Cancellation letters, ending billions of rands of South African universities’ US Government-funded HIV and TB research grants with immediate effect, started to roll in over the weekend — with one affected researcher anticipating that more than 300 such grants will be ended, holding massive implications for tertiary learning and research institutions and substantive job losses.
Some experts estimate that as much as 70% of South Africa’s medical research, or up to $400m when both direct and sub-grants are considered for the past financial year, is funded through the National Institutes of Health (NIH), comprising 27 institutes and centres, each focusing on a specific area of research.
The NIH finances about three-quarters of biomedical research worldwide, writes Mia Malan of Bhekisisa.
Last Friday, the University of the Witwatersrand’s Wits Health Consortium, the unit through which the institution runs its clinical trials and donor-funded projects, received cancellation letters for all components of a grant of $2.5m, which ends in November 2027.
The grant was awarded through the NIH’s National Institute of Allergy and Infectious Diseases (NIAID).
Cancellation letters, sent on behalf of the chief grants management officer of the NIAID, Emily Linde, seem to be standard and tell researchers “they do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness”, also accusing them of harming “the health of Americans”.
The Wits project was run by chief investigators Helen Rees, head of the Wits Reproductive Health Institute, and Ian Sanne, heading the Clinical HIV Research Unit, who now also works for the international development group, Palladium, as its chief medical officer.
The research, which has been running since 2007, fell under the Wits Research Group Clinical Trials Unit, and conducted HIV and TB prevention and treatment studies, as well as trials for hepatitis and HIV-related cancers.
Some South African universities, that were sub-grantees of health research awards from US universities like Columbia University in New York, were sent stop-work orders on Friday, after the US institutions lost their own grants.
Science magazine reports that the former head of the South African Medical Research Council, Glenda Gray “received notice that her $3.1m grant for a clinical trial unit in Soweto (run through Wits) has moved from an approved to a pending status”.
The Centre for the Aids Programme of Research in South Africa, Caprisa, headed up by Salim and Quarraisha Abdool Karim, which receives considerable NIH funds, is on red alert: “We have not received any NIH grant termination letters yet. We are expecting them anytime,” Salim Abdool Karim said.
TB grants end as US faces TB outbreaks
Over the years, some of the HIV prevention studies at Sanne’s and Rees’ project were carried out on groups of people with a higher chance of getting HIV, like teen girls and young women in Africa, transgender people and female sex workers.
Their cancellation email stated stated “their award no longer effectuates agency priorities” and that “research programmes based primarily on artificial and non-scientific categories, including amorphous equity objectives, are antithetical to the scientific inquiry, do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness”.
Worst of all, the note said, “so-called diversity, equity, and inclusion (DEI) studies are often used to support unlawful discrimination on the basis of race and other protected characteristics, which harms the health of Americans”.
“Therefore, it is the policy of NIH not to prioritise such research programmes.”
The letter’s references to diversity, equity and inclusion probably refer to the Wits unit’s research on transgender people and female sex workers, groups that the Trump administration doesn’t like.
But Sanne said the references to DEI in their letter don’t make sense; although some of their research has focused on groups such as transgender people and sex workers, a large part of their work is focused on finding effective TB treatment for children and better medicine for people with multidrug-resistant TB, as well as preventive TB treatment.
“In many ways, our work ticks every box of President Trump’s ‘let’s make America great’ boxes. It makes America safer, stronger and more prosperous, because it will protect people from falling ill from TB, and most of the patents and intellectual property of new medicines that we test lie with US companies.”
Experts weigh in
Linda-Gail Bekker, who heads up the Desmond Tutu Health Foundation at the University of Cape Town, and also receives NIH funding, warned that the additional body blow to local clinical research enterprise comes as new TB infections “are the highest for a long time in the USA”.
By Saturday, Bekker had not received a cancellation letter for her grant, but says: “Bringing the HIV and TB epidemics to a place where they no longer bear a public health threat is of global concern. South Africa has played a significant role and contributed to our understanding and progress in that quest.”
Yogan Pillay, head of HIV and TB delivery at the Gates Foundation, which also funds HIV and TB research, and whose work the US Government’s funding cuts is likely to impact, warns: “The cuts mean that innovation on preventing and treatment of HIV will stall, and eliminating or ending Aids will now be but a dream… HIV will continue to spread.”
Trump: ‘No corrective action is possible here’
The Wits project did important TB research. One study, published in February and included on the NIH website, looked at how well doubling doses of the antiretroviral drug, dolutegravir works for TB patients.
Previous trials looked at how safe it was for pregnant women with HIV to take preventive TB medicine, at how well long-acting, injectable forms of antiretroviral therapy worked for teens, and how well the two-monthly anti-HIV jab worked.
The email said: “Although NIH generally will suspend (rather than immediately terminate) a grant and allow the recipient an opportunity to take appropriate corrective action before NIH makes a termination decision, no corrective action is possible here.
“The premise of this award is incompatible with agency priorities, and no modification of the project could align the project with agency priorities.”
Terminations not unexpected
But the grant terminations were not unexpected – or, at least not since last week. On 12 March, Science magazine reported that the NIH’s Acting Director, Matthew Memoli, asked officials at the Institutes to compile lists of South Africa-related grants. The email had similar wording to other NIH requests for information that led to the termination of dozens of grants involving transgender health, vaccine hesitancy, “and other topics the administration does not support”.
At least 300 US university projects have also had their grants terminated by the Trump administration, many of them US universities, leading to protests across America.
South African researchers have started talks with philanthropic foundations and the government to step in with funding, Sanne said, “but there are not yet clear outcomes”.
Projects in South Africa that received cancellation letters were told that they could “object and provide information and documentation challenging” their terminations.
But they first have to follow a “first-level grant appeal procedure that must be exhausted” before they’re allowed to “file an appeal with the departmental appeals board”.
Should projects choose to appeal, they have to submit a request within 30 days after receiving their terminations.
Sanne said he planned to make use of the appeal process and if unsuccessful, at the very least negotiate a way to terminate trials ethically and responsibly.
“Our research saves lives and the NIH has helped us to do that,” he explains. “What we now need to do is to convince them of the value of that rather than to terminate decades of investments that will result in the loss of lives.”
To not invest in science is to not invest in the growth of our GDP’, said MRC chief scientific officer Glenda Grey.
The NIH is the biggest funder of medical research in SA, providing grants to projects at the MRC and many top universities, reports BusinessLIVE. Much of the work focuses on HIV and TB but the NIH also funds research on non-communicable diseases.
“The only place where we can definitively answer questions about HIV prevention, treatment, cure and microbicides is South Africa. Disinvesting in SA means we won’t have the answers that could contribute to both global and local science,” Gray said in a webinar hosted by the Academy of Science of SA (Assaf) on Wednesday.
“There is … an assault on science,” said Gray, who is also the principal investigator of the Brilliant consortium, a multi-country network of scientists working on HIV vaccine development.
South Africa has been central to global efforts to develop HIV prevention tools and improve treatments because it has a high prevalence of the disease, a strong regulatory system and well-established clinical trial infrastructure.
The scientific community needs to persuade government and the private sector of the investment case for science, said Gray. “There is a strong correlation between scientific output and GDP. To not invest in science is to not invest in the growth of our GDP,” she added.
A sword now hangs over the extensive research enterprise the NIH has supported in SA for 30 years. At risk are scientific careers, lab infrastructure, and the relationships scientists have built with communities who participate in clinical trials.
Wits Reproductive Health and HIV Institute director Helen Rees expressed disappointment there had been little response so far from the private sector and high net worth individuals.
“I’m not seeing a big mobilisation of funds to replace the Pepfar shortfall (and) I haven’t seen much conversation around what are already shortfalls for research and which may become worse.
“I’m not sure that the private sector necessarily understands the value of research and innovation – it’s key to the development of economies,” she said.
MRC President Ntobeko Ntusi said no single partner in the global health environment could readily fill the void left by the US.
“We need to look to Europe, Asia, the private sector and philanthropy,” he said.
Science article – Fear spreads that NIH will terminate grants involving South Africa (Open access)
Bhekisisa article – Trump ends SA’s HIV and TB research grants (Creative Commons Licence)
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