The rollout of a new injectable drug that could revolutionize efforts to prevent HIV transmission. A potentially groundbreaking malaria vaccine. And studies to find more efficient and effective ways to get health services to remote communities.
All of these research efforts are now in jeopardy after the Trump administration paused all foreign aid and then canceled more than 80% of the U.S. Agency for International Development’s contracts. U.S. Secretary of State Marco Rubio confirmed this week that 5,200 USAID programs have been terminated. Those that were spared will now be implemented by the State Department. The administration has also moved aggressively to diminish the role of science in government — dismantling scientific agencies, cutting research funding, and laying off scientists en masse.
Amid the fallout, USAID-funded research efforts across major global diseases, including HIV, malaria, and tuberculosis, are now at risk.
That includes research that looks at the most effective ways to implement HIV prevention tools, including the long-acting injectable lenacapavir, which has shown 100% efficacy in preventing HIV transmission in some studies.
It also includes clinical trials of vaccines for malaria and HIV. Once interrupted, these trials are as good as canceled, which means millions of dollars wasted and — more worryingly — the health of study participants needlessly put at risk.
These pauses and cancellations will also have an enormous impact on the long-term response to these diseases and not just in terms of groundbreaking innovations that are lost or delayed.
In Uganda, I spoke to the director of an organization trying to design a model to improve access to health services for underserved communities. They received a transformational grant from USAID last year that would allow them to study a promising approach to delivering services, with an eye toward exporting it to other countries.
That grant has now been canceled. This has had an immediate impact on the organization, of course, but it also robs the world of potentially valuable insights into how to improve the HIV response.
Read: Cuts to USAID-funded research another blow to global HIV response
Read more: USAID funding cuts jeopardize breakthrough drugs and research
Opinion: Trump’s war on science imperils global development and cooperation
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If you need any convincing about the importance of funding for research, look no further than a new study that has identified the right dosage of a highly effective HIV treatment to give to newborns who are at risk of being infected.
Dolutegravir has long been the backbone of HIV treatment and prevention. That includes often being used by HIV-positive pregnant women to prevent them from transmitting the disease to their newborns.
Except, in some instances, women are either not on treatment or don’t adhere to it regularly. In those cases, there is a risk that their baby can develop HIV either during delivery or while breastfeeding. This appears to be how the majority of the estimated 1.4 million children worldwide with HIV were infected.
Thanks to a new study from researchers in Thailand and South Africa, clinicians now know how much dolutegravir to give newborns who are at risk to help prevent them from becoming infected. Those researchers are now waiting to see if their evidence will convince the World Health Organization and other guideline committees to recommend dolutegravir in cases where newborns are at risk.
Read: Will infants finally have access to a highly effective HIV drug?
Fear has not been the only reaction to the pauses and cancellations in U.S. aid. Among health experts in Africa, there is also frustration that the health systems in their countries were allowed to become so dependent on donors.
My colleague Sara Jerving reports that there was also some optimism at the recent Africa Health Agenda International Conference in Kigali that the continent might be at a turning point. Like it or not, the cuts to U.S. global health aid might force African leaders to reimagine their health systems and how they are financed.
They are not the only ones thinking along these lines. During a recent Devex Pro event, Olusoji Adeyi, the president of Resilient Health Systems, said there is an opportunity for fundamental change to how global health is funded and sustained.
“This is a moment of reality for [countries],” he said. “They can do under duress what they should have done during calmer periods.”
He pointed to the need for greater regional manufacturing of everything from bed nets to malaria vaccines, which would make countries less dependent on donors.
In Kigali, conference attendees talked about the need to move away from the vertical systems that donors often favored toward more integrated approaches to health. There was also a call to emphasize prevention, which can help lower overall spending on health since stopping the spread of disease is cheaper than treating it.
And everyone seems to agree that African leaders will also need to figure out how they can increase domestic health financing despite high debt burdens. The solution will vary from country to country, but some governments are already looking at taxes on items such as tobacco and alcohol.
Read: ‘How did we get here?’ — African health experts on ending aid dependence
Read more: Global health expert blasts aid addiction and dysfunctional system (Pro)
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—That’s the whopping number of USAID contract terminations that Chemonics, the agency’s largest for-profit contractor, has had rescinded. The firm has had more than 100 contracts and cooperative agreements with the agency canceled since the start of the second Trump administration. As a result, it has had to furlough at least 750 of its U.S.-based staff members, with plans to put more employees on temporary leave.
The termination letter that was rescinded focused on supply chains for malaria products.
The restoration of Chemonics’ singular contract comes amid a broader confusion about what exactly the administration has canceled. Some partners said they have actually been contacted by USAID to find out if their contracts have been terminated.
Read: Chemonics received over 100 US govt terminations, 1 was rescinded
+ Catch up on the latest news, in-depth analysis, and exclusive insights on how the Trump administration’s policies are reshaping global development.
Amid all the upheaval in the global health space, Gavi, the Vaccine Alliance announced a three-month delay to its high-level replenishment summit. The event, which is hosted in Brussels, will now take place on June 25 to coincide with the European Council Meeting.
Gavi is looking to raise $9 billion from donors to fund its work from 2026 until 2030.
It was always going to be a tough task. There has been a crush of replenishment and fundraising efforts in the global health space over the past two years, many of which have fallen short. And that was before the Trump administration took a wrecking ball to the entire global health infrastructure.
The United States already made its commitment to Gavi’s replenishment under former President Joe Biden’s administration, pledging at least $1.58 billion in support. There’s no guarantee that the Trump administration will uphold that agreement. But despite cutting plenty of other global health spending since taking office, Trump has left U.S. support for Gavi’s core programming intact — for now.
Read: Gavi delays $9B replenishment event amid tough fundraising environment
The pause in U.S. global aid funding has disrupted the global supply chain for distributing lifesaving HIV medicines, leaving supplies in places such as Kenya worryingly low. [Reuters]
A federal judge in Missouri ruled that the Chinese government was responsible for covering up the start of the COVID-19 pandemic and ordered Beijing to pay more than $24 billion. Chinese officials have rejected the ruling. [The New York Times]
Tanzania has declared the end of its Marburg outbreak after recording no new cases over 42 days. [WHO]