This week, the George W. Bush Institute, alongside 10 global health organizations and leaders, released recommendations on the next steps for ensuring success of the America First Global Health Strategy. The recommendations call for implementation that protects progress and prevents communities from being left behind.
We’ve also launched a series of firsthand accounts from people whose lives have been transformed by U.S. global health programs, The Lasting Impact of America’s Global Health Legacy.
In the first installment, Elina Mwasinga, National Coordinator for the National Association for Young People Living with HIV in Malawi, shares how access to treatment allowed her not only to survive, but also to lead and advocate for other young people. As she says, “PEPFAR is the reason my life continued.”
Our recommendations with other global health leaders and Elina’s story are both a roadmap and reminder of what must be protected as the America First Global Health Strategy moves forward. Country ownership should remain the goal, but successful transitions will require reliable financing, strong health workers, community engagement, transparency, and clear accountability.
Bush Institute Insights
The America First Global Health Strategy should build on decades of the rigorous, established and transparent programming that has led to millions of lives saved. The Bush Institute, joined by a coalition of several global health organizations and leaders, has outlined the following recommendations for the Administration and Congress to ensure the strategy sustains past successes, accelerates progress, and successfully transitions toward country ownership:
- Tailor implementation to country realities and protect continuity of care. Bilateral agreements should reflect each country’s capacity and political environment, provide reliable funding at sufficient scale, support integrated health systems, and avoid disruptions as countries assume greater responsibility.
- Make programming data-driven, transparent, and outcome-focused. The Strategy should track prevention, treatment, retention, and other measurable results; use disaggregated and independently verified data; establish next-generation targets beyond 2030; and mobilize sustainable domestic financing.
- Keep communities, technical experts, and oversight institutions engaged. Civil society, faith-based organizations, implementers, and U.S. government experts should help shape and carry out agreements, while Congress, Inspectors General, and the Government Accountability Office should strengthen reporting, reviews, and accountability.
Country ownership of programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) will only succeed if it protects the people, partnerships, and systems responsible for today’s gains. You can read the full recommendations here.
America First Global Health Strategy Updates
On Sunday, FHI 360 co-hosted a pre-conference event ahead of AIDS 2026 with the Bureau for Global Health Security and Diplomacy examining the status of bilateral health agreements (MOUs) and implementation plans, followed by a discussion with Ministries of Health, implementing partners, and other stakeholders.
During the meeting, Bureau officials shared details regarding the MOUs and implementation plans, including that despite only 34 MOUs completed, there are 71 countries developing implementation plans with the U.S., including over 50 with PEPFAR programming. Several countries will not have implementation plans due to the U.S. budget being small enough to not require coinvestment. The team also shared that not all U.S. global health funding flows from bilateral agreements. The State Department will also retain several centrally managed funding “buckets,” that are directed toward innovation, incentivization, and other awards.
According to a press release last week, Senator John Cornyn (R-TX) secured several commitments from the White House to ensure that PEPFAR and global health funding would be spent as obligated. They include:
- “Spending plans for FY25 and FY26 PEPFAR funds, including a timeframe for future awards to faith-based organizations;”
- “A guarantee that the more than $270M planned transfer from the U.S. State Department to the Centers for Disease Control and Prevention (CDC) will be completed;”
- “And a confirmation that all unobligated PEPFAR funds expiring in September will be obligated as expeditiously as possible and include appropriate notification to Congress.”
Finally, during their most recent board meeting, the Global Fund Board approved two measures to help countries sustain lifesaving HIV, tuberculosis, and malaria programs. The first expands access to the Global Fund’s pooled procurement platform using financing outside Global Fund grants, allowing countries to continue purchasing quality-assured, affordable medicines and health products. The Board also updated its Risk Appetite Framework to identify emerging threats earlier and strengthen impact-driven decision-making. These changes come as 61 disease components across 35 countries prepare to transition out of Global Fund support during Grant Cycle 8, beginning in 2027.
Figure of the Week
The U.S. Department of State committed $100 million for emergency food aid
The U.S. Department of State announced a new two-year, $100 million partnership with Operation End Starvation to provide lifesaving nutrition assistance to children at risk of or suffering from severe acute malnutrition. The American-led public-private partnership will use philanthropic contributions alongside U.S. investment to support efficient procurement and nutrition programs for children younger than five.
The award complements more than $1 billion in recent U.S. humanitarian assistance to UNICEF and the World Food Program, including over $235 million for nutrition. It also builds on $173 million in U.S. nutrition assistance provided in 2025, which delivered more than 27,000 metric tons of ready-to-use therapeutic food across 15 countries and treated nearly 2.7 million children.
Additionally, the U.S. Department of Agriculture announced an agreement with Catholic Relief Services to provide up to $235 million in emergency food and nutrition assistance for millions of people facing extreme hunger in Sudan and Ethiopia.
Ally Updates:
AIDS 2026, the 26th International AIDS Conference, is underway in Rio de Janeiro and virtually through July 31, bringing together researchers, policymakers, implementers, and communities at a critical moment for the global HIV response. Some resources worth noting at the conference:
- AVAC has assembled session roadmaps, infographics, and resource hubs on HIV prevention, long-acting PrEP, and the research pipeline to help participants navigate the week.
- The Elizabeth Glaser Pediatric AIDS Foundation is highlighting the urgent work still needed to end pediatric HIV, including sessions on community health workers, treatment continuity, and research from Malawi and Cameroon.
- At the conference, Gilead will present new prevention and treatment research, including long-term findings on twice-yearly lenacapavir for PrEP and phase 3 results on a potential once-weekly HIV treatment.
- amfAR will discuss their most recent PEPFAR Pulse Study, conducted with the Johns Hopkins Bloomberg School of Public Health, Funders Concerned About AIDS, and Data Etc. across 166 PEPFAR-funded organizations in 46 countries. The report study seeks to understand HIV service delivery following disruptions in foreign assistance last year.
- For a broader view of the debates shaping the conference, former State Department official Dr. Jirair Ratevosian’s “Five Things I’ll Be Watching at AIDS 2026” tracks the funding reset, delivery challenges, new models of care, the role of AI, and whether political commitments will translate into action.
In the News
- Several global health experts, including myself, spoke with Devex’s Jenny Lei Ravelo about the role of non-communicable disease (NCD) programming in the America First Global Health Strategy. I was able to share the impact of Go Further, a program launched in 2018 by the Bush Institute, PEPFAR, and UNAIDS. Women living with HIV are up to six times more likely to develop cervical cancer, a disease that is entirely preventable with routine screening and treatment of precancerous lesions. Go Further has conducted over 10 million cervical cancer screenings for women living with HIV through the PEPFAR system to ensure that women who survive HIV can also avoid a preventable cancer. The program is a valuable example for integrating low-cost care for NCDs that impact the lives of those affected by some of the deadliest communicable diseases.
- In a report available for Pro subscribers, Devex outlined the current state of play for U.S. foreign assistance, as former USAID functions have transitioned to the State Department. Devex outlines the current aid strategy, the status of funding, and the Department’s leadership in foreign assistance.
- Five faith-based organizations, including Bread for the World and the National Association of Evangelicals, are urging the White House to release congressionally-appropriated funding for PEPFAR, the Global Fund, and Gavi. In a letter to Office of Management and Budget Director Russell Vought, the groups emphasized that the timely disbursement of the $6 billion Congress approved for PEPFAR is critical to HIV prevention, maternal and child health, and tuberculosis programs worldwide.
- In Kenya and Zambia, faith-based hospitals have been forced to scale back community outreach, home visits, and HIV testing after significant declines in funding for staff and services, reports Christianity Today. Health workers describe reorganizing programs and taking on multiple roles to continue serving rural communities and ensure that PEPFAR-supported antiretroviral medicines reach patients. Without sustained outreach, more people living with HIV will miss treatment, increasing the risk of illness and HIV transmission, particularly in hard-to-reach areas where faith-based organizations have long been a lifeline.
- The adoption of bilateral health agreements under the America First Global Health Strategy remains uneven across Africa. Ghana rejected a proposed $109 million agreement over concerns that health and genomic data could leave the country without reciprocal protections. Zimbabwe declined a deal, citing similar questions about medical data and access to resulting drugs or vaccines. Kenya’s $2.5 billion agreement also faced legal challenges over patient privacy before receiving approval. U.S. partnerships with national governments can increase domestic health spending, reduce overhead, and build durable, country-led systems. However, their success will depend on transparent negotiations, civil society engagement, clear safeguards for patient data, and mutual accountability.
- On July 13, the ONE Campaign hosted More than a Match at the National Center for Civil and Human Rights in Atlanta, bringing together leaders in sports and development to discuss how athletics can advance health, security, and economic opportunity. Panelists shared examples of sports creating pathways to education and leadership, accompanied by a museum exhibit highlighting the power of sports to unite people and inspire hope.
- In malaria-endemic countries, one in three people with fever, often the first sign of malaria, seek care from private health providers, including local clinics, pharmacies, and drug shops, according to a new Unitaid report. However, many of these providers remain disconnected from national health systems, creating gaps in treatment quality, disease surveillance, and access to affordable, quality-assured tests and medicines. To improve access to malaria care, the report calls for governments and partners to include private providers in national malaria strategies, integrate their data into public monitoring systems, and pair clear standards with sustainable financing and supervision.
- As of July 20, the Centers for Disease Control and Prevention (CDC) reported 2,344 confirmed Ebola cases and 930 deaths in the Democratic Republic of the Congo, making it the third-largest Ebola outbreak on record. 80% of new cases in eastern Congo come from unidentified transmission chains, making the outbreak difficult to track. Containing the outbreak is becoming even more challenging, with health workers at treatment centers going on strike over unpaid salaries and other remote regions facing rebel threats, weak infrastructure, and misinformation, reports AP News.
