of innovative technologies” for global health, alongside other language supportive of research and innovation for specific health areas. The report also directs that global health security funding be made available to support the Coalition for Epidemic Preparedness Innovations, an international vaccine development partnership, consistent with prior fiscal year levels, which was $100 million. It is positive to see the House send a clear and unequivocal message to the administration that investments in research and development (R&D) are essential to delivering on the United States’ global health goals, given that the vast majority of global health awards financing R&D were terminated earlier this year, following the administration’s foreign assistance review.“Investments in global health programming are a fundamental pillar of America’s national security agenda. It makes America safer by supporting early detection and protection from dangerous outbreaks…and improving health infrastructure to bolster prevention, preparedness, and response….It makes American stronger and more prosperous by strengthening global economic stability…and unleashes American ingenuity in creating medicines, treatment, technology…and more.” – House FY26 National Security, State, and Related Programs billConcerning cuts The cuts in the bill from FY25 enacted funding levels are spread across several initiatives and health areas, including reductions to the President’s Emergency Plan for AIDS Relief (PEPFAR); the Global Fund to Fight AIDS, Tuberculosis and Malaria; family planning and reproductive health; and topline funding for former USAID global health programs, which could potentially trickle down to cuts to global health security programming, given specific funding levels for this area were not specified in the bill or report. See the chart below for a more detailed comparison of funding lines in the House bill and percent changes compared to FY25 enacted and the President’s Budget Request. Program House FY26 bill ($ million) FY26 House vs FY25 enacted (%) FY26 House vs PBR (%) Global Health Programs, all $9,518 -5% +151% State Global Health Programs $5,895 -2% +55% PEPFAR $4,395 0% +51%  Global Fund $1,500 -9% Undefined* Former USAID Global Health Programs, now State $3,623 -9% Eliminated in PBR Maternal & Child Health $915 0% +976% of which Gavi $300 0% Eliminated in PBR Nutrition $172.5 +5% Eliminated in PBR HIV/AIDS† $330 0% Eliminated in PBR Vulnerable Children $32.5 +3% Eliminated in PBR Tuberculosis $394.5 0% +122% Malaria $800 +1% +89% Neglected Tropical Diseases $114.5 0% Eliminated in PBR Global Health Security‡ Undefined N/A N/A Family planning and reproductive health, across Up to $461 -24% Eliminated in PBR UNFPA§ $0 -100% Eliminated in PBR  *The PBR did not specify funding for the Global Fund but specified that a contribution could be made using Global Health Program funds. †  HIV/AIDS formerly at USAID are transferred to PEPFAR, adding to the PEPFAR amount reported in this table. ‡ Funded at $700 million in FY25 and funded at $200 million in PBR but not specified in House FY26 bill.  § Funded at $32.5 million in FY25 but eliminated in House bill and PBR.  These concerning proposed cuts could threaten decades of progress in advancing better health for families around the world and weaken America’s defenses against global disease threats. The bill also includes policy riders that prohibit funding for vital global actors, including the United Nations Population Fund and the World Health Organization, the latter in alignment with the administration’s executive order withdrawing from the organization. The bill also reaffirms the expanded “Protecting Life in Global Health Assistance” or “Mexico City Policy” restrictions, as well as forbids funding to organizations that provide transgender medical services, to any laboratories owned or controlled by adversary nations including China, or to support gain-of-function research, the last of which is written broadly enough to implicate both potentially dangerous research on pandemic risks as well as far lower-risk studies on infectious diseases. While the more favorable-than-expected House funding numbers represent a relatively positive development, in the context of USAID’s closure, mass grant terminations, and recent large-scale reductions in staffing at State, the bill also raises concerns about whether the State Department has the technical expertise or operational capacity to manage the former USAID portfolio effectively. It could also tee up a constitutional showdown in the courts if the administration ultimately chooses not to dispense funding as directed by congressional lawmakers or could spur further administration-driven efforts to claw back funding through recissions. What comes next The bill also represents just the first step in a long political process ahead. It will next go to the full House for a vote, then the Senate will advance its parallel bill, and then the two bills will need to be conferenced to work out differences before being re-voted on by both chambers and sent to President Donald Trump’s desk for signature. With its higher-than-expected funding relative to the White House’s request, the House bill provides a better starting place for these bicameral negotiations than many advocates anticipated we’d see this summer. Historically, the Senate has proposed higher funding levels for global health than the House and rejected many of the lower chamber’s more controversial political policy riders, so if the two chambers are able to reach a compromise and pass a bill, we could hopefully see funding levels increase to even closer to FY25 enacted levels, with some riders removed.  For many advocates and political observers, this bill and report represent a confusing split screen—the same Republican lawmakers who just recently voted to rescind millions in global health funds are now advancing relatively healthy funding for the same priorities. Does this indicate a change of heart? A divide between the beliefs of appropriators and other members of Congress? If such a bill advances, will the administration follow congressional directives, and will those same members push back if it doesn’t? Only time and the persistent work of advocates will tell.

We have seen tremendous strides toward gender equity and improved women’s health around the world, enabled through innovative technologies that empower and lift up women—but there’s still tremendous work to be done.   African women face a disproportionately high risk of dying from communicable diseases like HIV, tuberculosis, and malaria that are endemic in Africa, as well as a higher risk of pregnancy and birth complications than women outside the continent. At the same time, women are also the backbone of the health workforce in Africa, playing a vital role in supporting the health and wellbeing of their families and communities.  Yet, despite their unique understanding of the health challenges and needs of African women and communities, women in Africa are massively underrepresented in the field of research. Only 31 percent of professional researchers in sub-Saharan Africa are women, mirroring the 33.3 percent of researchers that are women globally. Moreover, women researchers have a harder time getting funding and support for their work.This gender gap has profound consequences—it contributes to gaps in our understanding of women’s health issues and in our arsenal of tools to treat women. For example, pregnant women and other women of childbearing age have long been excluded from clinical trials, leading to insufficient or unsafe options for these populations for a variety of diseases and health areas.To celebrate the achievements of African women, we’re spotlighting six African women researchers who have made significant contributions to global health research and supported the next generation of African researchers, including women.Dr. Damaris Matoke-Muhia Dr. Damaris Matoke-Muhia is a Kenyan molecular biologist who is leading the fight against malaria and other vector-borne diseases in Africa. She currently serves as Entomology Division Head at the Kenya Medical Research Institute, as well as a Kofi Annan Global Health Leader Fellow at the Africa Centres for Disease Control and Prevention.Dr. Matoke-Muhia has studied the behavior of mosquitoes for more than a decade, investigating why we’ve seen changes like shifts in biting habits, the emergence of a malaria vector previously endemic to Asia in Africa, and increasing resistance to insecticides, which have made these vectors harder to control, as well as researching new techniques to improve vector control. Through her work with the Pan-African Mosquito Control Association, Dr. Matoke-Muhia has also helped train other African women to become experts and leaders in vector control. She uniquely understands the need for women, who are often the ones implementing tools like bed nets to protect their families and communities, to be at the forefront of research and control efforts: “It is important that we ensure equal representation, as far as leadership, because women speak from experience and from what has worked and not worked at community levels. Women should always be at the forefront at leadership levels, which is key to elimination of malaria on the continent.”Dr. Monique Wasunna Dr. Monique Wasunna, a Ugandan-born doctor and researcher, has for decades been at the frontlines of African research into neglected tropical diseases. She worked for many years at the Kenya Medical Research Institute and currently serves as Africa Ambassador of the Drugs for Neglected Diseases initiative (DNDi), an organization she joined at its conception in 2003. In her current role, Dr. Wasunna engages African policy leaders and stakeholders to support research and development (R&D) collaborations that deliver new treatments for neglected disease. Throughout her career, Dr. Wasunna has led numerous clinical trials to find better treatment options for neglected diseases. At DNDi, her work helped the organization advance several groundbreaking new treatments for neglected tropical diseases, including an improved, affordable therapy for leishmaniasis and an all-oral cure for sleeping sickness, which replaced a toxic treatment that was the only previously available option.Dr. Wasunna is also a founding member of the Leishmaniasis East Africa Platform, which promotes clinical research and research capacity-building for leishmaniasis in the East Africa region. The platform has supported clinical trials that resulted in improved treatments for visceral leishmaniasis; trained hundreds of people in clinical care, research, and data management; and upgraded laboratories and hospitals across the region, enabling African researchers and research institutions to lead efforts to address neglected tropical diseases, like leishmaniasis, which are high concentrated on the continent.As she says in a piece cowritten by Dr. Wasunna and Dr. Matoke-Muhia, “African women scientists have already proven that they can lead inclusive, groundbreaking research and shape global health solutions. But we cannot wait another five generations for gender parity.”Dr. Delese Mimi DarkoDr. Delese Mimi Darko is a Ghanaian pharmacist who transformed her country’s regulatory and clinical trial ecosystem as head of Ghana’s regulatory agency and will now apply her expertise to the entire continent as she becomes the first-ever Director General of the African Medicines Agency, a recently established initiative to boost Africa’s regulatory capacity and ensure the safety and quality of medical products.As Chief Executive Officer of Ghana’s Food and Drug Administration and in previous roles during her multiple decades working at the agency, Dr. Darko helped establish a strong, stable, and integrated national regulatory system, which has achieved the World Health Organization’s highest maturity level designation. She also pioneered clinical trial regulation in the country, helping make the country a clinical trial leader in the West African region. Dr. Darko has taken on various advisory roles throughout her career, furthering partnerships and initiatives that support R&D and regulatory harmonization across the continent.In addition to helping transform the research and regulatory ecosystem of her country and now the broader African continent, paving the way for the next generation of African innovators, Dr. Darko has also highlighted the need for more female leaders: “Women [are] generally more altruistic and are therefore able to better consider other opinions and views. This makes us better team players and better leaders who, as a consequence, are able to take bold decisions based on wider consideration.”Dr. Quarraisha Abdool KarimDr. Quarraisha Abdool Karim is a South African infectious disease epidemiologist who for decades has been a global pioneer in HIV/AIDS research, leading research that has shaped the global HIV prevention landscape, particularly focusing on technologies for women. In 2001, Dr. Abdool Karim and her husband, also a world-class HIV/AIDS researcher, brought together a group of top HIV researchers to form the Center for the AIDS Program of Research in South Africa, which is today one of most influential HIV/AIDS research programs in the world.Dr. Abdool Karim’s work demonstrating that antiretrovirals previously only used to treat HIV/AIDS could also be used to prevent sexually transmitted HIV laid the foundation for the HIV prevention approach, pre-exposure prophylaxis, that is widely used today.Dr. Abdool Karim and her center’s work also led to the development of broadly neutralizing antibodies, antibodies that can neutralize a wide range of HIV variants, after discovering that one of the center’s study participants produced unique antibodies that not only attacked the strain of HIV she had but also targeted a broad swath of the HIV strains circulating globally. The isolation and recreation of these antibodies in a lab was a game changer—many of the most promising HIV cure strategies in development use them.Dr. Abdool Karim has spoken about the unique potential of researchers from backgrounds underrepresented in science to tackle those often-ignored areas of health and scientific query, saying, “these were very much our problems in Africa that few others were working on…and if we waited for solutions from elsewhere, it wasn’t going to come. We had to take the lead.”Professor Faith Osier  Professor Faith Osier is a Kenyan malaria researcher and professor who currently serves as Chair in Malaria Immunology and Vaccinology at Imperial College London and President of the International Union of Immunological Societies, the first African and only second women to hold the role. Professor Osier has dedicated her career to studying the immune response to the malaria parasite, particularly looking at what parts of the response can help protect against infection, information that is key to designing more effective malaria vaccines.  Professor Osier helped develop a custom tool, the first of its kind in Africa, which includes more than 100 parasite proteins that are potential targets of antibody responses. The tool helps researchers quickly test which proteins are triggered in strong immune responses using blood samples from malaria patients, giving researchers a clue into what proteins they should target in future vaccines.Professor Osier also built an international network of partners to share samples and epidemiological data on malaria parasites across Africa, which now spans 12 sites across seven sub-Saharan African countries. The network has assembled a dataset of 10,000 samples, each of which has been systematically analyzed, helping develop a map of parasite diversity across the region. The network has also helped develop malaria research capacity in Africa, providing training opportunities for students and early-career researchers. Professor Osier has spoken about her strong belief in the need to build African research capacity, “I think there has been a massive change in awareness or great momentum to support scientists in developing countries so that they can work on the problems that are facing their own countries, and I think it’s very important.”Dr. Francine NtoumiDr. Francine Ntoumi is an award-winning Congolese molecular biologist who founded and currently serves as President and Executive Director of the Congolese Foundation for Medical Research in the Republic of Congo, as well as Professor of Molecular Epidemiology of Infectious Diseases at the Institute of Tropical Medicine at the University of Tübingen, Germany.While Dr. Ntoumi’s own research has focused on malaria, tuberculosis, and COVID-19, she has also been a leading advocate of boosting African health research capacity and specifically supporting African women researchers throughout her career, as the first African leader of the Multilateral Initiative on Malaria and through her leadership at the  Central African Network on Tuberculosis, HIV/AIDS and Malaria, which works regionally to boost research capacity. “It might be difficult to convince Congolese girls they could be the next Marie Curie, but easier to convince them they can be me!” she said. “We have to banish this idea that only men can have ambition. If you are female and have scientific ability, you need to stand up.”These incredible female scientists and many others have contributed to considerable strides in research into the biggest health challenges facing the African continent and helped elevate African researchers, particularly women researchers, paving the way for a healthier, more scientifically engaged future for Africa and African women. Photo credits from top to bottom: Kenya Medical Research Institute, Drugs for Neglected Diseases initiative, Ghana Food and Drugs Authority, CAPRISA, Imperial College London, Congolese Foundation for Medical Research

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. LPIXEL, the University of Dundee, and Medicines for Malaria Venture (MMV) are partnering, with financial support from the Global Health Innovative Technology Fund, to develop a platform that uses advanced image analysis and machine learning to accelerate the discovery of novel antimalarials. Specifically, the platform will use images of stained parasite cells to better understand a compound's biological impact on the malaria parasite, providing key insights into its mode of action, a process that is usually months-long. As the emergence of parasite resistance to antimalarials poses a new threat to malaria control and elimination efforts, this new platform could help pave the way for new and effective therapies. MMV will also make the platform open access, enabling researchers around the world to use the technology to improve drug discovery efforts across a range of diseases. Results from a multi-country Phase 3 clinical trial published last week found that a shorter all-oral drug regimen was effective in some patients with pre-extensively drug-resistant tuberculosis (TB) but with mixed results. The trial tested the efficacy of 6- and 9-month regimens compared to the World Health Organization-recommended 18-month regimen, finding that while the shorter regimens had a high success rate, they did not meet the criteria to be considered at least as effective as the standard, in part because patients with extensive disease did not respond as well as those with limited disease. The trial provides important insights to guide future research into shorter drug regimens for those with drug-resistant TB. A team of researchers from Austria and Ghana recently published the results of a study testing a new pathogen detection test, finding that it was highly effective and suitable for low-resource settings. The test demonstrated high sensitivity and specificity, maintained its efficacy while being transported long distances at room temperature, and is extremely affordable. The researchers have made the test protocol open source, allowing it to be used to address critical unmet needs in low- and middle-income countries and other low-resource settings—it is already been used to develop an HIV test and a test for influenza and the virus that causes COVID-19. This research effort stemmed from challenges with implementing large-scale testing during the COVID-19 pandemic. 

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. On Friday, IAVI announced a €1 million investment from the Dutch government to further clinical evaluation of the organization’s investigational vaccine candidate for Sudan virus disease, a severe disease with potentially long-term health consequences, for which there are no vaccines or specific treatments. It is important to continue advancing the vaccine’s development in between outbreaks, coordinating with partners to generate key data, accelerate and improve manufacturing for the later stages of development and production, and ensure that a trial can begin promptly following the identification of a new outbreak. IAVI’s vaccine was tested in a trial during Uganda’s Sudan virus outbreak earlier this year and previously demonstrated promising results in animal models and a Phase 1 clinical trial in the United States.Researchers at the University of Texas and Moderna recently announced that in a preclinical trial in rodents, their mRNA vaccine candidate provided full protection against Marburg disease, a deadly disease closely related to Ebola, for which there are currently no licensed vaccines or treatments. Marburg has caused several outbreaks in sub-Saharan Africa, including one in Tanzania earlier this year, and the frequency of outbreaks has increased in recent years, as behavioral shifts offer more opportunities for the virus to spill over from fruit bats to humans. If the vaccine proves successful in future human trials, it could help play a key role in curbing the spread of future outbreaks.Last week, Novartis announced that the first malaria treatment for babies and small children who weigh less than 10 pounds has been approved by Swiss authorities, offering a new tool in the fight against malaria, particularly to help reduce the high rate of malaria deaths in young children in sub-Saharan Africa. Coartem Baby, developed by Novartis and the Medicines for Malaria Venture, offers significant improvement over the previous option of treating these babies and young children with versions of malaria drugs formulated for older children, which raises the risk of toxicity and overdose. Novartis plans to introduce the drug on a largely not-for-profit basis, and it could be rolled out in African countries within weeks, with the eight countries that participated in clinical trials of the drug expected to be among the first to receive it.