“There’s grief—personal and professional,” said one member. “But grief has quickly given way to grit. We’re not just holding the line—we’re working on drawing a new one.” Over the course of three private Chatham House Rules roundtables, the Bay Area Global Health Alliance brought together 47 leaders from 32 member organizations across geographies and disciplines. The goal was clear: take stock of this unprecedented moment, gain strength from sharing their collective experience, and begin to shape what comes next.

“This is a difficult and uncertain time for global health,” said Sara Anderson, Executive Director of the Alliance. “But what we do know is this: we are a community — and community is a form of resilience. None of us can face this moment alone, and none of us should have to.”

Participants spoke openly about the toll of the past 100+ days: sudden program suspensions, mass layoffs, withheld payments, and halted partnerships. Yet beneath the grief and uncertainty was something just as strong: momentum to move forward. 

Members are rethinking funding strategies, embracing digital innovation, and calling for stronger messaging that connects global health to U.S. security, innovation, and economic strength. LMIC-led efforts, job and talent preservation, and program continuity were top of mind, alongside bold ideas for reinvention.

What We Heard

Washington Update: Context from the Hill and Beyond

Each roundtable began with a candid update on the shifting U.S. government landscape, shared by colleagues with direct ties to Capitol Hill, agencies, and advocacy groups. What emerged was a picture of strategic instability and systemic breakdown:

• Massive budget cuts to USAID, NIH, CDC, and PEPFAR, with abrupt terminations of contracts—even for programs mid-implementation, and research that was underway.
• Restructuring efforts, including the proposed folding of USAID into the State Department and diminished global health authority across agencies.
• Delayed or unpaid obligations, creating financial crises for organizations that had completed work but haven’t been reimbursed.
• Low transparency, confusing executive orders, and ongoing legal battles around foreign assistance.

Participants described bipartisan concern on the Hill—but also hesitation among lawmakers who feel sidelined. One participant reflected, “There’s bipartisan frustration. Lawmakers are being asked to carry out policies they didn’t shape, and many don’t understand the full scope of what’s being lost.” (see latest USG Update)

Organizational Impact: Navigating Loss and Uncertainty

“We haven’t just lost funding,” said one participant. “We’ve lost clarity, continuity, and—most painfully—our people.” While the roundtables focused on collaboration and solutions, participants acknowledged the very real toll of the past several months:

• Thousands of layoffs across member organizations, from country offices to headquarters.
• Programs shuttered overnight, including clinical trials with active participants and global health R&D initiatives years in the making.
• Backlogged payments and frozen grants, pushing even financially healthy organizations into crisis.
• Conversations around consolidation, with some nonprofits exploring mergers, co-location, or shared staffing to survive.

Bright Spots

“There’s still energy here,” one member shared. “We just need to channel it.” Despite the disruption, participants shared numerous examples of momentum, resilience, and new models taking shape:

• LMIC leadership is rising, as partners step into more visible roles and design their own strategies, calling for transition plans that reflect local priorities and ownership.
• Private sector engagement is deepening, not just in philanthropy but in co-investment, research, and manufacturing.
• Design and systems thinking are spreading, bringing nimbleness and optimism to organizations under pressure.
• Collaboration is rising, as members share job leads, open data sets, and tools to stay connected and inspired.
• Advocacy is gaining traction, with members securing meetings on the Hill, passing local resolutions, and organizing across states.

Shared Priorities Across the Roundtables

1. Supporting the Workforce and Talent Pipeline

The erosion of the global health talent pipeline was a major concern. “Otherwise, we risk losing the infrastructure we’ve spent decades building,” said one participant. Members shared how they’re:

• Piloting jobseeker networks and LinkedIn coaching, peer-led support initiatives and new approaches to care
• Exploring shared staffing and reduced hours to avoid layoffs
• Endorsing high-performing staff to help them stay in the sector

2. Leading with and Learning from LMIC Partners

“Localization isn’t a long-term aspiration anymore,” said one participant. “It’s happening now—and it’s how we’ll survive.” As traditional donor models falter, LMIC-based organizations are increasingly leading the charge—developing community-led transition plans, partnering with local funders, and demanding new models of partnership. Participants also emphasized the value of convenings like this in helping global partners understand U.S. policy dynamics that are often opaque but deeply consequential.

3. A New Narrative Is Needed

“We can’t abandon the stories of lives saved,” one participant noted, “but we must lead with messages that land—economic competitiveness, biosecurity, and the innovation economy….We have to make the case that global health is a pillar of national strength.” Participants called for more strategic, multi-dimensional messaging—especially to reach U.S. decision-makers and the broader public. Priorities included:

• Emphasizing economic, security, and innovation implications
• Combining human stories with financial and policy relevance

4. Business Models Are Shifting—Out of Necessity

“We can’t just fundraise harder,” said one member. “We have to rethink the structure.” With U.S. government contracts frozen or canceled, organizations are exploring new ways to sustain operations and impact. “We’ve long built programs around where the money comes from,” remarked another participant. “Now we need to build around where the impact can go—and find the models that get us there.” Participants described a pivot toward more sustainable, diversified, and impact-driven models, including:

• Blended finance and catalytic capital approaches that reduce reliance on grant cycles.
• Impact investment models where ROI drives engagement—with social outcomes as co-benefits.
• Innovative finance to shift incentives from inputs to strategic outcomes to attract new sources of funding.
• Cross-organizational handoffs of high-impact programs that can no longer be sustained in-house.
• Exploration of blockchain and tokenization for transparency and efficiency in funding flows.
• Partnerships with private sector and corporate social responsibility (CSR) actors to co-design health interventions and tap into new capital pools.

Members suggested the Alliance could help spotlight real-world examples, convene conversations on nontraditional funding, and explore learning spaces focused on alternative business models and practical paths beyond aid—including ways to strengthen the case for investment in health in emerging markets. (See JPM Healthcare Conference Panel, Bellagio Center Convening, and AMR/Outcomes-Based Financing Initiative)

5. AI and Digital Tools Are Strengthening Resilience

“This is a moment to leapfrog,” said one member. “Not just to restore what we had, but to reimagine what’s possible. That’s where AI and digital health can help us.” Even as funding collapses, members are leaning into digital transformation to preserve and redesign impact. Across the sessions, participants shared ways they are using technology to:

• Support continuity of care through telehealth, digital case management and clinical decision support where staffing is limited.
• Harness AI for data analysis, scenario modeling, and adaptive learning.
• Maintain community-based insight pipelines that connect patients, health workers, and national ministries through mobile platforms.
• Use AI to analyze halted trial data. 

Organizations specializing in design and innovation stressed that digital tools—combined with listening, iteration, and trust—can build resilience into the system itself. “Digital tools are letting us listen, learn, and respond when everything else is crumbling,” one participant said.

The Alliance’s ongoing work in AI and tech-enabled health was repeatedly lifted as a strategic strength—and members asked for more cross-sector learning opportunities that bridge policy, design, and delivery. (See our AI and Global Health series)

How the Alliance Could Help

Across sessions, members provided ideas for how the Alliance might support the sector at this inflection point:

• Continue tracking and curating disruptions and opportunities, including U.S. funding shifts, global program terminations, and new pathways emerging in innovation and investment. (see May USG Update)
• Highlight and share examples of successful business model innovations, particularly those involving private capital, digital tools, and partnership-driven sustainability.
• Lift up LMIC-led solutions and leadership and elevate their visibility across the network.
• Strengthen the workforce; amplify jobseeker networks, talent matching, and shared staffing solutions.
• Convene new cross-sector connections, including between NGOs and investors, tech companies, CSR actors, or service-sharing partners (e.g., co-locating office space or pooling staff).
• Lead on messaging and narrative alignment across sectors, linking global health to lives, economics, and national security.

“The Alliance’s strategic advantage is its cross-sector perspective,” said one member. “You’re creating space for reimagining, not just reacting. And at this moment, that’s invaluable.”

Looking Ahead

As Board Chair Colin Boyle put it, “We’re not just trying to restore what was lost. We’re imagining what global health can be—stronger, smarter, and more connected.”

The Alliance will carry this work forward at its Annual Meeting on June 5, where themes of resilience, innovation, financing, and collaboration will take center stage. “The decisions we make now—about what we protect, how we partner, and where we innovate—could help define global health for the decade to come. This is a moment of reckoning. But it is also one of reinvention. And we are ready to support our members,” concluded Anderson.