On February 3, President Donald Trump signed the Consolidated Appropriations Act, which includes a $50 billion foreign affairs package. The spending represents a 16% cut from the prior fiscal year but lands nearly $20 billion above the White House's proposed budget.
To lead this week's coverage, Jirair Ratevosian, former chief of staff at the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), examines how the spending will reshape governing structures for global health, rewrite operational authority, and reorient long-term policy decisions for U.S. foreign assistance.
Next, Seed Global Health CEO Vanessa Kerry dives into the sovereignty versus multilateralism debate taking hold in global health. She writes that the aid funding vacuum left by the United States has triggered a surge of disconnected reform efforts to "put countries in the driver's seat," but those efforts could deepen the fragmentation they aim to fix. To overcome global health challenges, she posits that countries need a system where sovereignty sets the agenda and multilateralism enables it.
Ahmed Ogwell, CEO and president of VillageReach, continues from the other side of the debate. For African countries to gain bargaining power with global health suppliers, donors, and technology partners, Ogwell writes they should implement the Lusaka Agenda. He describes how prioritizing domestically financed health-care systems—ones led by national governments and communities—can create accountability and strengthen regional coordination.
The newsletter wraps with a response to a TGH article published in January about 10 considerations for global health reform initiatives in 2026. Unitaid's Executive Director Philippe Duneton warns that by focusing on consolidation, actors overlook how the future global health system will need to ensure equitable distribution of breakthrough medicines and diagnostics. To ensure that all populations receive lifesaving technologies, Duneton encourages countries to adopt a new multilateral platform that prioritizes affordable access.
Until next week!—Nsikan Akpan, Managing Editor, and Caroline Kantis, Associate Editor
