‘Disaster’ as health programs reel from USAID terminations

The Trump administration’s recent decision to terminate nearly 10,000 USAID-funded programs has sparked frustration and uncertainty among global health organizations, leaving them with unanswered questions and significant challenges. In South Africa, organizations working on HIV programs said the terminations will have disastrous consequences. “I predict a huge disaster … unless other sources can be found urgently,” said Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation — a nonprofit organization focused on HIV prevention, treatment and research. The impacts could be far reaching, from losing track of people on HIV treatment due to the absence of data and monitoring services, to limited screening and testing for HIV and tuberculosis, and the loss of services for survivors of gender-based violence. “We already know of 87 facilities that were providing post-violence care for 33,000 survivors last year whose services will disappear. These are survivors of rape and intimate partner violence with no post-exposure prophylaxis to prevent HIV infection, no psychosocial support or legal assistance or medical care,” said Lynne Wilkinson, a public health specialist based in South Africa. The terminations will also impact HIV research. Bekker said every USAID-funded research and development program has also been terminated. This includes a research program on innovations for preventing HIV and another providing long-acting cabotegravir for HIV prevention. “Those individuals have suddenly found themselves without the injectable pre-exposure prophylaxis that they had signed up for,” she said. Research for an affordable and effective HIV vaccine has also been gutted. Bekker said they had three clinical trials lined up, but they have been stopped “with the immunogen sitting in the fridge and [we’re] not being able to utilize them.” Given the pushback on diversity, equity, and inclusion by the new U.S. administration, “I initially thought this would target programs that specifically are suited to what we call key populations. But in fact, this has been across the board,” she said, with programs benefitting children and young women and girls also terminated. The impact on livelihoods is also huge. Many of those involved in delivering services in communities are also people living with HIV, and are reliant on these programs to provide for their families. Dr. Kate Rees, a public health specialist with Anova Health Institute, said the institute will have to let go of more than 2,800 people who work as data capturers, counselors and health care workers this Friday. She said it won’t be easy for these people to find a job. Health experts are now looking to the South African government to fill the gap and lead them out of the crisis, though it’s going to be a tall order. The U.S. funds about 17% of South Africa’s HIV and AIDS budget, which experts said translates to 7 billion South African rand, or around $378 million. On top of this, large international organizations are losing their funding, including UNAIDS and the Stop TB Partnership — which have both received program termination notices. “We have to be aware that the whole region is in deep trouble at the moment,” Bekker said. The Elizabeth Glaser Pediatric AIDS Foundation said it received termination notices for three primary USAID agreements that had been allowed to resume some work under a U.S. President's Emergency Plan for AIDS Relief waiver. The agreements cover HIV programs in Lesotho, Eswatini, and Tanzania and are supporting more than 350,000 people on HIV treatment, including thousands of children and pregnant women. Meanwhile, one organization working on family planning in Malawi wasn’t surprised by the termination. Donald Makwakwa, executive director of the Family Planning Association of Malawi, or FPAM, said his organization received guidance from the USAID Mission in Malawi two weeks ago that when he read “between the lines,” suggested his organization’s award will likely be terminated. His organization provides a range of services that includes family planning, cervical cancer screening and treatment, and HIV testing and treatment. It’s unclear now how it’d be able to continue serving communities covered by the program. Makwakwa said his organization is losing approximately $3 million with the terminated awards, which it is supposed to continue implementing for three more years. He’s also had to terminate the contract of 24 staff members hired to implement those programs. These are people, he said, who are relying on their employment for their day-to-day survival. “And now, unexpectedly, that support is being cut off. It's really a disaster,” he said. FPAM is required to pay staff one month's salary as notice, as well as their February salary. It’s unclear to Makwakwa if FPAM will be able to pay staff members with USAID funding. He’s hoping there will be details on that in the termination letter, which he has yet to receive from the prime contractor of the award. But the staff contracts are due for termination on Friday, and the organization has to find the means to pay what’s due. The implications go far beyond his organization and the people they directly support, however. Makwakwa anticipates there will also be an impact on foreign exchange in the country, as well as businesses from which these programs procure their supplies. Critical malaria programs were also cut. According to Malaria No More, three central malaria projects focused on service delivery, vector control, and delivery of antimalarial commodities were also canceled. “It’s still unclear the status of all of the various bilateral mechanisms but we have reason to believe many of those were canceled as well. In fact, we have not heard of a malaria contract yet that was not canceled,” a spokesperson from Malaria No More told Devex. “Despite publicly praising malaria programs and granting a waiver for life-saving malaria assistance, [U.S.] Secretary of State Rubio has signed off on these cancellations,” said Martin Edlund, CEO of Malaria No More. A researcher working on malaria vector control in another African country — who spoke on condition of anonymity as he is not authorized to talk about the cuts — is also concerned about the impact. The researcher said staffing for their laboratory, testing for the efficacy of malaria interventions, as well as implementation of malaria prevention activities such as indoor residual spraying and the procurement and distribution of insecticide-treated mosquito nets and anti-malarial drugs are all impacted by the termination of a large-scale multicountry project that focuses on malaria vector control programs. Their government has agreed to cover some of the cost of running the lab. But it’s unclear how they will be able to continue the rest of their activities. “The rest, I hope will be sorted out too,” the researcher said.