Global Health Watch: USAID Cuts, HHS Overhaul, PEPFAR Uncertainty & South Africa in the Crosshairs

March 28, 2025: Issue 9

March 28, 2025

This week we’ve seen plans to terminate thousands more USAID awards and completely overhaul the US Department of Health and Human Services (HHS), which oversees the National Institutes of Health, the CDC and the FDA. This comes as US funding for vital scientific research in South Africa faces new threats and the future of PEPFAR remains uncertain, with its reauthorization expiring this week amid shifting priorities and budget cuts.

Termination of USAID Awards

Approximately 86% of global assistance programs (nearly $76 billion) have been or will be terminated by the US administration according to a spreadsheet USAID shared with Congress this week—this includes grants already terminated or earmarked for cancellation. Gavi’s $2.63 billion life-saving vaccine delivery work is among the hardest hit programs. Overall, the government said it will continue only 898 of USAID’s 5,341 awards. This news follows the ruling in AVAC’s lawsuit earlier this month requiring the government to pay USAID partners for foreign aid work completed before February 13. New financial obligations and programs beyond February remain uncertain. 

IMPLICATIONS: Funding for HIV and other health programs are allocated by Congress. The sweeping cuts by the executive branch subverts the will of Congress and as outlined in court challenges, is well beyond its legal authority.  

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Major Overhaul to Department of Health and Human Services (HHS)

The US Department of Health and Human Services (HHS), which oversees 13 agencies, including the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) announced cuts to 20,000 jobs—reducing its workforce from 82,000 to 62,000—and streamlining 28 divisions into 15 to create a new “Administration for a Healthy America.” This sweeping reorganization, under Secretary Robert F. Kennedy Jr. aims to cut $1.8 billion annually.  

Coming out of Thursday’s announcement proposing major cuts and restructuring of HHS, no one at the CDC has received details on what it means for the agency. This comes after last week’s proposed cuts—between $700 million and $1 billion—of the CDC’s Division of HIV Prevention. A new analysis shows the historical importance of funding this Division and includes projections of the impact of cuts on new HIV infections, deaths, and costs.   

IMPLICATIONS: The cuts will hit the NIH, FDA and CDC especially hard. While officials insist “critical services” will remain unaffected, the FDA alone will lose 3,500 employees, raising concerns about the potential impact on food and drug oversight. HHS frames these changes as a necessary “painful period” to tackle issues like rising chronic disease. The CDC is expected to lose 2,400 employees, and NIH will lose 1,200 employees according to the HHS fact sheet.  

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Jay Bhattacharya Confirmed as NIH Director; South Africa’s Research Funding Under Threat

Despite concerns over vaccine skepticism, AIDS denialism and racist views of immunology, Jay Bhattacharya was confirmed as NIH Director. At his confirmation hearing when questioned about the proposed cuts to indirect cost rates at US universities, Bhattacharya defended the policy, saying it would enhance research efficiency while sustaining vital infrastructure. Bhattacharya pledged to focus the NIH on chronic diseases, rebuilding public trust in science through transparency and debate, and undergoing structural changes to support innovative research. On Wednesday, the NIH instructed staff to list all grants and contracts focused on “fighting misinformation or disinformation.” 

NIH grant managers have also been ordered to “hold all [research] awards” for South Africa according to a leaked memo that categorizes South Africa as a “country of concern” alongside China. Programs related to diversity, equity, inclusion, vaccine hesitancy, and climate change will not be prioritized and are being terminated.  

IMPLICATIONS: The entire biomedical research enterprise is under serious threat, with major concerns about infrastructure, scientific agendas, and training of next-generation researchers. In South Africa, it is estimated that the NIH funds as much as 70% of medical research; this potential funding cut could severely undermine critical HIV and TB studies, cripple South Africa’s capacity to conduct vital research, weaken global scientific collaboration, and deepen health inequities.  

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Reauthorizing PEPFAR

This week marked an important turning point for the future of PEPFAR as its reauthorization expired Tuesday, leaving the program in a precarious situation amid shifting political priorities and congressional gridlock. Jirair Ratevosian, former chief of staff for PEPFAR, warns in an opinion editorial that without a long-term legislative framework, PEPFAR partner countries will struggle to assume ownership of their HIV programs and services, and decades of progress could be reversed. He calls for transformative reforms to modernize PEPFAR. 

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PrEP in the Balance: Hopes and Fears in 2025

Read this new piece outlining the promise of next-generation HIV prevention, the challenges posed by the new US administration, and new resources to secure a future for PrEP research, development, and access. And explore this new analysis Impact of PEPFAR Stop Work Orders on PrEP for an in-depth look at what’s at stake for PrEP as an instrumental tool in the effort to reach epidemic control.

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