Like you, we're following rash changes in U.S. aid policy with concern. In an early bid to categorize the many harms, our team has assembled a roundup of concrete impacts on specific programs.
Like you, we're following rash changes in U.S. aid policy with concern. In an early bid to categorize the many harms, our team has assembled a roundup of concrete impacts on specific programs outside the U.S. in the areas of health and nutrition.
Stay tuned for updates, and please drop us a note if you find this helpful or would like to find ways to collaborate amid the crisis.
— Heather Ferguson, Executive Director
TOPICS: HIV, malaria, TB, pandemic preparedness, women's health, health delivery, health products, hunger and nutrition.
Global health
PEPFAR/HIV
The threat of interruption to PEPFAR jeopardizes 20 million people for whom the program provides HIV treatment, including 566,000 children under age 15. [WHO, Jan 28]
Despite a waiver exempting PEPFAR, "shuttered HIV and tuberculosis treatment programs have been told by their contacts at USAID that they cannot resume work until they receive written instruction that the waiver applies specifically to them." [NYT, Feb 1]
"The dismantling of USAID by the Trump administration means there are no staff to process waivers submitted by food and other aid organizations hoping to resume operations under humanitarian exemptions." [Reuters, Feb 7]
Globally, 222,333 people pick up new supplies of PEPFAR-funded ARVs every single day—and all of them are at risk. [AmfAR Impact Fact Sheet]
"In a survey of 275 organizations in 11 sub-Saharan countries conducted over the past week, all reported that their programs or services had shut down or were turning people away . . . At least 70 organizations reported disruptions in H.I.V. prevention, testing and treatment services, and 41 said that some programs had closed . . . " [NYT, Feb 5]
"Last year, PEPFAR supported HIV tests for 228,010 people daily. About 65% of these tests were administered in Uganda, Tanzania, South Africa, Mozambique, and Nigeria." [The Lancet, Feb 8]
Kenya
The US has suspended the supply of ARVs and other essential drugs to the Kenya Medical Supplies Authority. [The Standard, Feb 3]
In Kisumu County, Kenya, nine drop-in clinics for patients with HIV have already closed: "We have not received any communication on the waiver, it seems to be affecting only workers in the US. The mass lay-offs have already begun and programmes have stopped working." [The Lancet, Feb 8]
People queued at Mathare North Health Center in Nairobi hoping to stockpile ARVs, but "there was no one at the clinic to dispense the medications. Seventeen staff at the health center had already been told that their positions had been terminated." [Bloomberg, Feb 7]
"In Nairobi alone, 8,803 health workers had been laid off or had their contracts paused as part of the cuts. PEPFAR contributed nearly 30% of the medical resources needed for HIV treatment nationally." [Bloomberg, Feb 7]
"In Kenya, 40,000 doctors, nurses and other health workers have been affected by the freeze." [NYT, Feb 5]
"In Kenya, a mother of three said on Friday morning that her usual clinic had given her only one month out of her usual six-month prescription of anti-retroviral medicine amid concerns over shortages. The Kenyan health minister has said the country has six months’ worth of medication, but clinics have already resorted to rationing." [Washington Post, Feb 4]
"One of us . . . works at a mission hospital in Kenya that since the Jan. 24 stop-work order has seen no funds for its more than 3,160 H.I.V. patients and the 42 workers serving them." [NYT, Feb 10]
South Africa
In South Africa, at least three PEPFAR-funded programs—transgender clinics in the Wits Reproductive Health Institute, the Anova Health Institute’s Ivan Toms Centre for Health in Green Point and OUT’s Engagement Men’s Health clinics in Gauteng and the Eastern Cape—"let staff and patients know they were temporarily shutting their doors last week." [Bhekisisa, Feb 3]
"PEPFAR provides ARV treatment to at least 5.5 million South Africans every day." [AP, Feb 3]
The administration has threatened to cut off all funding to South Africa. [Politico, Feb 2]
"More than 15,000 people who had previously provided HIV testing, counseling and other social prevention programs were forced to stop working abruptly, and many had not returned." [Washington Post, Feb 4]
The U.S. waiver issued Feb 1 requires PEPFAR projects to receive certification that they qualify—otherwise, they can't restart. "Most South African projects have not yet received such certification letters. 'We all wonder, does the waiver apply to us or not,' says Linda-Gail Bekker, who heads up the Desmond Tutu Health Foundation at the University of Cape Town, which receives Pepfar funding, 'because there is a lack of clarity and communication.'" [Mail & Guardian, Feb 10]
"Pepfar promised 231 000 doses of a two-monthly anti-HIV shot, CAB-LA, to South Africa . . . In December, the plan also committed to join hands with the Global Fund and other donors to pay forenough doses for 2 million people in poorer countries of a six-monthly HIV prevention injection, lenacapavir . . . But Pepfar-sponsored PrEP, and other forms of HIV prevention, now seems unlikely." [Mail & Guardian, Feb 10]
"The 5 February memo states that populations-based HIV surveys such as the Human Sciences Research Council’s household survey, are also not covered by the waiver and neither are implementation science projects — South Africa has five CAB-LA implementation studies across 16 sites, some of them supported by Pepfar." [Mail & Guardian, Feb 10]
"According to the South African National AIDS Council’s (SANAC) civil society forum, at least 9,000 people have lost access to needle exchange and opioid substitution therapy (OST) in Mpumalanga, Limpopo and Gauteng. These closures leave people vulnerable to HIV, hepatitis C and overdoses." [CHANGE / Health Justice Initiative, Feb 10]
"PEPFAR implementers . . . have begun processes to place staff on unpaid leave or worse, retrenchment of staff, affecting thousands of workers (we know of about 4,000 thus far) who support vital services." [CHANGE / Health Justice Initiative, Feb 10]
Uganda
The Uganda Key Populations Consortium, which provides HIV treatment and other services, has lost 70% of its funding, shuttered nearly half of its 54 drop-in centers and terminated contracts of 28 of its 35 staff members. [NYT, Feb 5]
Pius Kennedy, a program officer with the Kampala-based nonprofit Africa Queer Network, told The Associated Press last week that he and five other permanent employees received a letter from USAID ordering them to stop work. [AP, Feb 6]
Uganda's Coalition for Health Promotion and Social Development, which monitors the quality of HIV programs, "has had to let go of 105 full-time staff members and community workers." [NYT, Feb 8]
At Ark Wellness Hub in Kampala, "We are telling people to go home and it's not just [our clinic]. There is no more medication left - or maybe there's one refill at the most. But people keep asking us, 'have you got any extra, any extra?'" [Sky News, Feb 10]
"In Uganda, over 200 staff working on HIV prevention projects at the Infectious Disease Institute (IDI) at Makerere University in Kampala have been placed on administrative leave." [Wired, Feb 8]
Since the U.S. aid halt, about 40 newborns per day in Uganda contracted HIV when funding for treatments stopped. [NYT, Feb 9]
Other countries
Millions of people in Sudan are contending with closures of healthcare units that rely on USAID funding to help limit the spread of HIV, malaria and TB. [The National News, Feb 6]
"HIV clinics in Tanzania have closed with thousands of health-care workers losing their jobs." [The Lancet, Feb 8]
In Nigeria, "'I know many staff of some clinics and centers who have been asked to stay at home,' says Ngozi Nwosu Juba, executive director of Vision Spring Initiatives . . . Organizations affected include APIN Public Health Initiatives, the Centre for Integrated Health Programs, FHI360, and Caritas Nigeria, all of whose work includes HIV/AIDS treatment and prevention." [Wired, Feb 8]
HIV R&D
A USAID-funded trial testing six new HIV prevention products has been suspended, meaning researchers can’t communicate findings to participants or partnering government agencies—a violation of the Helsinki agreement, which lays out ethical guidelines for medical research. [NYT, Feb 6]
Two USAID- and PEPFAR-funded HIV studies have been halted: one evaluating long-acting HIV injectable cabotegravir in thousands of participants across five countries and another set to trial two HIV vaccines in people in South Africa, Kenya and Uganda. [NYT, Feb 6;Science, Feb 5]
A Georgetown Global Health Nigeria-led field study "aimed at improving HIV treatment across the country" has been halted. [Wired, Feb 8]
Malaria and TB
Malaria
Through the President's Malaria Initiative, USAID in 2023 invested $778 million across sub-Saharan Africa and parts of Asia, supplying such essentials as "37 million mosquito nets, insecticide for 4.2 million homes, over 100 million rapid diagnostic tests, and treatments for 63 million people"—all of which is at risk. [Bloomberg, Feb 7]
Amid malaria transmission spikes in many countries, more than 1 million insecticide-treated bed nets along with antimalarial drugs and diagnostics sit in a warehouse in Ethiopia, unable to be deployed. [Nature, Feb 6]
Uganda’s National Malaria Control Program has suspended insecticide spraying and ceased shipments of bed nets for distribution to pregnant women and young children. [NYT, Feb 1]
In Myanmar, the delivery of rapid tests and malaria drugs has been frozen; even if deliveries resumed, some organizations have no workers left to distribute supplies. [NYT, Feb 1]
Frozen contracts between USAID subcontractors and anti-malaria bed net manufacturers means 2.4 million U.S.-funded nets bound for sub-Saharan Africa are sitting in Asian production facilities; contracts for some 8 million additional nets are "in limbo." [NYT, Feb 1]
"A malaria vaccine study in Britain has stranded volunteers who had received doses but now lack medical follow-ups for potential complications." [NYT, Feb 9]
Tuberculosis
Cambodia’s Khmer HIV/AIDS NGO Alliance (KHANA) lost funding for a TB program that "detects about 10,000 . . . cases each year, providing preventive treatment to some 10,000 close contacts and medical care for some 300 rural patients." [Al Jazeera, Feb 7]
"In Uganda, children enrolled in a tuberculosis treatment trial were cut off from potentially lifesaving medication." [NYT, Feb 9]
"In Cape Town, transgender people have been denied treatment for tuberculosis (TB) after the closure of a specialist clinic in the public sector." [CHANGE / Health Justice Initiative, Feb 10]
Pandemic preparedness
A USAID program monitoring the circulation of avian influenza in 49 countries has been shut down. [PBS, Jan 28]
Women's health
An estimated 11.7 million women and girls will be denied access to contraceptive care during a 90-day freeze of foreign aid funds for family planning, resulting in 4.2 million unintended pregnancies and leading to 8,340 maternal deaths. [Guttmacher Institute, Jan 29]
According to UNFPA, 50,000 pregnant women in Gaza are at risk of losing critical care and over 2 million people across Bangladesh, Pakistan and Sudan risk losing sexual and reproductive health services. [Devex, Feb 3]
Facilities in Nigeria that provide family planning supplies are facing stockouts, despite increasing demand for their services. [The Guardian, Feb 6]
"'No funds from the United States government means 40 percent of our budget gone,' said Donald Makwakwa, executive director of the Family Planning Association of Malawi (FPAM). 'It means that a quarter of our staff had to stop work immediately, thousands of people seeking health care had to be sent back.'" [RFI, Feb 5]
In Afghanistan, UNFPA "will have to suspend 600 mobile clinics and immediately terminate the contracts of 1,700 female health workers." [RFI, Feb 5]
"The nonprofit IPAS works with hundreds of organizations in dozens of countries to provide access to contraception, abortion and other reproductive health services. Many of the clinics have shuttered, some permanently, said Anu Kumar, the organization’s president. The speed of the disruption did not allow clinics time to make contingency plans or taper their dependence on the funding." [NYT, Feb 8]
Health delivery
In Gaza, International Medical Corps says stop-work orders have affected the operation of one of only three neonatal ICUs in all of Gaza; one of Gaza’s only stabilization centers for severely malnourished children; and an extremely busy ER that receives up to 200 patients a day. (In an update, IMC said "the U.S. government has approved funding to cover hospital services through mid-April.") [IMC, Jan 29;NBC News, Feb 8]
Also in Gaza, the nonprofit Anera has halted a project to restore and expand critical health services, including medicine and rehabilitative services, to individuals with a wide range of health needs. [Anera, Feb 3]
At the Thai-Myanmar border, the IRC shut down medical clinics serving "around 80,000 people" in nine refugee camps. Elsewhere in Thailand, the Burma Children Medical Fund has faced interruptions to its work transferring patients to hospitals. [ABC Australia, Feb 8]
More than 100,000 Myanmar refugees living in camps in Thailand have lost access to hospital services. [AP, Jan 29]
"On the border between eastern India and western Myanmar, the Chin Human Rights Organization suspended its US-funded programmes. Overnight, mobile health teams and other services for 31,000 people – mired in conflict and under barrage from Myanmar’s junta – ground to a halt." [The New Humanitarian, Jan 31]
In Ethiopia, 5,000 public health worker contracts depend on US assistance: 'All of these, in all regions of Ethiopia, have been terminated, as well as 10,000 data clerks, very important in Ethiopia.' [UN, Feb 7]
In Sudan, "more than half of the 10 million people targeted to receive health care probably would lose access because of the cuts. One medical group, which had treated more than 19,000 civilians, mostly women, in the past two months in Darfur, said it could no longer offer services without alternative funding." [Washington Post, Feb 4]
Health products
USAID’s coordination and delivery of more than $1 billion in corporate drug donations—including drugs to treat NTDs—has been halted. [The New Yorker, Jan 29]
92 million women and children in more than 25 countries have lost access to the medicines, supplies and systems USAID offered that helped increase access to vaccines, prenatal care, safe childbirth and contraception. [The New Yorker, Jan 29]
Some $500,000 worth of antibiotics, antimalarial drugs and other essential medicines are reportedly stuck at the Port of Sudan. [NBC News, Feb 4]
Essential medicines are “rotting in warehouses” in the DRC after halted USAID payments forced a humanitarian organization to shut off the air conditioning. [NBC News, Feb 4]
Trucking companies paid through a suspended USAID project can no longer reach Zambian villages with medical supplies, including drugs to stop hemorrhages in pregnant women and rehydration salts to treat life-threatening diarrhea in toddlers. Similar issues are also impacting deliveries in Haiti, Malawi, Mozambique and Nigeria. [NYT, Feb 1]
Product R&D
A USAID-funded clinical trial evaluating a biodegradable hormonal implant to prevent pregnancy has been halted after participants in the Democratic Republic already had the devices inserted. [NYT, Feb 6]
International Research Centre for Diarrhoeal Diseases Research, Bangladesh has laid off 1,000 people andpaused 10 U.S.-funded projects focused on TB, nutrition, fungal infection surveillance and the risk of viral spillover from animals to humans. [Science, Feb 5]
More than 30 in-progress studies have been halted, including trials evaluating treatments for malaria, cholera and tuberculosis, a study testing mRNA vaccine technology for HIV, and another evaluating a next-gen malaria vaccine. [NYT, Feb 6]
FHI 360 is furloughing 36% of its U.S.-based staff. [FHI 360, Feb 6]
Hunger and nutrition
About 500,000 metric tons of American-grown food—worth $340 million—are held up in U.S. ports, including 33,000 metric tons of soy products used to treat severe malnutrition in East Africa and other regions. [NBC News, Feb 4;Reuters, Feb 7]
Food aid stuck in limbo includes enough to feed at least 2 million people for a month; some items are likely to expire before the end of the 90-day funding freeze. [Reuters, Feb 7]
Despite the humanitarian aid waiver, the U.S. has "stopped purchases for foreign food aid programs," and the freeze "could hinder or halt the operations of organizations that provide millions of tons of food each year to help alleviate poverty in countries such as Madagascar, Tanzania and Honduras." [Reuters, Feb 5]
Aid organizations are without guidance on where and how to deploy humanitarian relief after the Famine Early Warning Systems Network (FEWSNET)—a crucial USAID-funded system that helps predict, prevent and respond to food insecurity crises—was shut down. [Reuters, Feb 7]
In Mozambique, $3.5 million of food for nearly 100,000 people risks rotting in storage and nearly 70,000 people in Ethiopia risk losing access to safe drinking water. [Devex, Jan 29]
Millions of families in Sudan who rely on food and medical assistance supported by USAID are at risk of hunger and malnutrition. [The National News, Feb 6]
In the Sudanese capital of Khartoum, "more than two-thirds of soup kitchens have closed in the last week." [Washington Post, Feb 4]
"In Bangladesh, food assistance for refugees will be cut by half in March and run out entirely in April." [Time, Feb 7]
"World Relief . . . has 3.9 metric tons of bean seeds in Haiti that it cannot distribute, because of the stop-work order. 'If they are not distributed soon, then the seeds will rot, farmers will miss planting season, and families will be at high risk for food insecurity.'" [Time, Feb 7]
"We have product sitting in warehouses waiting for decisions to be made, and that correlates directly with young children's lives," said the CEO of Edesia Nutrition, whose product feeds severely malnourished children "in places such as Ethiopia, Haiti, and Sudan." [Boston Globe, Feb 4]
In Ethiopia, a coalition of NGOs reports disruptions including about 200 severely malnourished children "at risk of death"; refugees in Amhara and Afar who "may not have another alternative to get health and nutrition services"; and in Tigray, "procurement of 20,000 chicken, 2,000 goats, distribution of agricultural tools for 19,500 individuals... halted." [Ethiopia HINGO Group, Feb 6]
The Norwegian Refugee Council has suspended essential aid: "The impact of this will be felt severely by the most vulnerable, from deeply neglected Burkina Faso, where we are the only organisation supplying clean water to the 300,000 trapped in the blockaded city of Djibo, to war-torn Sudan, where we support nearly 500 bakeries in Darfur providing daily subsidised bread to hundreds of thousands of hunger-stricken people." [NRC, Feb 10]
Next steps
Organizations like the HIV Modeling Consortium, ICVA, PEPFARWatch, UNAIDS, and others are tracking the impacts of U.S. policy changes. Meanwhile, collaborators across the international development and global health ecosystem are scrambling to preserve U.S. CDC and other data as U.S. government websites go dark:
In the face of irreversible harm, partnership and collaboration are the way forward. Our team recognizes with gratitude the efforts of our counterparts around the world.
If you have information to share, including datasets at risk of disappearance, please reach out to josh.axelrad@linksbridge.com.
Image credits
Reid Wiseman/NASA
U.S. CDC
U.S. CDC
Linksbridge SPC, 808 Fifth Avenue North, Seattle, WA 98109, USA
