In 2024, we wrote about resilience in our Annual Review. In 2025, we were forced to live it.
The sudden withdrawal of US government support through PEPFAR and USAID did not merely create gaps in services. It triggered a rupture. Clinics closed. Viral load testing stopped. Data systems went dark. And yet, as the official systems dimmed, community systems came online.
Within weeks of the funding cuts, our Watch What Matters teams in Malawi and South Africa were already documenting the crisis at facility level, producing some of the first community-generated evidence of what was collapsing, where, and for whom. Communities were not waiting to be studied. They were leading the analysis.
That is the story of 2025. Communities are not the last mile of global health. They are its foundation.
When the system failed, communities led
A system built on the goodwill of a single donor is not a system. It is a house of cards. What our teams demonstrated in real time was something the global health establishment has been slow to accept: when you strip back the institutions, communities are what remains.
The work we carried into every room
At GSIPA2M in Marrakech, we marked 30 years of the TRIPS Agreement and the access crisis it produced, making the case that communities, movements, and activists are the forces intellectual property monopolies did not anticipate. At the Financing for Development Conference in Seville, we marched through the streets in white coats demanding that health be treated as the foundation of everything else, not a line item to be cut. At IAS 2025 in Kigali, we argued that AI in the HIV response will only amplify existing inequities unless community-generated data becomes its grounding layer.
From shock to strategy
The strategy is what we build in response: breaking the barriers that make medicines unaffordable, rewiring how global health is financed, and embedding community data into the infrastructure of what comes next, including the AI systems now being designed.
The future is not something that will happen to us. It is something we will build, with communities at the core.