# Progress Against the World’s Deadliest Infectious Diseases Is on a Knife-Edge

In 2025, international funding for global health was cut at unprecedented scale and speed, disrupting programs to combat the world’s deadliest infectious diseases. HIV, tuberculosis (TB) and malaria still kill millions of people every year, and those of us engaged in the fight against them feared dramatic reversals of hard-won gains.

While the full impact is still to be determined, the picture is less alarming than we anticipated. In many countries, essential lifesaving services have proved remarkably resilient, a testimony to the determination of countries, communities and their partners to continue the fight.

But the cuts caused real damage to both service coverage and health outcomes. A [new report](/en/results/ "Results Report 2026") covering more than 100 countries where the [Global Fund](https://www.unaids.org/sites/default/files/2025-11/2025-WAD-report_en.pdf "UNAIDS World AIDS Day Report 2025") invests shows that the number of people receiving pre-exposure prophylaxis, or PrEP, to prevent HIV fell from 1.4 million in 2024 to 1.1 million in 2025. More than [2 million adolescent girls and young women](https://www.unaids.org/sites/default/files/2025-11/2025-WAD-report_en.pdf "UNAIDS World AIDS Day Report 2025") also lost access to essential health services, leaving a population already at heightened risk of HIV even more exposed.

Likewise, TB programs reported reductions or interruptions to community activities, contact investigation and active case finding – all of which are essential to finding TB early, starting treatment and preventing its spread. In malaria programs, some countries reported stock-outs of essential medicines, setbacks in efforts to monitor and respond to drug and insecticide resistance, and, in some instances, delays to prevention campaigns.

These are not marginal setbacks. Each one represents a missed opportunity to prevent an infection, find a disease early or connect someone to lifesaving care.

Yet it could have been much worse. Across the world, HIV, TB and malaria programs have adapted remarkably well under extraordinary pressure. Governments stepped up. Health workers stretched scarce resources. Programs found efficiencies. In many places, essential medicines and services continued to reach the people who need them most.

Prevention services fared worse than treatment. As international funding declined, countries focused limited resources on maintaining lifesaving treatment, while longer-term capacity strengthening, such as health worker training and investments in other health systems were deprioritized. These adjustments mitigated the immediate impact of the cuts, but partly at the expense of longer-term momentum.

One positive consequence was a sharper focus on efficiency and innovation. Countries are finding ways to sustain quality services at lower costs, while advances in prevention, diagnostics, treatment and service delivery are making every dollar go further.

For example, the HIV community is using the deployment of lenacapavir, a twice-yearly injectable PrEP, to re-energize HIV prevention. Almost 100% effective at preventing HIV, lenacapavir is a game-changer. With the first deliveries to Eswatini and Zambia in November 2025, and subsequent launches in a further eight African countries, partners are supporting the deployment of lenacapavir in high HIV-burden countries in Africa as swiftly as it is being deployed in high-income economies. Together with other prevention tools in the pipeline, such as alimatravir, a monthly oral PrEP, lenacapavir could enable us to dramatically reduce new HIV infections, and bring the goal of ending AIDS within reach.

For TB, innovation in screening and diagnostic tools is delivering a significant reduction in the cost of finding people with the disease. The global health community has already rolled out artificial intelligence-powered digital X-ray screening in over 20 countries, enabling low-cost, highly accurate identification of presumptive TB cases. New near-point-of-care molecular diagnostic devices – so far being deployed to 13 countries – can test for TB at a fraction of the previous cost. Together, these tools support countries to expand their efforts to find people with TB despite reduced resources.

For malaria, dual active ingredient insecticide-treated mosquito nets have the potential to reduce malaria cases by up to 45% in areas of insecticide resistance compared to standard nets, for less than a dollar more. So most countries have switched to this new type of net, which now accounts for 78% of new orders through the Global Fund’s procurement platform.

The cuts in external funding have also galvanized efforts to increase domestic health spending. Countries are determined to become more self-reliant, accelerating the transition to nationally financed health systems that are less dependent on external resources. But this is not a quick fix. Many of the countries most affected by HIV, TB and malaria have limited fiscal capacity and crippling debt burdens. They simply do not have sufficient financial resources to achieve self-reliance quickly. Further cuts in external funding would make transition harder by undermining progress against the diseases themselves. Transitioning the financing responsibility for diseases that are already well contained and on a downward trajectory of infections and deaths is far more feasible than trying to do the same for diseases that are growing threats.

The global health community proved more resilient and adaptable in 2025 than many anticipated. But we cannot be complacent. The model of global health financing that has delivered transformational progress over the last two decades is no longer sustainable. Donors are facing acute fiscal and political constraints. Countries are struggling with fiscal and debt challenges. Conflicts and insecurity are disrupting health services and increasing costs. Disease outbreaks and extreme weather events are diverting already scarce resources. Drug resistance is threatening hard-won progress. Human rights and access to essential services are facing pressures in many places.

To adapt to these new realities, we must reimagine the global health ecosystem and the way it is financed and delivered. That means tackling inefficiencies and accountability gaps, directing resources towards people facing the greatest risks, accelerating innovation, strengthening domestic financing and country leadership, and supporting a responsible transition from donor financing without abandoning countries before they are ready. We must keep the people and communities most affected by HIV, TB and malaria at the center of decision-making. Above all, we must remember what’s at stake – millions of lives, and the health and well-being of the poorest and most marginalized communities in the world.

This op-ed first appeared on [Forbes](https://www.forbes.com/sites/petersands/2026/09/16/progress-against-the-worlds-deadliest-infectious-diseases-is-on-a-knife-edge/ "Forbes").