US aid cuts threaten South Africa's status as powerhouse of HIV and tuberculosis research
At least 27 HIV trials and another 20 TB trials in the country have been put at risk by Donald Trump's deep cuts to foreign assistance and global health spending, new analysis shows.
Loss of the trials would hit research projects looking for new vaccines into both infections, as well as new long-lasting protective medicines and studies into the best way to treat children.
Having intense HIV and TB epidemics as well as world class universities and research institutes has made South Africa a leader in combating the two diseases.
Yet while the research has often been led by South African scientists, it has overwhelmingly been conducted with international funding, particularly with 20 years of generous United States government aid spending.
Prof Salim Abdool Karim, director of the Centre for the Aids Program of Research in South Africa, said: 'The US is such a big player in our country – South Africa is a powerhouse in medical research because of what the US spends.'
The bulk of funding for research came from the US National Institutes of Health (NIH), with the country receiving an estimated £111m ($150m) each year.
Prof Ntobeko Ntusi, the president and chief executive of the South African Medical Research Council (SAMRC), said earlier this year: 'In many ways the South African health research landscape has been a victim of its own success, because for decades we have been the largest recipients of both [official development assistance] funding from the US for research [and] also the largest recipients of NIH funding outside of the US.'
Now, unless alternative sources of money can be found, South African academic and research institutes could lose about 30 per cent of their annual income and may be forced to lay off hundreds of staff, the analysis found.
'There's been a huge dependence on US funding. The loss of it for South Africa means the cancellation of a huge amount of research,' said Tom Ellman, director of the MSF's Southern Africa Medical Unit (SAMU).
The joint analysis by Treatment Action Group (TAG) and Doctors Without Borders (MSF) of NIH-funded research found 39 TB and HIV clinical research sites are under threat, placing at least 27 HIV trials and 20 TB trials at risk.
The effect of cuts could be wider still, with research also funded through other US channels, including the US President's Emergency Plan for Aids Relief (Pepfar), which has been slashed by Donald Trump's administration.
Lindsay McKenna, TB project co-director of TAG said: 'Public funding from the US government to South Africa is the scaffold on which pharmaceutical companies, philanthropies, and other governments invest in transformative TB and HIV science.'
'These ongoing funding disruptions by the US government don't just affect US-funded research projects, they put in peril a much wider ecosystem of global research.'
Dr Ellman said a combination of the infections found in South Africa, its research base and its strong grass roots activism had combined, with US funding, to make the country so prominent in research.
He said: 'For years, South Africa has spearheaded the research and development of critical innovative medical tools for the prevention, diagnosis, treatment and care of HIV and TB which have saved lives not just within South Africa's borders, but also in communities worldwide.'
The country has more HIV patients than any other, with an estimated 8 million currently infected and 105,000 deaths annually.
The high prevalence of HIV goes hand-in-hand with a high prevalence of tuberculosis, because TB takes advantage of patients' weakened immune systems. Tuberculosis is the biggest cause of death among those with HIV in South Africa, which recorded 54,000 TB deaths in 2023.
At the same time, the country has strong research institutions and universities, and a history of medical innovation, including conducting the first heart transplant in 1969.
Finally, the history of the apartheid struggle, and later the fight in the early 2000s to get antiretroviral drugs in the face of government AIDS denialism, has produced well-organised and politically-engaged health activists.
According to the joint analysis, HIV trials now at risk include studies into using broadly neutralising antibodies (bNAbs) to find a cure, and also trials into long-lasting anti-HIV preventative jabs.
The Brilliant Consortium, a collaboration of African researchers led by the SAMRC working to develop an HIV vaccine, lost all funding even as it was about to begin an early stage vaccine trial.
Dr Ellman said: 'I think it would be a disaster if we gave up on the hope of finding an effective vaccine for HIV. All of that has been done with South Africa and without access to South African research and communities, it's not going to be possible.'
The emergence of some resistance to antiretroviral drugs has also highlighted the importance of trials to find new drugs which can deal with the phenomenon.
HIV trials are also looking at honing and improving existing treatment regimes, as well as simplifying and rolling out expensive techniques first used in the developing world.
TB trials at risk include studies for new drugs and shorter, safer regimens for treatment and prevention.
The cuts have a ripple effect beyond individual trials, because they also weaken research infrastructure which is used and relied on by other funders.
That could have a knock-on effect on trials looking at new TB jab possibilities, including the promising new M72/AS01E vaccine candidate.
South Africa is now scrabbling for alternative sources of funding to try to salvage as many of the research projects as possible.
Dr Ellman said: 'We call on all potential donors to step up, as without sustained investment, we will never end these deadly epidemics.'
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