Donald Trump's slew of executive orders in the past two weeks – including freezing foreign aid for 90 days and shutting down the US Agency for International Development – affecting lifesaving treatment and prevention programmes for TB, malaria, HIV and other diseases in more than 50 countries, have caused global panic and chaos.
Exacerbating the alarm was Trump’s pronouncement this week that he was cutting South Africa’s health funding because of the signing into law of the Expropriation Bill.
GroundUp reveals that this was allegedly a direct result of AfriForum having lobbied Trump about land expropriation.
In a social media post, Trump wrote: “South Africa is confiscating land, and treating certain classes of people VERY BADLY…A massive Human Rights VIOLATION… The United States won’t stand for it, we will act. Also, I will be cutting off all future funding to South Africa until a full investigation of this situation has been completed.”
Reuters reports that the US had committed $440m to South Africa in 2023, most of which supports HIV and TB health services, and at least 1 250 NGOs.
GroundUp writes that Al Jazeera reported in 2018 that AfriForum was “in the US to lobby government officials about the murders of white farmers and to warn investors about the ruling (ANC’s) proposed plan to expropriate land without compensation”.
The editorial takes the civil rights group to task for an action that it says has resulted in South Africans being punished.
“… AfriForum is part of a democracy representing an important constituency, mainly conservative white Afrikaans people, and is also an organisation that has done some good work.”
The editorial added that it was “AfriForum’s prerogative to be opposed to the Expropriations Act, but unacceptable to be lobbying the government of the most powerful country in the world to sanction South Africa in any way, irrespective of whether those sanctions target people who are dependent on HIV and TB programmes, ANC members or President Ramaphosa”.
“Kriel (AfriForum CEO) can show he is committed to the democratic process in South Africa by calling on Trump not to institute any sanctions against South Africa, including against ANC members or the President,” urged the writers.
While AfriForum issued a statement welcoming the announcement that the USA would investigate expropriation, in response to Trump’s X post this week, Kriel posted that it would “officially request the USA to directly punish senior ANC leaders and not the people of South Africa”.
Pepfar grinds to a halt
In the interim, local NGOs supported by the US President’s Emergency Plan for Aids Relief (Pepfar) were still awaiting formal guidance this week on the limited waiver after last week’s “stop-work” order, reports BusinessLIVE, with clinics being shut, medicines remaining in warehouses and healthcare workers and technical support staff being told to stay at home.
Pepfar provides 17% of SA’s HIV/Aids funding, allocating it $448.5m in the 2025 US fiscal year.
A partial waiver to the aid freeze for “emergency humanitarian assistance” and the details of which Pepfar programmes would be allowed to continue under this instruction only emerged in a US memo issued earlier this week.
These include “lifesaving HIV care and treatment services” – HIV testing; counselling and treatment; the prevention and treatment of opportunistic infections, including TB; laboratory services; and the procurement and supply chain management of commodities and medicines.
Permitted are the resumption of services to prevent mother-to-child transmission of HIV, including commodities, test kits, medicines and pre-exposure prophylaxis for pregnant and breast-feeding women, and “reasonable” administrative costs to deliver and oversee these programmes.
But large parts of Pepfar’s work remain on hold: the limited waiver does not apply to voluntary male circumcision; transgender clinics, like those run by the Wits Reproductive Health and HIV Institute; or clinics specifically aimed at men who have sex with men, provided by organisations like the Anova Health Institute.
The memo specifically excludes from the waiver activities that apply to abortions, family planning, gender or “diversity equity and inclusion” programmes, and any other activities not specified in the guidance may not be resumed without express approval.
Mitchell Warren, executive director of the HIV advocacy group Avac, said it was unclear who would provide direction to Pepfar’s implementing partners since the USAID headquarters were abruptly closed down in Washington.
Until now, USAID has played a key role in channelling funds and overseeing programmes supported by Pepfar.
South African born Elon Musk, who is leading Trump’s drive to shrink the federal government, said work was under way to completely shut down USAID.
SECTION27 has expressed concerns about the broader implications of the funding freeze on health services, saying that while Pepfar does not fund most of South Africa’s HIV programme, its contributions are still critical for specific areas, reports IOL.
Motsoaledi meets embassy
On Monday, Health Minister Aaron Motsoaledi had a meeting with Chargé d'Affaires for the United States Mission to South Africa Dana Brown to discuss bilateral health co-operation and the new policies on aid.
News24 reports that last week Motsoaledi said the government was snubbed by Washington when it sought clarity on the announcement that Pepfar would be frozen.
A joint statement was released by the Department of Health on Tuesday, saying: ”The Minister and the chargé d’affaires noted the importance of the assistance that South Africa has received from the US since the start of the HIV and Aids pandemic more than two decades ago.
“The Minister conveyed his thanks for this support. This assistance has been consistent and crucial to the drastic reduction in maternal-to-child transmission of HIV, infant deaths and the increase in life expectancy generally. Communication channels are open between the ministry and the embassy, and we continue to discuss our lifesaving health partnership moving forward.”
Motsoaledi said the government had first learnt through NGOs funded by Washington that aid would be halted.
Detailing his frustration, he had said: “Up to now, we haven’t received any letter from the American Government. This money, whether from Global Fund or Pepfar, it comes through Treasury and Treasury has no letter. Health has got no letter.
“The Department of International Relations & Co-operation has got no letter, and we tried to contact the embassy of the US, but we could not get them.
“So, how do we know that there is this funding withdrawal? Because the actual NGOs and the clinics funded from this Pepfar were the ones who received letters.”
The meeting between the two countries took place after Ramaphosa said on Monday that he was looking forward to meeting Trump to clarify Pretoria’s stance on the Expropriation Act, addressing and rectifying any misconceptions and misinformation about South Africa during their discussions.
Millions at risk
Further north, The New York Times reports that in Uganda, the National Malaria Control Programme has suspended spraying insecticide into village homes and ceased shipments of bed nets for distribution to pregnant women and young children, said Dr Jimmy Opigo, the programme’s director.
Medical supplies, including drugs to stop haemorrhages in pregnant women and rehydration salts that treat life-threatening diarrhoea in toddlers, cannot reach villages in Zambia because the trucking companies transporting them were paid through a suspended supply project of USAID.
Dozens of clinical trials in South Asia, Africa and Latin America have been suspended. Thousands of people enrolled in the studies have drugs, vaccines and medical devices in their bodies but no longer have access to continuing treatment or to the researchers who were supervising their care.
In interviews, more than 20 researchers and programme managers described the upheaval in health systems in countries across the developing world.
The programmes that have frozen or folded over the past week supported frontline care for infectious disease, providing treatments and preventive measures that help avert millions of deaths from Aids, tuberculosis, malaria and other diseases.
There will now be no one to take custody of millions of dollars’ worth of supplies for vital oxygen systems, purchased for programmes funded by USAID that support health clinics in some of the world’s poorest countries. The shipments, now in transit, are scheduled to reach ports in the coming days, but employees of those programmes have been ordered to stop work.
Few have been able to obtain clarification on whether and when their work can continue because their assigned contacts at USAID have either been fired or furloughed, or are under strict instructions to not talk to anyone.
Thousands of people have already lost their jobs as a result of the freeze. About 500 US-based employees of USAID were fired. In countries from India to Zimbabwe, staff for health projects were immediately fired. An organisation called the International Centre for Diarrhoeal Disease Research, Bangladesh, which does research on a top killer of children, laid off more than 1 000 employees this week.
Two-thirds of the staff of the President’s Malaria Initiative, an organisation founded by former President George W Bush that is the largest donor to anti-malaria programmes and research worldwide, have been fired.
USAID’s largest project is called the global health supply chain, an effort to streamline procurement of supplies for HIV, malaria, maternal health and other key areas, to make the system more efficient and save money. It operates in more than 55 countries where, in many cases, it supplies the bulk of key medicines. Now its global web of staff has been ordered to stop work except for essential tasks, like guarding commodities in warehouses.
In East Africa, medical researchers working on projects to find ways to stop transmission of HIV and develop more effective contraception have found themselves floundering for explanations to give to participants in their clinical trials.
‘Radical lunatics’
There has been talk among current and former agency employees and lawmakers that USAID, which receives its funding from Congress, could be subsumed within the State Department in a drastically reduced form.
Trump has disparaged the agency, telling reporters it was run by “radical lunatics”.
“We’re getting them out, and then we'll make a decision,” he said. He also praised Musk as “very smart” – who has posted a series of messages in recent days expressing fury at the aid agency and voicing conspiracy theories about it.
“USAID is a criminal organisation,” Musk wrote on Sunday in a social media post that many aid workers saw as confirmation the agency would soon be absorbed into the State Department and that some viewed as a potential threat to their personal safety.
“Time for it to die.”
USAID, which has a staff of more than 10 000 people and which spent about $38.1bn on health services, disaster relief, anti-poverty efforts and other foreign assistance programmes in fiscal year 2023, makes up less than 1% of the federal budget. It takes foreign policy guidance from the State Department, but has otherwise operated independently.
The USAID website went dark on Saturday – a possible indication of a looming loss of the agency’s autonomy that employees anticipated Trump would soon make official with an executive order.
The State Department website has a page with archived posts from the aid agency.
Lawmakers and aid workers also learned that at least some of the signs at the agency’s headquarters had been removed.
Job losses, lives at risk
The US is the world’s largest single donor. In fiscal year 2023, it disbursed $72bn of assistance worldwide on everything from women’s health in conflict zones to access to clean water, HIV/Aids treatments, energy security and anti-corruption work. It provided 42% of all humanitarian aid tracked by the United Nations in 2024.
Speaking more broadly about cutting America’s expenses and fraud, Musk estimated the Trump administration can cut $1 trillion from the US deficit next year.
He asserted, for example, that “professional foreign fraud rings” are stealing vast sums by masquerading as or creating fake digital US citizens.
Musk did not offer any evidence to support his fraud claim or explain how he reached the figure of $1 trillion.
BusinessLIVE PressReader article – NGOs wait for guidance on aid waiver (Open access)
Reuters article – Musk says he is working to shut down “beyond repair” USAID (Open access)
IOL article – Trump sets eyes on SA: 1,250 NGOs at risk from aid funding threat (Open access)
See more from MedicalBrief archives:
Trump’s funding freeze threatens to paralyse SA NGOs
African activists fear Trump will cut birth control funds
PEPFAR cuts may cost 9m years of lost life in SA and Ivory Coast