Ripple effects: How U.S. FDA layoffs threaten global health in low- and middle-income countries and weaken US competitiveness

Every year, delegates from around the world descend on Geneva, Switzerland for the annual World Health Assembly (WHA), a convening of key donors, decision-makers, and advocates who are seeking to drive the collective health agenda forward. But while this year offered many of the same lengthy debates, geopolitical outbursts, panel discussions, and late-night receptions, it was clear to all that we are not in normal times.   Global health is facing a moment of profound uncertainty. The financial strain on the World Health Organization (WHO) is just one signal of a wider set of systemic pressures— from donor fatigue to the imperative for countries to mobilize more domestic resources. This year’s forum arrived at a moment when expectations are high, but so too is the risk of backsliding without renewed commitments and smarter, more sustainable strategies. Despite this backdrop, delegates should rightfully celebrate some of the wins that WHO and member states notched this year on behalf of the global community.   Pandemic Agreement is adopted by delegatesIn what was the most anticipated moment of this year’s WHA, member states came together to adopt the Pandemic Agreement—an achievement met with standing ovations and thunderous applause. The moment marked not only a significant step forward for global health but also a rare and much-needed boost for multilateralism.  Deliberations had stretched on for three long years, and until the final moments, it remained uncertain whether negotiators would reach any substantive agreement. But they persisted, driven by the sense that this was a once-in-a-generation chance to ensure the mistakes of the COVID-19 pandemic are not repeated and to lay the foundation for a new architecture and obligations to drive greater equity in the development of and access to medical countermeasures.Notably, this agreement commits countries to develop policies attaching public interest conditions to research and development (R&D) funding—an unprecedented move with the potential to transform how treatments, tests, and vaccines are developed and delivered during health crises.  Additionally, it introduces a new global coordinating mechanism for supply chains and logistics, mandates national policies to ensure post-trial access to products for both trial participants and at-risk groups, and sets out guiding principles for a new Pathogen Access and Benefit-Sharing (PABS) system. Under this system, participating manufacturers would allocate 20 percent of their medical countermeasure production during a health emergency to WHO—supporting more equitable access and distribution around the globe.While delegates celebrated this historic milestone, the process is far from over. Global leaders must still finalize negotiations on the PABS system, which is widely seen by many low- and middle-income countries (LMICs) as the linchpin for ensuring equitable operationalization of the agreement.   More decisions will also have to be made around implementation, especially on financing capacity-strengthening efforts to ensure that countries can meet the new obligations enshrined in the agreement. But for now, many in the community are breathing a major sigh of relief and raising a glass to the successful completion of this arduous phase.   Financing at the forefrontGlobal health is facing a funding crisis as several major donors retreat, leaving many to wonder whether shared global goals and targets can still be achieved. Many major institutions are hindered by a lack of resources, and WHO itself faces an almost catastrophic budget shortfall.   At WHO’s Executive Board meeting in February, member states made the difficult decision to reduce the organization’s budget from $5.3 billion to $4.9 billion for the 2026-2027 period. Subsequently, the secretariat called for an even further reduced budget of $4.2 billion due to the anticipated decline in official development assistance.   During WHA deliberations, member states shared strong views about how the organization’s resources should be allocated. The regions of Africa, the Americas, and the Eastern Mediterranean called for the preservation of in-country work and greater alignment of budget allocations with public health need. In contrast, several donor countries, such as Australia, Canada, Switzerland, and the United Kingdom emphasized the need to safeguard WHO’s normative work, which has predominately been performed at its headquarters in Geneva.   In late April, the secretariat presented member states with a proposal to restructure WHO staff and activities. It recommends that work in Geneva be based around three technical divisions: Health Promotion and Disease Prevention and Control; Health Systems; and Health Emergency Preparedness and Response. The office of the Chief Scientist and the division of Business Operations would provide cross-cutting support. There have also been proposals to reduce the senior leadership team at headquarters from 12 to 7 and consolidate the number of departments from 76 to 34. WHO’s regional offices are finalizing their restructuring efforts as well, aiming to align more closely with the new model for headquarters.  While this plan has been relatively well received thus far, with many country representatives praising WHO for its consultative process, the devil will be in the details. Specifically, it remains to be seen how programs vital to health R&D and infectious disease response will be affected. So far, it is encouraging that WHO is retaining some of its key R&D functions, like the prequalification program and the office of the Chief Scientist. But the impact of the restructuring on disease-specific programs, like tuberculosis, malaria, HIV/AIDS, and neglected tropical diseases, is still unclear.United States makes surprising appearanceFor the first time since 1948, WHA convened without the United States. This absence was acutely felt—not only in the lack of a US delegation in diplomatic deliberations, but also in the ripple effects created across an already strained global health landscape. Nowhere was this more apparent than in the budget negotiations, where the vacuum left by US withdrawal and funding cuts loomed large, injecting uncertainty and apprehension into an already difficult process. Leaders were also thrown for a loop when they received a surprise video message from the new US Department of Health and Human Services Secretary Robert F. Kennedy Jr. In his remarks, which echoed many of the current administration’s previously shared concerns about WHO, Kennedy appeared to extend a bit of an olive branch, calling for “a new era of international health cooperation, free from political influence and corporate bias.” Yet, despite a sprinkling of conciliatory language and even praise for some of WHO’s efforts, he did not give any indication of a shift in policy, nor did he suggest that the United States would consider rejoining the organization at this time.  Secretary Kennedy did acknowledge, however, that infectious disease and pandemic preparedness need to remain national and global priorities, though how the US government intends to forge that cooperation outside of WHO, the Pandemic Agreement, and the International Health Regulations remains unclear.   As we approach the official US withdrawal from WHO in January, it will be interesting to see how the United States will seek to engage in global health dialogues and coordinate with multilateral institutions. The question remains whether the US government will stop the withdrawal or move toward some new framework that allows for limited technical collaboration.   Research takes a back seatAlongside the high-profile discussions on the budget and the Pandemic Agreement, this year’s WHA saw delegates tackle some 75 agenda items during the marathon nine-day session. Yet, R&D—typically a staple of WHA conversations—took a noticeable back seat. Few agenda items beyond the Pandemic Agreement addressed access issues, and virtually none focused on specific product types or infectious diseases. While this may not signal a troubling shift just yet, the innovation community cannot take for granted the need for continued and sustained advocacy to elevate health research as a priority. Even so, the week was not without its bright spots, with new commitments advanced to tackle antimicrobial resistance (AMR) and the impacts of climate change on health and to improve maternal and child health—offering concrete examples of where global health priorities are still gaining ground. Member states unanimously agreed to update WHO’s global action plan on AMR for discussion at next year’s WHA, with several nations underscoring the importance of developing new and effective medicines to keep pace with evolving drug-resistant pathogens. Many countries also offered support for WHO’s Global Strategy for Women’s, Children’s, and Adolescent’s Health, which is aimed at helping reach Sustainable Development Goals 3.1 and 3.2 to reduce maternal, newborn, and under-five mortality rates. Additionally, a new action plan on climate and health was also adopted, which includes R&D-enabling efforts to create stronger links between researchers and policymakers, expand access to financing and technical support, and promote greater cross-border collaboration.   This year’s WHA reflected both hard-won progress and tough realities—and it also set the stage for what comes next. The adoption of the Pandemic Agreement is more than a milestone; it's a mandate to turn consensus into action that advances equity and preparedness. As WHO confronts a reduced budget and undertakes a major restructuring, there's a chance for the organization to streamline, refocus, and emerge as a more agile, effective force in global health. If leaders can build on WHA’s momentum and commit to smarter, more inclusive cooperation, this moment of disruption could mark the start of a leaner and more resilient era in global health.  

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Last week, scientists announced a new project, funded by Wellcome, to expand the use of a low-cost, field-deployable, and real-time viral genome sequencing technique that has been widely used to detect COVID-19 variants to cover a wider variety of pathogens, helping public health officials surveil known and unknown pathogens of concern and respond to outbreaks more quickly and effectively. The project, which includes an international team of researchers, is supported by the Africa Centres for Disease Control and Prevention, the Asia Pathogen Genomics Initiative, and the World Health Organization International Pathogen Surveillance Network, which will help ensure that the system is broadly accessible around the world, even in places with limited resources and laboratory infrastructure.Harvard University researchers have found a drug combination that can kill the malaria parasite directly in mosquitoes so they can no longer spread the disease. Given the drugs can be absorbed the legs of mosquitoes, the goal is to create a cheap, long-lasting tool that could be applied alongside insecticides to bed nets in malaria-endemic regions. As resistance to the insecticides used on bed nets rises, this new method is less likely to lead to the emergence of resistance. The drugs, which were tested on materials similar to bed nets in a laboratory setting, killed 100 percent of the parasites. The method will be next tested in a real-world study in Ethiopia.A research team at Institut Pasteur has started a project testing a new rapid diagnostic that could detect the presence of the Plasmodium vivax malaria parasites early on after the initial mosquito bite—before symptoms arise—, helping patients receive appropriate treatment faster. Specifically, the researchers intend to design a test that can detect the presence of the parasite in blood samples from individuals whose infection is in the dormant liver stage, when it is difficult to detect infection. The project, which will run through 2030, has received around €6 million in funding from the European Union, as well as the British and Swiss governments.