Breakthroughs Blog: US budget

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.

Over the past century, partnerships between the US government and scientists have led to major breakthroughs in global health research and development (R&D). Consistent US government funding, combined with the nation’s strong research universities and entrepreneurial spirit, has positioned America as a world leader. This investment has paid off in both health and economic gains. However, that foundation has recently weakened, as US government actions have sharply reduced research spending and limited global health research collaborations. These changes risk driving US researchers abroad and eroding the very strengths that made the United States such a scientific powerhouse. The result could be fewer breakthroughs, fewer economic benefits, and a costly brain drain for our nation. How we got here America’s global health research leadership is built on the backbone of decades of government investment by agencies like the National Institutes of Health (NIH), the Biomedical Advanced Research and Development Authority (BARDA), the Centers for Disease Control and Prevention, and the US Agency for International Development (USAID). This support built a top-tier talent pool at home and drew innovators from abroad—giving the United States a strong competitive advantage. That advantage is now in jeopardy. Recent policy and budget decisions have led to the termination of thousands of NIH grants, the wind-down of BARDA’s mRNA vaccine work, the closure of USAID and near-total cancellation of its health R&D awards, and the loss of more than 20,000 jobs at the Department of Health and Human Services. More cuts and restructuring are proposed.New federal rules are also disrupting universities—the backbone of US biomedical research. To stay eligible for federal funding, institutions must meet shifting requirements, adding costs and uncertainty. At the same time, new NIH policies have restricted international partnerships and broadly limited "dangerous gain-of-function research,” including studies that leading experts consider to be safe. Research on infectious diseases like tuberculosis has been disrupted as a result.  Funding for training young scientists is also falling. NIH’s main program for supporting early-career researchers saw its grant spending drop from $2.2 billion in 2024 to $1.7 billion in 2025. Without reliable support, many students and junior researchers may take their talents abroad—or abandon their field altogether. The international response In the wake of these changes, other countries are moving quickly to recruit US researchers.  In May, the European Union pledged $567 million over three years to “make Europe a magnet for researchers.” Similarly, the Netherlands launched a new fund to attract top international scientists, and Norway unveiled a £7.2 million program to recruit researchers. The head of Norway’s Research Council pointed to the pressure US researchers are facing on academic freedom as part of its rationale.  Individual universities are also joining in. Aix-Marseille University in France launched its Safe Place for Science program to attract US scientists who may “feel threatened or hindered in their research.” The Free University Brussels created a dedicated point of contact for US researchers interesting in continuing their work in Belgium. The message from abroad is clear: America’s loss can be their gain. So what?As the US retreats, the center of gravity for biomedical research may shift overseas. Data from Nature’s jobs board shows that in the first few months of the current administration, US job-seekers applying abroad rose sharply: 41 percent more to Canada, 32 percent to Europe, 20 percent to China, and 39 percent to other Asian countries compared to the same period in 2024.  Early-career researchers are being hit hardest. At the most innovative and impactful stage of their careers, opportunities are disappearing. Many have been left jobless or unsure if they have a future in their field. The US economy is also at stake. In 2024, NIH-funded research supported more than 400,000 jobs across all 50 states and generated $94.60 billion in economic activity—a return of $2.56 for every dollar spent. Reductions in US spending could shift those economic benefits to other countries. And since no other nation has the resources to fully replace the US’s historic role, we could see fewer medical breakthroughs for the world overall. Without strong and predictable federal research support, the United States risks losing its place as a top engine of global biomedical progress. Young researchers see more uncertainty than opportunity, and other nations are investing heavily to take the lead, accelerating a US brain drain. If US policymakers do not act to restore the foundational factors that rooted American scientific leadership, the future of science may unfold elsewhere—and the next generation of discoveries may not be American-led.  

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. 

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.