The lives of millions of people are at risk as the US halts foreign aid, including funding to the  U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the largest fund dedicated to fighting a single disease.  

In a statement released on Sunday, the US state department says “foreign assistance funded by or through the State Department and U.S. Agency for International Development (USAID)” will be paused for review. This move is in line with the executive order signed by President Donald Trump last week suspending US foreign aid for 90 days. 

Putting a stop to PEPFAR’s work, even briefly, means jeopardising HIV prevention and treatment programmes around the world. 

“This is a matter of life or death,” International AIDS Society President Beatriz Grinsztejn says in a statement. “PEPFAR provides lifesaving antiretrovirals for more than 20 million people – and stopping its funding essentially stops their HIV treatment. If that happens, people are going to die and HIV will resurge.” 

The suspension of PEPFAR funding will have a significant impact on South Africa which has the highest number of people living with HIV – around 7.8 million, and the world’s largest HIV treatment programme with 5.9 million people on antiretroviral therapy.

But health department spokesperson Foster Mohale says there’s been no formal communication from PEPFAR about “what has been reported in the media as President Donald Trump’s announcement on freezing foreign aid”.  He says the department will communicate the implications of such a decision once it receives formal correspondence. 

Mohale didn’t respond to questions about the proportion of South Africa’s HIV programme that relies on PEPFAR funding, and the number of people on ART who would be affected by the suspension of PEPFAR funds. 

PEPFAR has been working in South Africa since 2004, funding more than 1250 community-based organisations which provide a range of HIV and TB services.   

PEPFAR funding has been an issue of contention in recent years as anti-abortion sentiment increased in the US. PEPFAR does not fund abortion services, but anti-abortion politicians and lobby groups have accused it of doing so. Last year the organisation’s mandate was reauthorised for a year, allowing it to continue some of its programmes until at least late March 2025. This was a departure from the previous authorisations of five years each, which signalled long-term commitment. 

A concerning policy shift

Professor Hassan Mahomed, a public health medicine specialist at Stellenbosch University, says if the suspension of funding signals a shift towards a US policy to no longer fund global initiatives, the ramifications will be far-reaching.  

“The worst case scenario is that we will see job losses within the next year in the sector, which will add to our huge unemployment problem and that’s going to be tragic,” he says. 

Beyond the job losses, the impact on South Africa’s health services would be catastrophic because the country is a recipient of funding through PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

Last week news that research grant reviews at the National Institutes of Health (NIH) have been suspended sent shock waves around the health research community. The NIH is the world’s largest public funder of biomedical research, this includes research on HIV and TB in South Africa. Many research groups at some of the country’s top universities are likely to face a funding gap which will have a detrimental effect on their work.

“The research grants we get from our local funding sources are a lot smaller than what we get from the NIH. A significant percentage of income for academic institutions comes from research funding,” says Mahomed. “But it’s not just about the funding, it’s about the collaborations that go with that funding.”

The online publication, Nature, reports that external communication has been paused, which means that NIH scientists can’t travel or take part in global meetings or make public appearances until at least the beginning of February. 

A blow to pandemic response

The shake-up at the NIH echoes the intentions expressed in Trump’s executive order last week announcing the US’ withdrawal from the World Health Organisation (WHO). In addition to stopping any monetary contributions, all US staff working with WHO would be recalled. 

The US is a founding member and a top donor contributing around 18% of the WHO’s budget. The withdrawal of US funding and expertise will undermine the WHO’s work. Mahomed explains that pandemics don’t respect boundaries, these health emergencies need global cooperation. But at this stage, it’s not clear what the US’ move away from the WHO will look like. 

“If the US withdrawal means that they’ll do their own thing, or that they’ll do things differently, it will have a negative impact on everybody.” 

While these developments are tragic for the people involved, Mahomed says they present an opportunity to reexamine Africa’s dependence on external funding. 

“One can also see it as an opportunity to strengthen the voice of the Global South and tap into the expertise in our own country and others like Brazil, Russia and China,” he says. – Health-e News