Global Health Watch: Africa Rises, Legal Battles Mount, and NIH in Turmoil 

February 21, 2025

This week’s issue covers African governments’ efforts to address the gaps left by the US foreign aid freeze, escalating legal battles, policy changes at NIH and communities mobilizing against it all.  

Over the years, AVAC-supported projects such as CASPR and COMPASS have been advocating for African governments to invest more in health. Now, in response to the US foreign aid freeze and the dismantling of USAID, African governments are beginning to address the enormous challenges ahead. This week, Nigerian lawmakers approved $200 million for its health sector; the Ministry of Health in Zambia committed to ensure uninterrupted HIV, TB and Malaria services despite the freeze; and health departments in South Africa are implementing contingency plans by offering HIV patients six-month supplies of medication to cope with freeze of US-funded HIV projects. Some leaders are arguing that the rollback of critical programs like PEPFAR, expose a long-standing dependence imposed by the Global North and see the crisis as an opportunity for African nations to invest in their own healthcare, research, and collaborative networks.  

READ: This commentary from the president of the South African Medical Research Council Ntobeko Ntusi: US aid cuts are an opportunity to reimagine global health. 

AVAC vs. Department of State

In new developments in the AVAC vs. Department of State case against the foreign aid freeze,  last Thursday, the US judge granted AVAC’s request for a “temporary restraining order” (TRO) that theoretically would restart funding. This week, the US government, in a court filing, argued it had the authority to suspend the foreign aid freeze, despite the restraining order issued by the judge. Public Citizen’s Litigation Group that is representing AVAC, filed a further motion on February 19 to hold USG officials in contempt for ignoring the order and to fully enforce the TRO. Read more about it in this Politico story. In the government’s response on February 20, they say they are following the TRO. We’ll see what the judge says! 

And perhaps the most interesting part of our motion on the 19th is the exhibit from a “Jessica Doe”, the alias for a USAID whistleblower whose story in her declaration describes the toll in human suffering of the freeze. It is alarming.

IMPLICATIONS: Regardless of the court’s ultimate ruling, many programs will likely be eliminated or redesigned according to the State Department’s waiver process—one that excludes primary prevention beyond PMTCT and eliminates rights-based, science-driven advocacy.

FOLLOW ALONG: You can follow along with progress on the case at, https://avac.org/avac-vs-dept-of-state/. 

JOIN US: Today at 9:00am ET / 17h00 EAT where the lead lawyer from Public Citizen, Lauren Bateman, and Mitchell will discuss the case on a Public Citizen call that’s open to all; you can join here. 

The US administration significantly reduced staffing across the Department of Health and Human Services (HHS), firing approximately 3,600 employees. Many of those dismissed worked at the National Institutes of Health (NIH) and on emergency preparedness and at National Institute of Allergy and Infectious Diseases (NIAID).  

Later today, Friday, a judge will review another lawsuit challenging the executive order which would cap indirect costs at the NIH at a far lower level—a temporary restraining order was granted last weekend pausing this action. However, if the government is successful in executing the order, the new cap is expected to result in the loss of billions of dollars to support NIH-funded research at academic campuses around the country, forcing labs closures and significant job losses among researchers around the world.  

IMPLICATIONS: Reducing NIH’s workforce and indirect cost rates could cripple critical biomedical research and compromise the nation’s ability to address both chronic and emerging health threats. While the administration defends these actions as necessary streamlining and cutting wasteful spending, critics argue that the indiscriminate nature of the firings jeopardizes vital health initiatives and undermines public trust in government support for scientific innovation. 

READ: Mass firings decimate US science agencies–Science

In the latest legal challenge against the administration’s dismantling of USAID, 26 former and current USAID employees have filed a lawsuit against Elon Musk. They allege that Musk, through his leadership of the Department of Government Efficiency (DOGE), decimated the agency without proper authority, acting without a formal appointment or congressional nomination. 

IMPLICATIONS: This case, the fourth of its kind targeting actions against USAID, underscores the chaotic and reckless nature of these measures, which are dismantling decades of progress in global health and humanitarian aid. 

Civil society advocates across global health continue to organize and drive action through the new Community Health & HIV Advocates Navigating Global Emergencies (CHANGE) coalition, developing resources for advocates and organizing to protect access to HIV treatment and prevention. Find their resources featured in Global Health Watch and contact them at [email protected]. Community-led organizations are also mobilizing rapidly in response to the foreign aid funding freeze and the immediate disruptions they are experiencing—clinics closing, staff layoffs, and shortages of critical supplies like ARVs and HIV testing kits. Emergency meetings, such as those convened by UNAIDS, are underway to assess the damage and coordinate mitigation measures.   

The science and academic communities are also mobilizing, articulating the impacts of NIH’s cap on indirect costs, filing class action lawsuits to stop the firings, and organizing the March 7 event, Stand Up for Science, in Washington, D.C.  

IMPLICATIONS: With policies changing overnight, legal decisions being ignored, and funding being abruptly halted, there’s an urgent need for health systems that do not rise and fall with political whims. This crisis is an opportunity to create a stronger, more sustainable and more resilient global health framework that truly protects and empowers communities.  

Resources

• The Impact and Implications of Recent US Government Federal Funding Reductions on Health Programmes, The Steve Biko Centre for Bioethics at The University of the Witwatersrand event recording 
• Most Lifesaving Services Remain Paused: A Rapid Assessment of the PEPFAR StopWork Order, amfAR, CHANGE, Data ETC 
• Litigation Tracker: A public resource tracking the legal challenges to the Trump administration’s executive orders, Just Security
• Tracking the Stop Work Order, PEPFAR Watch 

What we’re reading:

• Early impacts of the PEPFAR stop-work order: a rapid assessment—JIAS  
• US Science in Peril—JAMA  
• As HIV Activists Disrupt PEPFAR Hearing, an Expert Explains the Damage Trump Has Already Done to the U.S. Global AIDS Fight–Positively Aware 
• The mess inside Rubio’s ‘lifesaving’ waivers—Devex  
• What Trump’s freeze in federal funding means for the global fight against AIDS—NPR  
• Health Department green-lights longer supply of antiretroviral medicine amid US aid freeze—Daily Maverick (SA) 
• How the health department will deal with Pepfar’s near collapse—Bhekisisa  
• I Used to Run the N.I.H. Here’s What Worries Me—New York Times (opinion) 
• The future of PEPFAR and U.S. HIV programs—Positively Aware 
• Emergency Food, TB Tests and H.I.V. Drugs: Vital Health Aid Remains Frozen Despite Court Ruling—New York Times 

In other news, there was more progress in HIV prevention: the US FDA agreed to an expedited review of the new drug application of lenacapavir for PrEP. Read Gilead’s press release. The FDA has until June 19 to issue its decision. The Lancet also published new data from the B-PROTECTED clinical trial, finding the dapivirine vaginal ring is safe to use during breastfeeding. And The 8^th replenishment of the Global Fund has launched. 

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