\n Previously, PEPFAR was jointly run by the US Agency for International Development<\/a> (USAID), CDC and other agencies, and overseen by the State Department. But the new plan will swiftly move much more control to the State Department. Multiple critics and experts have told CNN that they support the idea of streamlining PEPFAR \u2013 work to improve its efficiency was already underway \u2013 but they believe this new approach will severely diminish the initiative\u2019s effectiveness and sideline the health experts at CDC.\n <\/p>\n \n The 120 US-financed awards for the CDC branch of PEPFAR<\/a> are expected to end within weeks without replacement mechanisms in place, according to a recent analysis of publicly available data by the Health Security Policy Academy, a US-based think tank.\n <\/p>\n \n \u201cThe result could be a second global health woodchipper: the abrupt destruction of operating systems that patients, clinics, health workers, laboratories, and ministries of health still depend on,\u201d wrote the authors of the analysis.\n <\/p>\n \n The impacts are expected to vary greatly from country to country. Mozambique, Tanzania and South Africa will be hit particularly hard by the funding cliff this year, the analysis shows<\/a>.\n <\/p>\n \n The awards fund a range of services including community testing, HIV clinical services, HIV lab services, Pre-Exposure Prophylaxis (PrEP) medication and more. Many of the expiring overseas programs have been running for 15 or 20 years, since the funding was typically renewed in five-year cycles.\n <\/p>\n \n In addition to not renewing US-funded programs that happen to expire in 2026, the State Department is also planning to replace some of CDC\u2019s other remaining awards and has told CDC to cancel some open funding opportunities, according to one CDC official.\n <\/p>\n \n \u201cIt really does feel like the end of PEPFAR,\u201d the CDC official, who was not authorized to speak on the record, told CNN. \u201cIn a lot of cases, the State Department mechanism is not set up yet. So, this isn\u2019t handing it from one set of experts to another \u2013 this is taking it away from one set of experts and putting it in a big box with a question mark.\u201d\n <\/p>\n \n Another part of the new strategy launched in May is transitioning to a system in which partner countries choose from a \u201cmenu\u201d of services, paying \u00e0 la carte for which CDC services they want. Analysts say that will take the US health agency out of the driver\u2019s seat and turn it into a contractor of sorts.\n <\/p>\n \n Trump administration political appointees \u201chave been pretty clear the overall funding is going way down,\u201d the CDC source added, saying that State Department officials have made clear that they are no longer interested in funding certain systemic work, such as health surveillance systems, certain laboratory work and health workforce training. For the parts of PEPFAR programs that they do want to keep funding, like health workers and medications, \u201cit\u2019s really just for one or two more years, and then they\u2019ve already told some of the countries we\u2019re pulling the plug.\u201d\n <\/p>\n \n The State Department though has said that funding for operations will increase, as it transitions to what it\u2019s calling the \u201cAmerica First Global Health Strategy.\u201d<\/a> The changes to PEPFAR are part of that broader strategy, in which American aid will be funneled through a new system of one-on-one Memoranda of Understanding (MOU) with individual countries, rather than distributed through international aid partners and organizations.\n <\/p>\n \n \u201cThe State Department expects CDC overseas operating funding to increase \u2013 not decrease \u2013 under the America First Global Health Strategy,\u201d a State Department spokesperson said in response to questions from CNN.\n <\/p>\n \n \u201cThe Trump Administration is preserving and strengthening PEPFAR\u2019s lifesaving impact, maintaining CDC\u2019s world-class technical role, and ensuring US assistance is producing durable results,\u201d the State Department spokesperson said. They said that each country receiving aid is now working through a plan for implementation of the MOU agreements and that the CDC remains \u201cthe preferred provider for all technical services to recipient countries.\u201d\n <\/p>\n \n A spokesperson for the US Department of Health and Human Services, which oversees CDC, said: \u201cThe suggestion that the America First Global Health Strategy will \u2018deteriorate\u2019 global health programs ignores decades of CDC\u2019s work to build sustainable public health capacity around the world,\u201d adding that \u201cCDC continues to implement global health programs funded through Congressional appropriations.\u201d\n <\/p>\n \n The State Department\u2019s restructure of PEPFAR has drawn widespread criticism from experts, members of Congress and former CDC officials who worked under both Republican and Democratic administrations.\n <\/p>\n \n In an essay published in the health news outlet Stat in May, eight former CDC directors warned<\/a> that the State Department strategy, \u201cdone in haste as currently planned\u2026 will destroy PEPFAR and undermine health security around the world and in our own country.\u201d They added that the fee-for-services menu \u201crisks pulling out the scaffolding and expertise\u201d of the program before an effective alternative is in place.\n <\/p>\n \n The former CDC directors urged the State Department, CDC and Congress to work together on a more stable transition plan.\n <\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/07\/gettyimages-2212118972-20260708125302046.jpg\")
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