The US National Institutes of Health (NIH) has – without explanation – lifted a hold on payments for scores of existing grants to South Africa, apparently softening its previous controversial change to its foreign funding policy that had put many clinical trials abroad in limbo, and hopefully rebooting critical research, reports Science.
An alternative payment scheme announced this week could allow those studies to continue, and “I am delighted” that some projects can now move forward, said HIV researcher Monica Gandhi of the University of California-San Francisco, who has three NIH grants backing work in South Africa.
Gandhi was among researchers who had appealed to the agency’s director, Jayanta “Jay” Bhattacharya, to restore their funding.
“This is progress and we are grateful for that after what seemed like a very long two months.”
NIH-funded researchers in South Africa are also buoyed by a separate agency reversal. In a 27 June email, NIH official Michelle Bulls informed grants staff that although no new awards can be made to South Africa, existing sub-awards with clinical research can continue under its new “supplement” plan.
And ongoing prime awards to South African researchers, which make up about 100 of the country’s NIH grants, “may proceed”, the memo states.
South African researchers who have laid off employees in recent months got the good news this week in a call with NIH grant officials, said Professor Glenda Gray, leading HIV/Aids researcher at the University of the Witwatersrand and chief scientific officer of the SA Medical Research Council.
“We have lost time and opportunity and had to retrench critical staff,” she said. “We hope we can rapidly restart our research and fulfil our mission to contribute to science to mitigate HIV and TB.”
Disruptions to foreign clinical trials, including layoffs by various groups, began in March when the NIH moved to freeze or terminate its nearly 280 grants for projects in South Africa.
On 1 May, NIH announced it would no longer allow foreign “sub-awards” – money for scientists abroad carved out of a “prime” grant held by a US principal investigator.
Instead, these must be converted to awards made directly to the foreign partner, who would have to submit their own grant proposals.
The shift, the NIH said, would improve tracking of grant money and better protect national security. But the agency warned that its new system for such foreign partnership grants might not be ready until 30 September.
Last year, the NIH funded about 3 600 sub-awards in foreign countries, totalling more than $400m, policy change sparking panic among the affected researchers.
Bhattacharya, a health economist whose research has involved work on foreign countries, has emphasised in public remarks that the NIH would continue to support international research.
He told Science in a 1 May interview that he had “turned … back on” the HIV research networks in South Africa, although researchers involved say they were still unclear that money would be forthcoming.
Now the NIH appears to be following through. Staff guidance dated 30 June maintains that grant renewal and new applications, including a foreign sub-award submitted after 1 May, will not be reviewed until the new tracking system is in place. But the document describes an exception for human subject research in applications submitted earlier, and for ongoing human studies.
As a temporary measure, the NIH grants staff can convert the sub-awards within these projects to special “supplements” to the main grant that will go directly to the foreign collaborator, the document says.
“It’s still a huge administrative lift and unnecessary but will allow foreign projects with human subjects to continue,” said an NIH grants official who asked not to be identified.
It’s unclear, however, whether the policy will restore South Africa awards that were terminated – not just frozen – as part of the NIH killing more than 2 000 grants touching on politically sensitive topics such as diversity and transgender research. A judge recently ruled that the NIH had to reinstate just a portion of those grants held by investigators in certain US states.
Meanwhile, research published in The Lancet has shown that the Trump administration’s move to cut most of the US funding towards foreign humanitarian aid could cause more than 14m additional and premature deaths by 2030, a third of them being children.
Davide Rasella, who co-authored the report, said low- and middle-income countries were facing a shock “comparable in scale to a global pandemic or a major armed conflict”, reports the BBC.
More than 80% of all programmes at the have been cancelled, a decision that “risks abruptly halting – and even reversing – two decades of progress in health among vulnerable populations”, said Rasella, a researcher at the Barcelona Institute for Global Health.
In their report, Rasella and his fellow researchers estimated that USAID funding had prevented more than 90m deaths in developing countries between 2001 and 2021.
They modelled the potential impact on death rates with an assumption that funding would be cut by 83%, the figure provided by US Secretary of State Marco Rubio in March when he announced the termination of funding.
The researchers suggested that the cuts could lead to a “staggering” number of more than 14m avoidable deaths by 2030, including those of more than 4.5m children under five.
The Lancet report was published as dozens of world leaders met in the Spanish city of Seville last week for a United Nations-led aid conference, the biggest of its kind in a decade.
The US, which snubbed the event, and by far the world's largest humanitarian aid provider, has operated in more than 60 countries, largely through contractors. According to government data, it spent $68bn on international aid in 2023.
USAID was seen as integral to the global aid system. After Trump’s cuts were announced, other countries followed suit with their own reductions, including the UK, France and Germany.
According to Rubio’s statements in March, there were still 1 000 remaining US programmes that would be administered “more effectively” under the US State Department and in consultation with Congress.
BBC – Trump global aid cuts risk 14 million deaths in five years, report says
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