The Bush Institute Global Health Newsletter

Hello,

As lawmakers return to Capitol Hill, it is worth reflecting on the progress we have made to end HIV/AIDS as a public health threat, thanks in large part to Congressional support for the President’s Emergency Plan for AIDS Relief (PEPFAR). According to the Joint United Nations Program on HIV/AIDS (UNAIDS) 2025 Global AIDS Update, new HIV infections have declined by 40% since 2010.

However, there were nearly 1.3 million new infections in 2024, which is far below the UNAIDS goal of 370,000 new global infections by 2025. Attention must be focused on ensuring PEPFAR programs are operating effectively over the next few years.

New medicines could accelerate progress and help us win this fight. Over the summer, the FDA approved lenacapavir, the twice-yearly HIV prevention injection that is over 99% effective at preventing new infections. There are also several new long-acting prevention drugs that are under review. Ending the global AIDS threat by 2030 is challenging but still achievable. Ensuring that these lifesaving medications are affordable and accessible is critical.

As HIV prevention expert and President of the International AIDS Society Kenneth Ngure puts it, combating the global AIDS threat is like traveling on an airplane: The destination is a world in which HIV/AIDS is no longer an imminent threat, and U.S. policymakers are the pilots.

Sincerely,

Hannah Johnson
Senior Program Manager of Global Policy
George W. Bush Institute

Figure of the Week

62.3 years

Thanks to medical advancements such as HIV prevention and treatment, life expectancy in sub-Saharan Africa has grown from 56.5 years in 2010 to 62.3 years in 2024, according to the 2025 Global AIDS Update from UNAIDS. The region has seen incredible progress over the last several years. An additional nine countries in sub-Saharan Africa are on track to achieve a 90% decline in the number of new HIV infections by 2030.

As the figure below shows, in 2024 the world was closer than ever to achieving the 95-95-95 targets of ensuring that 95% of people living with HIV know their status, 95% have access to antiretroviral treatment, and 95% have undetectable – and therefore not transmittable – levels of the virus in their blood. Several regions are very close to achieving these targets, but progress is not universal as some populations – including women and girls – are more vulnerable to contracting HIV than others.

Source: UNAIDS Global AIDS Update 2025 Executive Summary

Ally Updates

On July 31, the World Health Organization (WHO) announced its plan to pivot the administration of HIV/AIDS relief to local authorities. Sixty-five percent of all people living with HIV live in sub-Saharan Africa. Given the vast majority of lifesaving drugs are manufactured thousands of miles away from these populations most in need, the WHO sees investment in local manufacturing as the next step in providing effective, responsive HIV/AIDS assistance.

Self-sustainability is the new goal. A first step towards strengthening relief supply chains through local production is already underway in Mozambique. Universal Corporation Limited, a Kenya-based pharmaceutical company, is the first African manufacturer cleared to produce a first-line antiretroviral therapy for HIV infection, with support from the Global Fund. This development marks a significant milestone in the ongoing partnership between the Global Fund and the WHO as they collaborate to strengthen supply chain systems for on-the-ground HIV relief in Africa.

Bush Institute Insights

Dr. Deborah Birx, Bush Institute Senior Fellow and former U.S. Global AIDS Coordinator, spoke at the Aspen Health Festival in June. She highlighted the importance of American support in improving global health while ultimately helping countries develop an infrastructure to sustain their own needs. Dr. Birx advocated for increased support for local health workers in countries with high infection rates, who proved resilient amid the COVID-19 pandemic. Their contribution in fostering localized relief efforts to crises such as HIV/AIDS is essential, and Dr. Birx stressed the importance of tailoring relief efforts to communities' specific needs.

In the News

George W. Bush Institute Senior Advisor Monica Kladakis and Executive Director David J. Kramer emphasize the need for continued U.S. support of the Millennium Challenge Corporation in a piece for The Hill. The two argue that MCC’s board should consider the impact of possible cuts to more than half of its portfolio of compacts and smaller threshold programs – particularly America’s reputation as a reliable partner and U.S. economic, national security and diplomatic interests. MCC’s innovative model demands democratic governance, investment in people, and policies supporting economic freedom from its partners so they can build sustainable, democratic communities. A drastic reduction in the program’s work could leave unfinished projects that China could complete and claim credit for.

According to recent reports, HIV patients in at least 16 Russian regions are being denied routine HIV/AIDS tests that determine viral load count and suppression. Under national guidelines, these tests are meant to be prescribed every six months. These denials likely come as a result of budget constraints to Russia’s healthcare system owing to a diversion of resources to fund Russia’s war against Ukraine. Russian presence on the African continent has grown over the past two decades. As the United States reconfigures its strategy surrounding foreign investment, Moscow has taken even more interest in global health and pandemic preparedness by offering training and financial aid across the continent. Considering Russia’s history of HIV/AIDS denialism and challenges addressing one of the largest HIV epidemics in Eastern Europe, these are troubling developments that U.S. leaders should consider.

Officials at the National Institutes of Health are considering reallocating funding from the HIV/AIDS budget from research and development to implementation of the highly effective breakthrough drug, lenacapavir, reports Science. The potential efforts, which would capitalize on implementing the use of new and highly effective drugs, would require nearly one-third of NIH’s HIV/AIDS budget. The initiative would focus on the implementation of advanced medication for immediate relief, but the move would require the NIH to allocate funding away from ongoing HIV research. The NIH typically does not implement health programs, reserving those efforts for the Centers for Disease Control and Prevention (CDC) and other Health and Human Services agencies. Reallocating funding toward prevention breakthroughs prompts discussion in the global health community over task sharing and how best to balance current innovation with long-term relief efforts.

A recent editorial in The Washington Post argues that advances in medicine, such as the approval of lenacapavir, provides the tools to potentially end HIV/AIDS and eliminate the need for programs like PEPFAR. While U.S. funding still plays a crucial role in delivering and implementing medication to the communities that need it most, Gilead Sciences is seeking to increase accessibility to expensive drugs and has already licensed six subsequent manufacturers to produce lenacapavir at cost for low-income countries. Together with the Global Fund, Gilead Sciences has pledged to distribute two million doses, a small but impactful first step to deploying this critical resource and combating the global health threat of HIV/AIDS.

In a piece featured in Down to Earth magazine, University of Southern California Professor Jonathan Cohen argues for global investment networks to transition away from reliance on American leadership toward localized solutions. Cohen suggests that now is the time for a unified global community to emerge where robust health systems are being shaped by African governments themselves, with international partners playing a supportive role. The transition from an international global health system to a community-specific approach reflects the broader trend of experts offering viable solutions to global health threats in response to critical funding withdrawals.

Hannah Johnson
SENIOR PROGRAM MANAGER, GLOBAL POLICY

GEORGE W. BUSH PRESIDENTIAL CENTER
T: (214) 200-4375
E: Hannah.Johnson@bushcenter.org

www.bushcenter.org

About the George W. Bush Institute

The George W. Bush Institute is a solution-oriented nonpartisan policy organization focused on ensuring opportunity for all, strengthening democracy, and advancing free societies. Housed within the George W. Bush Presidential Center, the Bush Institute is rooted in compassionate conservative values and committed to creating positive, meaningful, and lasting change at home and abroad. We utilize our unique platform and convening power to advance solutions to national and global issues of the day. Learn more at www.bushcenter.org

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