Life After USAID

The dismantling of the United States Agency for International Development (USAID) is a disaster for global health.

It is estimated the United States (US) development cooperation has saved 3.3 million lives annually. About four million deaths on the African continent could have been prevented in the years to come.

As 60% of aid by the US President’s Emergency Plan for AIDS Relief (Pepfar) has been channelled through USAID, the impact on the HIV-AIDS programmes is dramatic.

According to joint United Nations Programme on HIV and AIDS (UNAIDs), a permanent end to Pepfar could lead to four million deaths and six million preventable infections by 2029.

South Africa should expect 500 000 additional deaths within the next 10 years. Even UNAIDs itself received 40% of its funds via USAID.

Unfortunately, the situation concerning tuberculosis (TB) is expected to worsen substantially. The abrupt closure of the projects leads to additional deaths by TB globally every seven minutes. The risk of multi-medicine resistant forms of TB rises.

The fight against malaria has been severely disrupted: 100 000 additional deaths plus 15 million infections are calculated for 2025 alone.

Fifteen years of progress are in jeopardy, according to World Health Organisation director Tedros Ghebreyesus.

The situation is especially grave for mothers, newborns and children. Global vaccination campaigns – even for measles – had to shut down immediately.

What can we do on a national level? Strategic thinking is crucial.

First, we will face patients who can no longer access medication. This is an immediate emergency.

Once we have stabilised this situation, we could consider rehabilitating the healthcare system and making structural changes.

It may be helpful to use the ‘public health action cycle’ to systematically analyse the situation with all players involved.

The better we analyse the situation, the more promising the outlook. Humanitarian standards, as well as health cluster guidelines should be applied.

Solidarity among all involved is an absolute pre-condition, while forming new alliances may be promising too.

Political advocacy must increase substantially – indications are that the US government was not aware of the massive consequences of its 0.1% budget cut.

The Roman Catholic Church, as the biggest global healthcare provider with more than 40 000 facilities worldwide, will be at the forefront internationally and locally.

Nevertheless, a national emergency management unit on HIV-AIDS, TB and malaria led by the Ministry of Health and Social Services would be more than helpful.

Andreas Peltzer

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