On Nov. 21, the Global Fund to Fight AIDS, Tuberculosis, and Malaria held its eighth replenishment summit, where partners pledged $11.34 billion to sustain progress against the three diseases, save lives, and strengthen health systems. The U.S. made a $4.6 billion commitment in recognition of the Global Fund’s role as an essential partner in scaling innovation and supporting frontline health workers, joined by strong pledges from long-standing partners and private-sector donors. The resources mobilized will help sustain critical programs while deepening investments in resilient, country-led systems capable of responding to future health threats.
While the outcome reflects meaningful unity in a challenging global health landscape, it still falls short of the Global Fund’s $18 billion goal. Finalizing outstanding pledges and ensuring swift, effective allocation of resources will be essential to maximizing impact. With continued commitment and partnership, the world can stay on course toward ending AIDS, TB, and malaria.
Figure of the Week
$7.4 billion
That’s the total amount committed over the past two weeks through bilateral health cooperation agreements signed between the United States and countries receiving U.S. global health investment.
Following the launch of the America First Global Health Strategy, the Department of State and PEPFAR set the goal of completing bilateral health agreements by the end of this year. Several countries, including Kenya, Rwanda, Liberia, Uganda, Lesotho, and Mozambique, have signed their bilateral agreements. Next, PEPFAR will begin working with country governments and partners to complete implementation plans by March 2026 with countries receiving the most U.S. health investment.
While the specific contents of the agreements are not publicly available, press releases from the Department of State outline mutual investment between countries and a gradual shift in program ownership.
For example, Bloomberg reports that the U.S. has signed a $2.5 billion, five-year agreement with Kenya. The deal shifts responsibilities such as health worker pay and procurement of medical supplies to the Kenyan government, while U.S. financing will support disease-tracking data systems and a national electronic medical record system. Kenya will increase its domestic health investment by $850 million, meeting new co-investment and performance benchmarks intended to advance long-term health self-reliance. The United States will contribute $1.6 billion over the next five years to support HIV/AIDS, TB, malaria, maternal and child health, polio eradication, disease surveillance, and infectious disease outbreak response and preparedness in Kenya. However, last week the Kenyan court suspended part of the agreement due to concerns of the safety of citizens’ health data.
Similarly, the U.S. signed bilateral health cooperation agreements worth $228 million with Rwanda, $2.3 billion with Uganda, $364 million with Lesotho, $176 million with Liberia, and $1.8 billion with Mozambique over the next five years. Dozens of agreements are expected to be completed in the coming weeks
Ally Updates
The U.S. Global Leadership Coalition released an addendum to its Blueprint for America to Win in the World, outlining policy priorities to strengthen national security through strategic international development. The coalition’s recommendations to maximize the impact of U.S. global health efforts include:
- Increasing long-term investments in global health and biosecurity to protect Americans from future pandemics and deadly outbreaks.
- Doubling down on high-impact, bipartisan programs such as PEPFAR, the President’s Malaria Initiative (PMI), Gavi, the Vaccine Alliance, and the Global Fund.
- Emphasizing the value of compacts and bilateral agreements to accelerate program delivery and encourage country-led health planning.
- Having clear exit strategies and stronger guardrails to support sustainable transitions to partner governments’ ownership.
In the News
- The U.S. renewed its commitment to global health with a $4.6 billion pledge to the Global Fund during the 8th replenishment summit, maintaining its role as the Fund’s largest donor and signaling continued support for institutions aligned with the priorities of efficiency, innovation, and strengthened country self-reliance outlined in the America First Global Health Strategy. The pledge comes amid broader uncertainty in the global financing landscape, as several top donors, including Canada, Germany, and the U.K., lowered their pledges compared to previous cycles. In contrast, South Africa tripled its average contribution over the past three cycles with a $26 million pledge, highlighting the continent’s dedication to “driving innovation and taking greater responsibility for [their] own health systems.”
- The U.S. Department of State announced a new partnership with Zipline International to expand access to lifesaving medical supplies across Côte d’Ivoire, Ghana, Kenya, Nigeria, and Rwanda. The agreement will provide up to $150 million to expand Zipline’s drone delivery network, enabling faster delivery of life-saving medical supplies to as many as 15,000 health facilities. The initiative leverages American-made robotics, artificial intelligence, and autonomous logistics to strengthen emergency response and health system resilience, particularly in rural areas with slow and unreliable logistics.
- According to the Clinton Health Access Initiative’s new report that examines the impact of reduced foreign health investments, HIV tests conducted are down eight percent across nine countries in the first half of 2025, corresponding to 3.4 million missed tests. Additionally, new HIV diagnoses declined 22% across 7 countries, corresponding to over 24,000 missed HIV diagnoses so far in 2025. The decline in HIV diagnoses does not equal a decline in HIV positive cases. Unfortunately, this decline likely means that those most vulnerable to HIV infection are not able to access testing.
- Matthew Barlett, a former appointee to the State Department, comments in an opinion piece for Fox News that U.S. global health leadership is entering a pivotal moment in the fight against HIV/AIDS with the introduction of a twice-yearly HIV medication that can both prevent transmission and act as antiretroviral treatment. Barlett argues that this innovation, coupled with sustained U.S. investments such as the recent $4.6 billion pledge to the Global Fund, could accelerate progress toward ending AIDS by 2030. He calls on the administration to ensure that programs like PEPFAR, the Global Fund, and UNAIDS are leveraged as effectively and efficiently as possible to sustain and advance this progress.
- A late-stage trial of a new antimalarial treatment, GanLum, has shown a 97.4% cure rate and strong performance against drug-resistant strains, marking one of the most promising advances in malaria care. Developed through a partnership between Novartis and Medicines for Malaria Venture, the drug could help counter rising resistance to current artemisinin-based regimens. The breakthrough comes as malaria remains a deadly threat, particularly for young children in Africa, where more than 500,000 people die annually.
- A policy brief released by the Center for Global Development outlines a three-track framework to guide PEPFAR’s gradual evolution while meeting U.S. global health priorities. The plan recommends transitioning service delivery to domestic systems in stable countries, extending timelines for higher-burden nations to strengthen financing capacity, and sustaining investments in the most fragile countries. These differentiated approaches aim to prevent financing gaps, safeguard accountability, and preserve PEPFAR’s legacy by ensuring uninterrupted access to lifesaving HIV treatment and prevention.
