The Trump administration’s disruption of foreign aid and threats to slash funding for the National Institutes of Health (NIH) have sent shock waves through the SA scientific community.
Researchers at the forefront of efforts to develop better HIV prevention tools, vaccines and treatments have been forced to halt clinical trials funded by the US Agency for International Development (USAID) and are now bracing for possible cuts to grants awarded by the NIH.
The NIH spends about $48bn a year on medical research in the US and is the world’s biggest donor to other nations, of which SA is the largest recipient. In 2022, SA won 86 of the 305 awards the NIH made to low and middle-income countries, amounting to $40.6m of the $108m disbursed.
“This is not charity. We compete viciously with scientists all over the world: when we win these grants it’s because our scientists are good,” says Glenda Gray, chief scientific officer at the Medical Research Council (MRC) and director of the USAID-backed Brilliant Consortium, a network of scientists in eight African countries that aims to create end-to-end vaccine development capacity, from basic scientific discovery through to clinical trials.
Trump’s freeze on foreign aid, pending a 90-day review to determine whether it aligns with his agenda, has had a devastating impact on the consortium, bringing its plans to start enrolling participants in its first clinical trial to a screeching halt.
“It’s a huge setback,” says Gray. Her team is now racing to secure alternative funds and figure out how to salvage the trial should the freeze on USAID become permanent.
This is no small task: Treasury and the health department are scrambling to figure out how to plug the gap if the US pulls the plug on its long-standing support to SA’s HIV/Aids programmes, and neither the department of science, technology & innovation nor the department of higher education & training have money to spare.
Local philanthropists have historically shied away from investing in science, and foreign donors have their own priorities that do not necessarily align with research planned for SA, she says.
SA’s strength at winning NIH grants has left it vulnerable to the changes threatened by the Trump administration. Not only is Trump’s team bent on cutting NIH funding to US institutions, but his pick for secretary of health and human services, Robert F Kennedy Jr, has previously indicated he wants the agency to turn its attention away from infectious diseases to noncommunicable diseases such as diabetes and Alzheimer’s.
“We have significant exposure to NIH funding — it supports activity in virtually all the intramural programmes within the MRC, and constitutes 28% of our budget,” says MRC president Ntobeko Ntusi.
“I’ve argued in parliament repeatedly that while they [MPs] see our ability to fundraise from external partners as a huge success it’s actually a huge risk.
“For a major public entity that is the custodian of health research to have the level of exposure we have is untenable. Our government needs to be funding more of the research that we do and reduce our reliance on external partners,” he said.
While Trump’s recent attempt to drastically reduce NIH funding to US institutions does not immediately affect SA awardees, it has raised fears that he will take similar action against foreign grant recipients too, says Ntusi.
Indirect costs are awarded to cover researchers’ operational expenses, such as administration, infrastructure and rent and until now US institutions have negotiated rates ranging from 30% to 70% of their grants.
Outside the US, indirect costs are capped at 8%, but even at this relatively modest level the funds are vital for SA’s research enterprise, says Ntusi.
The NIH has been integral to the careers of many of SA’s leading scientists, who have benefited from the Fogarty International Centre’s support for the global health research workforce, says Salim Abdool Karim, director of the Centre for the Aids Programme of Research in SA (Caprisa) at the University of KwaZulu-Natal.
Severing these ties would jeopardise the development of the next generation of scientists, devastate SA’s research capacity and precipitate a brain drain, he says.
The NIH operates a unique model, as it funds clinical trial networks spanning multiple countries backed by a pipeline of studies.
“It’s hard to see how anyone else could pick that up, as no other funder has that kind of arrangement. If the NIH is no longer able to provide us with funding it will be catastrophic,” he says.
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