Tag: aid cuts

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EDITORIAL | After Major Research Cuts, SA Charts a New Path

On By ModernMedia
To limit the damage from the US research cuts, the SAMRC mobilised a rescue fund of about R600 million.

Spotlight Editors

It has been a bruising year or so for medical researchers in South Africa with the US pausing, cancelling, and then resuming some grants. But as bad as things were, what played out wasn’t the worst case scenario, and momentum is now building toward recovery.

For decades, the United States government has been the world’s top funder of medical research. When it started cutting research funding last year, South Africa was caught in the firing line. This is because the US administration decided to specifically target South Africa, but also because South Africa was uniquely exposed due to the sheer volume of US-funded research here.

Over recent decades, South Africa built an impressive network of research groups and infrastructure to support high quality research – all underpinned by a strong regulatory environment, several good universities, and many productive partnerships with research groups from across the world. All this, plus the fact that we have large TB and HIV epidemics, means that South Africa was, and still is, one of the best places in the world to conduct research on these two diseases.

But a weakness of South Africa’s impressive research infrastructure was its overreliance on US funding.

To be clear, this was not an overreliance on aid or charity. South African researchers won grants from the US by coming out on top in rigorous and highly competitive selection processes. Much of the research done here benefited people around the world, including in the US.

Instead, the thing that we overly relied upon was that the US would continue to make medical research grants in a way that is rational and in our common interest.

There was much chaos and uncertainty last year with the pausing, cancellation, and resuming of grants. One small positive is that bad as things were, what played out wasn’t the worst case scenario we seemed to be heading for. At least some projects got their funding flows restored. You can read more about that in this Spotlight article.

But there is no doubt that the situation remains very bleak. While some studies that were already underway will be completed, it seems very unlikely that the US will fund any new studies in South Africa in the coming years. Given the historic scale of US investment here, the total volume of clinical trials conducted in South Africa will almost certainly fall precipitously.

Charting a new course

One ray of light in all this has been the response from the South African Medical Research Council (SAMRC) – probably the best run of all the entities linked to the Department of Health.

To limit the damage from the US research cuts, the SAMRC mobilised a rescue fund of about R600 million. This includes major contributions from National Treasury, the Gates Foundation, the Wellcome Trust and the ELMA Foundation.

Some of this funding has already helped sustain dozens of research projects and protect vital expertise during a period of instability. The current funding supports work in HIV, TB, newborn and child health, as well as non-communicable and other infectious diseases.

One example is a cutting-edge HIV vaccine clinical trial that began in January at the Desmond Tutu Health Foundation’s clinical research site at Groote Schuur Hospital in Cape Town. While still in its early stages, the study aims to help piece together what an effective HIV vaccine might look like.

Beyond the SAMRC’s efforts, universities and research institutions have also stepped in, raising funds to safeguard projects and retain skilled staff whose jobs were at risk.

Even so, we are still facing a massive net loss to money for medical research in South Africa.

What to do?

Funding from international partners will remain vital in South Africa. For now, the US government still invests substantial funds in South Africa, as does several philanthropies and the European Union, through the European & Developing Countries Clinical Trials Partnership. There are also new partnerships such as one we recently reported on between South African and Korean researchers.

Such partnerships are not just about money – science thrives where there is collaboration across national borders. In fact, almost all of the most important TB and HIV clinical trials conducted in South Africa in the last two decades were collaborations between researchers from multiple countries. No matter how you slice it, collaboration with international partners will remain an essential foundation of the medical research landscape in South Africa.

The problem was never that South African researchers took too much money from the US or other donors, or worked too closely with researchers based in other countries. One might quibble on details here and there, but on the whole, US-South African research collaboration in recent decades has been a resounding success.

Rather, the problem was that we invested so little of our own funds that we became overly vulnerable to changes in external funding.

Professor Ntobeko Ntusi, president and CEO of the SAMRC, previously told Spotlight that the SAMRC receives in the region of R2 billion from government per year, including funds from both the Department of Health and the Department of Science and Innovation.

Unlike so many parts of our government, the SAMRC is a well-run entity that got clean audits in each of the last five years. This strongly suggests that money allocated to it won’t be wasted or looted. If we understand recent messaging from the Finance Minister and National Treasury, this is precisely the kind of clean government spending that should be rewarded in future budgets.

Relative to health budgets more generally and to what government has historically spent on entities such as South African Airways, the SAMRC’s budget is tiny. As far as we can tell, the current funding level is largely a product of history – apart from the still widespread atmosphere of austerity, there really isn’t any other reason why the budget shouldn’t be scaled up over the next three years to be double what it is now.

The SAMRC supports a sector in which South Africa has truly world-class capacity – capacity that as we speak remains under threat. More than just the research studies and the jobs for young scientists, what is at stake here is the idea of South Africa as a place where we can do world-class medical research. Allowing funding cuts to extinguish this bright spark, would feel like a victory for Afro-pessimism.

The reality is that if President Cyril Ramaphosa and National Treasury seizes the opportunity, the shock of the US funding cuts could be turned into a bright new beginning for medical research in South Africa – all at a price that in relative terms is very low. Let’s hope they have the vision and ambition to seize the day.

Disclosure: The Gates Foundation is mentioned in this article. Spotlight receives funding from the Gates Foundation, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

Categories : Expert OpinionTags :

Global Health Infrastructure is Changing. Why Getting it Right Matters for SA

On By ModernMedia
Countries like South Africa benefited in very concrete ways from multilateral forums. Photo by Kindel Media

By Marcus Low

Funding cuts over the last year or so have created a crisis for multilateral health institutions. Which institutions emerge from this crisis, and in what form, will have real consequences for the health of people in South Africa, argues Spotlight editor Marcus Low.

In recent weeks, there has been a glut of articles from global health big-hitters, all concerned with how multilateral health institutions should, or should not be re-designed. These include articles from Philippe Duneton, Executive Director of UNITAID, Sania Nishtar, CEO of GAVI, and one co-authored by, among others, Anders Nordström, a former acting Director-General of the WHO, Helen Clark, a former New Zealand Prime Minister, and Peter Piot, the driving force behind UNAIDS from the mid-90s to 2008.

The immediate cause of all this debate is the stark reality that funding for multilateral health institutions have been cut dramatically in the last year, mainly, but not exclusively, due to the United States’ retreat from such international forums in favour of bilateral agreements. Even before the funding cuts, the financial outlook at entities like the World Health Organization (WHO) and UNAIDS was bleak. Over the last year, it has tipped over into outright crisis.

The WHO has already undertaken drastic organisational restructuring. Last year, a UN document raised the possibility of “sunsetting” UNAIDS by the end of 2026. It is likely that we will see several more organisations shrinking or disappearing altogether in the coming years.

Why does this matter?

The multilateral health institutions we’ve had in recent decades have not been perfect. They were often overly politicised, fraught with power imbalances, and not always capable of responding quickly and effectively to health emergencies.

But even so, it is unequivocally true that when it comes to healthcare, multilateralism has yielded many tangible benefits that are helping keep people alive. In a world where every country stands alone, these benefits will simply fall away.

There are many examples of such benefits. The WHO’s treatment guidelines for diseases like HIV and TB are public goods that are invaluable in many countries – here in South Africa they were particularly important as an antidote to the crackpot science that flourished in the period of state-sponsored AIDS denialism. The sharing of genomics data between countries was critically important at the height of the COVID-19 pandemic. Over an even longer period, the sharing of data on influenza strains has enabled the rational selection of vaccine components for each hemisphere each year. Medicines regulators in different countries increasingly share some of their work in order to speed their processes up and avoid duplication.

This year, a new HIV prevention injection containing the antiretroviral lenacapavir is being rolled out in South Africa and several other countries, largely with the help of the Global Fund, another international entity. A stable supply of low-cost lenacapavir should be available in around a year or two from now, due to market-shaping work done by UNITAID, the Gates Foundation, the Clinton Health Access Initiative, and Wits RHI. Such market-shaping often involves committing ahead of time to purchase certain volumes of a product to incentivise manufacturers to invest in production capacity, thus kick-starting the market for the product.

Then there is the recent history of how rapidly a new antiretroviral medicine called dolutegravir was rolled out in South Africa from 2019 – today over five million people here are taking it. The Geneva-based Medicines Patent Pool (MPP) negotiated licenses that allowed generic competition to start years earlier than would otherwise have been the case. That enabled the low prices and supply security that has facilitated the massive uptake of dolutegravir here and in dozens of other countries.

It is clearly in South Africa’s interest to help keep mechanisms like the above going.

But to reduce the value of these institutions to purely the technical would miss the essence of what animates them in the first place. The reality is that multilateral health institutions have often been at their most effective when people were driven by the need to address urgent health needs, as for example in the early days of UNAIDS. The belief that people’s health matter, no matter who they are, or where they live – essentially a belief in human rights – can make the difference between an ineffectual bureaucracy and a vital health movement. Our current crisis is not only one of technical capacity, but also one where the animating power of human rights-based thinking is being challenged.

How then should we think about redesigning global health?

There are some tensions between fighting to keep what we currently have and embracing big reforms. For example, on the one hand, given the aid cuts of the last year, people have good reason to be concerned about the potential closure of UNAIDS being a precursor to the further unravelling of the global HIV response. On the other hand, there are legitimate questions as to whether UNAIDS is still fit for purpose, given how the HIV epidemic has changed over the last three decades.

One of the most useful contributions in how to think about all this comes from Nordström and his co-authors. They outline four key paradigm shifts that help bring the current moment into focus. Their paper is worth reading in full for the nuances, but here is a brief paraphrasing of the four paradigm shifts:

  • The first shift is about recognising the fundamental changes underway in the global burden of disease and in demography. In short, while the key threats in the last three decades were the infectious diseases malaria, tuberculosis, and HIV, they are increasingly being overtaken by non-communicable diseases (like diabetes and hypertension) and mental health disorders. This shift is not yet reflected in the architecture of multilateral health institutions.
  • The second shift relates to the recentring of power from Geneva in Switzerland and New York and Washington in the USA to countries and regions, giving rise to an increasingly multipolar world. “This shift does not imply that multilateral cooperation is obsolete,” write the authors, “however, it requires a clarification of which future functions should be performed at the global level, and which should be performed by national and regional bodies.”
  • The third shift refers to the growing push to modernise the landscape of global health institutions. The authors write: “Leaders from low-income and middle-income countries have repeatedly critiqued the dearth of systemic support, the inefficiencies of vertical initiatives, and the resource-intensive bureaucratic processes that accompany them”. Considering these external and internal pressures, they argue there is a need to move from a complex and competitive system to a simpler, needs-based, and agile system.
  • The fourth shift is linked to the declining relative importance of development assistance, coupled with countries’ rising commitments to increase domestic financing for health. Although some international support will remain essential for low-income countries and humanitarian responses, the authors argue that domestic resources must be the engine of a new ecosystem and ways of working together.

All of these shifts are now occurring within the broader geopolitical context of what Canadian Prime Minister Mark Carney recently described as a “rupture in the world order”. He stressed that the great powers have turned their backs on the rules-based world order and have “begun using economic integration as weapons, tariffs as leverage, financial infrastructure as coercion, supply chains as vulnerabilities to be exploited”. This shift can already be seen in the US’s pivot from multilateralism to bilateral health agreements.

As Carney put it: “The multilateral institutions on which the middle powers have relied – the WTO, the UN, the COP – the architecture, the very architecture of collective problem solving are under threat.”

He argues that middle-powers like Canada, and I’d argue South Africa should aspire to be part of this group, should chart a way forward where they are not overly reliant on super powers like the US and China. Avoiding such an over-reliance is of course also an obvious lesson to take from the US’s abrupt cuts to health aid last year.

Maybe a first harsh reality to come to terms with then is that the rupture that is taking place in global geopolitics is also occurring in the world of global health. To think that we can go back to the way the WHO or UNAIDS were twenty years ago, is wishful thinking. The “rupture” might take time to propagate, but it will extend all the way.

What then is to be done?

Carney also makes the point that the rules-based order wasn’t in fact working as well for everyone as we liked to pretend. To a lesser extent, something similar could be said for multilateralism in health. Getting things done was often hard, the politics was often tricky, and when it came to the crunch, say on something like patents on medicines, the US and Europe almost always held sway.

As outlined above, countries like South Africa benefited in very concrete ways from multilateral forums, but somehow those benefits were never widely appreciated. Ultimately, it is telling that so many national governments have failed to put up the money the WHO requires to do its work – even before the current US withdrawal.

Maybe then, to make a reset of multilateral health institutions a success, will require that governments reassess and newly appreciate why it is that we need multilateral health institutions in the first place.

This will require a thorough and honest assessment of what we have gained from these institutions in recent decades. Things like market-shaping, patent pooling, pooled procurement, sharing of genomics and other data, regulatory harmonisation, guideline development, research cooperation, and multilateral fund raising have all been important and will continue to be so. We must make sure that in whatever emerges in the next few years, we have multilateral mechanisms that can deliver in all these areas.

But we will have to accept that those entities might look quite different from what we’ve come to know in recent decades. There will certainly be areas in which we still need global institutions like the WHO, but for some issues we might get more done by working with coalitions of the willing, or collaborating at a regional level – as we’re already seeing with the African Medicines Agency (although South Africa rather inexplicably hasn’t yet ratified the related treaty).

The reality is that apart from governments just not being willing to spend more on health at the moment, the enabling geopolitical substructure that we’ve been relying on for decades has given way. In many respects, this has been a disaster for our common good, but it is also an opportunity to craft new and more fit-for-purpose multilateral health institutions that are animated by a shared commitment to human rights. This is an opportunity that countries like South Africa must grasp.

As Carney put it: “We know the old order is not coming back. We shouldn’t mourn it. Nostalgia is not a strategy, but we believe that from the fracture, we can build something bigger, better, stronger, more just. This is the task of the middle powers, the countries that have the most to lose from a world of fortresses and most to gain from genuine cooperation.”

*Low is the editor of Spotlight.

This article was jointly published with Health Policy Watch, a global health news platform.

Disclosure: The Gates Foundation is mentioned in this article. Spotlight receives funding from the Gates Foundation, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

Categories : HIVTags :

HIV Funding Still Falls Short of Targets After Pledges: What’s at Stake

On By ModernMedia
Photo by Miguel Á. Padriñán

Melanie Bisnauth, University of the Witwatersrand

The US government paused all foreign assistance in January 2025. This abrupt decision affected the delivery of life-saving HIV medicines and the provision of HIV prevention services to millions of people. A UNAIDS report estimates there could be an additional 6 million new HIV infections and 4 million Aids-related deaths by 2029 if the world does not act.

In November 2025, a global health initiative, The Global Fund, raised US$11.34 billion for HIV/Aids, tuberculosis and malaria. Melanie Bisnauth, a public health professional in healthcare systems strengthening and HIV/Aids leadership, discusses how far this latest funding could go and how African nations can tackle the dwindling funding for HIV/Aids control.

What is the funding status for HIV/Aids?

Raising US$11.34 billion is significant but it falls short of the US$18 billion target. The Global Fund is trying to raise US$18 billion for its work from 2027 to 2029. The Global Fund is a worldwide partnership to end the epidemic of HIV/Aids, tuberculosis and malaria and ensure a healthier, safer and more equitable future for all.

It is only a partial response to the global funding gaps.

The US pledged US$4.6 billion to the Global Fund during the fund’s summit in November 2025, on the side of the G20 meeting in South Africa. It was a reduction from its previous pledge of US$6 billion to support prevention, treatment, care and related services for the three diseases. But it is also an indication that the US has not abandoned all multilateral global health efforts. It remains the largest single contribution to the Global Fund 2027 to 2029 cycle.

The shortfall may strain existing programmes and delay expansion of life-saving interventions for HIV/Aids, tuberculosis and malaria.

HIV remains a major global public health issue, having claimed an estimated 44.1 million lives to date. An estimated 40.8 million people were living with HIV at the end of 2024, 65% of whom are in the WHO African region.

Job losses could create inefficiencies or service reductions. Building a sustainable HIV response and meeting key goals was already challenging before the sharp funding decline in 2025. Over 11 million people had unsuppressed viral loads in 2024.

Overall, while the funds raised demonstrate continued global solidarity, they are insufficient to fully compensate for the US withdrawal and broader declines in donor support.

There are potentially long-term consequences. Reduced funding and service disruptions threaten to reverse years of progress. Infections could rise, especially in communities where viral suppression was already low. Lack of service delivery and supply of treatment will weaken trust in health systems and can lead to treatment interruptions, drug resistance and poorer health outcomes.

As the Global Fund’s executive director said at the Replenishment Summit, “the old model” of development funding is over. This model is the heavy reliance on international funding like USAID and other donor organisations.

It’s essential for countries to become more self-reliant. But the statement warned that too abrupt a transition could be dangerous.

I fear that the COVID-19 pandemic has already taken a toll on the quality of care provided. Healthcare systems are already overburdened.

National governments have to step up and locally support their healthcare systems, collaborate and build together, and strengthen their health funding structures.

What should the response be for better HIV funding in Africa?

Africa’s HIV response should be multi-pronged.

After attending the Africa Summit in Geneva in May 2025, stakeholders, country representatives, donor agencies and NGOs expressed a key message: those involved in the sector should not reinvent the entire wheel. There is value in the knowledge gained from programming, technical expertise, data insights, partnerships, communities and global health networks should be used to strengthen, adapt and scale what already works.

This will ensure that Africa’s HIV response remains community-centred, evidence-driven, and resilient in the face of emerging challenges.

The global health climate has changed and communities have lost trust because of severely disrupted or even completely cut programmes. African governments must allocate their own resources for HIV programmes, through budget prioritisation, health insurance schemes, and innovative financing such as public-private partnerships. Improvements, such as integrating HIV services into primary care, using data-driven targeting, and negotiating lower drug costs can maximise impact.

Strengthening regional collaborations and pooled procurement through organisations like the African Union or regional health bodies can improve bargaining power and reduce dependency on external aid. A balanced mix of donor support, domestic financing and operational efficiency is essential to maintain gains and expand access to treatment for all in need.

It is important not to rely solely on international support or one funding body. Diversifying funding portfolios is critical.

What effects has the withdrawal of US funds had?

Reduced US contributions led to immediate financial shortfalls, threatening ongoing HIV prevention and treatment programmes.

For example, some clinic supply and services faced disruption in delivery and supply of antiretroviral therapy, and stock-outs of treatment and malaria nets.

The world is still likely to feel the impact in the coming months. For example:

  • Progress towards epidemic control could slow, potentially increasing illness and death.
  • Programmes that relied heavily on US support have already scaled back services or will do so.
  • Funding uncertainty remains a major concern. Governments will have to reallocate limited domestic resources or seek alternative donors.
  • Global health co-ordination, technical assistance and advocacy efforts may be weakened. In the past these supported robust HIV responses in Africa in progress toward the UNAIDS targets.
  • Reliance on fragmented funding streams will increase.

How can African countries better fund their HIV programmes?

They can take steps that involve a mix of domestic revenue generation, efficiency gains and strategic partnerships:

  • diversify funding through raising domestic revenue, such as earmarked taxes
  • expand the reach of social health insurance coverage
  • leverage corporate investment and innovation through public-private partnerships
  • negotiate pooled procurement of drugs and diagnostics regionally to reduce costs
  • involve communities in decision making, which will help strengthen sustainability
  • integrate HIV programmes into broader health systems – it improves efficiency, reducing duplication and operational costs.

Melanie Bisnauth, Doctoral Researcher, School of Public Health and Public Health Technical Advisor, Anova Health Institute, University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : Healthcare Politics and RegulationsTags :

Spotlight’s Top 9 Health Stories to Watch in 2026

On By ModernMedia
With several important developments on the horizon, 2026 is set to be another eventful year in healthcare. Photo by Anna Shvets

19th January 2026 | By Marcus Low

From the limited rollout of a new HIV prevention jab to developments with new weight loss medicines, to high-stakes court cases relating to National Health Insurance (NHI), 2026 is set to be another tumultuous year in healthcare. Here are nine stories that Spotlight will keep a close eye on.

 1. How will things go with the local rollout of a new HIV prevention jab? 

Given the high rates of HIV in South Africa, the biggest HIV story this year is likely to be the rollout of a new HIV prevention jab at around 360 (roughly 10%) of South Africa’s public sector clinics. The jab, which contains the antiretroviral medicine lenacapavir, provides six months of protection against HIV infection at a time. It could be a gamechanger for people who, for whatever reason, struggle to take daily prevention pills. We will be tracking how and to whom the jab is made available and whether uptake meets expectations. 

As we reported last year, work is also underway on a new lenacapavir formulation that could provide 12 months of protection per shot. We’ll be scouring journals and conference programmes for new data on this formulation. 

2. Will we see better access to weight loss medicines? 

The class of diabetes and weight loss drugs called GLP1-RAs have taken the world by storm in recent years. Until recently, drugs like semaglutide (brand names Ozempic or Wegovy) and tirzepatide (brand names Zepbound or Mounjaro) were only available as injections. The GLP1-RA market is, however, set to be upended by the introduction of some of these medicines in pill form. The United States Food and Drug Administration (FDA) recently registered a semaglutide pill for use for weight loss. Another weight loss pill called orforglipron is also expected to be registered this year. One big question is when these pills will be registered and made available in South Africa and at what price. 

Another important GLP1-RA development this year will be the expiration of a key patent on semaglutide in India. This will open the door to generic manufacturers bringing their own versions of semaglutide to market – something that usually leads to substantial price reductions. We will be keeping a close eye on how this situation plays out and analysing what the implications are for people in South Africa. 

3. Might we see earlier than expected findings from pivotal TB vaccine trials? 

The one TB vaccine we have is over a hundred years old and only provides limited protection for kids. Several experimental vaccines are, however, currently being evaluated in late-stage clinical trials. Arguably, the most notable of these is the M72 vaccine, which is being assessed in a massive phase 3 study, partly conducted in South Africa. 

While timelines suggest most of the key TB vaccine studies will not yet have anything to report this year, it is possible that we might see a surprise or two. Findings are sometimes reported early if it becomes apparent ahead of schedule that a medicine or vaccine is clearly working, or clearly not working, as the case may be. Whether or not we see findings this year, it is important to start thinking about what a rollout might look like in our health system should results be as good as hoped. The M72 vaccine had around 50% efficacy in phase 2 trials, so there is reason for optimism. 

4. Will we see a concrete plan to address public sector healthcare worker shortages? 

Arguably, the most important dynamic in South Africa’s public healthcare system today is that provincial health departments are not employing enough healthcare workers across multiple categories. One reason for this is simply that budgets have generally shrunk over the last decade – obviously corruption and mismanagement in several provincial departments have made things even worse. There was a glimmer of hope in last year’s budget in which we saw a meaningful upturn in health funding for the first time in years, but that was at best a good first step toward recovery. As we enter 2026, our understanding is that all of the nine provinces are still facing severe healthcare worker shortages. 

More money for health in the next budget will certainly help, but there is a broader sense that government doesn’t really have a big picture vision for how to address the crisis. We do have a 2030 Human Resources for Health Strategy, but as with many such strategies, it seems to have so far gone largely unimplemented. 

5. Will enablers be held accountable for corruption such as that at Thembisa Hospital? 

One of last year’s big media moments was a Special Investigating Unit (SIU) press conference in which they described the extensive corruption said to have taken place at Thembisa Hospital. One snag, however, is that while the SIU can recoup funds and take matters to the Special Tribunal, the SIU does not conduct criminal prosecutions – though they can refer matters to the National Prosecuting Authority (NPA) for prosecution. Whether we will see successful NPA prosecutions relating to the Thembisa Hospital corruption is one of the year’s top questions. 

Unfortunately, even when the SIU does sterling work and delivers cases to the NPA on a plate, there is no guarantee that the NPA will do its job. One depressing example is that of Buthelezi EMS. Last year, the Special Tribunal ordered Buthelezi EMS (and other companies with similar names) to pay over half-a-billion Rand back to the state. The SIU also referred a related matter to the NPA in 2024 for prosecution, but Spotlight understands that the NPA has rather mind-bogglingly decided to drop the matter. 

6. Which, if any, senior health leaders will lose their jobs this year? 

While we won’t have national or provincial elections this year, that is no guarantee that we won’t see any health leaders losing their jobs. Over the last two decades, there have after all been many examples of people being ousted between elections, be it for purely political reasons or due to corruption scandals. 

Possibly the political leader in the health sector at greatest risk is KwaZulu-Natal MEC for Health, Nomagugu Simelane. Should the currently governing coalition of political parties in the province crumble, as it seems it might do, chances are several new MECs will be deployed, including for the health portfolio. 

There is also an outside chance that the country’s top health official, Dr Sandile Buthelezi, Director-General for Health in the National Department of Health, might be forced to step down. As reported by AmaBhungane, Buthelezi played a central role in an “irregular” R836-million oxygen procurement process and is also “at the centre of a Hawks investigation into allegations that he solicited a R500 000 bribe”. Our understanding is that Buthelezi has not been charged and that in the absence of charges he will stay in the job. 

7. What will happen in the landmark NHI court cases? 

Despite a new call for dialogue from Finance Minister Enoch Godongwana, chances for a political settlement over National Health Insurance (NHI) remains very low. The bottom line remains that Health Minister Dr Aaron Motsoaledi refuses to yield an inch on the version of NHI described in the Act and President Cyril Ramaphosa is not willing to force the matter. 

Instead, it seems the battle over NHI will this year be fought mainly in the courts. At our count, there are at least eight cases challenging the NHI Act, parts of the Act, or the process resulting in the Act. A first development to look out for is whether or not some of the cases will be combined and heard together. In case you missed it, last year we published a two-part series in which we tried to pin down the issues on which these court cases are likely to turn (see part 1 and part 2). 

While we will cover the NHI court cases in some depth, we will also try to foster constructive discussions on health reforms on our opinion pages and in our analysis. In our view, it is dangerously limiting to reduce the debate over South Africa’s healthcare reforms to a simple binary of whether one is for or against NHI. 

8. What will be left of the FDA, NIH, and CDC by the end of 2026? 

It used to be the case that United States Food and Drug Administration (FDA) decisions and health advice from the United States Centres for Disease Control and Prevention (CDC) carried a lot of weight around the world. In recent months, however, there have been increasing signs of political interference at these institutions and a turn away from evidence-based policy making. It seems inevitable that we will see more of the same in 2026 and the credibility of both the CDC and probably also the FDA will be further diminished. 

Similarly, the US National Institutes for Health (NIH) has been the world’s leading funder of health research for many years. But as with the CDC, the work of the NIH has been overly politicised over the last year and its reputation for rigour and scientific excellence has already been severely degraded. As with the FDA and CDC, the outlook is bleak. 

9. How well will SA and other countries recover from last year’s US aid cuts? 

With the dust settling after last year’s severe and abrupt cuts to US healthcare aid and US funding for medical research, the longer-term impacts of those cuts in South Africa and neighbouring countries should become clearer this year. Among others, we will get the first reliable estimates of key HIV and TB indicators for 2025 (reliable figures for a specific year are typically only published in the subsequent year). New HIV estimates from the Thembisa mathematical model (Spotlight’s preferred source for HIV estimates) should be out around the middle of the year, while new World Health Organization (WHO) TB estimates are usually released in November. 

Last year Motsoaledi was widely criticised by activists for underplaying the seriousness of the cuts for South Africa’s HIV response and the scale of specialised services and capacity that was destroyed here. Eventually some extra funds were made available in response to the cuts, but it amounted to only a small fraction of what was lost. The harsh reality is that in some places the aftermath of the aid cuts will be felt for years to come. 

At an international level, we are also not convinced that a clear roadmap has been set out for building back better after US withdrawal, though we’d be happy to be proven wrong. What is clear though is that entities like the WHO and UNAIDS are facing unprecedented financial and political pressures – it seems possible that UNAIDS will no longer exist a year from now. Much reform has already been undertaken at the WHO. By the end of the year, we should have some sense of whether things have stabilised and whether a coalition of willing nations is truly committed to keeping the WHO and multilateralism in health alive. 

We have outlined only nine health issues in the above, but there are of course many more questions that we could have added to this list. Some of those include: 

  • Whether we will see meaningful improvement in the South African government’s response to non-communicable diseases such as diabetes, cancers, and mental health conditions. 
  • How well implementation of South Africa’s latest TB recovery plan is going, and in particular how we are doing against the target of testing five million people in 12 months. 
  • How climate change will impact people’s health and whether the South African government is prepared for it. 
  • Whether South Africa will see real progress in addressing antimicrobial resistance. After adopting a good policy a few years ago, it appears momentum has been lost. 
  • Whether the state will start taking xenophobia in the healthcare system and around clinics and hospitals more seriously, as a recent court judgment requires it to do. 
  • Whether a serious effort will be made to better regulate private healthcare and to bring down the cost of private healthcare services and medical scheme membership – that after a half-baked effort to create a new tariff-determination framework was launched and then canned last year. 
  • Whether we will see legislation introduced amending the Patents Act in line with a policy adopted by government in 2018 and whether we’ll see progress on the much-delayed State Liability Bill, which should have relevance for the state’s vulnerability to medico-legal claims. 
  • Whether we will see concrete steps forward with the new electronic health records and data systems government is developing. 
  • What progress we might see with the local production of vaccines and pharmaceuticals – one of the areas in which we are quite optimistic, despite the lack of coherent and enabling government policy. 
  • What impact AI will, or will not, have in our healthcare system this year. 

Are there issues not mentioned here that you think Spotlight should cover in 2026? Let us know by commenting below this article or by tagging us on BlueSky. 

*Low is the editor of Spotlight. 

Republished from Spotlight under a Creative Commons licence.

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Categories : Expert Opinion HIVTags :

Salim Abdool Karim | Transforming Adversity Into Opportunity for the AIDS Response

On By ModernMedia
Epidemiologist Professor Salim Abdool Karim is internationally recognised for his significant contributions to research on HIV treatment and prevention. (Photo: Supplied)

By Salim Abdool Karim

As World AIDS Day 2025 swings by, CAPRISA Director Professor Salim Abdool Karim reflects on the frantic days following this year’s unprecedented cuts to health aid and research funding from the US, arguing that the deliberate disruptiveness was designed to be cruel. Nonetheless, he argues, our HIV response must now forge ahead on a path that is more affordable, sustainable and independent.

STOP WORK!

A “STOP WORK” order is immediate.

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) received its first US government “STOP WORK” order from the US Agency for International Development (USAID) on 27 January 2025, imposing a 90-day suspension on a major HIV prevention research project.

A week earlier, on 20 January 2025, incoming US President Donald Trump signed an Executive Order imposing a 90-day freeze on USAID funding. Shortly thereafter, Elon Musk and his Department of Government Efficiency arrived at the USAID headquarters to systematically dismantle it and terminate most of its projects. Within 7 days, the full effect of Trump’s decision was reverberating across the world. The acute US funding cuts disrupted its foreign aid programmes that had for years worked to improve the lives of the most vulnerable communities across the globe.

The impact was instantaneous. Several US-funded projects ground to a halt. Feeding programmes for the hungry, shelter projects for those displaced by war and conflict, daycare for abandoned children and many other programmes in dozens of countries around the world were stopped. The swiftness of the implementation of the USAID dismantling caught the world off-guard.

On 3 February, Secretary of State, Marco Rubio, declared himself to be the new head of USAID, giving Musk carte blanche to destroy it. That day, I was contacted by journalists from The New York Times and from the prestigious magazine Science for information on the impact of US funding cuts on our HIV research.

On 7 February, the New York Times front page headline, “Clinical Trials Left in Lurch By Aid Freeze” informed the world of the impact of the US funding cuts on AIDS research in Africa. It described in graphic detail the impact of the funding cuts on research Dr Leila Mansoor and Dr Disebo Potloane of CAPRISA were undertaking in partnership with world-leading US scientist Dr Sharon Hillier, in developing new HIV prevention technologies for women.

Exactly a month after the initial 90-day “STOP WORK” order, we were notified that this US government funded project had been officially terminated for good. Several other large US-funded projects in South Africa, such as an HIV-vaccine development project led by Professor Glenda Gray, also received termination notices.

While the US government is perfectly entitled – as it sees fit – to stop funding for any of its projects, the deliberate disruptiveness of its implementation was sadly designed to be cruel. Musk relished his destruction of USAID with a chainsaw performance on stage at the Conservative Political Action Conference on 21 February. Ironically, the chainsaw, which he had just received as a gift from Argentine President Javier Milei, was engraved with the phrase “Viva la libertad, carajo”, which is Spanish for “Long live liberty, damn it.”

‘Disownment of science’

The Trump administration effectively dislocated the highly effective partnerships forged by the US and South African scientific communities over the past three decades. It was not simply a withdrawal of funding, but the disownment of science that rocked these research collaborations. A devaluing of science and an era of disinformation set in.

False information from the Trump administration is now rife, from debunked theories regarding autism from vaccines to the supposed dangers of paracetamol during pregnancy to the fictitious “white genocide” in South Africa or “Christian genocide” in Nigeria. This is a threat to democracy and to the decades of progress made in the AIDS pandemic.

Science, in its search for the truth, is under attack, as disinformation-based policies become official.

No time to wallow

Following the initial shock, we realised that we had zero time to wallow in this grief of sorts. CAPRISA went to work mobilising our own resources, reaching out to participants in terminated studies to offer them medical and emotional support. In March and April, our scientists routinely worked late into the night on new grant applications to research funders besides the US government. That hard work is now beginning to bear fruit as new grants begin to fill the gaps in our research funding.

These unprecedented disruptive funding cuts have been a stark reminder to never take donor funding for granted. And certainly, never to be as heavily reliant on a single donor again. While overseas development aid is intended to be altruistic, it has often come with strings attached. Those strings were a rude awakening in 2025 and has left several governments and non-governmental organisations, who were dependent on US foreign aid, in the lurch.

Scientific breakthroughs in HIV, including those by South Africa’s many highly accomplished AIDS researchers, have had widespread global impact benefitting vulnerable groups from all walks of life. Ironically, the funding cuts comes at a time when even greater resources are needed for research to successfully navigate the “last mile” on the way to the Sustainable Development Goal of ending AIDS by 2030.

As this year’s World AIDS Day theme, “Overcoming disruption, transforming the AIDS response” reminds us, this is the time to forge ahead on a path that transforms the response to one that is more affordable, sustainable and independent. As African scientists, we have already begun to take bold steps on the path to greater independence, thereby shifting our focus away from the disruption towards charting a determined path to a world without AIDS.

*Abdool Karim is the Director of CAPRISA and Pro Vice-Chancellor (Research) at the University of KwaZulu-Natal in Durban.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

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Categories : Healthcare Politics and Regulations HIVTags :

Withdrawal of US Aid Has Hurt South Africa’s HIV Programme

On By ModernMedia
The cancellation of US aid funding to South Africa is harming the country’s HIV response. Source: Unsplash CC0

By Marcus Low and Nathan Geffen

The number of HIV viral load tests is significantly lower than expected, according to an analysis of data from the National Health Laboratory Service which Spotlight and GroundUp obtained through the Promotion of Access to Information Act.

The number of HIV viral load tests recorded by the National Health Laboratory Service (NHLS) is significantly less than expected since February 2025. We are aware of no compelling reason to explain this except the withdrawal of US aid.

All patients in the public health system with HIV are supposed to get viral load tests regularly, usually once a year. These tests are used to determine if HIV is being suppressed successfully in their blood using ARV medicines. If the number of viral load tests declines, it likely indicates either that patients are being lost to the public health system, they are being monitored less diligently, or the system for recording viral load tests has become less accurate. Any one of these would imply a serious hit to South Africa’s public sector HIV programme.

GroundUp and Spotlight used the Promotion of Access to Information Act to request, among other things, viral load test numbers from the NHLS. We were provided a spreadsheet with the number of tests per month for each province from January 2015 to September 2025. 

The current US Administration began taking steps to reduce US aid across the world after Donald Trump was inaugurated as president on 20 January 2025. Billions of rands have been withdrawn from South Africa. This caused some services, especially for vulnerable people — including gay men, sex workers and trans people— to close almost immediately, such as the Ivan Toms Centre in Cape Town and Wits University facilities in Johannesburg. US aid also funded support systems, such as data collection.

Public health experts have accused the government of being in denial about the consequences of the withdrawal of US aid. Health Minister Dr Aaron Motsoaledi has responded defiantly. In May, he stated that a record number of people had been initiated on ARVs over the previous months, a claim disputed by epidemiologists.

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We asked a biostatistician to examine the NHLS data we received. She analysed the change in viral load tests by month and province over time. She found that the number of viral load tests for the period February to September this year is statistically significantly lower than what one would expect based on previous years. This confirms the view of public health experts: the withdrawal of US aid from South Africa has hit the HIV programme badly.

The decline in viral load numbers was previously reported by the Daily Maverick and Reuters for March and April. This was inevitable given the sudden withdrawal of US aid. But the new data shows that the decline has been sustained until September. The decline has occurred in every province except Limpopo.

How Viral Load Testing Performed Against Expectations, Feb–Sept 2025

ProvincePredictedActualDifference% Differencep_value
Eastern Cape545,061463,510-81,551-150.0007
Free State285,423234,671-50,752-180.0002
Gauteng1,210,8911,006,833-204,058-170.0002
KwaZulu-Natal1,475,3601,284,008-191,352-130.0001
Limpopo419,357441,31421,95750.1550
Mpumalanga532,713450,495-82,218-150.0007
North West326,907292,150-34,757-110.0002
Northern Cape64,85558,746-6,109-90.0017
Western Cape324,074290,011-34,063-110.0205
National5,184,6404,521,738-662,902-130.0003
*This table presents the expected and actual numbers of viral load tests conducted by the National Health Laboratory Service in South Africa from February to September 2025.

By looking at the change in viral load tests since 2015, a biostatistician estimated the number of viral load tests that there should have been for the period February to September 2025 using a standard linear regression model. She found that the actual number of tests declined significantly. A p-value less than 0.05 is considered statistically significant. Except for Limpopo, the p-values are substantially less than 0.05 for every province. The analysis takes into account that the NHLS suffered a data hack in 2024, and consequently, there is missing data for a few months.

An even simpler analysis also raises red flags. The absolute number of viral load tests conducted from February to September 2025 (4,521,738) is slightly lower than it was over the same period in 2023 (4,554,463) (due to a cyber attack, the NHLS’s 2024 figures are not a reliable comparison). Given that the number of people on HIV treatment is expected to increase over time and that everyone should be getting at least one viral load test per year, one would expect the number of viral load tests to have increased by a few hundred thousand since 2023.

These results show that the HIV programme has been set back. It is possible that tens of thousands of people have been lost to care. Also possible is that they are disproportionately the most vulnerable patients treated at specialist US funded facilities that closed as a consequence of the funding cuts.

Nevertheless the HIV programme is still successfully treating millions of people and South Africa is far better off than other African countries, such as Mozambique, whose response to HIV is almost entirely paid for with foreign aid.

Fewer patients have viral rebound. But is it a silver lining?

People with HIV who are on ARVs should have, after a few weeks, an undetectable amount of virus in their blood. This is what the viral load test measures. But if the ARVs stop working or a person stops taking their ARVs regularly, the virus will rebound in their blood.

The NHLS counts the number of viral load tests for which patients have more than a thousand copies of HIV per drop of blood. For these patients, the virus has rebounded in their blood.

The percentage of viral rebound cases has come down in 2025.

This might be because the standard ARV regimen has improved. A drug called dolutegravir is now part of the regimen, and it is known to do a better job of suppressing HIV than the drug it replaced a few years ago. This would be the good-news explanation, a silver lining in the data.

But it’s also possible that it’s because vulnerable patients treated in specialist clinics funded by US aid are more likely to have viral rebound and they are the ones who have been lost to the HIV programme. This would be the bad-news explanation.

At this point, we don’t have data to know which explanation of the viral rebound improvement is correct. The situation also varies substantially by province. The real picture might be a complex interaction of multiple factors.

This article was jointly produced by Spotlight and GroundUp.

Republished from Spotlight under a Creative Commons licence.

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Categories : HIVTags :

Response to Aid Cuts and HIV Prevention Injections Dominate Discussions at SA AIDS Conference

On By ModernMedia
Photo by Sergey Mikheev on Unsplash

By Ufrieda Ho

A dire picture for HIV/Aids funding emerged at the 12th South African AIDS Conference, raising the call for resilience, adapting and also for government to raise its game.

The what-next of South Africa’s HIV response will have to be centred on getting back to basics, leveraging on advances in treatment options and learning fast about adapting in a world without US aid for health services.

These were among the key takeaways from speakers at a plenary session at the 12th Southern African Aids Conference held in Kempton Park last week.

Professor Linda-Gail Bekker, executive officer of the Desmond Tutu Health Foundation, in her address took stock of “the incredible devastation around the world” from the virtual overnight shutting off of funds and human resources as Donald Trump returned to the US presidency in January 2025.

“It was $460 million into the wood chipper for us. And the worrying thing is that it could take us back to the harrowing scenes of 2000 [the height of Aids deaths in the country],” she said.

This comes against what she called the two largest challenges for South Africa’s HIV response: sub-optimal 12-month retention in care and viral suppression. Meaning the struggle to keep patients on treatment beyond a year and helping them stay on antiretrovirals that reduce the amount of virus in the body to a minimum.

The picture painted by Bekker and others is bleak, with much uncertainty remaining as to how South Africa might plug the funding holes left by the abrupt US aid cuts.

Bekker shared research by the Health Economics and Epidemiology Research Office (HE²RO), a division of the Wits Health Consortium at the University of the Witwatersrand. Their research shows that the fallout in the next three years could see South Africa experience a 29% to 56% increase in new HIV infections, or an additional 150 000 to 295 000 cases by 2028. Unless the South African government is able to take over services, there could be a 33% to 38% increase, or an additional 56 000 to 65 000 AIDS-related deaths in that period. (Spotlight previously reported on the HE²RO modelling in more detail here.)

The modelling also suggests that government will need additional funding of between $620 million and $1.4 billion (roughly R10 billion to R24 billion) between 2025 and 2028 to replace the local services that received US government funding.

In July, Treasury allocated R763 million in emergency funding to fill the gap, a fraction of what the HE²RO researchers estimate is needed. In addition, the Gates Foundation and the Wellcome Trust pledged R100 million each for research to the South African Medical Research Council on condition that the South African government doubled their contributions, which government committed to over three years. This added up to an R600 million bailout for research, also a fraction of the amount of research funding that has been lost.

The shortfall remains massive. Last year, Pepfar (United States President’s Emergency Funds for AIDS Relief) funds flowing to South Africa totalled over R7.5 billion.

Calls for greater transparency

Throughout the conference, there was also strong calls from attendees and speakers for government to be more transparent about its plans to mitigate the funding cuts and to provide credible data and information about monitoring and measuring of the success of their interventions. This includes details on how it plans to provide all stable patients with enough medicines for six months at a time. Such multi-month supplies mean people have to travel less to collect medicines, thus making it easier to stay on them. Rollout of multi-month dispensing has been very uneven across the country.

Questions were also raised over a lack of full transparency regarding the price of lenacapavir, a breakthrough HIV prevention injection that provides six months of protection per shot. As we recently reported, the South African government will be paying $60 per person per year for the jab, with other donors paying the rest – it is not publicly known how much this “rest” is. The deal was setup by the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gilead Sciences – the company that makes lenacapavir – and several private donors. Last week, Spotlight published an op-ed in which activists questioned the lack of full transparency about the price.

Dr Sandile Buthelezi, director-general for the National Department of Health, told attendees about the possibility of bringing forward the rollout date for lenacapavir from April next year, to possibly as soon as November this year. He did not answer questions about the price negotiations. He did however confirm that negotiations with The Global Fund has seen them commit to ringfencing US$29 million for procurement of lenacapavir over the next two and a half years.

Doing more with less

Having to do more with less, Bekker said at the conference, will mean the need to build a “resilience bridge”. For her, this means preserving the “two most important interventions” of providing continued access to antiretroviral treatment and to HIV prevention treatments – both long-acting injections and prevention pills.

She added that it also means better efforts to reach the population of people living with HIV who have been diagnosed but are not on treatment. In February 2025, government launched its ‘Close the Gap’ campaign aimed at placing an additional 1.1 million people on treatment by the end of this year. Bekker said the number of people living with HIV who are not on treatment is closer to 2 million people. According to Thembisa, the leading mathematical model of HIV in the country, of the roughly eight million people living with HIV in South Africa, around 6.2 million are on treatment.

How South Africa is progressing against the 1.1 million target is not clear. Figures previously shared by Health Minister Dr Aaron Motsoaledi indicated that over half a million people had been initiated on treatment in a matter of months. This raised eyebrows since, on the face of it, it means that people had been started on treatment this year more quickly than at any other time in South Africa’s HIV response. It also wasn’t clear whether the number of people who had stopped treatment had been subtracted from the number starting treatment. Questions Spotlight previously sent to the health department seeking clarification of the numbers went unanswered. Similar questions were also raised in an open letter and an op-ed published by Spotlight and GroundUp. As yet, Spotlight has not seen answers to the questions raised about the numbers shared by the Minister.

“We need to make services [more] amenable to retention so it means multi-month dispensing and differentiated care,” Bekker said. Differentiated care refers to treating people differently based on their needs – for example by not requiring healthy people living with HIV to visit the clinic as often as sicker people.

“Bad policies that reflect ideology and bias, mean the most vulnerable are deterred from assessing the services they need, and this includes our key populations,” she added of the challenges that people like sex workers, members of the LGBTQI+ community and people who use drugs face in clinics where they are judged, harassed or discriminated against.

Dr Lise Jamieson, a senior researcher at HE²RO, echoed Bekker’s sentiments and said a first priority remains to arrest any backsliding of care as South Africa restructures its HIV programme to match the money it has currently. “It is clear that the one thing that we absolutely cannot drop is our HIV treatment programme – it saves lives,” she said.

For Yvette Raphael, the co-founder and co-director of Advocacy for the Prevention of HIV and Aids (APHA), the undergirding socio-economic factors that have given HIV its stranglehold in South Africa remain largely unchanged.

She said: “I am one of the people who are ageing with HIV and suffering from other non-communicable diseases that come with this”, highlighting the need to address the evolving nature of HIV in the country and the need to address it alongside conditions such as diabetes and heart disease.

But she added that it is still teen girls and young women who are at a disproportionately high risk of acquiring HIV. Her message was for better youth-targeted responses that are community-level responses not top-down strategies.

“Make HIV a priority sustained by local and district government structures, not up here in our national and province centres,” she said.

“Make HIV prevention harder to ignore and weave HIV intervention services with skills training and income generating programmes. We know that employment in this country is low, so young people cannot be expected to continue a healthy life without spaces where they can generate income for themselves, this will [in turn] reduce their vulnerability and dependency on older men.”

She added that government had to step up to what should always have been their role as Pepfar funding was never meant to substitute the work of government. Raphael said: “Pepfar was here to support the government in the early days of HIV. However, some of our government officials saw that as a way of evading their responsibility, and we are now here.”

Note: The Gates Foundation is mentioned in this article. Spotlight receives funding from the Gates Foundation, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council and subject to the South African Press Code.

Republished from Spotlight under a Creative Commons licence.

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Categories : Healthcare Politics and Regulations HIVTags :

Inside SA’s Multi-million Rand Plan to Fill US Funding Void

On By ModernMedia
Photo by Miguel Á. Padriñán

By Jesse Copelyn

In response to US funding cuts for South African health services and research projects, National Treasury has provided the National Department of Health with hundreds of millions of rands in emergency funds. Spotlight and GroundUp look at how precisely the government intends to spend this money.

Health Minister Dr Aaron Motsoaledi recently announced that National Treasury had released roughly R753 million to help plug the gap left by US funding cuts to South Africa’s health system. Another R268 million is also being released in the following two years for researchers that lost their US grants.

But this may only constitute the first round of emergency funds from government, according to sources we spoke to. The health department is planning on submitting a bid for an additional allocation later on, which will be considered by Treasury. But this will likely only be approved if the first tranche of funding is properly used.

So how is the money supposed to be used? To find out, we spoke with officials from the National Treasury, the National Department of Health and the South African Medical Research Council (SAMRC).

Money for provinces is for saving jobs at government clinics

The current tranche of money comes from Treasury’s contingency reserve, which exists partially to deal with unforeseen funding shortfalls. It was released in terms of Section 16 of the Public Finance Management Act.

Of the R753 million that’s been announced for this year, Motsoaledi stated that R590 million would be going to provincial health departments via the District Health Programme Grant – a conditional grant for funding the country’s public health efforts, particularly HIV, TB, and other communicable diseases. Such conditional grants typically give the health department more say over how provincial departments spend money than is the case with most other health funding in provinces.

To explain how government officials arrived at this figure, it’s worth recapping what services the US previously supported within provinces.

Prior to Donald Trump becoming US president on 20 January, the US Agency for International Development (USAID) had financed health programmes in specific districts with high rates of HIV. These districts were scattered across all South Africa’s provinces, save for the Northern Cape.

The funds were typically channelled by USAID to non-governmental organisations (NGOs), which used the money to assist the districts in two ways.

The first is that NGOs would hire and deploy health workers at government clinics. The second is that the NGOs would run independent mobile clinics and drop-in centres, which assisted so-called key populations, such as men who have sex with men, sex workers, transgender people, and people who inject drugs.

Following the US funding cuts, thousands of NGO-funded health workers lost their jobs at government clinics, while many of the health centres catering to key populations were forced to close.

In response, the health department began negotiations with Treasury to get emergency funding to restore some of these services. As part of its application, the health department submitted proposals for each province, which specified how much money was needed and how it would be used. (Though this only took place after significant delay and confusion).

Since Treasury couldn’t afford to plug the entire gap left by the US funding cuts, the provincial-level proposals only requested money for some of the services that had been terminated. For instance, funding was not requested for the key populations health centres. Instead, the priority was to secure the jobs that had been lost at government health facilities.

As such, the total amount that was requested from Treasury for each province was largely calculated by taking the total number of health workers that NGOs had hired at clinics and working out how much it would cost to rehire them for 12 months.

Rather than paying the NGOs a grant to deploy these workers as was done by USAID, the health department proposed hiring them directly. This meant that they calculated their wages according to standard government pay scales, which is less than what these workers would have earned from the NGOs.

The total came to just under R1.2 billion for all the provinces combined.

Treasury awarded roughly half of this on the basis that the money would be used to finance these wages for six months, rather than 12. This amounts to the R590 million for provinces that was announced by Motsoaledi.

If all goes smoothly and this money is used effectively to hire these staff over the next six months, then a new tranche of Section 16 funding could be released in order to continue hiring them. Funds might also be released to fund the key populations health sites.

A concern, however, is that the money may just be used by provinces to augment their ordinary budgets. If the funds aren’t actually used to respond to the US cuts, then it is much less likely that more emergency funding will be released.

At this stage, it is too early to tell how provinces will use the money, particularly given that it appears that at least some of them haven’t gotten it yet.

Spotlight and GroundUp sent questions to several provincial health departments. Only the Western Cape responded. The province’s MEC for Health and Wellness, Mireille Wenger, said that the funds have not yet been received by her department, but that once they were, they would be directed to several key priority areas, including digitisation of health records, and the strengthening of the primary healthcare system.

It’s thus not clear whether the province will be using any of the funds to employ health staff axed by US-funded NGOs. In response to a question about this, Wenger stated that “further clarity is still required from the National Department of Health and National Treasury regarding the precise provincial allocations and conditions tied to the additional funding”.

What about research?

Of the R753 million that’s been released for this year, R132 million has been allocated to mitigate the funding cuts for research by US federal institutions, primarily the National Institutes for Health (NIH). Unlike USAID, the NIH is not an aid body. It provides grants to researchers who are testing new treatments and medical interventions that ultimately benefit everyone. These grants can be awarded to researchers in the US or abroad as part of a highly competitive application process.

Researchers in South Africa are awarded a few billion rands worth of grants from the NIH each year, largely due to their expertise in HIV and TB. But over the last few months, much of this funding has been terminated or left in limbo. (See a detailed explanation of the situation here).

The R132 million issued by Treasury is supposed to assist some of these researchers. It will be followed by another R268 million over the following two years. The Gates Foundation and Wellcome Trust are chipping in an additional R100 million each – though in their case, the funds are being provided upfront.

All of this money – R600 million in total – is being channelled to the SAMRC, which will release it to researchers via a competitive grant allocation system.

According to SAMRC spokesperson Tendani Tsedu, they have already received the R132 million from Treasury, though they are still “finalizing the processes with the Gates Foundation and Wellcome Trust for receipt of [their donations]”.

The SAMRC is also in negotiation with a French research body about securing more funds, though these talks are ongoing.

In the meantime, the SAMRC has sent out a request for grant applications from researchers who have lost their US money. The memo states: “Applicants may apply for funding support for up to 12 months to continue, wind down or complete critical research activities and sustain the projects until U.S. funding is resumed or alternative funds are sourced.”

“The plan,” Tsedu said, “is to award these grants as soon as possible this year.”

Professor Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, told us that the hope is that the grants could fill some of the gaps. “This is a bridge and it is certainly going to save some people’s jobs, and some research,” she said, but “it isn’t going to completely fill the gap”.

Indeed, the SAMRC has made clear that its grants aren’t intended to replace the US funding awards entirely. This is unsurprising given that the money that’s being made available is a tiny fraction of the total grant funding awarded by the NIH.

It’s unlikely that research projects will continue to operate as before, and will instead be pared down, said Bekker.

“It’s going to be about getting the absolute minimum done so you either save the outcome, or get an outcome rather than no outcome,” she said.

In other cases, the funds may simply “allow you to more ethically close [the research project] down,” Bekker added.

For some, this funding may also have come too late. Many researchers have already had to lay off staff. Additionally, patients who had been on experimental treatments may have already been transitioned back into routine care. It’s unclear how such projects could be resumed months later.

In response, Tsedu stated: “For projects that have already closed as a result of the funding cuts, the principal investigator will need to motivate whether the study can be appropriately resurrected if new funds are secured.”

The SAMRC has established a steering committee which will adjudicate bids. They will be considering a range of criteria, Tsedu said, including how beneficial the research might be for the South African health system, and how heavily the project was impacted by the US funding cuts. They will also consider how an SAMRC grant could “be leveraged for future sustainability of the project, personnel or unit”, added Tsedu.

An endless back and forth

The job of the SAMRC steering committee will likely be made a lot more complicated by the erratic policy changes within the NIH. On 25 March, the body sent a memo to staff – leaked to Nature and Bhekisisa – instructing them to hold all funding awards to researchers in South Africa. After this, numerous researchers in the country said they couldn’t renew their grants.

However, last month, Science reported that a new memo had been sent to NIH staff which said that while South African researchers still couldn’t get new grants, active awards could be resumed.

Since then, some funds appear to be trickling back into the country, but certainly not all. For instance, Spotlight and GroundUp spoke to one researcher who had two active NIH awards before the cuts. He stated that one of these was resumed last month, while the other is still paused.

Bekker also told us that she had heard of one or two research grants being resumed in the last week, though she said the bulk of active awards to South Africa are still pending.

“Where people are the prime recipients [of an NIH grant] without a sub awardee, there seems to be a queue and backlog but some [of those awards] are coming through,” said Bekker. “But how long this is going to take and when it might come through, we’re waiting to hear.” She said a strategy might be to apply for the SAMRC bridging funding and “if by some miracle the [NIH funding is resumed]” then researchers could then presumably retract their SAMRC application.

In the meantime, health researchers will have to continue spending their time working out how to respond to the abrupt and increasingly confusing changes to funding guidelines that have dogged them since Trump assumed office.

“It’s such a dreadful waste of energy,” said Bekker. “If we were just getting on with the research, it would be so much better.”

This article was jointly produced by Spotlight and GroundUp.

Republished from Spotlight under a Creative Commons licence.

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Categories : Healthcare Politics and RegulationsTags :

Global Fund to Cut R1.4-Billion to SA for HIV, TB and Malaria

On By ModernMedia
Photo by Reynaldo #brigworkz Brigantty

By Liezl Human

The Global Fund to Fight AIDS, TB and malaria (Global Fund) has notified Health Minister Aaron Motsoaledi that it will reduce funding to South Africa by R1.4-billion.

Global Fund said it would be reducing allocations for the seventh grant cycle from R8.5-billion to about R7.1-billion, a 16% reduction. Of this, 55% would be allocated to the National Department of Health and the rest to non-profit organisations such as the Networking HIV & AIDS Community of Southern Africa, Beyond Zero, and the AIDS Foundation of South Africa.

The fund informed recipient countries in May that it would be revising over 200 grants amidst funding shortfalls.

Global Fund was established in 2002 and provides funding for HIV, TB and malaria programmes in over 100 countries. According to its 2024 results report, 72% of its funding from 2021 to 2024 went to sub-Saharan Africa.

Other African countries also received notification of funding cuts. Mozambique’s allocation decreased by 12%, Malawi’s by 8% and Zimbabwe by 11%.

The shortfall in funding is due to Global Fund not having received money pledged by national governments. Over US$4 billion of the shortfall is due to the United States not fulfilling its pledge.

We reported last month how Mozambique’s health system has crumbled amidst USAID funding cuts.

In South Africa, funding cuts from PEPFAR earlier this year have led to clinics closing down, health staff getting retrenched, and people struggling to access HIV medication.

“As you know, the external financing landscape for global health programs is going through significant changes, with substantial impact on lifesaving services for the fight against the three diseases and health and community systems,” the Global Fund said in its letter to South African representatives.

The letter continued that while the Global Fund has “received some significant donor payments in recent days”, prospects to give the full grant cycle 7 (GC7) pledges “remain highly uncertain” and still face a risk of funding shortfalls.

“This is a difficult and unavoidable decision, which may require your country to reconsider how best to use the remaining GC7 grant amounts together with domestic resources and other sources of funds to keep saving lives,” the Global Fund said.

Foster Mohale, Department of Health spokesperson, said that the funding cut did not come as a surprise. Mohale said the department is “working with the provinces” to ensure that “service delivery” is not disrupted, and to apply measures to ensure “efficient use of limited resources”.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : Cancer HospitalsTags :

Closure of US-funded Cancer Clinic Further Burdens Public Hospitals

On By ModernMedia
The Cervical Cancer Screening and Prevention Clinic at Helen Joseph Hospital in Johannesburg was forced to shut down in mid-May after losing all its funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR). Photos: Elna Schütz

By Elna Schütz

Hundreds of cervical cancer patients will likely be referred to overburdened hospitals following the closure of the Cervical Cancer Screening and Prevention Clinic at Helen Joseph Hospital in Johannesburg.

Following over 20 years of operations, the clinic was forced to shut down in mid-May after losing all its funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR). It relied on some financial reserves to taper its activities over several months. Most clinic staff have been let go.

The clinic served women who were referred from across Johannesburg and as far as Springs. A significant part of that group lives with HIV.

“Many of these women are from underserved communities with limited access to specialist care,” says Dr Mark Faesen, Specialist Gynaecologist with the Clinical HIV Research Unit (CHRU).

The clinic offered critical cervical cancer screening and follow-up services, including Pap smears and colposcopies – a cervical examination for abnormalities. The clinic was managing around 1,400 patients annually. “It served as a clinical and research hub, preventing many cancers,” Faesen says.

We spoke to Zinhle (name changed) who was screened at the clinic after feeling ill for a year and who sought help at four different hospitals.

“When I got [to this clinic], I was received with a warm welcome,” she says, emphasising that every step of the process was explained to her and she was made to feel comfortable. “Where else are we supposed to go?”

Zinhle says she is deeply upset that she can no longer be treated at the clinic if she needs it again.

Faesen says the clinic’s closure will put immense pressure on other public hospitals offering these services, like Rahima Moosa or Chris Hani Baragwanath. This is likely to lead to longer waiting times for screening, diagnosis and treatments. “Early detection is important,” Faesen says. “Without timely diagnosis, outcomes are far poorer.”

Lorraine Govender, the National Manager of Health Programmes at the Cancer Association of South Africa (CANSA) says they are deeply concerned by the closure, as it is a serious setback in the ongoing fight against the disease.

Cervical cancer is the second most common cancer in women in South Africa, and results in the most deaths. It is curable if diagnosed and treated early. A Human Papillomavirus (HPV) vaccination also reduces the risk of cervical cancer. While low screening rates and backlogs in treatment have been long-standing across the country, Johannesburg appears to be particularly burdened. The shutdown of this clinic adds to a larger shortage of screening and treatment in Gauteng.

The Department of Health has previously stated that while it has improved vaccination efforts against cervical cancer, “screening and treatment are lagging behind”. The national health policy calls for women aged 30 to 50 to be screened at least three times in their lives. Women living with HIV should be screened at least every three years.

Cervical cancer screening services are limited and overwhelmed at most public hospitals, Faesen says. “The funding cuts have a knock-on effect: increasing patient loads at the few remaining colposcopy clinics.”

Lorraine Govender, the National Manager of Health Programmes at the Cancer Association of South Africa (CANSA) says they are deeply concerned by the closure, as it is a serious setback in the ongoing fight against the disease.

“Cervical cancer is both preventable and treatable when detected early, making continued access to screening services vital … The closure of this Johannesburg clinic must be a call to action,” Govender says.

Faesen stresses the urgent need for increased funding for decentralised screening services to fill the gaps created by clinics like the one at Helen Joseph Hospital. “Equipping more public sector sites with colposcopy capability and training personnel is also essential.”

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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