When the White House proposed to claw back billions in foreign aid already appropriated by the U.S. Congress, it framed the move as part of the Trump administration’s push to “eliminate wasteful USAID foreign assistance programs.”
Yet that same administration is now preparing to destroy nearly $10 million worth of contraceptives within the next two weeks — supplies that U.S. taxpayers have already paid for and that experts say could prevent thousands of maternal deaths and millions of unintended pregnancies.
Some of the contraceptives don’t expire until 2031, and the disposal will cost the U.S. government an additional $155,000 or more. Organizations such as MSI Reproductive Choices offered to shoulder the cost of shipping and distributing the supplies, but the administration rejected that offer.
The contraceptives are part of a large group of commodities that are being squandered, whether as part of a U.S. government decision to destroy them or because the items have already become inedible or expired. The Atlantic reported last week that 500 metric tons of emergency food that could feed 1.5 million children were left to expire in a warehouse in Dubai. Nearly 800,000 mpox vaccines that the previous U.S. administration promised to donate to African countries are also expiring in less than six months, preventing their use, according to Politico.
Wastage in the health sector isn’t new, unfortunately. There are medical devices that are left unused in health facilities, and millions of expired COVID-19 vaccines. But to deliberately burn supplies that can be used to save lives? The math isn’t math-ing.
Democratic Sens. Jeanne Shaheen and Brian Schatz introduced a bill early this month blocking the further destruction of such commodities before they spoil or expire. But with a Republican-controlled Congress, its fate remains uncertain. And even if it passes, how much can still be saved?
Read: $9.7M in US-funded contraceptives slated for incineration this week
Read more: Senators slam Trump official over expired food aid
ICYMI: US Congress clears Trump's $9 billion rescissions package
Another waste?
Capacity building is that ubiquitous term often mentioned in global health to help strengthen skills or processes in lower-income settings. But one private sector CEO argues funding for this type of work isn’t always the most efficient — and can even be seen as corruption.
Nicolas Boillot, co-founder and CEO of SystemOne, a global health software company, writes in an opinion piece for Devex: “Rather than rewarding efficiency or transparency, traditional donor-funded global health programs have tended to focus on ‘capacity building,’ which prioritizes the development of local institutions and workforce.” This may be a response to a system where donor funds are seen as job creation opportunities.
His suggested solution? Pay for results, such as by shifting to funding products “that can easily and quickly report on their usage and impact, while reducing the funds for job-creation ‘projects’ that are subject to huge swings in funding and are difficult to measure.”
Do you agree? Let us know via checkup@devex.com.
Opinion: Global health must shift to reward impact and reduce corruption
A most contentious term
There’s a reason why mobile clinics or drop-in centers have become valuable in the global HIV and AIDS response — they serve as important places for people to test for HIV, or get their HIV prevention and treatment medications, without the fear of stigma.
But much of the support for these efforts came from external funding, which started to crumble in recent months as traditional donors scale back on their foreign assistance budgets. The biggest gut punch? The scaling back of PEPFAR, the U.S. government's flagship HIV/AIDS program and the world’s largest bilateral supporter of the HIV response.
In its current state, PEPFAR has been restricted to only offering HIV prevention drugs to pregnant and breastfeeding women. It is also expected to abide by U.S. President Donald Trump’s executive order to eliminate diversity, equity, and inclusion programming, which means eliminating programs designed specifically to support LGBTQ+ communities. And it could even cease to exist as a dedicated program for the HIV response — if a State Department plan to shut it down in a few years and transform it into a platform that focuses on disease outbreak detection and response materializes, according to a report by The New York Times.
This will have an immense impact on the HIV response globally. Already, organizations providing HIV services at discreet, stigma-free locations have been affected by the U.S. funding cuts, raising fears it will force people to seek services in public health centers, or worse, not to seek them out at all out of fear of being arrested in countries where activities such as sex work are criminalized.
There have been efforts to integrate HIV services in countries’ public health systems over the years, which would allow people to access what they need in one location. But the current push for integration — which comes under the context of funding cuts — is being met with concern and resistance.
“Integration means being shoved into an overburdened health system, neglected for decades … only to be ridiculed for our HIV status, for our gender identity, for our sexual orientation, for our age,” Yvette Raphael, co-founder of Advocacy for Prevention of HIV and AIDS in South Africa, said during a protest at the recent International AIDS Society conference in Kigali, Rwanda.
Read: Why ‘integration’ has become a ‘dirty word’ in HIV programming
Preparation is key
Another impact of the PEPFAR cuts is the shortage of antiretroviral medicines. In the city of Jinja in Uganda, people living with HIV and AIDS are currently receiving just a week’s worth of medicines versus two months of supply, or sometimes none at all.
This creates concern for two reasons: It has the potential to disrupt people’s treatment, and it adds to costs as they have to travel more often to check on the medicines’ availability.
But international NGO World Neighbors says some of them can afford the frequent trips and access care in case of interruptions. How? Through a long-term program the INGO has put together that allows people living with HIV and AIDS to earn a living and access financing within their communities.
Read: How economic resilience projects are helping HIV patients survive aid cuts
Related: Where is the political demand to eliminate pediatric HIV/AIDS? (Pro)
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One big number
40%
—That’s how much the World Health Organization projects health aid will decline in 2025 from 2023 levels, as a result of significant funding cuts from some of the world’s biggest donors, including the United States and several European countries.
This will be particularly challenging for low-income countries heavily reliant on external aid for their health. But it also risks further increasing the likelihood of people spending their own money for their health needs, which can push individuals or families into poverty, especially when health care costs are substantial.
WHO data showed that increases in health spending in low-income countries between 2000 and 2022 were driven by external aid and out-of-pocket spending, with the latter comprising over 40% of total health spending in low- and lower-middle-income countries. In the African region, out-of-pocket spending accounted for more than 50% of the total health spending in 11 countries.
Read: WHO projects up to 40% cut in health aid in 2025
What we’re reading
The U.K. government is axing The Fleming Fund, which supports low- and middle-income countries to combat antimicrobial resistance, as part of wider aid cuts. [The Times]
A new study shows that an experimental messenger RNA vaccine improved the effects of a common anti-cancer drug, raising hopes for a potential universal cancer vaccine. [CNBC]
WHO says its operations in Gaza have been compromised after Israel attacked its facilities and mistreated and detained staff. One staffer remains in detention. [BBC]
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
