Funding Cuts Push Global Health Partnerships Toward Local Ownership

Infectious disease research and training partnerships should shift from donor-recipient models toward shared, locally led ownership as global health funding contracts, according to speakers at a session at IDWeek 2026.

The symposium, “Building Equitable Research and Educational Partnerships in Infectious Diseases,” was moderated by Paulina Rebolledo, MD, an associate professor of medicine and global health at Emory University, and introduced by Caline Mattar, MD, of Washington University in St. Louis, on behalf of the IDWeek Global Health Subcommittee.

Funding Cuts Are Reshaping Global Health Research

Rebolledo said the dismantling of the US Agency for International Development (USAID), the US exit from the World Health Organization, and budget cuts in France, Germany, and the United Kingdom have pushed development assistance for health to its lowest level in years. Clinical trials have halted, participants have been left without follow-up, and research teams built over many years are at risk of breaking apart.

"Perhaps the question before us is not only how we fill these gaps but also whether this is the moment to really reimagine how partnerships come together altogether," Rebolledo said. She asked who sets the research agenda, who leads and receives credit, and who owns the data and samples, and called for "moving from a donor and recipient toward ownership."

Bidirectional Clinical Exchange Faces US Visa Barriers

Tracy Rabin, MD, SM, associate professor of medicine at Yale School of Medicine, presented "Building Bilateral Equitable Clinical Exchanges," describing the collaboration between Makerere University and Yale in Uganda, which she codirects. Now 20 years old, the program has bilateral leadership and centers on faculty development and trainee exchange. Rabin said Yale chose education because of what it could realistically offer. "We are not Doctors Without Borders... we're not funders like the Gates Foundation," she said. "But what we can do is we can teach."

The program has trained 32 faculty, all but one of whom continue to practice, teach, or conduct research in Uganda, with the remaining graduate teaching in Kenya. Rabin added that the exchange has underscored "that there are best practices in both settings that can be beneficial to each."

Rabin said a persistent gap limits the model's equity. "There is no visa category that will allow you to do hands-on clinical training unless you're applying to residency," she said. Clinicians who have graduated from medical school can visit US institutions only as observers, a role that bars them from independently taking a patient history or examining a patient. Some administrators describe it as "hands in pockets and lips sealed," she said.

Rabin coleads a working group at the Consortium of Universities for Global Health that is pursuing change at the federal, state, and institutional levels. Its efforts include a white paper supporting a J-1 exchange visitor visa amendment, a pitch deck for state medical boards, and a toolkit for institutions hosting short-term visitors.

Rabin said the argument that "seems to be more useful these days" is a public health one. "Diseases certainly know no borders," she said, noting an ongoing Ebola outbreak in the Democratic Republic of the Congo.

As of June, 24 states had legislation creating accelerated licensure pathways for international medical graduates, and 17 more had proposed it, she explained. It is unclear whether those laws will help or complicate efforts to expand short-term clinical training, and she raised concern about brain drain from countries that train these physicians.

Six Pillars Define Sustainable Global Health Programs

Dawd Siraj, MD, MPH, a professor of medicine in the Division of Infectious Diseases at the University of Wisconsin, presented "Best Practices in Partnership Equity in Global Infectious Diseases Programs," drawing on 25 years of partnership work in Ethiopia and Rwanda. Funding is critical, he said, but the "real test of sustainability" is whether local institutions, leaders, and researchers can continue the work after external partners leave.

Programs built around individuals, he said, risk "creating dependence rather than capacity." He urged attendees to "think about the transition, the gradual transition of those programs to local ownership."

He outlined 6 pillars: local priorities, institutional commitment, workforce development, research equity, projects built for the long term, and adaptability. Programs that falter, he said, usually have 1 or more of these as a weak link.

Siraj illustrated the first pillar with Rwanda, where health leaders had set a goal of quadrupling the health care workforce in 4 years. His advice for partners was to "listen to the needs of the local leaders first before you act." After his team saw widespread antimicrobial resistance at King Faisal Hospital in Kigali, local clinicians asked for guidance on antimicrobial use for common infections. The partnership is developing guidelines and an antibiogram, a summary of local resistance patterns, a survey of health care workers, and a smartphone app, built by a University of Wisconsin engineering student, to deliver them.

For institutional commitment, Siraj said "people retire, administrations change, and governments also can change," and "our long-term aim should be building institutions." He recommended a memorandum of understanding that spells out each side's responsibilities. His department's agreement with the Rwandan Ministry of Health has been signed by both parties.

The University of Wisconsin Department of Medicine also commits to training 2 to 3 Rwandan collaborators in its grant application workshop. Virtual education, including a continuing medical education program for Ethiopia during the Marburg virus outbreak, extends reach beyond those who can travel, and he called a virtual training platform "one of the strongest sustainability strategies."

On research equity, Siraj said the historical legacy of global health research has been "extraction of data and publication with little or no contribution from developing country partners." His team discusses authorship ahead of time, he said. He closed by saying sustainable programs are defined by "what continues after you leave the place."