Health Minister Aaron Motsoaledi said talks had begun with local and international foundations on funding to fill the budget shortfall in its HIV/Aids treatment programme, which he says is a priority.
The Trump administration’s halting of the supply of life-saving drugs for HIV, malaria as well as TB, and medical supplies for newborn babies, has affected numerous organisations supported by USAID, jeopardised the jobs of at least 15 000 health workers, and ignited fears that it could also collapse the ARV treatment programme.
However, Motsoaledi said “Trump does not owe us a cent”.
TimesLIVE reports that while addressing MPs during a debate on the matter, which was sponsored by EFF leader Julius Malema, he said funding talks had already started with philanthropic and prominent domestic and international foundations to plug the gap.
“In the meantime, we have met many funders, the Clinton Health Access Initiative, the Elmar Foundation, the Gates Foundation, the Foreign and Commonwealth Development Office of the UK, our own FirstRand, the trustees of the Solidarity Fund – not the Solidarity that ran to Trump but the Solidarity Fund established during Covid,” Motsoaledi said.
“I want to emphasise that there’s no government or funder in the world that has put money aside waiting for Trump to explode. That’s why we’re meeting them but none of them (is yet saying) we’re giving you this much.”
Not possible
Of the 271 606 people employed in HIV/Aids-related work, 254 452 are government-funded, while only 15 000 relied on US-funded programmes.
However, their primary focus, Motsoaledi said, was on patients receiving antiretroviral (ARV) treatment, but he has made it clear the government cannot fill the funding gap on its own.
“Doing everything USAID was doing may not be possible. I am saying this because some of the money was for research investigations and related activities. Our immediate aim is that nobody must run out of ARVs when they need and deserve them.
“It's not about filling the whole gap; it’s about prioritising and seeing what is more urgent and what we can afford, because we are not going to hide and claim we can afford everything that Pepfar gave. Even our funders, many of whom are international, have told us that even if they come in and help, they may not be able to give us everything Pepfar was providing.”
South Africa has received about R146.52bn from the US Government since the programme was launched in 2003. For the current US financial year (October 1 2024 to September 30 2025), more than R7.4bn was allocated.
Motsoaledi previously assured patients receiving treatment through US-funded programmes that they would still receive treatment from the government, reports Daily Dispatch.
He said he was engaging the National Treasury to discuss the financial implications and present the department’s urgent needs.
“We have told our provincial departments that we will meet them almost once a week to see what is more urgent, whether they can bring all the patients to the public health facilities where clinics have been closed, and whether they can second (transfer) extra staff from the Department of Health.”
Untreatable TB bug
Meanwhile, concerned global experts are worried that dangerous new forms of tuberculosis, for which there is no treatment, could emerge as a result of US aid cuts, and put poorer countries, including South Africa, at risk.
Dr Lucica Ditiu, who heads the Stop TB Partnership, said she feared that interruptions to people’s treatment would allow the airborne bug to mutate into a new, untreatable form.
Moreover, a lack of diagnostic services, which have also been badly affected by the Trump administration’s aid cuts, would allow TB to spread more easily, she told The Guardian.
Programmes working to detect, treat and research new ways to fight TB are among nearly 10 000 health projects worldwide to receive notices at the end of February that the US was terminating its funding.
The US has historically provided between $200m and $250m a year in bilateral funding to poorer countries for their work on TB, the World Health Organisation said, warning that “abrupt funding cuts” would “cripple TB prevention and treatment efforts, reverse decades of progress, and endanger millions of lives”.
In a statement, the organisation said: “Early reports to WHO from the 30 highest TB-burden countries confirm that funding withdrawals are already dismantling essential services, threatening the global fight against TB.”
That included layoffs of health workers, drug supply chains breaking down, disruption to laboratory services, and collapsing data and surveillance systems, it said.
The Stop TB Partnership – a UN-hosted network of organisations working to fight the disease – received a notice that the US was terminating its funding, before a second message saying the termination was rescinded.
However, Ditiu said funding flows had yet to resume, and that she still worried about the effect of wider cuts on the fight against TB.
The US State Department has said its strategy was now that “every dollar we spend, every programme we fund and every policy we pursue, must make America safer, stronger, and more prosperous”.
But Ditiu said: “Stopping the TB response doesn’t do any of this. First of all, it makes none of us safe, because TB is airborne. You cannot stop it at the border. It’s spread through air – as long as you breathe, you will get it. And not just TB, but also drug-resistant TB and extreme drug-resistant TB.
“The current measures will probably create additional strains because there are people with interrupted treatment, there are people not diagnosed and so on.”
Ditiu said 2024 was the “best year on record” in terms of diagnosing and treating people with TB. Those achievements would now “roll backwards”.
The world now faced a “very grim” situation, she said. Drug-resistant tuberculosis remains hard to treat, with even modern six-month regimens coming with significant side-effects.
“I know there were groups doing research on extreme drug resistance, including in South Africa, that were stopped right away,” she said. “That means people receiving whatever treatment there are now out of treatment.
“So you can potentially create a bug with extreme drug resistance – you create a bug that is virtually resistant to everything we have,” she said. “And this is the scary picture.”
In 2023, there were 10.8m new TB cases and 1.25m people dying from the disease. The US itself has had two TB outbreaks in the past three months, in Kansas and North Carolina.
The WHO and UN have set targets of eradicating the disease by 2030, but even before the US aid decision, there was an $11bn shortfall in the global response.
Disrupted treatment and diagnosis during the pandemic resulted in doctors seeing “more complicated” forms of TB in their patients, Ditiu said, including some with holes in their lungs. It was a pattern she expected to see repeated, particularly among the poor and vulnerable.
Ditiu said there could be drug shortages later in the year as countries used up their supplies.
Some countries with high levels of TB, like South Africa, Indonesia, the Philippines, Nigeria and India, may be able to find their own resources, she said, but others were likely to struggle, “especially in Africa”.
She hoped institutions like the African Development Bank or World Bank would be able to help but thought people would die as a result of the cuts.
It was “heartbreaking”, she said. “I’m upset that we trusted that the solidity of a commitment from a country like the US would be there forever.”
See more from MedicalBrief archives:
US Supreme Court unblocks Trump foreign funding freeze
Who will plug the US funding gap?
SA should prepare for ‘worst case scenario’ after Trump cuts