Policy Updates

On November 25, 2025, the US State Department approved a grant of up to US$150 million over three years to Zipline International Inc., an American robotics and autonomous drone delivery company, to expand healthcare operations in Rwanda, Ghana, Nigeria, Kenya, and Côte d'Ivoire, potentially reaching 15,000 health facilities and providing 100 million people with access to blood and medications.

The grant marked one of the first major US global health funding announcements since the Trump administration's foreign assistance freeze, dismantling of USAID, and release of its 'America First' global health strategy. US Undersecretary of State for Foreign Assistance, Humanitarian Affairs, and Religious Freedom Jeremy Lewin characterized the partnership as an example of innovative, results-driven partnership at the core of the America First foreign assistance agenda.

The funding was structured on a pay-for-performance basis, with initial payments unlocked when participating governments signed contracts committing to pay for ongoing logistics services. The five governments committed to pay up to US$400 million in utilization fees. Rwanda, where Zipline began operations in 2016, is expected to be the first to sign.

On November 21, 2025, the US pledged US$4.6 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria for 2026-2029 at the 8^th Replenishment pledging event in Johannesburg, South Africa.

The Global Fund reached US$11.3 billion of its US$18 billion target, with the US maintaining its matching pledge ratio requiring the Global Fund to secure US$2 from other donors for every US$1 contributed.

The pledge represented a modest decline from the US$6 billion the US committed in the previous funding cycle. Undersecretary of State for Foreign Assistance, Humanitarian Affairs and Religious Freedom Jeremy Lewin announced the pledge in a video message, noting the reduction was to account for needed reforms and efficiencies. Lewin praised Executive Director Peter Sands' leadership and the organization's track record, stating the Global Fund would play a role in America's new vision for global health engagement.

The pledge came amid uncertainty about whether the US would contribute at all, following the Trump administration's dismantling of the country's foreign assistance infrastructure and withdrawal from many multilateral commitments.

On November 21, 2025The Global Fund held its Eighth Replenishment Summit, in Johannesburg, South Africa, co-hosted by the governments of South Africa and the UK on the margins of the G20 Leaders' Summit, securing US$11.3 billion in pledges to sustain the fight against AIDS, tuberculosis, and malaria.

Partners from more than 30 countries pledged support to save lives and strengthen systems for health, marking the first replenishment held on African soil. The summit demonstrated global solidarity despite fiscal tightening, conflict, and global uncertainty, though total pledges fell short of the ambitious target set in the Investment Case and several donors had yet to confirm their pledges.

The US, the Global Fund's largest donor, committed US$4.6 billion. The UK pledged GBP850 million (US$1.1 billion), while Germany confirmed EUR1 billion (US$1.2 billion) and Canada pledged CAD1.02 billion (US$723 million). France noted that its support remained unchanged. Spain increased its pledge to EUR145 million (US$167 million), Italy pledged EUR150 million (US$173 million), the Netherlands contributed EUR146 million (US$169 million), and additional pledges came from many other donors. South Africa committed US$37 million, including US$10 million from the private sector. African countries made solidarity commitments totaling US$52 million. G20 member states reached US$9 billion in commitments.

Within the private sector, the Gates Foundation pledged US$912 million, the Children's Investment Fund Foundation pledged US$135 million, and (RED) committed US$75 million. Overall, private sector support reached US$1.3 billion.

On September 18, 2025, the US Department of State, under the leadership of Secretary of State Marco Rubio, released its America First Global Health Strategy, a comprehensive plan to align US global health programs with American national interests, security, and prosperity.

While the plan reaffirms commitment to goals for HIV/AIDS, malaria, and TB, the strategy marks a significant pivot from previous administrations, failing to mention previous administration and historically bipartisan priorities, including maternal and child health, routine immunizations, nutrition, and family planning. The document frames global health as a tool to counter Chinese influence, particularly in Africa.

The strategy is built on three pillars:

• "Making America safer" by improving disease surveillance and outbreak response;
• "Making America stronger" by shifting to bilateral agreements with partner countries; and
• "Making America more prosperous" by protecting the US economy from pandemics and promoting American health products.

The plan outlines a move away from NGO-led program delivery toward direct, multi-year bilateral agreements with recipient governments. The agreements will require co-investment from partner countries and will be tied to performance benchmarks. The US administration aims to finalize the deals with the 87 countries that received US health funding in FY2023 by the end of 2025, which is a timeline seen as highly challenging by global health experts, particularly in light of severe cuts to government global health staff.

The strategy justifies the shift by targeting “inefficient and wasteful” spending, asserting that 60% of current funding goes to overhead and program management rather than frontline services.

Critics raised concerns that the new model poses significant challenges, highlighting that a purely bilateral approach is seen as insufficient to tackle transnational threats, which require the broad, multilateral cooperation offered by institutions like the WHO. Another point of concern highlighted by health experts is the reduced funding for program management and technical assistance, which could weaken the detailed data collection and reporting that have historically allowed for close congressional oversight.

On September 11^th, 2025, the US State Department announced US$250 million in new public health assistance to the Philippines.

The new funding is intended to address public health challenges, with a focus on tuberculosis and maternal health. The assistance will also support investment in preparedness, detection, and response capabilities to reduce the threat of emerging diseases.

The programming builds on US$63 million in assistance announced during Philippine President Ferdinand Marcos Jr.’s official visit to Washington in July 2025. The US administration highlighted the announcement as a demonstration of its 'America First' foreign assistance approach.

On September 11, 2025, the US House Foreign Affairs Committee introduced two major pieces of legislation: the DFC Modernization Act of 2025, which proposes to increase the US DFC's lending cap to US$250 billion, and a series of bills aimed at reforming the US State Department.

The DFC Modernization Act, which closely resembles a proposal from the Trump administration, would increase the DFC's total lending cap from US$60 billion to US$250 billion. The bill would also allow the agency to invest in HICs for the first time, establish a revolving fund for equity investments, and raise the threshold for congressional notification of investments from US$10 million to US$100 million.

The second set of bills seeks to reform the US State Department by codifying changes made under US Secretary of State Marco Rubio. The proposals include the creation of an undersecretary for foreign assistance and a 'global health compact' model designed to shift funding responsibilities to partner countries, which would include a phase-out of PEPFAR funding. The legislation also suggests tying foreign assistance to a country's alignment with US policy positions.

Former OPIC CEO Robert Mosbacher Jr. expressed concern about linking the DFC bill to the more contentious State Department authorization. A short-term extension for the DFC may be necessary to allow more time for negotiation.

On September 4, 2025, the US Department of State announced a plan to provide the HIV-prevention drug lenacapavir to two million people by 2028, a commitment delivered through the PEPFAR and the Global Fund.

The developer of the drug, Gilead Sciences, stated it would offer the drug at no profit for the initiative. The plan follows a similar commitment made in December 2024, which had been put in doubt by funding cuts to the USAID in early 2025. As a key implementing agency for PEPFAR, USAID is on the front lines of the global HIV/AIDS response, working to deliver prevention, treatment, and care services. The funding cuts in early 2025 created significant uncertainty about the US government's ability to follow through on its global health commitments.

The announcement received mixed reactions. Health advocates criticized the target of two million people as too low to have a significant epidemiological impact compared to the estimated 40 million people in need of PrEP in SSA. Experts also raised concerns about implementation, questioning which populations would be prioritized, how logistical challenges like cold-chain and training would be addressed, and what the "at-cost" price from Gilead would be.

On August 13, 2025, a US court ruled that the Trump administration could continue to withhold billions of dollars in foreign assistance, clearing the way for the administration to cut already-appropriated spending for foreign assistance.

The court found that development organizations that receive government funding do not have cause to challenge the funding cuts. The decision overturned a lower court’s March 2025 order that had required the administration to continue processing foreign assistance payments, including nearly US$4 billion for global health activities through September 2025 and more than US$6 billion for HIV/AIDS programs through 2028. The new ruling noted that the administration had already paid out substantially to existing contracts since the lower court's ruling in March 2025.

The panel also ruled that under the Impoundment Control Act of 1974, only the GAO, Congress's independent watchdog, could legally challenge the president’s efforts to withhold foreign assistance funding. The Impoundment Control Act of 1974 was enacted to limit the president's power to withhold funding that has been appropriated by Congress. While the GAO has the power to sue to force the release of funds, it has not yet done so.

On August 7, 2025, the US Department of State announced a US$93 million grant to UNICEF to provide lifesaving food aid to nearly a million children suffering from malnutrition across 13 countries.

The grant will provide 11,000 metric tons of American-made RUTF for approximately 800,000 children through June 2026 in Haiti, Mali, Niger, Ethiopia, Sudan, South Sudan, Nigeria, Madagascar, Central African Republic, Democratic Republic of Congo, Djibouti, Kenya, and Chad and support the transport of an additional 1,200 metric tons of abbrRUTF for 87,000 children. However, UNICEF noted that a further two-to-three-month delay is expected before the products are delivered. UNICEF USA President and CEO Michael J. Nyenhuis welcomed the commitment, which according to a department spokesperson will draw down the entire prepositioned stock of RUTF.

The funding was authorized after months of delays and is UNICEF's first large grant for 2025 from the US. The amount is less than half of what the US government has typically allocated for this purpose. In 2024, the former USAID spent about US$200 million on similar work.

The US has historically funded roughly half of the world's supply of RUTF, and the US funding freeze in early 2025 severely disrupted the global supply chain of nutrition commodities. US funds for 2025 still have not yet been released to manufacturers, the WFP, transporters, or many organizations that operate malnutrition programs. In Nigeria, the WFP has had to shut down 150 clinics, and other assistance organizations reported similar clinic closures and dangerously low supplies across Africa and Asia that put thousands of children's lives in immediate danger.

On August 1, 2025, the French health ministry stated it could not legally intervene to stop the planned destruction of US$10 million in contraceptives held in Belgium, which were purchased by the USAID under former President Joe Biden and set to be destroyed by the administration of President Donald Trump, despite strong public outcry to intervene.

The US decision sparked criticism in France, with rights groups and left-wing politicians urging their government to halt the plan. France's health ministry, however, stated it had no legal basis to seize the products, as the products are not drugs of major therapeutic interest and no supply shortage exists in France. Multiple organizations, including MSI Reproductive Choices, offered to purchase the contraceptives at no cost to the US government, but their offers were rejected.

The contraceptives, mostly long-acting products like IUDs and birth control implants, were intended for countries in SSA and stored in Geel, Belgium. A US State Department spokesperson stated the decision to incinerate the unexpired products was based on the Mexico City Policy. The policy, reinstated in early 2025 by the Trump administration, prohibits providing assistance to NGOs that perform or promote abortions, though none of the products held in Belgium align with that description. The destruction was estimated by the US State Department to cost US$167,000.