Janeen Madan Keller

New @cgdev.org piece w @rachelbonnifield.bsky.social on charting PEPFAR’s next chapter

We propose a three-track framework, w some ideas on how to operationalize this evolution, with a healthy dose of caution on need for a prudent approach to safeguard PEPFAR's legacy

Financing at a Crossroads: How the Global Fund Can Adapt to a Shrinking Aid Landscape Amid widespread donor retrenchment, the Global Fund faces an era of austerity that threatens the sustainability of its donor-dependent, grant-based financing model. This paper models an alternative fi...

Full paper here if you want to dive deeper into our models and projections

www.cgdev.org/publication/...

This is *not* a wholesale solution. It involves trade-offs & raises unresolved policy questions, but it offers many benefits:
1. It ⬇️dependence on donors
2. It provides a transition pathway🛣️for countries
3. It brings health money💰 on-budget
4. It stretches donors' contributions further ↗️

Our main finding: If the Global Fund introduced this approach in 2026, reflows could reach up to $1 billion per year by 2033, that's roughly 20% of its current yearly disbursements

Drawing inspiration from elements of the World Bank’s model, we project a scenario where the Global Fund would continue to provide 💵 grants for low-income countries but would introduce loans 🏦 for middle-income countries

Amid widespread donor retrenchment, global health institutions, like the Global Fund, are facing an uncertain funding outlook. Given this new reality, we argue it's time to rethink the donor-dependent, grants-based model that the Global Fund has long relied on

📣Excited to share new @cgdev.org research w co-conspirators @clemencelanders.bsky.social & Rowan Rockafellow exploring an alternative funding path for the Global Fund in a shrinking aid landscape

Full disclosure, it's a bit wonky🤓 so hang on for the ride

Summary blog: www.cgdev.org/blog/weather...

ICYMI: New @cgdev.org‬ blog with Witold Więcek on a high-impact opportunity in global health that's especially relevant amid budget constraints: optimizing vaccine regimens & doses

Thanks to Alex Tabarrok for coverage in @marginalrev.blogsky.venki.dev

marginalrevolution.com/marginalrevo...

Tomorrow! Dr. Seth Berkley joins @rglenner.bsky.social to discuss his new book, Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity. They’ll unpack the science & lessons from the global vaccine effort.

There's still time to RSVP! ⬇️
https://go.cgdev.org/4qtZdb7

The World Bank Group is planning to reorganize its research functions. The results could be even uglier than the powerpoint: an end to independent research at the institution and conflicts of interest all over...

New blog with @eeshani.bsky.social, link in reply.

Tmw/Thursday: Don't miss this stellar #AnnualMeetings @cgdev.org panel on solutions to the GH financing crisis

@sanianishtar.bsky.social @gavi.org @jarottingen.bsky.social @wellcometrust.bsky.social Mamta Murthi World Bank Hitoshi Hirata JICA & @rglenner.bsky.social

www.cgdev.org/event/sustai...

@cgdev.org is hosting a lineup of thought-provoking events during the IMF & World Bank Annual Meetings. We hope to see you there!
#CGDEvents #2025AnnualMeetings

PEPFAR’s Next Chapter: From the Ashes, a Path for Constructive US Global Health Engagement? A new PEPFAR blueprint is beginning to take shape, offering a surprisingly strong foundation for a constructive path forward. If backed by real resources and well implemented, it could lay the groundw...

A new PEPFAR blueprint is taking shape.

If backed by real resources, it could lay the groundwork for a sustainable transition and true country ownership. @rachelbonnifield.bsky.social & @jmadankeller.bsky.social unpack strategic shifts that could define PEPFAR’s next chapter:
https://bit.ly/3Kvx7eT

Vaccines are one of the most powerful tools in public health. They have saved hundreds of millions of lives by preventing deadly diseases like measles, polio, and smallpox. Before vaccines, these infections were common; surviving them often meant facing severe complications or lifelong disability.

A $45 Treatment Can Save a Starving Child. US Aid Cuts Have Frozen the Supply

USAID funded roughly half the world’s supply of ready-to-use therapeutic food. The dismantling of the agency has disrupted the global supply chain that provides the packets, leaving thousands of malnourished children at risk of dying.

Bar chart showing the death rate from tuberculosis in 2021 for a selection of countries. Someone in Lesotho, the Central African Republic, or Gabon is at least 3,000 times more likely to die from TB than someone in the United States or Denmark. Data source: WHO (2024). Chart CC BY Our World in Data.

✍️ New article: "The world left its fight against tuberculosis unfinished — how can we complete the job?"

With a $2.5B shortfall, Gavi, the Vaccine Alliance, faces tough choices.💉📉

Ahead of this week’s Board meeting, @cgdev.org experts propose five ways Gavi 6.0 can stretch resources while protecting its most impactful work:
bit.ly/3IyStXX

Map of countries where the DHS was the only source of maternal mortality data

In February, the US gov shut down the Demographic & Health Surveys.

It was the only data source on maternal & child health, births, household structure in many countries – making it crucial for research.

In a new article I explain why it should be rescued.
ourworldindata.org/demographic-...

How do you find $2.5 B in savings when every decision has consequences for access to life-saving vaccines? With Center for Global Development colleagues, here are 2 core principles and 5 suggestions. Give it a read and let us know what you think. #gavi

How Gavi 6.0 Can Take a Bigger Leap Gavi’s board and leadership must stretch scarce resources to fulfill a challenging double mandate: (1) stabilizing immunization outcomes and fiscal solvency in Gavi-eligible countries facing severe he...

Vaccines are a global health best buy, so it's unfortunate Gavi is in this position at all

Nevertheless, Gavi's Board and leadership faces some tough choices on how to prioritize

We offer 5 options we see as the "least bad" choices, that yield savings while preserving Gavi's impact

We argue that @gavi.org should prioritize a dual mandate:

1) Stabilize vaccine budgets in the poorest countries

2) Transform the financing model over time through a radically simplified “New Compact Envelope Financing” approach

How Gavi 6.0 Can Take a Bigger Leap Gavi’s board and leadership must stretch scarce resources to fulfill a challenging double mandate: (1) stabilizing immunization outcomes and fiscal solvency in Gavi-eligible countries facing severe he...

Amid a broader global health financing crisis, @gavi.org faces a $2.5B budget shortfall

Read our new @cgdev.org brief on how Gavi 6.0 can take a bigger leap w @rachelbonnifield.bsky.social @peterbaker17.bsky.social @tomldrake.bsky.social & @orinlevine.bsky.social

www.cgdev.org/publication/...

A Lean World Health Organization for the Global Good In this brief—the first in the Tough Times, Tough Choices series that will target the major global health and development institutions and their funders—we propose a different approach: radically stre...

1st edition of our @cgdev.org series "Tough Times, Tough Choices" is hot off the press

Facing budget cuts, we argue WHO's leadership must chart a path of retrenchment to a lean @who.int for the global good

w/ @peterbaker17.bsky.social & @rachelbonnifield.bsky.social

www.cgdev.org/publication/...

From coop to cave: Inside the high-tech hunt for H5N1 and Disease X The Telegraph joined scientists in Cambodia’s vibrant wet markets and vast bat caves to test revolutionary new disease surveillance tools

From coop to cave: Inside the high-tech hunt for #H5N1 and Disease X

Great piece in the @telegraphnews.bsky.social by @sneweyy.bsky.social

www.telegraph.co.uk/global-healt...

#FfD4 kicks off next week against the backdrop of aid cuts & a traffic jam of replenishments among health & other concessional funds

But it's clear these funds need a major overhaul. Our new
@cgdev.org blog highlights 3 action items:

www.cgdev.org/blog/concess...

cc: @clemencelanders.bsky.social

"It’s fair to say that humanitarianism's “Great Depression” moment has come. The sudden, almost overnight loss of US Government funding has exacerbated a reality where the majority of humanitarian needs were already unfunded. Something has to give."

RFK Jr. says US won’t donate to global vaccine effort Kennedy ripped into Gavi, the Vaccine Alliance, in a video address at its pledging summit.

This is a travesty & a nightmare. The US was a founder of @gavi.org. It lowers global vaccine costs, has vaccinated 1B children, & averted 19M deaths. This pull out will cost 100s of thousands of children's lives a year - and RFK Jr will be personally responsible.
www.politico.com/news/2025/06...

Cutting US funding for @gavi.org which leads on global vaccination efforts is incredibly shortsighted and misguided

@charlesjkenny.bsky.social & I argued why in this @cgdev.org blog 👇

www.cgdev.org/blog/why-tru...

The Market for Prescription Drugs Is Broken. Here’s Why Trump’s Executive Order Would Make It Worse The US pays—by far—the highest prices for on-patent prescription drugs of any country on earth. The White House just issued an executive order purporting to fix this problem. But the proposed solution...

The Trump admin's proposed solution for high US drug prices is misguided, writes @rachelbonnifield.bsky.social,
@charlesjkenny.bsky.social, & @jmadankeller.bsky.social.

It risks stifling drug innovation and slashing access abroad, with little benefit to US patients⬇️
www.cgdev.org/blog/market-...

The Market for Prescription Drugs Is Broken. Here’s Why Trump’s Executive Order Would Make It Worse The US pays—by far—the highest prices for on-patent prescription drugs of any country on earth. The White House just issued an executive order purporting to fix this problem. But the proposed solution...

US drug prices are way too high—but the Trump EO to “fix” them would make things worse for everyone.

We break down the economics of reference pricing here — and explain why it’s a bad approach for the US 👇

With @charlesjkenny.bsky.social and @jmadankeller.bsky.social

www.cgdev.org/blog/market-...