SA health research faces blow from NIH ban

SOUTH AFRICA – In May 2025, the U.S. National Institutes of Health (NIH) announced a sweeping new policy that “prohibit[s] all foreign sub-awards” on NIH grants.

In practice, this means U.S. researchers can no longer pass any NIH funding through to overseas collaborators. Since much South African research has been funded as subgrants of U.S.-led projects, the policy threatens to remove “billions of rands” from South African health research.

South African scientists receive roughly R6.6–6.7 billion (≈US $350 million) annually from NIH – about 70% of the country’s medical research funding.

For example, University of Cape Town (UCT) Vice-Chancellor Mosa Moshabela reported that UCT alone had 155 U.S.-funded projects worth R2.5 billion and at least 475 positions dependent on NIH grants.

Under the new rules, most of that support will not be renewed after May 1. Existing grants were not immediately terminated, but any routine renewal or extension that would have included a foreign subgrant was simply withheld.

NIH officials told affected South African researchers that projects run on U.S. sub-awards would not be continued, effectively canceling the next year of funding on many clinical studies.

Evidence of this impact has already emerged. The policy is not retroactive, but grants due for renewal after May 1 have simply lapsed.

As a result, active NIH-funded trials in South Africa are “already grinding to a halt,” particularly in HIV and tuberculosis (TB) research.

For example, Sean Wasserman (UCT) had been leading a promising TB drug trial that would have halved treatment duration, but NIH officials informed him on April 30 that his final installment of funding would not arrive and that “all activities at the South African site need to cease.”

In an interview he described the consequences: hundreds of study staff lost their paychecks overnight, and trial participants on experimental TB regimens suddenly had “no one to [monitor and] do” their care.

Those patients must now be shifted back onto the standard 6‑month treatment – “longer than if they had never been part of the trial,” Wasserman lamented.

Likewise, the Wits Health Consortium (Wits University) reported that an NIH-funded US $2.5 million HIV/TB prevention grant (ending 2027) was abruptly canceled by the NIH with only hours’ notice.

Patients and staff are being withdrawn in mid-trial. As one Wits clinician asked, “Trial volunteers will be put at risk if studies are stopped abruptly. Is this compliant with international standards of human ethics?”

In sum, South Africa stands to lose effectively most NIH-derived funds – estimates suggest up to 70% of its medical research budget – within months.

Research organization heads (e.g. SAMRC CEO Ntusi) report “several terminations” of HIV and TB grants arrived just before the policy, and no alternative funding sources are in place. UCT alone warned that “over 200 staff members” have “no mechanisms… to retain” their positions without NIH support.

Effects on other African research

The NIH ban is global, so researchers across Africa are similarly affected. Many NIH international trials span multiple countries, meaning pausing a South African site often disrupts the entire project.

For example, Wits researcher Patrick Arbuthnot leads a U.S.-funded “Brilliant Consortium” HIV vaccine program involving scientists in Nigeria, Zimbabwe, Kenya, and other African nations.

Sites in those countries now face the same fate as South Africa’s, as U.S. collaborators can no longer send them grant money.

In Uganda and South Africa, a major study of the long-acting HIV prevention drug lenacapavir (involving 5,000 young women) had just demonstrated 100% efficacy; USAID and NIH were poised to fund its rollout, but that pipeline “is completely gone” according to project leaders.

In Southern Africa more broadly, entire HIV programs are jeopardized. Southern African countries (with the world’s highest HIV burdens) had long relied on U.S. support: with the recent cuts clinics for key populations are closing, workers are losing jobs en masse, and patients fear treatment gaps.

For instance, Zimbabwe – where USAID had historically funded ~80% of HIV services – is struggling with basic supplies like condoms amid the funding vacuum.

Governments are scrambling to respond: Nigeria’s cabinet recently approved a multi-billion naira health emergency package after U.S. aid was paused, and South Africa’s government immediately added roughly R1.5 billion to its health budget to try to backfill losses.

Across Africa, essential trials could be put on hold. Even without South Africa-specific examples, watchdog groups warn that hundreds of NIH trials worldwide may lose their sites in Africa and other regions.

Public reports indicate that as of late March NIH staff compiled lists of some 237 South Africa-related grants across all NIH institutes; presumably similar lists have been made for collaborators elsewhere.

In malaria, vaccine and TB networks, U.S. lead institutions have already informed overseas partners that their funding will cease.

The full scope is still unfolding, but observers note that “trials across other parts of the world are likely being affected” by the blanket ban.

Scientific and ethical consequences

Halting international trials has both scientific and moral costs. Africa’s epidemic context is essential for many breakthroughs – every major HIV or TB vaccine or drug advance of the last two decades has depended on African trials.

For example, TAG’s Lindsay McKenna warns that cutting NIH-funded TB trials in South Africa would delay lifesaving vaccines and treatments by years.

NIH researchers also note that their experimental therapies often must be tested in Africa’s high-prevalence settings to prove effectiveness.

Delaying or stopping these trials does not contain disease – it only delays cures. As one US leukemia-research CEO put it, pulling out of African AIDS studies is like “taking the train off the tracks” in the global fight against HIV.

Former NIH director Francis Collins likewise called the move “short-sighted and self-defeating,” since infectious diseases have no borders.”

Ethically, researchers emphasize that trial participants cannot be abandoned mid-study. Stopping a trial means patients lose access to the study treatment and sometimes to any care.

Johns Hopkins’ Richard Chaisson warned, “You can’t just stop mid-study. We have an ethical responsibility to continue treating people.”

South African trialists recount how they now have participants on experimental regimens who must be switched to standard therapy without proper monitoring– a scenario many consider unethical.

South African Science Minister Blade Nzimande noted the “real-life consequences for patients enrolled in crucial scientific trial and treatment programmes” when funding is withdrawn.

UCT’s HIV clinician Linda-Gail Bekker warned that decades of US–South Africa partnership have built “critical infrastructure and expertise,” whose loss would be “a step backwards for global health.”

Reactions from scientists and officials

The ban has elicited strong criticism from African and international leaders. In South Africa, the government convened a special working group to address the NIH cut, noting that it will “greatly impair cutting-edge USA–SA… collaborations to combat HIV/AIDS and TB” and jeopardize patients in ongoing trials.

The South African Medical Research Council (SAMRC) reports that “termination letters” have already ended several hundred million rand of grants, mainly in HIV and TB, even before the policy took full effect.

UCT’s Moshabela warned that losing NIH funding would slough off hundreds of university posts and damage publication output and global rankings.

Abroad, eminent scientists have decried the decision. UCSF’s Peter Hunt called terminating these grants “profoundly unethical” since “infectious diseases have no borders.”  

He and others note that U.S. patients benefit directly from Africa-based research on HIV and TB. Bekker (UCT) echoed this point on global health infrastructure.

Treatment advocates at the global level also spoke out. The AIDS advocacy group TAG stressed that American health will suffer too if trials in Africa stop.

Leading funders of cancer and HIV research warned that cutting off African trial sites will cause “devastating” delays to new treatments.

The prevailing view among experts is that the policy is counterproductive: it breaks years of collaboration and undermines both science and ethics in global health.