Tough Times, Tough Choices

The Tough Times, Tough Choices series offers timely, practical guidance to major global health organizations and international development institutions and their funders on how to allocate resources strategically and effectively in an era of aid austerity.

More from the Series

BRIEF

A Radically Simplified Global Fund to Meet the Moment

February 05, 2026
This brief—the latest in our Tough Times, Tough Choices series—examines the Global Fund’s current approach to resource allocation and the implications of those choices in today’s funding environment. It then outlines three “radical simplification” shifts—implemented in differentiated ways across cou...
BRIEF

Tough Times, Tough Choices: Charting PEPFAR’s Next Chapter While Safeguarding Its Legacy

November 14, 2025
The Trump administration and key congressional lawmakers are shaping a new US government approach to the future of PEPFAR, alongside other global health programs like malaria and tuberculosis. We propose a differentiated three-track framework to operationalize a responsible PEPFAR transition while m...
Blog Post

A Lean World Health Organization for the Global Good: Four Responses to Our Proposal

September 05, 2025
In July, the global health team published the first entry to CGD’s Tough Times, Tough Choices series, targeting the World Health Organization (WHO). We argued that WHO leadership and its member states lacked a clear, shared vision of the WHO’s needed role in the global health ecosystem—and were atte...
BRIEF

How Gavi 6.0 Can Take a Bigger Leap

July 18, 2025
Gavi’s board and leadership must stretch scarce resources to fulfill a challenging double mandate: (1) stabilizing immunization outcomes and fiscal solvency in Gavi-eligible countries facing severe health financing shocks; and (2) laying the groundwork for durable transformation via a radically simp...