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 October 19, 2025, US President Donald Trump halted all US assistance to Colombia after Colombian President Gustavo Petro accused the US of murdering a fisherman in a Caribbean strike meant to target the transportation of illicit drugs, ending hundreds of millions of dollars in American assistance.

Colombia received an estimated US$230 million in the US budget year that ended on September 30, 2025, already a significant decline from recent years, in which Colombia typically received at least twice as much funding. Trump stated all payments and subsidies to Colombia would cease and announced he would reveal new tariffs on October 20, 2025. Colombia is the top recipient of US assistance in Latin America, with funding previously set to exceed US$400 million at the start of 2025 before earlier cuts reduced it to approximately US$100 million.

Petro rejected accusations of complicity in the illicit drug trade and defended his government's counternarcotics efforts. The Colombian Foreign Ministry described Trump's statement as a direct threat to national sovereignty.

On October 17, 2025, at the G7 Development Minister’s Meeting in Washington, D.C., US Senior Official for Foreign Assistance, Humanitarian Affairs and Religious Freedom Jeremy Lewin urged partners to prioritize efficient development programs that catalyze private investment and counter debt-trap diplomacy.

The meeting, held on the margins of the WBG and IMF Annual Meetings, focused on mobilizing private capital, reforming multilateral institutions, and increasing burden-sharing. Lewin urged partners to prioritize efficient development programs that bypass the ' NGO industrial complex,' catalyze private investment, and advance strategic imperatives, highlighting the recent US reform of its 'wayward' foreign assistance system.

Lewin underscored the importance of the G7 as a platform for US cooperation on humanitarian issues, development, and security. 

During the World Bank-IMF annual meetings on October 15, 2025, US Representative French Hill highlighted similar themes and stated that the US sought 'actual development' that stayed true to organizational mandates and produced results. He criticized perceived mission creep in multilateral institutions and stated that the US should maintain its shareholding in multilateral institutions to advance American interests and secure reforms. Hill also emphasized that 'America First' meant US leadership rather than isolation.

On September 25, 2025, the US administration issued a presidential memorandum to investigate and disrupt networks and organizations, including nonprofits, that the administration views as supporting political violence, coinciding with Department of Justice instructions to investigate George Soros's Open Society Foundations for potential racketeering charges.

The memorandum, titled Countering Domestic Terrorism and Organized Political Violence cited the recent assassination of conservative activist Charlie Kirk, attacks on federal officers, and over US$2 billion in property damage from riots as justification for the new measures. The strategy calls for Joint Terrorism Task Forces to investigate funders and employees of organizations aiding in such activities. The memorandum also instructed the US Treasury and the IRS to identify and disrupt financial networks and ensure that tax-exempt entities, many of which are registered as nonprofits, are not directly or indirectly financing political violence.

The Open Society Foundations, which has distributed more than US$23 billion worldwide, condemned the instructions to the Department of Justice as politically motivated attacks on civil society meant to silence free speech. Soros founded the origins of the organization in 1984 to support democracy, especially in communist and former communist countries. The foundation funds groups promoting human rights, democracy, and equity.

The National Council of Nonprofits echoed the Open Society Foundations' concerns, stating that there was no evidence linking nonprofit organizations and foundations to recent political violence. Nearly 200 philanthropic organization released a joint open letter condemning political violence and warning against using the tragedy for partisan gain.

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 15, 2025, a UN Women report revealed that progress on women's rights is stagnating and regressing due to conflict, aid cuts, and a backlash against gender equality, and called on governments at the UN General Assembly in New York to commit to renewed action, highlighting that the US$420 billion needed annually to advance gender equality is a fraction of the US$2.7 trillion spent on the military.

The report, a gender snapshot monitoring progress on the SDGs, found that 676 million women and girls lived near deadly conflict in 2024, the highest number since the 1990s. Women are also more likely to be affected by rising food insecurity. The report projects that climate change could push an additional 158.3 million women and girls into extreme poverty by 2050.

Director of UN Women’s policy division, Sarah Hendriks, contrasted the US$2.7 trillion in annual military spending with the estimated US$420 billion needed to advance gender equality. The report also noted a digital gender divide, which if addressed, could lift 30 million women and girls out of poverty by 2050 and generate a US$1.5 trillion increase in global GDP by 2030. UN Women is calling for renewed commitments at the UN General Assembly, 30 years after the Beijing Declaration.

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.