Breakthroughs Blog: State Department

Earlier this week, the Global Health Technologies Coalition (GHTC) and partners brought more than 25 innovative global health technologies to Capitol Hill to highlight how US government investments in global health research and development (R&D) are saving lives in the United States and around the world. Each technology displayed—whether a vaccine, diagnostic, drug, device, or nutrition solution— demonstrate how these investments not only protect the world’s most vulnerable people but also strengthen America’s own health security, help prevent pandemics, and fuel high-quality US jobs and economic growth. The exhibit offered a snapshot of a larger story of how the United States is doing well by doing good. Between 2007 and 2022, the US government invested just under $46 billion in global health R&D. These investments helped drive the development of 67 new technologies approved since 1999 for neglected and (non-COVID-19) emerging diseases. At the same time, they created 600,000 new US jobs and yielded knowledge expected to generate more than $255 billion in long-term benefits for the American economy—a six-fold return on investment. This exhibit showcased what’s possible when science, purpose, and smart policy align. Explore the exciting US-backed breakthroughs displayed below. VACCINESSingle-dose vaccines for Sudan and Marburg viruses on the rVSV vaccine platform IAVI, a nonprofit based in New York and New Jersey, is advancing single-dose vaccines for the Sudan and Marburg viruses using the proven rVSV vaccine platform, the same technology behind an Ebola vaccine that has helped contain recent outbreaks. Sudan and Marburg viruses continue to spark deadly, Ebola-like outbreaks, yet no approved vaccines or treatments exist, underscoring the urgency of this work. These vaccine candidates are being developed with critical support from the Defense Threat Reduction Agency at the US Department of Defense (DoD) and the Biomedical Advanced Research and Development Authority (BARDA). Novel oral polio type 2 (nOPV2) vaccine PATH, a nonprofit developer based in Washington state with an office in the District of Columbia, alongside the University of California, San Francisco; the Washington-based Gates Foundation; and global partners, developed nOPV2, a next-generation oral polio vaccine. nOPV2 maintains the same advantages of the original oral vaccine but has been specifically engineered to be less likely to seed vaccine-derived polio outbreaks in communities with low immunization coverage. This breakthrough, which is accelerating global efforts to end polio, also benefitted from critical development support from the US Centers for Disease Control and Prevention (CDC).Next-generation malaria vaccines PATH and the University of Oxford are developing next-generation malaria vaccines designed to overcome key limitations of the currently available options and help turn the tide of this longstanding global health challenge. This work has received vital US government support from the US Agency for International Development (USAID), the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), and the DoD Walter Reed Army Institute of Research and Naval Medical Research Command. Additional US-based partners, including Johns Hopkins University in Maryland, the Scripps Research Institute in California, and the University of Texas at Austin, alongside a constellation of international collaborators, also played a critical role in advancing this research.DRUGSPretomanid, a novel tuberculosis (TB) drugTB Alliance, a New York-based nonprofit, developed pretomanid, a groundbreaking drug for treating highly drug-resistant TB. As part of a six-month combination regimen, it has drastically reduced treatment duration and complexity for patients compared to previous regimens that required up to 20 or more pills a day—as many as 14,000 total over the course of 18 months or more of treatment. This work was backed by US federal funding from USAID and NIAID and advanced in partnership with a broad coalition of American companies, nonprofits, and universities, including AbbVie Inc. in Illinois, Advancing Clinical Therapeutics Globally for HIV and Other Infections in the District of Columbia, the Gates Foundation, Harvard University in Massachusetts, Johns Hopkins University, Johnson & Johnson in New Jersey, RTI International in North Carolina, Texas A&M University, the University of Illinois Chicago, and the University of North Carolina at Chapel Hill.Child-friendly TB medicinesTB continues to infect millions of people worldwide each year, with children facing a heavy burden—an estimated 1.3 million new pediatric cases were reported in 2023. For decades, children with TB were treated with crushed adult pills, a practice that was difficult for caregivers and often led to inconsistent dosing. TB Alliance developed child-friendly TB medicines that are palatable, fast-dissolving in water, and precisely dosed for children, ensuring young patients finally have access to safe, appropriate, and easy-to-administer therapies. This work received vital funding from USAID and was advanced in partnership with other international donors and organizations, as well as US-based partners, including Management Sciences for Health in Virginia and Baylor College of Medicine in Texas.Inhaled oxytocin for the prevention and treatment of postpartum hemorrhage Postpartum hemorrhage, or excessive bleeding after childbirth, is the leading cause of maternal deaths globally. To address this urgent challenge, Monash University has developed an investigational heat-stable, inhaled powder formulation of oxytocin designed to provide the same protection as the injectable gold standard treatment. By eliminating the need for refrigeration and trained providers to administer injections, this innovation could greatly expand access to lifesaving care for mothers in low-resource settings. This work received funding from USAID and support from US-based partners, including the Gates Foundation and Johnson & Johnson, alongside other international collaborators. Monoclonal antibody therapy to prevent and treat Nipah virus (MBP1F5) The Coalition for Epidemic Preparedness Innovations, whose US headquarters are in the District of Columbia, is supporting the development of a monoclonal antibody therapy being advanced by California-based Servare GMP and Mapp Biopharmaceutical to prevent and treat Nipah virus, a highly lethal zoonotic disease with no approved treatments or vaccines. This work received support from the DoD Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense and Uniformed Services University, as well as USAID.Tafenoquine, a single-dose therapy for relapse prevention of P. vivax malaria & long-acting injectable malaria prophylaxisThe Medicines for Malaria Venture and GSK—whose US headquarters are in Pennsylvania— developed tafenoquine, a single-dose treatment to prevent the difficult-to-treat relapses characteristic of Plasmodium vivax malaria. By replacing multi-day regimens, tafenoquine simplifies care for patients and helps malaria-endemic countries accelerate progress toward elimination. Its development received crucial support from USAID, the DoD Walter Reed Army Institute of Research, and the US Food and Drug Administration through its Priority Review Voucher Program.The Medicines for Malaria Venture, Oregon Health & Science University, and the California-based Calibr-Skaggs Institute for Innovative Medicines are co-developing a long-acting injectable malaria prophylaxis designed to provide combination protection against both Plasmodium falciparum and blood-stage P. vivax malaria. This next-generation approach aims to offer durable, simplified prevention for people in high-risk areas. The work received important support from USAID and the Department of Veterans Affairs.Injectable lenacapavir for HIV prevention Gilead Sciences, a California-based biopharmaceutical company, developed lenacapavir, a groundbreaking new HIV prevention drug requiring twice-yearly injections. In pivotal Phase 3 trials, lenacapavir demonstrated remarkable efficacy across key populations, including historically underserved groups. Developed using evidence from NIH-funded research, it offers discreet, long-acting protection, providing an alternative to daily pills or bimonthly injections and making HIV prevention more accessible and easier to sustain.  DEVICESEllavi Uterine Balloon Tamponade for postpartum hemorrhage As noted earlier, postpartum hemorrhage is the leading cause of maternal deaths worldwide. The Ellavi Uterine Balloon Tamponade is a low-cost, easy-to-use inflatable device placed inside the uterus that uses pressure to rapidly slow or stop bleeding. Designed specifically for use in low-resource settings, it offers a simple, lifesaving intervention where advanced care is not always available. The device was developed by PATH and Sinapi Biomedical, with support from USAID, the Gates Foundation, and other partners.Anne® One continuous wireless vital sign monitoring platform Life-threatening pregnancy risks can too often go undetected in areas with limited resources and health care workforce. The Anne® One continuous, wireless vital-sign monitoring platform, developed by Illinois-based Sibel Health, Inc. and supported by the Gates Foundation and the Steele Foundation for Hope in New Hampshire, helps identify complications in real time, helping improve care for both mothers and babies. The technology can also enhance monitoring and care for patients of all ages, whether at home or in hospital settings. The work received key US government support from the Small Business Innovation Research program and the NIH RADx for Maternal Health Challenge, BARDA, and the DoD Medical Technology Enterprise Consortium.Monthly dapivirine vaginal ring for HIV prevention The dapivirine vaginal ring, originally developed by the Maryland-based International Partnership for Microbicides and now advanced by the Population Council in New York, is a flexible silicone ring that users self-insert, which reduces the risk of HIV infection. The ring provides one month of protection by slowly releasing the antiretroviral drug dapivirine, offering a discreet, user-controlled prevention option. Its development received critical support from NIH, USAID, the Gates Foundation, and other international donors and partners.Microarray needle-free “button” for vaccine and drug delivery Micron Biomedical, based in Georgia, developed a microarray needle-free “button” that could one day be used for delivering vaccines and pharmaceuticals without the need for traditional injections. This innovative, pain-free solution could be self-administered, reducing barriers to vaccination and treatment. It also limits or eliminates the need for refrigerated storage, simplifies transport and storage, and produces no sharps waste, making it especially valuable for low-resource settings. This technology received US funding support from CDC and BARDA (through the New York-based Global Health Investment Corporation) and was developed in partnership with other US-based groups, including the Gates Foundation, PATH, and Emory University in Georgia.Nifty Cup Millions of babies are born each year who are unable to breastfeed because they were born prematurely or have conditions such as cleft lip or palate. In low-resource settings, commonly used feeding tools can be impractical or difficult to keep hygienic. To address this challenge, PATH partnered with Washington-based collaborators, The University of Washington School of Dentistry and Seattle Children’s Hospital, with support from USAID and Laerdal Global Health, to develop the Nifty Cup. This low-cost silicone feeding cup is durable, gentle, easy to disinfect and simple for caregivers to use—a great example of a frugal, high-impact innovation designed specifically for low-resource environments.  HEATmarker™ vaccine vial monitor Most vaccines require continuous refrigeration to remain effective, which can be a significant challenge in remote and low-resource settings worldwide. Breaks in the cold chain can lead health workers to discard perfectly good vaccines because they suspect heat damage or, worse, unknowingly administer doses that have lost potency. To solve this, PATH and New Jersey-based Temptime (later acquired by Illinois-based Zebra Technologies) developed the vaccine vial monitor, a small sticker placed on vaccine vials that changes color when exposed to too much heat, clearly indicating whether a vaccine is still safe to use, preventing waste and saving lives. This simple, low-cost innovation reduces waste, improves safety, and helps ensure lifesaving vaccines reach the people who need them. The work received crucial support from USAID.BD Uniject™ auto-disable prefillable injection system Injectable drugs and vaccines have saved countless lives, yet administering them safely in low-resource settings presents challenges—health workers require appropriate training and if reused, syringes can spread dangerous infections. With funding from USAID, PATH designed the Uniject™ system, now manufactured by New Jersey-based BD. It’s an inexpensive, pre-measured and -filled syringe that automatically disables after a single use. This technology enables health workers with minimal training to safely deliver correctly dosed injections, prevents syringe reuse, reduces product waste, and ultimately saves lives and costs.BD SoloShot™ auto-disable syringeBD and PATH also partnered on the SoloShot™ auto-disable syringe, with support from USAID, which locks after injection, also helping prevent reuse and bloodborne disease transmission. Interceptor® G2 dual-insecticide bednetAs rising insecticide resistance threatens progress against mosquito-borne diseases such as malaria, Zika, and dengue, the Interceptor® G2 dual-insecticide treated bednet represents an important evolution of one of global health’s most essential prevention tools. Developed by BASF, whose agriculture division is based in North Carolina, the Interceptor® G2 uses two insecticides to improve effectiveness against resistant mosquito populations. Its development was supported by the President’s Malaria Initiative, USAID, and CDC, as well as the Gates Foundation, the Innovative Vector Control Consortium, and other international partners.  DIAGNOSTICSLumify AI-assisted handheld ultrasoundLife-threatening risks during pregnancy can go undetected in areas with limited health care resources, leading to deaths, as well as complications for both mothers and their babies. But a portable, artificial-intelligence-powered ultrasound developed by Philips Healthcare, whose North America offices are located in Massachusetts, with support from BARDA and the Gates Foundation, is addressing this challenge head on by helping improve access to screening for pregnant mothers in low-resource settings.Determine™ Antenatal Care Panel; Determine™ HIV Early Detect, Determine™ HBsAg 2, and Determine™ Syphilis TP rapid testsIllinois-based company Abbott developed a rapid panel test capable of simultaneously detecting HIV, hepatitis B virus, and syphilis, three major infections that pose serious risks to maternal and newborn health. The combination platform, which could simplify testing for health systems and patients and improve testing coverage, builds on individual in vitro rapid tests for each virus, which were developed by Abbott and later procured and scaled with support from the US President’s Emergency Plan for AIDS Relief (PEPFAR).OraQuick™ Ebola Rapid Antigen Test, Investigational Marburg rapid antigen test, and OraQuick™ HIV Self-TestOraSure Technologies, a Pennsylvania-based diagnostics company developed the OraQuick™ Ebola Rapid Antigen Test, a point-of-care tool that enables fast, presumptive diagnosis of Ebola virus disease. By providing results in minutes, the test supports health workers in rapidly isolating patients, initiating potentially lifesaving treatment, and ensuring safe and dignified burials that reduce transmission risk. The test was developed with support from BARDA.With support from BARDA, OraSure is also advancing a similar rapid antigen test for Marburg, a related virus to Ebola that also causes sever and often fatal disease.OraSure also has an oral HIV self-test, built on the same platform as its Ebola and Marburg tests. As the first US Food and Drug Administration-approved HIV self-test, it provides discreet, rapid testing for patients at home in as little as 20 minutes. The US government has supported scale-up of this product globally through PEPFAR.Co-Dx PCR Pro™ for on-site PCR testingThe PCR Pro™ molecular diagnostic platform from Utah-based Co-Diagnostics is designed to enable health care professionals to conduct on-site PCR testing, expanding access to fast, accurate testing outside traditional laboratory settings. With test panels available for flu, COVID-19, and RSV as a multiplex test and, separately, HPV and TB, the platform—developed with support from the NIH RADx program, as well as from PATH and the Gates Foundation for specific applications—has the potential to transform decentralized testing globally.NUTRITION INNOVATIONSReady-to-use therapeutic food for the treatment of severe acute malnutrition Nearly one third of children under five worldwide suffer from malnutrition. But a ready-to-use therapeutic food Plumpy’Nut has been a game changer. Developed by scientists at Washington University in St Louis and the French Institut de Recherche pour le Développement, manufactured by Georgia-based Mana and New Hampshire-based Edesia Nutrition, and scaled up with support from USAID and now the Department of State, this essential mix of vitamins, milk, and peanut butter allows severely malnourished children to recover and stay recovered with just a few servings.  Vitamin A biofortified corn Vitamin A deficiency is the leading cause of preventable child blindness worldwide. It impairs growth and immunity, increasing the risk of severe illness from common childhood infections such as diarrhea and measles. Corn biofortified with Vitamin A, developed by the District of Columbia-based Harvest Plus program at the International Food Policy Research institute, with support from USAID’s Feed the Future program, has been a transformative innovation. When consumed regularly, it can provide up to half of daily vitamin A needs for women of reproductive age and children. Thanks to our partners the American Society for Microbiology, the American Society of Tropical Medicine and Hygiene, Research!America, the Innovative Vector Control Consortium, IAVI, Monash University, Philips, Co-Diagnostics, HarvestPlus, Micron Biomedical, BASF, the Medicines for Malaria Venture, TB Alliance, Abbott, Mana, BD, Zebra Technologies, Sibel Health, the Coalition for Epidemic Preparedness Innovations, PATH, Gilead Sciences, OraSure Technologies, and the Global Health Investment Corporation for supporting this event. 

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.

Nearly six months into fiscal year 2024 (FY24), the US government has finally agreed upon a budget for the remaining six months. Nevertheless, March brings with it a new appropriations cycle forcibly run in parallel with the last. With the release of the President’s Budget Request (PBR) for fiscal year 2025 (FY25) and ongoing meetings with appropriations staff, the prospects for future US spending on global health research and development (R&D) are coming into focus, with both good and bad on the horizon.FY24 spending package: A mixed bag for global health R&D This year’s appropriations process was certainly one for the history books in that it was historically difficult—largely due to partisan divisions and threats to the House speakership. But on March 22, moments before a partial government shutdown was set to go into effect, a six-bill “minibus” was voted through by the House of Representatives and the Senate and later signed into law, which will keep the government operational until September 30. This second spending package included funding bills for Labor, Health and Human Services, Education, and Related Agencies (LHHS); State, Foreign Operations, and Related Programs (SFOPS); and Defense, which are a mixed bag for funding for global health R&D.LHHSThe LHHS bill, which covers funding for the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Biomedical Advanced Research and Development Authority (BARDA), included some welcome increases to agencies and programs that support global health research alongside overall stagnant funding.Out of the three agencies, BARDA, which focuses on the R&D of countermeasures against emerging health threats, received the largest increase in funding with a $65 million (6.8 percent) boost over fiscal year 2023 (FY23) levels, bringing its total budget to $1.015 billion. The CDC, America’s lead public health agency, and NIH, the primary agency responsible for biomedical health research, witnessed marginal adjustments, with their budget lines most relevant to global health R&D remaining largely static. Notably, CDC's National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) received a $9.5 million (1.27 percent) boost, which will help bolster crucial surveillance initiatives such as the Advanced Molecular Detection program.  Additionally, the minibus also included complimentary directives, known as report language, which were championed by GHTC, that reinforce the importance of global health and neglected disease research taking place at CDC and NIH. It also included important language encouraging BARDA to consider the needs of people living in low-resource settings in its R&D funding decisions and directing the agency to provide more transparent and regular reporting on its investments and allocate at least $10 million of its budget to create a new Disease X medical countermeasures program to develop tools against viral families with pandemic potential.SFOPSThe SFOPS bill covers global health work undertaken by the US Agency for International Development (USAID) and the US Department of State (State). Unfortunately, the FY24 spending package included a significant cut of $530.95 million (5.3 percent) to State and USAID global health programs.Much of this reduction is due to a decrease in funding by $350 million for the US contribution to The Global Fund to Fight AIDS, Tuberculosis and Malaria, which fell from $2 billion in FY23 to $1.65 billion in FY24. While this is a large cut, it was both expected and supported by advocates, given that US law caps the maximum contribution that the United States can make to the fund relative to the contributions of other donors. Thus, the “cut” was implemented in line with the cap to avoid a harsh drop-off in US funding in the coming years. Accordingly, many advocates are not viewing it as an actual cut. The remaining decrease in funding comes from a significant $200 million (22 percent) cut to USAID Global Health Security (GHS). The FY24 funding for GHS of $700 million retains a $100 million carve-out for a US contribution to the Coalition for Epidemic Preparedness Innovations, or CEPI, but advocates are still piecing together what the $200 million slash could mean for other GHS programming. This picture is further complicated by the opaque nature of how the US government intends to fund a contribution to the World Bank Pandemic Fund, which is neither specified in the bill in terms of a funding number nor in the programmatic budget line. The Biden Administration announced last year its intent to contribute $250 million to the fund, but this contribution is not actually detailed in the spending package, so it remains unclear how this commitment will be realized. Slightly cushioning the overall cut to State and USAID global health programs are some modest increases to the budget lines for the maternal and child health (through an increase in funding to GAVI, the Vaccine Alliance), nutrition, and other public health threats programs.In a key win for global health research advocates, Congress also included accompanying report language for SFOPS directing USAID to increase its spending for health R&D over the prior fiscal year and to publish an annual report on its health R&D activities and investments. Notably, the reauthorization of the US President’s Emergency Plan for AIDS Relief, or PEPFAR, was also included in the SFOPS bill but only for one year, so authorization will expire next March. This one-year reauthorization tees up another battle, which will certainly be shaped by the political climate and controlling parties following the presidential and congressional elections this fall.DefenseWhile few may think of the US Department of Defense (DoD) as a key global health player, the agency’s spending supports R&D against epidemic-prone diseases and other health issues that pose a risk to US national security and service members stationed abroad—so its investments contribute to combating diseases endemic in many of the world’s poorest places. Encouragingly, language supporting DoD's research on infectious diseases and the development of medical countermeasures was included in the accompanying Defense bill report.Unfortunately, however, Congress did not include tuberculosis among the diseases eligible to be funded via the DoD-led Congressionally Directed Medical Research Program’s (CDMRP’s) Peer Reviewed Medical Research Program (PRMRP), as has been the case in years past. This is a point of future advocacy since the CDMRP PRMRP funds other neglected and emerging diseases in line with the list of eligible diseases defined in the Senate’s Defense bill each year.FY25 President’s Budget: A story of lowered ambitionOn March 11, President Joe Biden released his FY25 budget request, outlining his administration's recommendations to Congress for spending for the next fiscal year. The FY25 PBR is more moderate than Biden’s FY24 proposal, which can be largely attributed to the administration upholding their end of the debt ceiling bargain to keep overall spending levels capped at roughly FY23 levels. But even still, the lack of boldness for global health activities across the board was felt by advocates.With respect to global health programs at State and USAID, the budget proposes an overall decrease of approximately $733 million (7 percent) compared to FY23 enacted levels. This includes a $175 million (4.2 percent) cut to USAID and a $558 million (8.9 percent) cut to State global health programs. Concerning the latter, the cut comes from the PBR proposing a $1.19 billion contribution to the Global Fund, which would be an $810 million reduction from FY23 levels. As previously noted, this drastic cut is due in large part to the cap imposed on maximum US contributions; however, advocates are still pushing for $1.65 billion in FY25, citing projections that the US contribution can be set higher without violating the cap. The proposed USAID cut is more nuanced and comes from an accounting choice by the administration to transfer funding for the US contribution to the Pandemic Fund ($250 million) from under the Global Health Security line at USAID to the budget for State’s new Bureau of Global Health Security and Diplomacy, which will now manage US engagement with the fund. In conversations with the agency, the movement of this funding is not being perceived as a cut—leaving USAID’s global health programs largely untouched in the PBR. Most programs are flat funded, though the budget proposes a modest $30 million (3.3 percent) boost to USAID’s maternal and child health programs and a reduction of $26 million (4.5 percent) to USAID’s family planning account.On the LHHS side, the budget proposal is slightly rosier, though far from ambitious. The PBR proposes increases of $20 million (2.1 percent) for BARDA and $1.4 billion (2.3 percent) for NIH overall, with the latter including a modest boost of $18.72 million (0.3 percent) for NIH’s National Institute of Allergy and Infectious Diseases but flat funding for NIH’s Fogarty International Center, which supports global health research and training. CDC received a proposed increase of $465.4 million (5 percent) in the PBR, with NCEZID receiving a $30 million (4 percent) increase and the Center for Global Health flat funded.Notably, CDC’s congressional budget justification proposes that $20 million of this funding for NCEZID be put towards wastewater surveillance, which is programming that is currently being supported unsustainably via emergency funding for the COVID-19 response. Additionally, in the BARDA congressional budget justification, the administration suggests a $20 million boost “to increase BARDA’s Broad Spectrum Antimicrobials and Combatting Antibiotic-Resistant Bacteria portfolio" through engagement with the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator, or CARB-X, an international partnership focused on accelerating the development of new antibacterial innovations.While GHTC understands the administration’s fiscal situation and negotiating position with Congress, the discrepancy between the administration’s ambitions from the FY24 PBR to the FY25 PBR are stark, with some agencies seeing decreases of over $1 billion between the two presidential requests.FY25 outlook: Not great, but not badWhile it may feel cruel for advocates, there is no breathing room between the FY24 and FY25 appropriations processes. Additionally, the constraints the global health community felt in 2024 in the wake of the Fiscal Responsibility Act of 2023—also known as the Biden-McCarthy Debt Ceiling Deal that capped spending growth—are still with us. Even though the outcomes of the FY24 spending package were discouraging for global health advocates—it went better than many expected. For FY25, while a robust and bold global and public health budget is the goal—holding off any cuts and returning to FY23 topline budgets for global health programs will be critical. GHTC will be working to communicate that message clearly while keeping in mind the uphill battle caused by the parameters forced upon appropriators by last June’s debt ceiling deal.Other obstacles like election-year politicking and a remarkable loss in global health champions in Congress will make future negotiations harder and will require advocates to go more on the offense. Pushing for stronger toplines and no cuts will be vital in FY25 to get the gains the community needs to get the world back on track toward eradicating neglected diseases and better preparing for emerging threats.

Last Friday, President Joe Biden signed into law a $1.5 trillion spending bill that will fund the US government through the remainder of fiscal year 2022 (FY22), which began October 1, 2021, and concludes in September. The outcome followed months of tense negotiations by Congress—which had passed a series of temporary funding measures, known as continuing resolutions, to keep the government funded at FY21 levels since the start of this fiscal year—and last-minute maneuvering to try to pair annual spending with emergency aid for Ukraine and the COVID-19 response domestically and globally.While the bill ultimately included welcome boosts across key agency programs that fund global health and medical research, summarized below, in very disappointing news, emergency funding for COVID-19—including $4.5 billion for the global response—was stripped from the final package at the 11th hour due to disagreements on how to cover costs. This leaves an uncertain path ahead for the Biden administration to execute its COVID-19 plan, as previously appropriated funds for the domestic and global response are nearly depleted—raising the prospect of having to halt ongoing government-sponsored COVID-19 research trials, among other impacts. House Democrats have promised to advance a stand-alone COVID-19 emergency funding package, which could provide an influx of urgently needed funds, but it’s unclear whether such legislation could gain the 60 votes needed in the Senate since Republicans are demanding any new bill be paid for via offsets of unspent funds, a requirement many Democrats are opposed to.Below GHTC takes a detailed look at the spending bill and its impact on accounts that finance global health research and development (R&D) programming.State and Foreign OperationsThe final spending bill included $9.8 billion in funding for Global Health Programs at the State Department and US Agency for International Development (USAID), which represents an increase of $630 million, or 6.9 percent, over FY21 enacted levels. The vast majority—$510 million—of that increase is designated for global health security programming at USAID, a 268 percent increase over FY21 funding. This funding includes a $100 million allocation for the Coalition for Epidemic Preparedness Innovations (CEPI) to support vaccine development for potentially epidemic threats, which is both welcome news and higher than the $50 million pledge for this fiscal year announced by USAID Administrator Samantha Power at the CEPI pledging summit just a few days prior.Beyond global health security, the remainder of the increase—$130 million—was spread across other global health accounts. The tuberculosis and maternal and child health program lines at USAID received the largest increases at $52 million (16.3 percent) and $34.5 billion (4 percent) respectively, while nutrition, malaria, and neglected tropical diseases were each increased by $5 million and vulnerable children was increased by $2.5 million. USAID’s HIV/AIDS and family planning lines received flat funding compared to last fiscal year while the President’s Emergency Plan for AIDS Relief, or PEPFAR, under the State Department, was boosted by $20 million (0.5 percent). No global health-related accounts at USAID or State saw their funding cut. In other important news, in the joint explanatory statement accompanying the bill, Congress included language, for which GHTC advocated, directing USAID to develop and publicly release a new multi-year strategy on health R&D detailing its goals and how it plans to invest across health areas. USAID’s current health R&D strategy runs through 2022, so the fulfillment of this congressional directive will help ensure continuity and that research remains a priority for USAID’s global health programming.While it was positive to see Congress provide a major funding boost for health security programming and some modest increases to other global health accounts, overall, these funding increases fell short of what many advocates had hoped for, and in many cases what the House and Senate bill drafts released in 2021 had proposed. The COVID-19 pandemic has increased both the challenges and costs of operating health and research programs worldwide, so this funding package, even with increases, fails to match the scale of today’s expanding needs.Health and Human ServicesThe spending bill provided much larger, but uneven, increases across Department of Health and Human Services (HHS) subagencies and programs that support global health R&D. The National Institutes of Health (NIH) received $44.96 billion in funding, representing a $2 billion, or 4.7 percent, increase over FY21 levels. This included an increase of $253.1 million, or 4.2 percent, for the National Institute of Allergy and Infectious Diseases and a $2.8 million, or 3.4 percent, increase for the Fogarty International Center, which works to strengthen research capacity in low- and middle-income countries.Meanwhile, the Biomedical Advanced Research and Development Authority (BARDA)—an agency that supports development of medical countermeasures against health threats and a central player in COVID-19 R&D through then Operation Warp Speed—received a significant funding boost from Congress. It was appropriated $745 million in funding, a $148 million, or 24.9 percent, increase over the prior fiscal year. This funding envelope supports the agency’s entire research portfolio, which covers chemical, nuclear, radiological, and biological threats—both man-made and naturally occurring—so it is at the agency’s discretion to determine what of this funding it ultimately spends on R&D for naturally occurring health threats, including emerging infectious diseases, pandemic influenza, and antimicrobial resistance. Congress included in the bill’s accompanying joint explanatory statement language requested by GHTC expressing support for BARDA to expand its work on naturally occurring threats and provide more detailed reporting on such spending.The Centers for Disease Control and Prevention (CDC), which is a smaller but still important player in supporting global health R&D, received overall funding of $8.5 billion, a $582.4 million, or 7.4 percent, increase from the prior year. Within that, the Center for Global Health received a $54 million, or 9.1 percent, increase, with 93 percent of that increase designated for the global public health protection line focused on health security and the remainder spread across accounts funding global immunization, HIV/AIDS, tuberculosis, and parasitic diseases and malaria. The National Center for Emerging and Zoonotic Infectious Diseases, which funds select R&D for diagnostics and vaccines against infectious diseases, received a $45 million, or 6.9 percent, increase over FY21 enacted levels. These CDC increases were seen by many advocates as disappointing compared to evident needs. Challenges faced by the agency during the COVID-19 pandemic have underscored the need for a more significant influx of funding for this historically under-resourced agency to modernize its systems and improve staff retention.In addition to providing increases for the three HHS agencies above, Congress appropriated $1 billion for HHS to set up a new Advanced Research Projects Agency for Health, modeled after the Defense Advanced Research Projects Agency, to speed development of medical breakthroughs by funding high-risk, innovative projects. This funding was far lower than the $6.5 billion requested by the Biden administration and interestingly was designated to HHS to establish the agency under the Office of the HHS Secretary, rather than within NIH as the Biden administration and some congressional leaders had proposed. GHTC has pushed for this proposed agency to focus on poverty-related and neglected diseases, as a key area of market failure by industry; however, it remains unclear what health areas this new agency will initially prioritize as it is stood up.While FY22 was a bit of a mixed bag for global health R&D, with important increases across some programs but other areas falling short, advocates are already gearing up for the budget battle ahead for FY23, with the Biden administration expected to release its FY23 budget proposal soon.