US-Funded Programmes in South Africa Benefit the US Too

The US President’s Emergency Plan for AIDS Relief (PEPFAR) distributes billions of dollars annually across the world to HIV programmes. But President Donald Trump appears to be trying to end it.

There are severe criticisms to be made of US foreign aid. It is often wasteful and almost always very bureaucratic. It sometimes serves sinister interests, such as when a vaccination project in Pakistan was used in the effort to catch Osama bin Laden, a ploy that hurt public trust in vaccines in that country. Billions of dollars in US military aid goes annually to Egypt and Israel, who use that aid to oppress people.

But US aid, mostly for HIV in South Africa, and for food and health care in other African countries, has been very beneficial for these countries, as well as the US and the world. The withdrawal of this aid by President Donald Trump will damage not only Africa but the United States too.

Aid directly benefits the US economy. Associated Press reports that the shutdown of USAID is “upending livelihoods for nonprofit workers, farmers and other Americans”. “US organisations do billions of dollars of business with USAID and the State Department, which oversee more than $60-billion in foreign assistance. More than 80% of companies that have contracts with USAID are American, according to aid data company DevelopmentAid.”

The President’s Emergency Plan for AIDS Relief (PEPFAR), which started in 2003, has given billions of rand towards health projects in South Africa. Getting PEPFAR money is a highly competitive process. Winning bidders have to show they know what they are doing and that there will be health benefits. Together with funding from the US National Institutes for Health (NIH) and the US Centers for Disease Control and Prevention (CDC), PEPFAR has helped South Africa develop several world-class centres that are excellent at research, including running sophisticated medical trials. The results have been stunning. Here are just a few examples but there are many more.

The START trial, whose results were published in 2015, showed that people with HIV benefit from starting antiretroviral treatment as early in their infection as possible. Previously patients would only start when an immune marker reached a particular point. START changed the management of HIV around the world. There were nearly 4,700 patient volunteers in the trial which took place in sites across the world. But South Africa contributed the most participants: 518.

The HPTN 052 trial, whose final results were published in 2016, showed that if people with HIV took antiretroviral medicines, there was almost no risk of passing the virus on to their HIV-negative partners. This too has informed HIV guidelines across the world.

Last year a clinical trial, PURPOSE-1, showed that a twice-yearly injection of a new drug gave women total protection from HIV. The trial was conducted in South Africa and Uganda. This drug will likely be used by women across the world, including Americans.

While there still isn’t an effective vaccine against HIV, scientists are making incremental progress towards one. Many clinical trials on new potential vaccines take place in South Africa and other African countries. At least two of those trials are paused because of the suspension of US aid.

It’s not just HIV; the infrastructure that PEPFAR has helped build has facilitated research in many areas of health care, including operational research that leads to better patient outcomes. There were also South African sites for some of the highly successful Covid vaccines.

Currently there is a tuberculosis outbreak in Kansas and it is likely that the enormous amount of research on TB conducted in African countries, in part funded by the US government, will help contain it.

Conducting health research here is a win-win for South Africa, the United States and the world. We have many people willing to participate in such research. Trials are relatively affordable to run here, and we have first-class infrastructure needed to ensure that clinical research is done well and ethically.

The withdrawal of US aid is a very hard knock for South Africa and catastrophic for some African countries, but the United States and the rest of the world also lose. Hopefully sense will prevail and the US government will restore PEPFAR and other aid that has been extremely beneficial to millions of people around the world, including American citizens.

The author is GroundUp’s editor.

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