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Defense, healthcare, crypto and AI: How the midterm election could affect stocks
Democratic gains in Congress could bring tougher oversight of major companies and shift billions of dollars in federal spending and regulatory policy.
Trade, politics and security examined in latest Mexico Country Outlook by Rice’s Baker Institute
This year’s edition of the Mexico Country Outlook from the Claudio X. González Center for the U.S. and Mexico at Rice’s Baker Institute for Public Policy presents data and analysis across key domains such as trade, energy and environmental policy. The report will be unveiled Nov. 12 at the Baker Institute and by livestream where the discussion will offer critical context on emerging domestic trends and their broader implications for the U.S.-Mexico relationship.
How science influenced Abdul El-Sayed's politics
The Michigan senate-elect says evidence-based policymaking, public health and scientific scrutiny of corporate influence shape his positions on healthcare, environmental safety and government
Caltech, Dr. Lucy Jones launching disaster resilience center to bring science and policy together
The center’s central goal will be to bridge the gap between scientists, whose findings hold answers to how to best respond to and mitigate disasters, and local decision-makers and community members.
Politics, cool space photos, and more politics
What the U.S. election means for space policy and NASA science, voting for the coolest space images, and updates on Society advocacy.
Christina Lambert is turning 14 roundtable topics into a policy plan for West Palm Beach
Christina Lambert turns community roundtables into West Palm Beach priorities.
What hospice can learn from home health’s fight against fraud
As policymakers intensify efforts to combat fraud, waste and abuse in hospice, there may be an important lesson hiding in Medicare’s history.
Some defense politics is local
The direction of defense policy and corresponding federal spending within many states hinges on the outcome of Election Day.
Science Policy Faces a Post-Election Shake-Up in Congress
Decisions on spending and White House control over science grants await a lame-duck Congress.
Trump says Democrats 'did a good job,' blames Republican candidates for midterm losses
Voters delivered a significant rebuke to President Donald Trump on Tuesday by handing Democrats control of the Senate, rejecting his handpicked candidates while airing widespread concerns about high costs in the wake of his war against Iran and his punishing tariff policy.
How Democrats’ Big Win Could Reshape Health Care
Democrats scored huge margins in Congress and made big gains at the state level. What does it mean for health policy in the final two years of the Trump administration and beyond?
Money out of Politics ballot measure faces First Amendment challenge
The Mackinac Center for Public Policy argues provisions of the proposal violate the First Amendment. It filed a federal lawsuit Wednesday.
“Looking for certainty”: Evansville business leaders reflect on midterm elections
EVANSVILLE, Ind. (WEHT) — Economic growth is called to question at the Evansville Regional Economic Partnership’s 2026 Policy Focus. E-REP brought in Rob Engstrom, the president of the Washin…
Shaping the Future of Maternal Mental Health Diagnosis Through Precision Technology - Policy Center for Maternal Mental Health
On October 29–30, 2026, the Policy Center for Maternal Mental Health brought together patients with lived experience, clinicians, researchers, and…
What do the midterms mean for health care?
STAT unpacks what the midterms mean for health policy, MAHA, and health insurance.
1115 Waiver Watch: A Look at Budget Neutrality Policy Changes
This brief discusses key Medicaid policy changes included in CMS budget neutrality guidance and identifies open questions about how the policy changes may be clarified and how they may affect states with existing 1115 waivers or states interested in applying for new ones.
Health Equity & Access Weekly Roundup: November 6, 2026
This week in health equity and access: Medicaid cuts; mailed FIT outreach; EEOC pregnancy rules; GLP-1 Bridge access; and 2027 policy shifts.
NH's Business: NH Public Policy and State Budget
Fred Kocher sits down with Gene Martin, the executive director of the New Hampshire Fiscal Policy Institute.
SESAME Symposium Places Science Diplomacy at the Heart of Regional Cooperation, Peace and Human Responsibility
The role of science in a world increasingly shaped by conflict, technological rivalry and deepening political divisions was at the heart of an international symposium held at the Synchrotron-light for Experimental Science and Applications in the Middle East (SESAME) in Allan, Jordan, on 28 October 2026. Bringing together senior scientific leaders, diplomats, policymakers and researchers from across the region and beyond, the symposium examined how major research and technology infrastructures can advance international cooperation, strengthen scientific capacity and contribute to peacebuilding.
New Majorities, New Gavels: What Congressional Turnover Means for Business
Congressional turnover in 2027 could reshape committee leadership, staffing, oversight, and legislative strategy as the 120th Congress begins.
What Democratic control of Congress means for healthcare in 2027
Tuesday’s forecast-busting blue wave puts wind in the sails of Democrats who have promised a stark departure from Trump-era healthcare policy—though whether or not the shifts will be incremental or | Tuesday’s forecast-busting blue wave puts wind in the sails of Democrats who have promised a stark departure from Trump-era healthcare policy—though whether or not the shifts will be incremental or seismic hinges on intra-party debates and the president’s veto.
Trans sports bans get voter approval in 4 states
Voters in four states — Arizona, Colorado, Nebraska and Washington — are on track to pass or have passed measures to restrict transgender athletes’ participation in sports, a key policy focus of the Trump administration.
What are the health stakes of the midterms? Policymakers, lobbyists, and experts weigh in
No matter what happens on Election Day, the midterms will have sweeping implications for American health care. More than two dozen experts on what could come next.
Anwr oil development hindered by political instability, Daniel Turner warns
Power of the Future founder and Executive Director Daniel Turner warns that political instability hinders Anwr oil development. He explains how policy shifts stall long-term energy infrastructure investments.
GW Law's Health Law and Policy Program Names its 2026-2027 Gersh Fellow
The Health Law and Policy Program is pleased to announce the student selected for the 2026-2027 Debbie Gersh Health Privacy Fellowship, Madison Neiman, class of 2028.
Cook County Department of Public Health Awards $475,000 to Expand Youth Mental Health Programs in Four Suburban Communities - Cook County Department of Public Health
Today, Cook County Department of Public Health launched Building Healthier Communities 2030, suburban Cook County’s Community Health Improvement Plan. The plan was announced together with Cook County Board President Toni Preckwinkle, Cook County Department of Public Health, community organizations, healthcare providers and cross-sector partners. Building Healthier Communities 2030 serves as both a collective vision and a practical roadmap that will guide public health efforts across suburban Cook County through 2030.The plan aligns with President Preckwinkle's Policy Roadmap and reflects a shared commitment to advancing health equity through coordinated, community-informed action.
Health Brief: Medicare’s big payment shake-up
Plus: A new “STEM wave” is headed to Congress, with doctors and other medical professionals ready to take on health policy fights.
Democratic doctors on the ballot amid health policy changes
Presented by AstraZeneca{beacon} Healthcare Healthcare The Big Story Doctors command the stage ahead of Election Day Dozens of Democratic medical professionals are on the ballot for Congress a…
Upfront: Boom or Bust
My uncle John was probably the smartest guy in my family tree, a master’s degree chemist who worked for more than 30 years at Savannah River Plant near Augusta, Georgia. He was hush-hush about his work at the plant, which played a key role in the fabrication of nuclear weapons that underlie U.S. defense policy. […]
Dan Goldman and the dawn of performative politics
Ee are witnessing the end of an era, the end of politics centered primarily on policy, principle, and sincere conviction, and the emergence of something different: politics of performance.
KFF Analyzes the Role of Health Care in the Midterms
The midterm elections mean changing power dynamics and shifting legislative agendas in Congress, both next year and during the upcoming lame duck session—the period between the November election and the new session beginning in January. As policymakers consider next steps, new KFF polling analysis examines the role health care played in voters’ decisions. Key Takeaways […]
Anthropic clamps down on Claude’s AI video game clones
Anthropic says infringing IP is against its usage policy.
How to convince more Rhode Islanders to get health insurance? Make it cheaper.
One year after premiums skyrocketed for HealthSource RI participants, costs are coming back down to Earth with discounts available for 30,000 who sign up or reenroll during the 2027 open enrollment period. The subsidies come from state funding and policy directives aimed at replacing expired federal tax credits.
WHO’s Trillion-Dollar Climate-Health Case Rests On Taxing Fossil Fuels
Scaling up six climate and health measures worldwide could prevent 1.6 million deaths a year and generate $3.9 trillion in economic benefits annually, the
Washington voters approve transgender athlete ban
Washington voters are projected to reverse the state’s long-standing policy that has allowed transgender girls to compete on girls’ and women’s school sports teams, according to Decision Desk HQ.&n…
Seasoned French Diplomat Returns To Lead Pandemic Annex Talks
France’s Ambassador for Global Health, Dr Anne-Claire Amprou, is joining the leadership of the World Health Organization (WHO) body negotiating the missing
OpenAI lays out new policy framework for data centers
OpenAI backs data-center rules requiring developers to cover grid costs, and disclose all water, energy, noise and job data.
Small Business Insider: Election Response, Entrepreneurial Surge, Policy Update & More - Small Business & Entrepreneurship Council
● Election Results Amplify Call to Address High Costs and Economic Uncertainty ● Kerrigan in the DC Journal: America’s Innovation Economy Runs on Small Business – Why Protecting Bayh-Dole Matters ● Featured Interview on BRN: Kerrigan on CHOICE Arrangements ● ICYMI: America’s Entrepreneurship Surge Continues – Nearly 5 Million Business Applications Filed Through September ● […]
Reaching Across the Aisle to Lower Health Care Costs
Following a panel organized by Penn LDI and Penn Washington, two health policy experts share how both aisles of Congress can reduce health care costs.
‘The world is out of control’: how political strategist Claire Ainsley is challenging the left to take it back
From children struggling with their mental health to adults worried about AI, many of us feel neglected and ignored by politicians. How would Keir Starmer’s former director of policy fix that?
This Week In Politics: G20 Foreign Ministers’ Meeting
Amid national divides over the upcoming midterm elections, international friction also surfaced at the Group of Twenty’s (G20) foreign ministers’ meeting in Atlanta, Georgia, on Friday, Oct. 30, and Saturday, Oct. 31. Top diplomats from the G20, an international forum comprising the world’s largest economies that convene to address global economic policy and development, gathered...
Georgia helped inspire Medicaid work rules. Its own rules may end
Georgia’s Medicaid work rules program helped shape a national policy, but the state may let its own requirements expire as federal mandates spread.
FDA Approves First Generic Of HIV Prevention Drug, Lenacapavir
The US Food and Drug Administration (FDA) has approved the first generic version of lenacapavir, the highly effective twice-yearly injection to prevent HIV,
Trump’s Whole Theory of Power is in Ruins
More than any American president, Trump has used fear as a central tool of policymaking. He doesn’t look so fearsome today.
Ballot measures affirm divisions over abortion and transgender issues
Voters in 2026 midterm elections decided state health policy ballot measures on abortion rights, marijuana laws, science bonds, and transgender youth care.
Tripling Climate Adaptation Aid Would Leave Developing Nations 70% Short
The pledge to triple climate adaptation funding hammered out in the closing hours of last year's UN climate summit in Brazil would still leave developing
PIMCO’s Libby Cantrill: The politics around data centers are bad
PIMCO head of U.S. public policy Libby Cantrill breaks down the new balance of power in Congress' impact on markets on ‘Barron’s Roundtable.’
Health Official Praised a Drug Policy. Now, Eyes on Her Stock
ARPA-H chief Alicia Jackson's role in rollback of hormone therapy warning is under the microscope
New wave of health and STEM candidates could reshape US science policy
A massive cancer drug deal, a new license for gut-targeted drugs, and both regulatory and company-led halts on clinical trials led the news this week.
An open letter to Governor-Elect Dr. Amy Acton on addressing LGBTQ+ health disparities
'LGBTQ+ Ohioans and people living with HIV should not simply be the subjects of policy discussions; instead, they should have a meaningful role in shaping the policies that affect their lives.'
Cleveland Fed’s Hammack says restrictive rates needed to cool inflation
“I expect that monetary policy will need to move to a restrictive stance to bring inflation back to 2% in a timely manner,” Beth Hammack said Thursday, Nov. 5, in remarks prepared for an event in Zurich.
Leading the Health Care Workforce Through Change: Leadership, Policy, and Innovation in Action
On Sept. 17, human resources (HR) and employee relations leaders from seven essential hospitals gathered in Washington, D.C., for “Leading the Health Care Workforce Through Change: Leadership, Policy, and Innovation in Action.” Hosted by America’s Essential Hospitals and Essential Hospitals Institute with support from the Robert Wood Johnson Foundation, the convening focused on strategies for […]
Uneven And Fragile Progress Against Neglected Tropical Diseases
While substantial progress has been made in driving down the global burden of neglected tropical diseases (NTDs), trends are “uneven and fragile”, and
America's Housing Crisis Is on the Ballot This Election Day
With the cost of housing a top concern among Americans ahead of next Tuesday’s midterm elections, voters in four states will decide how their governments should address the problem. There are six statewide housing policy measures on the ballots – the largest number of housing ballot measures in a ...
Seattleites rally in support of trans girls after state voters approve sports ban
Advocates and allies rallied at Seattle’s Westlake Park Thursday night in support of transgender girls, many still reeling from an election night blow. A state initiative that will restrict trans girls from competing in girls sports was approved by Washington voters, reversing a longstanding policy that has allowed K-12 students to play on teams that match their gender identity.
Health Care in the 2026 Midterm Election
This dashboard focuses on KFF’s analysis of the role health care costs and other health policy issues played in voters’ decisions in the 2026 midterm elections, including in key Senate races. It examines the role of rising health costs on voters’ decisions, views on the Trump administration’s health care policies, and opinions on the government’s role in health care amid discussions of Medicare for All.
Pritzker has spent $545 million on politics over past 10 years
Gov. JB Pritzker has spent $545M on political committees since 2016. Data shows the full scope of his political spending in Illinois.
E-bike injuries slow down at Orlando Health
Orange County Public Schools updated its e-bike policy, now allowing only licensed high schoolers on campus.
Campbell hosts Harnett business leaders for economic update
Photo by Campbell University Harnett County has grown more than 27% over the last 15 years and is on the cusp of significant growth in the business sector as well. Campbell University recently hosted the 2026 Harnett County Economic Development Update; this was the university's third year in a row hosting the event. The annual event invites elected officials, business leaders and stakeholders from Harnett and its neighboring counties to share updates on new projects, economic trends and announcements from the previous year. Campbell’s continued involvement is part of its five-year Strategic Plan, launched earlier this year, which lists “community impact” as one of its four main objectives. “Every place I have ever worked, the university has been viewed by its surrounding community and region as an asset to economic development, as an inducement to business and industry and as a driver of innovation. It has been seen as the indispensable partner for growth,” Campbell President Dr. William M. Downs told the group of about 200 in attendance. “We ask that you save us a seat at your table when you are dreaming big about the future of this county and beyond. Campbell University is open for business, and we’d like to do business with you.”In addition to Campbell, Harnett is home to Harnett County Schools and its Career & Technical Education programs and a satellite campus of Central Carolina Community College, home of the Eugene Moore Manufacturing & Biotech Solutions Center (the largest training facility in the state). Stephen Barrington, Harnett County Economic Development director, shared the county’s latest initiatives, focus areas and opportunities in economic development. He lauded Campbell and the county’s strong educational and training infrastructure for training the area’s current and future workforce.“Workforce is at the top of the list when we talk about economic development,” Barrington said in a press release. “Work and skill-ready talent remains at the top of the list [of assets in Harnett County]. We’re extremely grateful for the education and training of our students for the next generation.”One big project landed in September when Harnett County was awarded a $500,000 Build Ready Sites grant from the North Carolina Railroad Company to advance a rail-served industrial site. The investment will help prepare the property for future development and strengthen Harnett County’s ability to compete for rail-served projects. The funding will support Byrd Industrial Site B, an 83-acre site with 58 developable acres within the Byrd Industrial Sites in Lillington.Harnett County is also actively working with Samet Corp. is actively working with Samet Corp. on the development of a 175,500-square-foot speculative industrial building to stimulate economic development.Featured speaker was Ted Abernathy, founding and managing partner of Economic Leadership, a small group of data, strategy and best-practice policy experts that work with companies, foundations and business organizations to analyze competitiveness, develop strategy, support leadership, tune communications and reimagine the future.Abernathy lauded Harnett County’s proximity to one of the fastest-growing and most business-friendly regions in the country — the Research Triangle and Raleigh-Durham metropolitan area — and said Harnett needs to attract more businesses that offer higher-paying jobs to compete. “The quality of the jobs you attract is one of the challenges for you as you go forward,” Abernathy said in a press release. “You need more high-paying jobs. A big chunk of the population here is making $25 to $50 an hour, which is good. But where you’re really weak is this high end. If you looked at Raleigh or Durham or Mecklenburg, that number would be a third of their jobs.”Learn more about Harnett County Economic Development and current projects happening at harnettedc.org.
On Demand: Understanding the Rise in Uninsured Children in Kansas
On Nov. 5, 2026, KHI hosted a convening that examined the rise in Kansas children without health insurance, the data and policy responses. Watch the recording.
National health experts dissect election wins, effects on healthcare policy
A national health expert expects Democrats to quickly move to reverse Medicaid cuts passed in the One Big Beautiful Bill Act and to restore Affordable Care Act premium subsidies, which led to millions of people losing health insurance coverage.
Spotlight on: Advocacy
••• SPONSORED SECTION ••• MAKING THE CASE Helping policymakers understand how their decisions affect the communities they serve. Advocacy means taking action to support a cause deemed worthy, influencing public policy and supporting one’s community. Businesses are increasingly learning the importance of making their case in a transparent, positive manner. This section features three organizations […]
Funders Float 'Natural Selection' For Non-Profit Neglected Disease Drug Developers As Global Health Aid Dries Up
Today a single dose of tablets cures the disease. Acoziborole, registered in the Democratic Republic of the Congo in June, was developed by Sanofi and the
The Trump-Kennedy Effect On US Health: Slow-Burn Damage Over Decades
Cuts to Medicaid, the health services for low-income Americans, and fewer childhood immunisations – alongside persistent insinuations that vaccines are unsafe
Get Your Healthcare at … Costco?
To ensure that the entry of companies like Costco into healthcare is positive for consumers, policymakers may want to closely monitor impacts on access to services, costs, and outcomes to the same degree as is done for traditional providers.
EXCLUSIVE: Dismissing Geneva Mergers, Global Fund’s Dybul Wants To Focus On Country Capacity
Returning to lead the Global Fund, Mark Dybul argues that the future of global health lies with domestic health systems, not agency mergers in Geneva. Evoking the founding ambition of the early 2000s, the incoming Executive Director explains how the Accra Reset and US bilateral aid can align under unified national plans - and how his active ties to Washington can help navigate political fragmentation.
City of Independence to make recommendations on better supporting local businesses
The City of Independence hopes new policy changes will make it easier for small businesses to stay open, operate and grow.
Ruiling Yuan: Health Policy Matters in Advancing Cancer Care
Ruiling Yuan: Health Policy Matters in Advancing Cancer Care / advocacy, American Society of Clinical Oncology, Anjali Sibley, ASCO, ASCO Health Policy CoP,
Autism care is bigger than ABA. Federal policy should be, too
The Centers for Medicare & Medicaid Services (CMS) took an important step last month when it released a new toolkit for states on applied behavior
Can money ‘buy' elections? What big political donors get in return
Can wealthy donors buy political influence, or even an election? In the fifth episode of Follow the Money, we speak with U.S. senators, political scientists and campaign finance experts about how money can give candidates an advantage, provide donors access to elected officials and potentially shape policy decisions.
AI Lost Big in the Midterms. What Does That Mean for Your Business?
The message of the “AI midterms” is that technology policy has become an electoral issue, not just a regulatory one. In the U.S., the longstanding embrace of “permissionless innovation” may be fading. If that’s the case, technology companies and their customers face a rapidly changing political environment. What should business leaders do? Many will continue to follow individual bills, lawsuits, elections, and agency proceedings as separate events. This is an essential element of any business’s strategy. But standing alone, it misses the larger picture of how these activities affect each other. Leaders should put together a team to follow six battleground issues: liability for tech-related harms, privacy and data access, competition, infrastructure, public subsidies and other government resources, and preemption and overlapping authority.
After taking control of Congress, Democrats vow major probes into Trump's 'tentacles of corruption'
Corruption topped the list of concerns for voters who ousted Republicans and handed Democrats control of Congress in the midterm elections. Now, the newly empowered Democratic Party is putting the issue front and center as its leaders chart their course for investigations and policymaking.
Post-midterms, hospitals still face a long road to policy relief, advisers warn
Hospitals facing major policy headwinds won’t be able to sustain operations through cost cutting or revenue protections alone, and they shouldn’t bank on immediate political relief following this w | Regardless of where this week's midterms land, hospitals have their work cut out for them in navigating impending policy headwinds unlikely to vanish in 2027 and beyond, consultants and health system heads warn.
The Midterms Rattled AI Stocks. Here’s What to Watch in the Broader Economy.
Politics, policy, and markets collided this week as AI-exposed stocks faced a selloff after the midterms. There are reasons for cautious optimism despite the volatility, but two questions—how strong the economy is and what is driving the selling—will determine what comes next.
Business groups mount fresh campaign for long-term renewal of information sharing law
Major business groups are pressing Congress to include a 10-year renewal of the 2015 cyber threat information sharing law in the annual defense policy bill.
Large health systems are feeling the pinch from new federal policy
Health system executives shared their outlook for the rest of the year during last week’s third-quarter earnings calls.
Catherine K. Ettman Receives the IAPHS Milbank Quarterly Early Career Award in Population Health
News article: The Milbank Quarterly was pleased to present its Early Career Award in Population Health to Catherine K. Ettman, PhD, an assistant professor in the Department of Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health, at the 2026 Interdisciplinary Association for Population Health Science (IAPHS) Conference in September.
How a political race can be called with just 2% of precincts reporting
Elon University Professor of Political Science and Public Policy, Jason Husser, explains how the Associated Press can make projections long before all the votes are counted.
Last Call for 11.2.26 – A prime-time read of what’s going down in Florida politics
A digest of the day's politics and policy while the bartender refreshes your drink.
Data privacy, Middle East policy: CT politics news
Plus: Briefs filed in support of CT’s assault weapons ban and PURA approves new solar tariffs
When papers become currency: a Chinese debate about trust in science
Last Saturday, 31 October, I went to the University of Hong Kong’s Beijing Centre for its Talent Forum. It was the fourth stop in the series this year, following events in Shanghai’s Zhangjiang, Shenzhen’s Qianhai, and on HKU’s main campus. The programme covered a remarkable distance in one afternoon. HKU’s Xiao-Jing Wang discussed computational neuroscience, intelligence, and the prefrontal cortex—before even delivering his inaugural public lecture to students back in Hong Kong. His colleague Bing Zhang took us from the Big Bang to artificial intelligence. Tsinghua’s Xue Lan asked how AI might reshape the institutional infrastructure underpinning higher education. There were lively panels featuring industry leaders from JD.com, Xiaomi, Haier—and Kaiser Y Kuo on the closing panel discussing innovation and international connections. I cannot pretend to have followed every detail of the brain models or the astrophysics. The talk that stayed with me was closer to something we have covered before: Zhou Zhonghe 周忠和 on papers, evaluation, and scientific trust. Zhou is a palaeontologist, an Academician of the Chinese Academy of Sciences, and an international member of the US National Academy of Sciences. He is also editor-in-chief of The Intellectual (知识分子), China’s leading science commentary platform. His subject was uncomfortable enough for a room full of successful academics: what happens when the system for recognising good science starts rewarding something else? Part of my interest came from our sister newsletter, The East is Read, which covered the controversy around “Geng Tongxue” in May. A PhD dropout from Beihang University, Geng has publicly challenged papers by prominent researchers through detailed online allegations of manipulated images and fabricated data. At Tongji University, an investigation into a challenged Nature paper found academic misconduct, and the dean of its life sciences school was removed. The affair brought doubts about academic integrity well beyond laboratories and university committees. How could someone outside the established hierarchy spot problems in papers that had passed through prestigious journals and institutions? And what, exactly, had all that prestige guaranteed? Zhou approached these questions through two essays published in July by The Intellectual: one by Wang Xiaodong, director of the National Institute of Biological Sciences, Beijing, and a response by Wang Liming, of Shanghai’s Shangsi Institute of Natural Sciences. Both began with the controversy over Geng. Their arguments deserve a wider audience, so I want to put parts of them alongside what Zhou said on Saturday. Wang Xiaodong’s starting point is evolution. A research system selects for the behaviour it rewards. Grants, jobs, journals, talent programmes, and prizes collectively determine which scientists prosper and which practices get passed down from advisors to students. “Whatever the system rewards is what it will evolve to produce,” he writes, citing the ancient Chinese saying: The King of Chu loved slender waists, and many in the palace starved to death. That is a more demanding diagnosis than saying there are dishonest people in science. Punishing a fraudster does not change the selective environment that made a particular kind of research profitable. His account also gives scientific success an awkward role in the story. As Zhou put it on Saturday, science became a victim of its own success. Once research became central to industry, national power, and economic growth, universities and laboratories expanded, and public money followed. That created an administrative need for rapid decisions: who should get the next grant, the next laboratory, the next appointment? The difficulty is that the true value of a discovery may take years or decades of testing and building to become clear. Resource allocation cannot wait that long. Publication counts, journal prestige, impact factors, and citations therefore become convenient ways to make an instant judgement. “The real problem is not that these indicators have no value,” Wang Xiaodong writes, “but that they are trying to answer a question that only time can answer.” Telling administrators simply to stop counting papers will never be enough. They still have budgets to distribute and appointments to make. Something has to replace the shortcut. Zhou described the consequences inside publishing. Papers acquire ever more requirements: a complete story, polished presentation, extensive datasets, and accessibility to readers beyond the immediate field. Individually, those demands sound reasonable. Together, he warned, they produce formulaic “eight-legged” papers 八股文 and rigid reviewing, while genuinely original or non-consensus work struggles to get past journal editors—some of whom wield immense gatekeeping power despite having limited laboratory experience themselves. Meanwhile, the demands for sprawling, “complete” narratives have fuelled a wider replication crisis. Wang Xiaodong uses a mahjong metaphor to describe the result: put the complex papers published by the exact same lab over several years side by side, and they often look like “Thirteen Orphans” (十三不靠)—every tile completely unrelated to the next, and none of them reproducible by outsiders. Zhou also spoke frankly as an editor who has trouble finding reviewers. Everyone wants someone else to review their work; qualified senior researchers have little time to return the favour. The labour is anonymous, unpaid, and brings almost no institutional recognition, so it increasingly gets passed down to postdocs and graduate students. And while anonymity protects reviewers from rank and personal favours, hyper-specialisation means an author’s most qualified reviewer is often a direct competitor, shielded from accountability. The protection and the problem coexist. Wang Liming takes the argument a step further. The decisive change, in his essay, is the instant conversion of academic honour into material resources. Once a paper can be cashed in for funding, a job, students, commercial investment, or even a company valuation, scientists are alienated from their work: they must keep minting this “research currency” to keep their teams alive. He is careful not to romanticise the past. The old world of gentleman scientists—financially independent figures like Boyle and Darwin who needed nothing from external funders—was also a closed club that excluded people without inherited wealth, women, and much of humanity outside the West. Professional science allowed ordinary people, himself included, to become researchers. Nobody should want to undo that. The problem, in his account, is an exchange system that becomes too uniform and too difficult to correct. His most pointed Chinese example is the “hat” (帽子): the prestigious talent designation that brings continuing access to money, laboratory space, students, and institutional influence. “If papers are the circulating currency of the research system, then a ‘hat’ is a bond that pays interest over the long term,” he writes. A paper at least requires another round of peer review. A title in the Chinese context can lock in a judgement made years ago and turn it into permanent status rent, regardless of whether its holder is still doing good science. Here, official institutions hire, organise, and evaluate scientists. Unlike honours awarded by autonomous academic communities in the West, a Chinese “hat” blends non-scientist administrative power with state authority. Once granted, it turns a past judgement into permanent status rent that is nearly impossible to revoke—because taking a hat off would imply that official authority erred in putting it on. Both Wangs see China as experiencing, at compressed speed, pressures present across global science. Research expansion, rising investment, publication growth, and elaborate evaluation metrics arrived in China within two or three decades rather than two or three centuries. Zhou agreed with that international framing—noting that recent US White House science policy documents and the new president of the US National Academy of Sciences, a fellow palaeontologist who recently visited Zhou’s institute in Beijing, have raised strikingly similar warnings about consensus-bound peer review, short-term project grants, and the replication crisis. Still, Zhou emphasised that China’s traditional hierarchy, personal networks (guanxi), and the ethos that “a good scholar becomes an official” (学而优则仕) amplify those pressures at home. So what would change things? Here Zhou’s tone differed from the call for a revolution in scientific trust in Wang Xiaodong’s essay. As an evolutionary biologist, Zhou favoured patchwork repair (修修补补). Living systems survive through accumulated adjustments; dramatic mutations are usually fatal. Science cannot return to a small, slow-moving pastoral era, especially after the successive accelerations of professionalisation after the Second World War, the internet, and now artificial intelligence. But it can alter the local environment in which researchers work. He pointed to domestic experiments designed to support unconventional research and diversify funding, including Tencent’s New Cornerstone Investigator Program, the Xplorer Prize, and the Future Science Prize. He also mentioned participating in reviews for “major non-consensus projects” under the National Natural Science Foundation of China. One guiding principle he recalled was wonderfully direct: “Failure is allowed; corruption is not” (允许失败，不允许腐败). That distinction would mean quite a lot if taken seriously. An honest attempt that fails should not have to disguise itself as a success to survive an assessment. Wang Liming’s essay adds a sharp caveat to the optimism about new domestic funders. Multiple organisations do not automatically produce multiple ways of judging science. If the same pool of senior domestic scientists makes the decisions through the same two-round review procedures, it is still “fake diversity.” He argues for three distinct kinds of money: broad baseline funding governed by fair procedures; patient funding for questions that take ten years; and non-consensus funding based on individual taste, deliberately empowering a few genuine experts to make biased, contrarian bets on eccentric ideas that would inevitably be averaged out by a committee. Replacing one monopoly with another achieves little; a healthy ecosystem needs variance. Zhou’s proposals for publishing were similarly concrete: strip papers of their resource-allocation burden and return them to recording discoveries and establishing priority; separate dissemination from evaluation, as eLife and Peer Community In do; adopt more modular “micro-publications” and real-name endorsements; recognize the labour of editors and reviewers; and give replication work proper credit rather than treating it as an unpublishable dead end. AI makes every part of this debate more urgent—and Zhou wove it throughout his talk. In his own preparation, he used AI to survey the declining influence of academic monographs, noting how tools are already changing how scholars gather information. More fundamentally, he placed AI as the latest great acceleration in scientific history: just as the internet sped up the pace of research and tightened external resource pressures, AI is compressing the cycle again. In the essays Zhou cited, AI cuts both ways. Wang Xiaodong expects large language models to erase much of the English-writing disadvantage long faced by Chinese scientists, further swelling the flood of papers coming out of Chinese labs. Wang Liming sees AI accelerating both ends of the trust crisis: it lowers the cost of paper mills and fabricated images just as quickly as it lowers the cost of automated image forensics, data auditing, and code reproduction. “Whoever builds the verification layer wins,” Wang Liming writes. His proposed alternative to the static, packaged “story paper” is a continuously versioned “unit of discovery” containing a falsifiable claim, raw data, analysis code, experimental parameters, and an ongoing log of independent checks—where negative results and failed replications are recorded rather than buried. Zhou ended his keynote by bringing AI back to the question of scientific honour and credit. Citing a recent Intellectual discussion on “What AI Means for Mathematics” featuring Fields Medalist Deng Yu 邓煜—at a moment when AI is already batch-solving mathematical conjectures, as HKU Vice-President Lin Chen noted in his opening remarks—Zhou agreed that human researchers must remain the principal agents: AI is a tool that frees scientists from tedious calculation to think about deeper, messier real-world problems. Yet that partnership creates a thorny new evaluation problem. When a breakthrough is made with AI, what is the human contribution and what is the machine’s? And since AI models distil centuries of accumulated human scholarship, is it right that the credit and value flow so heavily to the private AI companies building the tools? The old struggle over how to assign scientific honour is acquiring a whole new layer. What I took away was a serious discussion of how science can remain trustworthy as its scale, incentives, and tools change. These were scientists with real standing inside China’s system questioning how that standing is produced, and proposing changes that would affect their own institutions and peers. That made the afternoon at HKU’s Beijing Centre worthwhile. At the close, Wang Feng, Director of Communications and Public Affairs at HKU, said the value of the forum series—which heads to Hangzhou in December and cities like Chengdu early next year—would lie in the real cooperation it helped bring about. The university has plenty to celebrate: this week it topped the QS Asia rankings for a second consecutive year, alongside its 11th-place position in the QS World University Rankings 2027. For me, bringing this debate to an audience beyond the people who review papers and allocate grants was a useful contribution. Share [ The East is Read PhD dropout’s exposé forces an academic fraud reckoning in China A former doctoral student turned blogger has shaken China’s academic establishment by publicly accusing prominent university scholars of fabricating data and manipulating papers, triggering investigations at several leading institutions and drawing rare attention from state media… Read more 5 months ago · 43 likes · 8 comments · Yuxuan JIA ](https://www.eastisread.com/p/phd-dropouts-expose-forces-an-academic?utm_source=substack&utm_campaign=post_embed&utm_medium=web&embedding_publication_id=47580)
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AFGHS co-signatory countries ask health care users to help fill the financing gap
Hundreds of thousands of Ugandans living with HIV on antiretrovirals could be targeted for user fees or community health insurance schemes requiring modest premium payments, according to the April 2026 version of the country’s America First Global Health Strategy implementation narrative.1 As part of the “sustainable financing for the private not for profit sector” strategy, 491 facilities will be targeted for a phased introduction of user fees and scale up of community health insurance programs.2 In the Ugandan context, PNFP facilities include faith-based hospitals and other health facilities, US missionary organizations and centers of excellence—services that are often co-located at government facilities but run with additional financial and technical resources. 402,000 people—or about 28 percent of the total Ugandan adult PLHIV population on treatment—get ART from the private not for profit sector. The selected facilities provide the majority of ART and prevention of mother to child transmission (PMTCT) services. The plan doesn’t give the total number of clients served by the 491 facilities, so it is not possible to give a precise number. But the majority of 402,000 is a figure in the hundreds of thousands—hence the estimate I’m using.3 The April draft of the Ugandan implementation plan narrative is the only one I’ve been able to review. But the government of Uganda is not alone in turning to health care users to help fill the financing gaps caused by the abrupt withdrawal of US funds. In July 2025, the Government of Liberia introduced user fees for previously free services including “registration, accommodation, patient feeding, hospitalization, and a wide range of surgical and diagnostic procedures.”4 Earlier that year, Liberia rolled out a revolving drug fund designed to stabilize drug supplies by “allowing patients to pay a small fee for standardized, quality medications,” according to a Ministry of Health press release.5 (Both of these approaches had been proposed in the National Health Policy 2022-2031; media coverage explicitly connects the launch with the US foreign aid cuts.) The health financing strategies proposed by Uganda and established in Liberia are qualitatively different from user fees officially adopted by specific health facilities to cover funding shortfalls caused by the new US approach.6 The latter is a stopgap, adhoc change. The former is a national governmental adoption of policies that pass costs on to health care users, despite evidence that such approaches can exacerbate inequities and leave deficits unfilled. Two countries does not make a pattern, but they do point to urgent questions: Have other countries, including Liberia, included user fees or community health insurance schemes in their implementation plans? If so, do any of these narratives have what Uganda’s lacks: a fall-back plan in place in case these strategies for sustainable health systems fail to deliver—as they have before? I wonder if you think about it Subscribe Predictable pitfalls Both community-based health insurance and user fees are as old as the hills. And after decades of people climbing up these hills, duking it out, climbing back down—neither strategy has shown the results the Ugandan implementation plan is counting on. This is, in fact, a hill some folks are willing to die on. (You knew I’d get there, right?) In November 2025, an African-led team of health system experts published a paper directed at low- and middle income country governments trying to figure out how to create self-sustaining health systems. The money wasn’t coming back. It had been more than nine months since the season of freezing, waivering and wood-chippering; two months since AFGHS tumbled into the world touting co-financing requirements and reductions in future US government health aid. Governments were looking for strategies for sustainable, self-financed health systems, the authors wrote. For countries considering user fees and community health insurance to fill the financing gaps, they had a simple message: Don’t. On user fees, the paper states: “Reliance on user fees is ultimately a regressive and inequitable approach. It places a disproportionate burden on the poor and undermines health system goals of equity and financial protection. […] There is overwhelming evidence that user fees mobilise very limited resources for the public health sector, making it an inefficient mechanism for revenue mobilisation.” On community health insurance: “Attempting to shift the burden of funding previously donor-funded services, such as HIV care and management, and TB treatment, onto contributory schemes would exacerbate their fragility and fail to protect the population.”7 The WHO says that community-based health insurance “cannot be expected to provide a major source of funding or coverage,” and noted that most schemes offer only moderate benefit to individuals paying into them, and exclude the poorest segment of the population.8 And yet, the US-Ugandan implementation plan says that community health insurance is “the central pillar of this [PNFP] sustainability strategy” and that this approach that will generate “pre-paid pooled funding at facility and community level [that] improves financial risk protection for households, reduces catastrophic out-of-pocket expenditure, and generates structured, transparent revenue streams that can progressively absorb recurrent costs including health worker salaries.” Unfortunately, Uganda’s own history suggests the pillar might not be able to bear this weight. Ugandans Have Been to this Rodeo Before—and Some Want Their Money Back Uganda introduced its first community health insurance scheme in 1996 with support from international donors.9 Thirty years later, somewhere between 0.2 and 0.3 percent of the population is covered by CHI; just over 1 percent has any kind of health insurance.10 User fees were universally introduced in 1993 as a condition of a World Bank loan.11 They were abandoned in 2001, and in 2004—the year I moved to Uganda to watch the free HIV program get underway—a definitive study found that the fees did not improve health systems and outcomes.12 In 2004, most clinics and hospitals had ‘free’ and ‘fee for service’ options for getting care.13 The fee for service, or “cash and carry” programs had often been established in the years prior to PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. People who could afford to paid for the drugs, often at facilities in the private-not-for-profit (PNFP) sector. When free drugs arrived, some people who’d been paying kept on doing so, perhaps because of shorter wait times, greater confidentiality, convenience or other factors. But in the year that I spent visiting the same clinics around the country week after week—including a “center of excellence” that maintained separate days for cash and carry clients and those accessing free ARVs—lots of people who had been paying tried to switch to the free option. They’d paid because they had no other choice. They’d sold pieces of family land, begged family members for loans, bought pills by the week, and sometimes by the day. Or they were just cash-strapped, like most of us, and wanted the funds for other things. 14 Twenty-two years later, this hasn’t changed. Ugandans pay out of pocket for 30-40 percent of their health care costs, leading one paper to declare that “falling ill is more than a health crisis. It is a financial emergency.”15 One recent study found that up to 48.5 percent of households dealing with tuberculosis sold something, took out a loan or dug into savings to defray the costs of TB care—which is supposed to be universally free.16 The Ugandan implementation plan does anticipate challenges. It proposes a phased approach, with 187 facilities introducing user contribution systems in Year 1, 152 in Year 2, and 153 in Year 3. Willingness to pay and feasibility studies will precede roll out; fees will be tiered by region, and a waiver system is proposed to ensure that no one has to pay who is unable to. Moreover, the plan provides for quarterly reviews of epidemiological data to “ensure that user contributions do not compromise epidemic control gains, ART continuity for the client cohort, TB case management, or PMTCT services.” Alt text: A screenshot of a table included in the implementation plan narrative that is the subject of this stack. It’s got a fetching pink bar at the top. It uses the abbreviation “CHI” which is Community Health Insurance, and FBO which is Faith Based Organizations, and it details the number of facilities that will implement user fees with waivers and community health insurance schemes over the five years of the agreement. As I said in the footnote, this is a super interesting document with a lot of other rich material. Tell me what you see—and what you would have focused on. And if you’ve seen something like this, or anything else that strikes you, in another implementation plan, tell me that too. You can use the Substack message platform or try me on Signal at @endaplague_again.25 (because @mercoonfan was, weirdly, taken). But the plan doesn’t fully explain what will happen if this approach doesn’t work out. Yes, progress will be monitored, and corrective action triggered. However, there is no specified funding replacement if premium and fee revenue prove inadequate. Instead, the authors write, “Currently, COEs serve a total client cohort of over 180,000 across 28 facilities. In the initial years, the U.S. Government (USG) will provide financial support for clients; over time, user fees generated by COEs will become the primary source of funding for sustaining their services.” Failure does not really seem to be an option. Health insurance schemes are more acceptable to the Ugandan population than user fees. Members of Parliament and civil society traveled to Ethiopia to see how that country’s scheme worked. In a follow up report, a veteran civil society group recommended allowing the “health insurance ecosystem to grow organically and [to] keep reviewing the law and regulations as this growth takes root.”17 One study found that more than three-quarters of Ugandans were willing to join a health insurance program.18 However, coverage of community-based health insurance is minimal, as is coverage of any kind of insurance—including private plans.19 A national health insurance scheme bill has been stalled for several years and presently sits with President Yoweri Museveni.20 Community-based health insurance scheme that do exist are expanding in number, but losing enrollees. Between 2022 and 2026, the number of community-based health financing schemes across the country increased by 42 percent, while the number of people enrolled decreased by nearly 11 percent.21 None of this means that community-based health insurance should not happen in Uganda—or that people do not want insurance. It doesn’t even mean that user fees and waivers won’t ever work. But there is highly relevant evidence from Uganda and the surrounding region that it is quite optimistic to describe community health insurance and user fees as central supports for sustainable financing in any sector of the health system. And now for the best-case scenario In the best-case scenario22, the Ugandan approach does exactly what it sets out to do, and so does the Liberian fee structure and revolving pharmacy fund—though I’ve not confirmed that these are in the MoU. In one best-case scenario, Uganda is an outlier, and user fees and community health insurance are not recurrent pillars of self-sustaining financing in other countries’ implementation plans. In another best-case scenario, all countries that include these strategies enjoy success beyond anyone’s evidence-informed wildest dreams: reliable funding generated by health care users fees, great health care outcomes for everyone, no exacerbation of inequities, no crippling household debt. No sold land, repurposed school tuition or high-interest loans. In the best-case scenario, not one of the hundreds of thousands of Ugandans living with HIV receiving antiretrovirals from 491 PNFP facilities misses a refill or leaves care because of user fees or community health insurance premiums. This is the best-case scenario for these people for their own health, and for their families. It is also the best-case scenario if Uganda wants to stay on the path to eliminating HIV as a public health threat. According to the country’s most recent data, 96.5 percent of people living with HIV on antiretrovirals are virologically suppressed. Epidemic control depends ensuring that 95% of people living with HIV know their status, 95 percent of those individuals are on ART, and 95% of those individuals are virologically suppressed. Uganda is still struggling with the first “95"—a frankly abysmal 85.3 percent. If HIV epidemic control and the attendant prevention of new infections, avoidable suffering and premature death matter, the country cannot afford to lose any clients who are currently in care.23 As I write this a couple hours before the polls close for the US elections in the city I live in, I say with soul-deep sincerity: I am rooting for the best-case scenario. I think it’s safe to say that we all are.24 I think it’s also safe to say that if the US and co-signatory governments have inked plans that lead to successful expansion of community health insurance and strategic use of user fees, we all would like to know, now, so that we don’t miss the opportunity to celebrate when success happens. The implementation plan narratives have to enter the public domain. They are the fullest expression of a strategy co-created by two governments. There are assumptions and details that people living in the US and co-signatory countries need to understand that are not available in the MoUs or, to date, in the Congressional Notifications. Some of these details can help other countries that are, as I write this, still working on implementation plans. Others, like a solid count of how many other countries have plans for expanding user fees or health insurance, are important for regional and global health architecture reform initiatives. No matter how this election night turns out, there will be a slew of new Congressional member orientations, briefings and talking points papers in the next few months. Release of implementation narratives should be a bullet point in every context that AFGHS is discussed. These documents can be redacted so that procurement sensitive information isn’t disclosed. There is much more historical precedent for sharing such documents than there is for relying on user fees to fill health financing gaps. Let’s look at the information together so we can hope for the best and prepare for, you know, the other thing. Alt text: A substack first: a bicep selfie! It’s my arm - peachy-white skin, black shirt (flannel, notch neck, too hot for this appallingly balmy November weather, if you’re wondering) and a sticker that says I VOTED 2026. Beige letters on red for I voted. Beige on blue for 2026. You bet I did.25 In your wildest dreams. Subscribe 1 This is a really, really rich 95 page document. There are fascinating ideas and detailed plans in it. It is all worth reading AND I have, in this post, highlighted an instance of content that could pose challenges and certainly posits success of strategies that haven’t worked before. I would love to hear what readers’ see that’s interesting and should be lifted up as something to check for in other implementation plans. I will also shortly be adding a static page to the substack site where implementation plan documents will live. I will put the url into this footnote and it will also be there on emilybass.substack.com by the end of the week. Uganda Implementation Narrative Section 4 April 22 2026 Draft 1.51MB ∙ PDF file Download Download 2 User fees are costs charged for visits, labs, medicines or other health services, usually at the time they are provided. Community health insurance, or community-based health insurance, is what the World Health Organization calls “micro insurance,” which is health insurance targeted at low-income people. 3 As usual (by which I mean always), please prove me wrong. 4 https://smartnewsliberia.com/liberias-ministry-of-health-announces-2025-hospital-service-fees-for-public-facilities/?utm 5 https://moh.gov.lr/news/2025/grand-cape-mount-leaders-residents-embrace-new-community-pharmacy-program/?utm 6 https://www.christianitytoday.com/2026/09/hiv-usaid-pepfar-africa-foreign-aid-cuts-mission-hospitals/?utm 7 https://gh.bmj.com/content/10/11/e021270 8 https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-CBHI 9 https://pmc.ncbi.nlm.nih.gov/articles/PMC2827475/ 10 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 11 https://pmc.ncbi.nlm.nih.gov/articles/PMC527704/ 12 Same citation as the footnote 2 - the article is called “Learning from failed health care reform in Uganda.” To which I say: If only. If. Only. 13 There is a whole taxonomy of user fees to be aware of, if not commit to memory. Out of pocket costs are everything that someone pays for themselves. In this Stack, user fees are planned and policy-supported out of pocket costs. There are also out of pocket costs that people pay to buy drugs or receive tests or health care assessments that would be free if the drugs were on the shelves, or the machines or kits were available, or the staff were on site. A user fee is usually designed to be modest, pegged to willingness to pay, and may be waiveable at the point of care for anyone who is unable to do so. The costs for things that would otherwise be free are whatever the market will bear and people either have to pay them or go without. Out of pocket costs for services and stuff that aren’t available in public facilities are different again from bribes or unofficial fees that some health workers may impose, even though most are indefatigable, tireless and tired, and devoted to their clients. 14 For the record—which really is these footnotes—I would give a whole stack of fridge magnets for a systematic analysis of the economic and social impact of the Mass Unemployment Event in AFGHS countries among the very people who used to be able to afford and cover user fees, both for themselves and vast family networks. Locally employed USAID technical staff, house cleaners, caregivers, drivers and technicians were financial anchors for cousins, friends, friends’ children, friends’ childrens’ cousins, teachers, pastors, neighbors and so many other kinds of kin. Aid recipients lost direct funding; many other people who had not been aid recipients, but parts of the elaborate care webs that function as safety nets for so many people, lost crucial support too. And that’s even before we get to the people who worked at the hotels and restaurants and bars where people employed by the US and its implementing partners used to spend disposable income. Those businesses have lost revenue; those folks have lost jobs. It will be some time coming—and someone will have to fund this work—but I do hope it happens. And I hope, as usual, to be proven wrong. 15 https://eprcug.org/blog/how-out-of-pocket-healthcare-costs-keep-driving-ugandans-into-poverty/ 16 Another straight-to-the-point journal article title. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. https://pubmed.ncbi.nlm.nih.gov/32938411 17 https://www.cehurd.org/download/technical-policy-brief-on-community-health-insurance-scheme/?wpdmdl=13661&refresh=6ae9122f5d4ed1793659439 18 https://pmc.ncbi.nlm.nih.gov/articles/PMC10125197/ 19 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 20 https://ugandapost.news/uganda-to-make-health-insurance-mandatory-by-2026/ 21 https://shu.org.ug/download/235 22 With a nod, tip of the stack hat, and wag of the Mercoon tail to a deeply valued reader who told me that I have a tendency to speculate about the worst-case scenarios a little too much of the time. 23 https://news.mak.ac.ug/2026/10/uphia-2025-shows-ugandas-hiv-status-awareness-gap-despite-strong-treatment-outcomes/ As you’ll see in the next footnote, I’ve already written a subSubstack on another topic, so I will be brief with regard to the study referenced in this article. The Uganda Population-Based HIV Impact Assessment, or UPHIA, will never happen in this way again. For more than a decade, PHIAs have been supported by the US government as a way to generate accurate estimates of country progress on key HIV indicators. They are a holdover from the PEPFAR program that was laser focused on ensuring US taxpayer dollars subsidized progress in pandemic control. There may be other population-level surveys and the data may even be publicly released, as the entire set of FY2026 MER data have not. But PHIAs will never happen again. If you’re wondering whether the estimates of HIV progress at country level might get less reliable….you’re not alone. 24 Ooh baby, I hate “we” in almost all forms. But sometimes I go there, when I am looking for company, which I am. Because this Stack moves into the somewhat-uncharted territory of assessing what the implementation plan narratives may suggest about co-signatory countries’ roles and responsibilities to the people living within their borders. The MoUs, specimen and data sharing agreements were templates. Countries’ answers fit into pre-specified questions that did not include, “how are you going to fill financing gaps and stabilize your health system as this plan unfolds?” In contrast, the implementation narratives are open form—the product of co-creation between the two governments. Co-creation can mean lots of things, but nothing leads me to believe that implementation plans are ghost-written by the US government, or that contents were imposed by the US counterparts. Instead, I think the parts of the plans that read like country government initiatives are endorsed, if not initiated by, those governments. For instance, the Ugandan implementation plan narrative describes plans for revenue-generation through fees charged for equipment calibration, repair and maintenance provided through Uganda’s National Equipment Calibration Laboratory, and laboratory accreditation through the Uganda National Accreditation Service (UGANAS), targeting private sector, PNFP, research and academic clients. That’s super specific and also quite ambitious. It doesn’t read like an American idea. There’s also a provision for solar panels, and other stuff that feels country owned and driven. This is where it gets interesting. If co-creation is the case, then both the US and co-signatory governments are accountable for the contents and the outcomes. Most discourse about AFGHS to date has focused on the decisions that America has made, or demanded that other countries make. The AFGHS architects have monopolized the hot seat. As they should, in so many ways. America absolutely created the conditions under which countries needed to come up with health financing strategies to fill unanticipated, catastrophic funding gaps. And with not-too-long a lens, we can look back and see that America is also on the hook for its role in the Bretton Woods institutions that made user fees and health system fiscal austerity conditions of loans during the era of structural adjustment. But in the here and now, it is not at all clear to me that the US is requiring Uganda or any other country to implement specific approaches to sustainable financing. Instead, it is as the authors of that paper up in footnote 6 suggest: African governments have agency. As implementation plans roll out—whether or not the narratives are shared—it will be important to understand what this agency looks like and what it means for people, including the poorest of the poor. And it will be important to figure out how to talk about it safely, respectfully and critically in places other than the literal and metaphorical footnotes. 25 This week’s song is “Once upon a time” by the Moody Blues. (I know, this is gonna be a weird, largely banger-free end of 2026 playlist. HMU with requests.) AND please do watch the video and appreciate the truly amazing opening sequence—a drum kit wasteland, a coupla plastic bags, a bit of sand. Sort of like the hill where fiscal austerity policies that put costs on health care users might go to perish. But then there’s a lady with amazing hair. It’s worth it.
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