How do we explain the peril that global health faces? Covid and the post-Covid backlash. The Biden years’ “status quo” approach. Less support in Europe. Excessive debt in Africa. The generational shift in Congress and aging of the flagship programs: “Time has passed.” “We never really dealt with PEPFAR’s treatment mortgage.” Dealing with the conservative critique of US global health funding Is essential to revitalize bipartisanship. 2025 could be rocky, should resources shrink. “We need to be creative, and realistic.” What should we make of the emerging Trump leadership team, most significantly, Senator Rubio, Elise Stefanik, RFK Jr., and Jay Bhattacharya?