Global Health: A Plan Against Disease, Pandemics and Drug Resistance, and Its Test in 2026

Introduction

Infectious disease remains one of the largest causes of preventable death on the planet. Malaria, tuberculosis and HIV alone killed about 2.4 million people in the most recent years for which the World Health Organization and UNAIDS have published estimates, most of them in low-income countries and many of them children. The tools that prevent most of those deaths already exist and are cheap by the standards of rich-country health budgets: insecticide-treated nets, antiretroviral drugs, TB diagnostics and treatment, and childhood vaccines.

Two further threats make global health a species-level problem as well as a humanitarian one. A new pathogen can spread worldwide within weeks; the WHO Director-General told the UN General Assembly in September 2026 that COVID-19 caused more than 20 million excess deaths between 2020 and 2023 and wiped more than US$10 trillion from the global economy (WHO). Antimicrobial resistance (AMR) works more slowly, eroding the drugs that make surgery, childbirth and cancer treatment safe. The three problems share the same foundations: surveillance, laboratories, health workers, supply chains and the international institutions that coordinate them.

This essay sets out a plan across all three, then tests it against the events of 2025 and 2026, a period in which international health funding fell faster than at any point on record, the United States left the WHO, and an Ebola epidemic with no licensed vaccine spread across eastern Congo.

Where things stand

The burden of the three major infectious killers, from the latest official reports:

Measure	Figure	Source
Malaria cases, 2024	282 million	WHO World Malaria Report 2025
Malaria deaths, 2024	610,000	WHO World Malaria Report 2025
People who fell ill with TB, 2024	10.7 million	WHO Global TB Report 2025
TB deaths, 2024	1.23 million	WHO Global TB Report 2025
New HIV infections, 2025	1.2 million	UNAIDS, July 2026
AIDS-related deaths, 2025	570,000	UNAIDS, July 2026
People living with HIV not on treatment, 2025	9 million of 41 million	UNAIDS, July 2026

Malaria cases rose by about 9 million between 2023 and 2024, and the WHO African Region carried 94 percent of cases and 95 percent of deaths (WHO). Since 2000, malaria control has averted an estimated 2.3 billion cases and 14 million deaths. TB remains among the deadliest single infectious agents; its incidence fell 12 percent and its death toll 29 percent between 2015 and 2024, well short of the End TB milestones of 50 and 75 percent (WHO). HIV deaths and new infections are at their lowest levels in more than 30 years, with new infections down 42 percent and deaths down 57 percent since 2010 (UNAIDS).

Drug resistance is already common. The WHO’s 2025 surveillance report found that one in six laboratory-confirmed common bacterial infections in 2023 resisted antibiotic treatment, rising to one in three in the South-East Asia and Eastern Mediterranean regions (Health Policy Watch). The UN’s 2024 political declaration on AMR put the annual number of deaths associated with bacterial resistance at about 4.95 million (WHO). The Global Research on Antimicrobial Resistance project, published in The Lancet, forecasts more than 39 million deaths directly attributable to resistant infections between 2025 and 2050, with annual attributable deaths reaching 1.91 million by 2050 (CIDRAP).

Money is falling while these numbers stand still. The Institute for Health Metrics and Evaluation estimated that development assistance for health dropped 21 percent from 2024 to 2025, with US funding down 67 percent, more than $9 billion (Think Global Health).

Part I: The plan

The plan has eight elements. The first two protect and extend what works against the big three diseases; the next five build defences against outbreaks, pandemics and drug resistance; the last deals with money and with conflict zones.

1. Keep the proven commodity programmes fully funded

The cheapest lives to save are the ones that existing programmes already reach: nets and seasonal malaria chemoprevention, antiretroviral therapy, TB case-finding and treatment, and routine childhood immunisation. Most of these commodities reach poor countries through two pooled funds, the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, and through the US bilateral programme PEPFAR. The Global Fund’s investment case for 2026 to 2028 asked for $18 billion (Aidspan). Gavi asked for $11.9 billion for 2026 to 2030, which it said would protect 500 million children and avert 8 to 9 million deaths (Gavi). WHO’s malaria strategy set a funding target of $9.3 billion a year by 2025, and the TB target is $22 billion a year by 2027 (WHO malaria report executive summary; EATG).

A Lancet study covering 133 countries estimated that USAID programmes were associated with a 15 percent fall in all-cause mortality and a 32 percent fall in deaths of children under five, and with about 91 million deaths averted between 2001 and 2021 (France 24). Donors should treat these programmes as the last items to cut when budgets shrink.

2. Put new tools into use quickly

Several new products can change the course of each epidemic if they reach people at scale:

Long-acting HIV prevention. Lenacapavir, a twice-yearly injection, offers protection to people who cannot take a daily pill. Prices must fall through generic manufacture under Gilead’s voluntary licences.
Malaria vaccines. WHO recommends two, RTS,S and R21. In its pilot programme RTS,S was associated with a 13 percent reduction in all-cause child mortality. By the end of 2024 the vaccines had been introduced in 17 countries (WHO malaria report executive summary).
Next-generation antimalarials. Novartis’s ganaplacide-lumefantrine (GanLum), the first new class of malaria treatment in more than 25 years, cured 97.4 percent of patients in a phase III trial of 1,688 people in 12 African countries, against 94.0 percent for the standard treatment, and worked against parasites carrying resistance mutations (Novartis).
TB vaccines and diagnostics. As of August 2025, 18 TB vaccine candidates were in clinical trials, six of them in phase III (EATG).

Donors should finance early purchases so that new tools reach high-burden countries within a few years of approval.

3. Build surveillance and outbreak response into every health system

Every country needs laboratories that can confirm a novel pathogen within days, trained rapid-response teams, genomic sequencing capacity and a public-health workforce that is paid on time. The amended International Health Regulations, which entered into force on 19 September 2025, require governments to designate a National IHR Authority and created a new “pandemic emergency” alert level above the existing public health emergency of international concern (WHO). The plan asks every state party to staff and fund those authorities, and asks regional bodies such as the Africa Centres for Disease Control and Prevention to hold surge teams and stockpiles.

4. Finish the pandemic rules

The WHO Pandemic Agreement was adopted by the World Health Assembly on 20 May 2025, with 124 votes in favour, none against and 11 abstentions in committee. It needs ratification by at least 60 countries to enter into force, and it cannot open for signature until states agree on an annex setting up a Pathogen Access and Benefit-Sharing (PABS) system (Health Policy Watch). The annex is the core bargain: countries that share pathogen samples and genetic sequence data quickly get a guaranteed share of the vaccines, tests and treatments developed from them. Without such a guarantee, a country that detects a new pathogen has weaker reasons to share samples quickly.

5. Build the capacity to make countermeasures fast and everywhere

The plan pairs the legal bargain with physical capacity: standing funding for vaccine platforms that can be adapted to a new pathogen, pre-negotiated contracts with manufacturers, and regional manufacturing in Africa, Latin America and South Asia so that supply in an emergency does not depend on export decisions by a few rich countries. The plan gives existing bodies such as Gavi larger standing budgets and pre-agreed triggers for releasing them.

6. Slow antimicrobial resistance at its sources

The 2024 UN political declaration set useful targets for 2030: a 10 percent cut in AMR-associated deaths from the 2019 baseline, at least 70 percent of human antibiotic use from WHO’s lower-risk “Access” group, basic water and sanitation in every health facility, meaningful reductions in antimicrobial use in farming, and $100 million in catalytic funding for national action plans (WHO). The plan adopts those targets and adds a point the GRAM researchers stress: better access to basic care and existing antibiotics in poor countries could avert 92 million deaths between 2025 and 2050, far more than new drugs alone (CIDRAP).

7. Pay for new antibiotics without rewarding overuse

Antibiotics are a poor commercial investment because new ones are held in reserve and sold in small volumes. WHO counted 90 antibacterial agents in clinical development in 2025, down from 97 in 2023; only 15 were innovative and only five worked against at least one of its “critical” priority bacteria (WHO). The fix is a “pull” incentive that pays for availability instead of volume. England’s subscription model does this: NHS contracts pay fixed annual fees of £5 million to £20 million per drug, set by clinical value and linked to supply, stewardship and surveillance requirements, from an annual budget of £100 million (The Pharmaceutical Journal). The plan calls for the United States, the European Union and Japan to adopt comparable schemes, which together would create a market large enough to sustain research.

8. Move financing onto a durable footing and protect health in crises

The plan asks middle-income countries to raise domestic health spending on an agreed schedule, while donors commit to multi-year, predictable funding for the poorest and most fragile states and phase out support gradually with clear timelines. In war zones, the plan asks donors to fund health workers’ salaries directly when governments cannot, and asks parties to conflicts to guarantee access for vaccinators and outbreak teams.

Sequencing

The first two years should protect existing commodity programmes, finish the PABS annex and staff national IHR authorities. Years two to five should bring new tools to scale (lenacapavir, malaria vaccines, GanLum and new-generation nets), establish pull incentives for antibiotics in the largest markets and build regional manufacturing. Transition of middle-income countries to domestic financing should run over five to ten years, with public milestones so that it does not become a sudden withdrawal.

What makes it stick politically

Health security is the argument that crosses party lines in donor countries, because outbreaks travel; an imported Ebola case was confirmed in France in August 2026 (WHO). Commitments written into multi-year pledges and treaties survive changes of government better than annual discretionary grants.

Where reasonable people disagree

Vertical programmes or health systems. Disease-specific funds deliver measurable results quickly, but critics argue they distort national priorities and leave primary care underfunded.
Speed of transition. Some argue that aid dependence weakens domestic accountability and that firm transition deadlines force governments to invest. Others reply that many high-burden countries carry heavy debt service and cannot absorb the cost in five years.
Multilateral or bilateral channels. Supporters of bilateral deals value leverage and accountability to donor taxpayers; supporters of the WHO and the pooled funds value scale, pooled purchasing and legitimacy in recipient countries.
Pathogen sharing and intellectual property. Many developing countries want binding benefit-sharing obligations on manufacturers; pharmaceutical companies and some high-income governments argue that heavy obligations will slow research and deter participation.

Part II: The plan in the world of September 2026

The funding collapse

Development assistance for health dropped from about $49.6 billion in 2024 to $39.1 billion in 2025 by IHME’s estimates, with the steepest reductions in sub-Saharan Africa (25 percent) and cuts by the United Kingdom, France and Germany as well as the United States (Think Global Health). UNAIDS reported that international HIV assistance fell from $8.8 billion in 2024 to $7.3 billion in 2025, the lowest level in nearly two decades (UNAIDS). Funding for HIV testing fell 22 percent in high-burden countries, funding for condoms fell 93 percent, and use of pre-exposure prophylaxis dropped 38 percent between 2024 and 2025 (Healio). Official development assistance for malaria fell 21 percent, largely because of US reductions, and total malaria funding in 2024 was $3.9 billion, 42 percent of the $9.3 billion target; planned surveys were cancelled or postponed, though most net campaigns stayed on track (WHO malaria report executive summary). Global TB funding reached only $5.9 billion in 2024, about a quarter of the target, and WHO estimated that donor cuts beginning in 2025 could cause up to 2 million additional deaths and 10 million additional TB cases between 2025 and 2035 (EATG).

The mid-2025 Lancet study projected that an 83 percent cut in USAID funding could lead to more than 14 million avoidable deaths by 2030, including more than 4.5 million children under five (France 24).

What this means for the plan. Element 1 is the one under most pressure. The cuts fall hardest on prevention, testing and community services, the parts of programmes that stop future infections.

Replenishments fall short of target

The Global Fund’s eighth replenishment raised $11.34 billion at its November 2025 summit in Johannesburg, against an $18 billion target and $15.7 billion raised in 2022. The United States pledged $4.6 billion, keeping its rule of matching one dollar for every two from other donors (Aidspan). Later pledges brought the final total to $12.64 billion, which the Board confirmed in February 2026. It allocated $10.78 billion to countries for 2026 to 2028, with defined timelines for some countries to leave Global Fund support (Global Fund).

Gavi’s June 2025 summit in Brussels raised more than $9 billion of its $11.9 billion target, led by $1.6 billion from the Gates Foundation and more than €2 billion from the EU and its member states (Gavi). The United States made no pledge. Congress had appropriated $600 million for Gavi, but the administration withheld it for months after Health Secretary Robert F. Kennedy Jr. objected to Gavi’s use of vaccines containing the preservative thimerosal. Gavi began phasing those vaccines out, although WHO reviews have found the preservative safe in small doses (CIDRAP). The funds were released on 29 July 2026, after pressure from Senator Jeanne Shaheen (Office of Senator Shaheen).

What this means for the plan. The Global Fund secured about 70 percent of its target and Gavi about 76 percent. The Global Fund’s shift toward transition timelines is consistent with element 8, though its pace is being set by the shortfall.

The United States moves from multilateral to bilateral

The United States completed its withdrawal from the WHO on 22 January 2026, a year after Executive Order 14155, ending all funding and recalling staff; the government said it would work instead through direct bilateral engagement (CDC). The WHO, which said the decision made “both the United States and the world less safe” (WHO), cut its 2026–27 base budget to $4.2 billion, 21 percent below the previous $5.3 billion (Health Policy Watch), and planned to shed about 2,371 staff, a quarter of its workforce, by mid-2026, while still facing a $1.05 billion funding gap for the biennium (Health Policy Watch).

The US replacement is the America First Global Health Strategy, released on 18 September 2025 after USAID’s dissolution. It channels aid through five-year bilateral memoranda of understanding under which partner governments take on rising shares of costs and most are expected to reach full self-reliance by the end of the agreement (Brookings). By 11 September 2026, 35 countries had signed. The agreements total $24.1 billion over 2026 to 2030, with partner countries contributing 39 percent; for those 35 countries, US funding is $7.5 billion (34 percent) lower than in the prior five-year period (KFF). Namibia became the first country to announce a planned exit from PEPFAR, taking full responsibility for its HIV response from 2028 (Bush Center). South Africa, which accounts for more than half of Africa’s lenacapavir users, was not offered an agreement, and Zambia and Zimbabwe discontinued negotiations (Think Global Health). Brookings has criticised the compacts for dropping community testing and services for high-risk groups unless countries pay for them, and for conditions unrelated to health (Brookings). Supporters say the compacts give countries predictable plans and push them toward ownership.

What this means for the plan. The compacts adopt the goal of element 8, domestic financing on a schedule, at a pace set by the donor. Their test is whether transition timelines track what each country can afford. The plan should also now assume a smaller WHO focused on norms, emergencies and data.

The pandemic agreement stalls on its annex

The PABS annex was due for adoption at the World Health Assembly in May 2026. Negotiators did not finish, and the Assembly extended their mandate, with the outcome to go to the Assembly in May 2027 or to a special session earlier (WHO). The working group’s eighth session, from 14 to 18 September 2026, advanced the text without concluding it (WHO). At the second UN General Assembly High-Level Meeting on Pandemic Prevention, Preparedness and Response on 25 September, countries stressed the urgency of finishing the annex, with adoption now targeted for May 2027 (WHO). Because the agreement cannot open for signature until the annex is adopted, the earliest realistic entry into force has slipped by at least a year.

What this means for the plan. Element 4 is behind schedule, and negotiations continue. The annex settles who gets vaccines first, and it deserves more political attention than it is getting.

Ebola in eastern Congo: the preparedness test in real time

The most serious outbreak of 2026 is an epidemic of Ebola disease caused by Bundibugyo virus, a species for which no licensed vaccine or specific treatment exists. The outbreak was confirmed in May in the Democratic Republic of the Congo and Uganda, and WHO declared it a public health emergency of international concern that month (WHO; WHO). As of 23 September 2026, Congo had reported 7,890 confirmed cases and 3,799 deaths, a case fatality ratio of 48.1 percent, across 63 health zones in seven provinces. Ituri province, the epicentre, accounted for 6,032 cases (WHO). Cases rose 73 percent in North Kivu over the preceding three weeks; about one in three new cases was identified only after death, and children under five were dying at a rate above 60 percent (UN News).

Surveillance detected the virus, but conflict, displacement and insecurity in the Kivus and Ituri have hampered contact tracing and access (WHO). Health workers at several facilities struck over unpaid wages in July and August as foreign aid dwindled (Wikipedia). A clinical trial of treatments began enrolling patients on 2 July, and vaccination with Ervebo, the vaccine licensed against a different Ebola species, began on 27 August with no certainty that it protects against Bundibugyo (WHO). As of mid-September the response faced a funding gap of $1.1 billion (Bush Center).

What this means for the plan. The epidemic supports elements 3, 5 and 8 directly. Vaccines funded in advance for every known Ebola species would have changed the first months of this outbreak. Paying health workers in conflict zones is part of outbreak control.

Malaria: resistance and an invasive mosquito

The biological threats to malaria control grew while funding fell. Artemisinin partial resistance is now confirmed in Eritrea, Rwanda, Uganda and Tanzania and suspected in Ethiopia, Namibia, Sudan and Zambia; in parts of Uganda more than half of parasites carry resistance-associated mutations, and the partner drugs lumefantrine and amodiaquine look increasingly vulnerable (WHO malaria report executive summary). Anopheles stephensi, an urban mosquito from South Asia, has been reported in nine African countries. A genomic study published in Science in June 2026 found that its insecticide resistance was already established when it arrived in Africa, which weakens the protection offered by nets and indoor spraying (LSTM). WHO also names climate change and conflict as drivers of malaria resurgence (WHO malaria report executive summary).

GanLum is the main new answer to drug resistance, but as of this writing it has not been approved; Novartis said in November 2025 that it would seek approval as soon as possible (Novartis).

What this means for the plan. Element 2 has become urgent for malaria. Countries with confirmed resistance need multiple first-line therapies now, and regulators and the Global Fund should prepare to procure GanLum as soon as it is approved.

HIV prevention: a breakthrough arriving during a funding crisis

By April 2026 initial deliveries had reached nine African countries, support was being extended to 12 more, and the United States and the Global Fund have set a joint goal of reaching 3 million people by 2028 (Global Fund). The Global Fund opened an expedited pathway for quality-assured generics in April 2026 and expects initial generic supply in late 2026, with broader availability in 2027 (Global Fund). UNAIDS says only thousands of people are currently using it, while 20 million need access to antiretroviral-based prevention, and it warned that without urgent action more than 3 million people could become infected by 2030 (UNAIDS).

What this means for the plan. Lenacapavir cannot make up for the collapse of community testing and prevention services on which it depends. The plan’s priority for HIV is to pair generic scale-up with funding for the outreach that finds the people at highest risk.

Antimicrobial resistance: some progress on drugs, little on money

On 12 December 2025 the US Food and Drug Administration approved zoliflodacin (Nuzolvence), a first-in-class single-dose oral antibiotic for gonorrhoea, developed by GARDP and Entasis Therapeutics, now part of Innoviva Specialty Therapeutics, as a public-private partnership (STAT). England’s expanded subscription contracts were scheduled to start in 2026 (The Pharmaceutical Journal). The US PASTEUR Act, which would set up a similar model, was before the Senate in late 2024 (The Pharmaceutical Journal), and its status in 2026 is unclear. The 2024 declaration called for an independent evidence panel on AMR in 2025, and consultations on its design were under way in mid-2025 (Quadripartite Joint Secretariat on AMR); whether the panel is now operating is unclear from published sources.

What this means for the plan. Elements 6 and 7 have made little progress since 2024. AMR remains the most neglected of the three threats relative to its forecast toll.

Part III: Revised priorities

The events of 2025 and 2026 point to six priorities for the next six to twelve months, in order:

Close the Ebola funding gap and pay the responders. Fund the $1.1 billion shortfall, pay health workers in eastern Congo directly, and finance vaccine and treatment trials for Bundibugyo virus through to results.
Protect prevention inside shrinking programmes. Global Fund allocations, US compacts and national budgets should keep HIV testing and community outreach, TB case-finding, and malaria net and chemoprevention campaigns ahead of lower-value spending.
Make transitions realistic. Donors and recipients should revisit co-financing schedules country by country, with debt relief or concessional finance where debt service crowds out health budgets, and find a path for countries left outside the US compacts, starting with South Africa’s HIV programme.
Finish the PABS annex, at a special session in 2026 if possible. A deal before May 2027 would open the Pandemic Agreement for signature and start the ratification clock.
Get new tools through regulators and into procurement. Prepare GanLum procurement and multiple first-line therapies for malaria in countries with confirmed artemisinin resistance, and move lenacapavir generics to scale in 2027.
Enact antibiotic pull incentives in large markets. The United States, the European Union and Japan should each adopt a subscription or market-entry reward, building on the English model.

Conclusion

The tools against infectious disease work, and the record since 2000 shows it: 14 million malaria deaths averted, HIV deaths down by more than half since 2010, and TB deaths falling across Africa. The events of 2025 and 2026 left the plan’s logic intact while exposing how much of it depended on one donor and on institutions that can lose a quarter of their staff in a year.

The immediate risk is that prevention and surveillance, the parts of health systems that do not show results until something goes wrong, are cut first. The Ebola epidemic in eastern Congo is the current example of what follows when a pathogen with no vaccine reaches a conflict zone with unpaid health workers.

This essay reflects reporting available as of late September 2026. The Ebola epidemic, the PABS negotiations and US appropriations for the 2027 fiscal year are all moving quickly, and some figures here may be out of date within weeks.