Fears Grow That US May Pull Funding for South African Medical Research

Researchers funded by the US National Institutes of Health are bracing for the worst, after rumours circulated that the agency is planning to cancel grants for South African clinical studies.

• Researchers in South Africa funded by the United States National Institutes of Health (NIH) have been warned that their grants may be terminated in the coming days.
• One NIH-funded clinical trial in South Africa is testing whether we can shorten TB treatment regimens, which would make it easier for patients to complete their treatment.
• Tens of millions of rand have already been spent but if funding is pulled the trial will be forced to stop before getting results.
• Dozens of TB patients are on experimental treatment regimens as part of the trial. Their care would be under “immediate threat” if funding is pulled.

Researchers funded by the US National Institutes of Health (NIH) are bracing for the worst, after rumours circulated that the agency is planning to cancel grants for South African clinical studies.

Professor Ntobeko Ntusi, the CEO of the South African Medical Research Council (SAMRC), told GroundUp that “we were alerted on Thursday last week that the NIH is considering imminently terminating all grants to South Africa … many of us believe these are likely to be announced in the coming days.” Ntusi previously told Spotlight that US grants make up 28% of the SAMRC’s funding.

On Sunday, the University of Cape Town (UCT) sent an email to the health faculty, warning that while they still don’t have confirmation “developments over the last two days indicate that the termination of US federal funding to South Africa appears to be imminent”. The email states that UCT has established a task team to “plan mitigation measures” if US-funded research projects are terminated.

The United States Agency for International Development (USAID) had already cancelled most of its aid agreements in February, both for recipients in South Africa and the rest of the world. Since then, a range of life-saving programmes have shut down, such as a Western Cape project that was helping orphaned children with HIV medication. But grants from the NIH have to date remained largely intact.

Unlike USAID, the NIH is not an aid agency supporting vulnerable people in poor countries. Instead, it awards competitive grants for research projects that ultimately benefit the world, such as clinical trials that test new medicines. Some 99% of all drugs that were approved by the US Food and Drug Administration in the 2010s were developed with at least some NIH funding.

Perhaps because it isn’t strictly aid, President Donald Trump’s initial executive order suspending global development funding didn’t lead to the mass canning of overseas NIH grants. But concerns are growing that in South Africa specifically, this may be about to change.

On Friday, Science Magazine reported that the acting director of the NIH had sent an email to staff earlier that week asking them to compile a list of NIH grants for projects in South Africa. The email reportedly contained “similar wording” to a previous request for information about NIH grants related to transgender health and vaccine hesitancy. Many research projects that focus on these topics subsequently lost their funding with immediate effect.

An “immediate threat” to patient care

Associate Professor of infectious diseases at UCT Sean Wasserman has been running an NIH-funded clinical trial in South Africa. He told GroundUp that at present the primary concern is that the grant could be cancelled at any moment.

“How do you plan around this? What do you tell the staff? The potential for a sudden termination of their contracts is just shocking” he said.

The clinical trial, which includes a study site in South Africa and another in Haiti, is testing an experimental tuberculosis (TB) regimen which is given to patients for three months, rather than the usual six. If the regimen is successful, it would halve treatment time for TB patients, increasing the chance of them completing their full course of medication.

The US also has sporadic TB outbreaks, most recently in Kansas. A shortened TB treatment regimen would benefit US health care too.

Wasserman explained that the current treatment duration “keeps people in clinics and in contact with the healthcare system for a long time, which is a real cost to people. [For instance] It makes it difficult to maintain a job … And that also leads to treatment fatigue”.

As a result many people stop taking their medication before the six months is up, which means they end up getting sick again. Cutting the treatment time to three months could prevent this from happening as often.

The trial is already three years in. Tens of millions of rand have already been spent, and there are currently 85 TB patients who are being monitored in South Africa and Haiti. But if the NIH cancels funding, all this work could end up being for nothing. This not only means that we won’t get answers to a crucial medical question, but it could also endanger the trial participants.

“There’s an immediate threat to patient wellbeing and care,” says Wasserman.

Although all the participants would still be able to get treatment in the ordinary health system in South Africa, they wouldn’t necessarily be managed correctly.

“They’re on experimental drug regimens,” says Wasserman. “Transitioning them back to routine care is not ideal because the [experimental regimens] can have effects for weeks or months, which need to be monitored, which routine care isn’t set up to do.”

First strike

If the NIH is looking to cancel funding for research projects in South Africa, then this may be linked to Trump’s executive order from 7 February, which states that the US would not provide “aid or assistance” to South Africa due to its alleged persecution of Afrikaans people and “racially disfavoured landowners”.

Since Trump’s inauguration, South Africa has lost billions of rand in USAID grants, but so have other countries. Over 80% of all USAID agreements have been terminated globally, according to the US Secretary of State.

As such, a termination of NIH grants would be the first concrete action by the Trump administration to cancel funding for South Africa specifically.

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