Trump terminates over 300 HIV and TB research grants, appeals possible

More than 300 USAID HIV/TB grants are expected to be terminated by Sunday, posing significant implications for tertiary institutions, including substantial job losses.

Over the weekend, organisations received termination letters, ending billions of rand in US government-funded HIV and TB research grants for South African universities.

The withdrawal of funding from the US President’s Emergency Plan for Aids Relief (Pepfar) escalated in February when USAID sent letters to NGOs informing them of the permanent cancellation of funding in South Africa.

Major USAid research funding cut overnight

According to Mia Malan, founder and editor-in-chief of Bhekisisa, experts estimate that as much as 70% of South Africa’s medical research, potentially amounting to $400 million (about R7.2 Billion) when considering both direct and subgrants, is funded through the National Institutes of Health (NIH).

Malan said the University of the Witwatersrand’s Wits Health Consortium received cancellation letters on Friday evening for all components of a $2.5 million (about R17.1 million) grant that was awarded through the NIH’s National Institute for Allergies and Infectious Diseases and was scheduled to end in November 2027.

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The termination notices sent on behalf of USAID’s chief grants management officer, Emily Linde, reportedly looked standardised and claimed the research projects “do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness.”

Ironic timing of USAID funding terminations

The Wits project, led by Helen Rees, head of the Wits Reproductive Health Institute, and Ian Sanne, head of the Clinical HIV Research Unit, received their termination notice on Human Rights Day.

“Ironically, our grant ended on Human Rights Day. That day is there to help and protect the vulnerable. Now the US government is forcing us to do the opposite,” Sanne told Bhekisisa.

“Trial volunteers will be put at risk if studies are stopped abruptly. Is this compliant with international standards of human ethics?”

Other grants reportedly terminated include research projects at the Centre for the Aids Programme of Research in South Africa (Caprisa), headed by Salim and Quarraisha Abdool Karim.

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Former head of the South African Medical Research Council, Glenda Gray, “received notice that her $3.1 million (about R56.5 million) grant for a clinical trial unit in Soweto has moved from an approved to a pending status.”

Trump administration cites DEI concerns

The cancellation notices stated that the awards “no longer effectuate agency priorities” and that “research programmes based primarily on artificial and non-scientific categories, including amorphous equity objectives, are antithetical to the scientific inquiry.”

The letters further claimed, “so-called diversity, equity, and inclusion (“DEI”) studies are often used to support unlawful discrimination on the basis of race and other protected characteristics, which harms the health of Americans.”

Malan reported that Sanne argued these references to DEI were misplaced.

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While some of their research has focused on groups such as transgender people and sex workers, a significant portion concentrates on finding effective TB treatments.

“In many ways, our work ticks every box of President Trump’s ‘let’s make America great’ boxes. It makes America safer, stronger and more prosperous because it will protect people against falling ill from TB. Most of the patents and intellectual property of new medicines that we test lie with US companies,” Sanne explained.

Experts warn of severe consequences

Linda-Gail Bekker, who heads the Desmond Tutu Health Foundation at the University of Cape Town, warned that this blow to clinical research comes at a critical time when TB infections “are the highest it’s been for a long time in the USA.”

In a briefing held on 27 February, Bekker presented modelling studies suggesting dire consequences: “Over a 10-year horizon, whilst there may be some cost saving in the short term, in the longer term, we will lose money.

ALSO READ: Health experts warn of ‘huge disaster’ as USAID terminates Pepfar HIV funding in SA

“We stand to lose all the investment over the last 25 years if we do not work hard to fill the gaps that this funding freeze is causing. Secondly, we will see lives lost. So, in excess of half a million unnecessary deaths will occur because of the loss of the funding and up to a half a million new infections.”

Meanwhile, Yogan Pillay, the head of HIV and TB delivery at the Gates Foundation, warned: “The cuts mean that innovation on preventing and treatment of HIV will stall and eliminating or ending Aids will now be but a dream, and HIV will continue to spread. It’s absolutely tragic.”

USAID cuts impact on healthcare services

Public health expert Lynne Wilkinson previously detailed how the funding cuts affect healthcare services, emphasising that Pepfar funding complemented government services by focusing on hard-to-reach populations.

“This wasn’t duplication of government services; it was complementary, providing that final push to achieve those 95 targets and reduce our infections and our HIV and TB mortality,” Wilkinson said.

“This is the entire HIV and TB programme put at risk of unravelling across public sector facilities, communities and key population services.”

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Specific impacts include limited data capturing, reduced HIV testing, diminished treatment literacy and adherence support, and the potential elimination of pre-exposure prophylaxis (PrEP) services for high-risk individuals.

Appeal process available

According to Bhekisisa, projects that received cancellation letters were informed they could “object and provide information and documentation challenging” their terminations but must first follow a “first-level grant appeal procedure” before being allowed to “file an appeal with the departmental appeals board.”

Should projects choose to appeal, they must submit a request within 30 days of receiving their terminations.

Malan reported that Sanne plans to utilise the appeal process and, if unsuccessful, negotiate a way to terminate trials ethically.

“Our research saves lives and the NIH has helped us to do that,” he explained.

“What we now need to do is to convince them of the value of that rather than to terminate decades of investments that will result in the loss of lives.”

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Government response on USAID funding cuts

Health Minister Aaron Motsoaledi has previously provided reassurance regarding medication supplies.

According to Motsoaledi, “90% of the supply of ARVs comes from the South African fiscus, while 10% is from the Global Fund, which is not affected by Pepfar.

“The department also has contracts in place with ARV suppliers.”

When US President Donald Trump permanently closed the funding gap for health organisations across South Africa initially, Department of Health spokesperson Foster Mohale advised patients not to panic about accessing medication.

“Anyone who was receiving HIV treatment through or sponsored or funded by the US government, we say it’s not the end. Please just go to the nearest public hospital,” he said.

“No, we don’t foresee any shortage of ARVs provided by the government.”

Access to medication has not been the only challenge.

Earlier this month, the Treatment Action Campaign (TAC) reported that over 15 000 healthcare workers lost their jobs due to the US government’s decision to stop foreign aid to South Africa.

TAC chairperson Sibongile Tshabalala stated that this decision has severely impacted healthcare services and NGOs.

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The withdrawal of US-funded Pepfar support from clinics led to the loss of 15 154 experienced clinic staff. Tshabalala noted that the immediate effects are already being felt, with longer wait times, reduced medication supplies, and some people being turned away from clinics.

She warned that the situation could worsen over time.

Call for government action

Health experts have called for immediate government intervention to fill the funding gaps and prevent a public health disaster.

“It’s time now; the government must act up and speed up the implementation plan to close the gap,” urged Tshabalala.

“We are calling for our government to step up and do something about what is happening. We can’t afford to die.”

Bekker similarly appealed: “I look to our own South African government urgently to say, ‘How do we fill the gaps so that lives are not lost, infections are not incurred?’ because we have been caught sleeping at the wheel.”

Sanne says South African researchers have started talks with philanthropic foundations and the government to step in with funding, “but there are not yet clear outcomes.”

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