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A Major Turning Point in the Global Public Health Landscape

In 2026, American universities will need to adapt to a more complicated global reality.

Last year was a destabilizing time for global public health. Sharp reductions in global health funding, mainly caused by shifts in United States foreign aid, withdrawals from major multilateral organizations, and domestic cuts to public health infrastructure, have had ripple effects across the world. These cuts significantly impact not only low- and middle-income countries (LMICs) but also global health institutions, research systems, and universities in the United States that serve as central hubs for global health education, research, and implementation. A key question for 2026 and beyond is not what we have lost as a global health community, but how US universities need to adapt to a more complicated global reality.

In many LMICs, the recent reduction of US development assistance changes how health systems operate. Despite the bipartisan congressional support that the President’s Emergency Plan for AIDS Relief (PEPFAR) has, disruptions caused significant service interruptions for global HIV and tuberculous services. Even when limited waivers for “lifesaving” services were granted, shifts in administrative structures and funding streams have created operational bottlenecks, leaving many countries struggling to access and provide support. By the end of 2025, UNAIDS reported that over two million women and girls had lost access to essential health services, and millions at risk of HIV infection had diminished access to prevention tools such as pre-exposure prophylaxis (PrEP). These developments underscore how heavily many health systems in LMICs rely on external funding, highlight the need to focus on greater country accountability, domestic financing, and more resilient support models. 

Within the United States, changes in federal public health funding have already altered the landscape in which universities and research institutions operate. Reductions across agencies such as CDC, NIH, and FDA mean fewer federal resources for global health collaboration, surveillance, and training. For example, the proposed reductions in global programs funded by the NIH Fogarty International Center, which has historically trained thousands of scientists worldwide, signal that US universities must rethink how they sustain international partnerships and capacity-building. 

I speak to this not only as a dean, but from personal experience. For more than 30 years of my career, I have continuously worked on federally funded grants as both a Principal Investigator and Co-Investigator. During this time, I have seen firsthand the transformative impact of these grants. These investments were instrumental not only in building capacity within collaborating institutions in LMICs but also in generating far-reaching benefits for US universities and faculty. These grants sustained research partnerships, strengthened global clinical and data platforms, and expanded the scientific reach of US investigators, enabling innovative, high-impact research that would not have been possible otherwise. They enhanced mentorship, enriched academic environments, and positioned US institutions as global leaders by demonstrating that capacity building abroad translates into scientific, educational, and security dividends here at home.

Now in this evolving and at times unpredictable global health landscape, US universities must look beyond the traditional federal funding model and assume that long-standing models of global engagement will not change. Instead, we need to become more adaptable, more entrepreneurial, and more globally connected. This is not just about surviving funding cuts; it is about rethinking how academic institutions contribute to global health in a multipolar and resource-limited world. US universities must fundamentally diversify their academic and financial models for global health by building stronger partnerships with private foundations, philanthropic organizations, and multilateral organizations. 

It starts with moving beyond a project-based approach to global health, and instead committing to long-term institutional partnerships. Too often, academic collaborations have been short-term, grant-driven, and centered around US priorities. The new reality demands more reciprocal, durable relationships in which universities co-design research agendas with LMIC partners. Institutions across the world should invest in joint research centers; shared training and research programs for leaders who can operate effectively in resource-limited settings; and faculty exchange initiatives that build trust and continuity beyond any single funding cycle. It also means recognizing that capacity-building is not charity—it is about equity, respect and strategic investment in global health security and scientific innovation.

The landscape of global health has undoubtedly shifted, but academia still holds a unique position to shape its future. Evidence from decades of global health investments clearly shows that even small investments generate significant returns. The cost of inaction is too high, and the stakes involve the well-being of nations and the global community. By diversifying funding, strengthening partnerships, focusing on impact, modernizing training, and embracing innovation, academic institutions can turn this disruption into opportunities to build a more resilient and equitable global health system. Now more than ever, academic leadership is called to think, teach, and do what is right for global solidarity.

Warm regards,

Adnan Hyder, MD, MPH, PhD

Dean and Robert A. Knox Professor
Boston University School of Public Health