When the choice was made to hold this year’s Global NCDA Forum in February, no one could have guessed it would be held in the eye of a storm - the announcement of the US withdrawal from WHO and dismantling of USAID. This letter was written by our President Monika Arora and CEO Katie Dain, as a call to keep up the momentum and unity of the Forum as we chart a new way forward for global health.

Many of you were with us just a few weeks ago at the Global NCD Alliance Forum 2025 held in Kigali, Rwanda. More than 700 delegates from 90 countries convened under the theme of “Leadership on NCDs in 2025 and beyond”. We took critical steps as a civil society movement to identify how we can inspire bold action on NCDs, mobilise the sustainable financing that is so urgently needed, and strengthen communities to advance the NCD response.

Insightful plenaries and thought-provoking sessions gave a platform to so many voices, including civil society, lived experience and youth advocates, and trailblazing governments. New connections, partnerships and initiatives were cultivated from local to global. A strong focus on evidence-based solutions and what is working across the NCD response inspired hope that progress can be put back on track. And leadership from the Africa region was clearly on display, with the Forum leaving a lasting legacy for both political and civil society action.

The energy, vibrancy, and excitement were tangible throughout those three days, emerging even more united as a civil society community ahead of the fourth UN High-Level Meeting on NCDs later this year. We were able to plan and coordinate ahead of this golden opportunity, uniting behind The Call to Lead on NCDs and the five NCDA campaign priorities, as well as the Kigali Youth Declaration, which was launched at the closing of the Forum.

A main takeaway from the Forum was that we are stronger together as a movement and a community. We know what to do and we know our goals for the HLM; now we have to grab this opportunity with both hands and be united in our advocacy efforts.

And this was even more so given the geopolitical backdrop to the Forum, with the NCD and global health community reeling from the announcement of the US government withdrawal from WHO and the dismantling of USAID. These abrupt decisions cast great uncertainty over the future of health financing and undermine the role and strength of WHO, making the Forum a pivotal moment for the NCD community to regroup and strategise.

The fall-out of the Trump Administration’s decisions for global health is already evident. Since the Forum took place, over 90% of USAID contracts for humanitarian and development work around the world have been terminated. Essential health programmes that have been running for decades and provide life-saving treatment for people living with infectious diseases in LMICs, as well as supporting reproductive and primary healthcare services for millions of women and girls, are being severely disrupted or ended.

Although NCDs receive a very small fraction of USAID funding (less than 1%), the impact will be far reaching for the entire health sector. The level of cuts will leave a massive shortfall in health financing for nations and entire regions - Africa alone is facing a staggering US$ 12 billion shortfall. All aspects of health systems are likely to be weakened in LMICs, including the health workforce, access to essential medicines and products, infrastructure and service delivery, and health information systems. And there is concern that as health budgets shrink, health systems may revert to a more vertical, disease-specific approach, threatening recent gains made in integrated people-centred care. There is a real risk that NCDs could be even further deprioritised, especially at the primary care level.

Whilst the Forum provided advocates with a timely opportunity to discuss these threats and uncertainties, there was also a real sense of this moment bringing us even closer together as a growing community, calling on us in the longer term to “reimagine” and chart a new way forward for global health. To shift towards a future of self-sufficiency in healthcare for LMICs, with a greater focus on national ownership and country-led responses. A greater focus on domestic resource mobilisation, with health taxes on tobacco, alcohol and SSBs offering an even more important tool to increase fiscal space and invest in health services in these challenging times. And now more than ever, making the case for investments in upstream prevention as well as health systems that are integrated, treating the whole person rather than individual conditions.

Global cooperation and solidarity are more essential than ever before to ensure health, wellbeing and security around the world. We want to thank our members for your continued commitment and dedication to improving the lives of people living with NCDs, and we look forward to rolling up our sleeves and working together to capitalise on the UN High-Level Meeting on NCDs this September.

Sincerely,

Dr Monika Arora, President of NCDA

Katie Dain, CEO of NCDA

About the authors:

Dr. Monika Arora is President of NCDA and a public health scientist working on health promotion and health advocacy with a focus on NCD prevention and control. She is Executive Director of Delhi-based NGO, HRIDAY, Director and Professor of Health Promotion for the Public Health Foundation of India and a founding Governing Board Member of HIA and chairperson of SEAR- NCDA. She has served as a member of the WHO-Ad Hoc Working Group on Implementation, Monitoring and Accountability on Ending Childhood Obesity, WHO CSWG that supported UNHLM on NCDs (2018-2019) and Second WHO CSWG (2019-2021). Currently a member of World Heart Federation’s Advocacy Committee. Dr. Arora has been honoured with the Best Practices Award by Global Health Council, 2011, WHO DG’s World No Tobacco Day Award, 2012; Dr. Prem Menon outstanding service award, 2018 by World-India Diabetes Foundation.

Katie Dain is Chief Executive Officer of the NCD Alliance, and has worked with NCDA since its founding in 2009. Katie is widely recognised as a leading advocate and expert on NCDs. She co-chairs the WHO Civil Society Working Group on NCDs, and has served as a commissioner on the WHO Independent High-Level Commission on NCDs, The Lancet Commission on NCDIs of the Poorest Billion, The Lancet Commission on Global Oral Health, and The Rockefeller-Boston University Commission on Health Determinants, Data and Decision-making. She is also a member of the Steering Committee for the Coalition for Access to NCD Medicines and Products. Her experience covers a range of sustainable development issues, including global health, gender equality and women’s empowerment, violence against women, and women’s health. Before joining the NCD Alliance, she held a series of policy and advocacy posts in international NGOs and government, including the International Diabetes Federation (IDF) in Brussels; the UK Government as a gender policy adviser; Womankind Worldwide; and the Terrence Higgins Trust.