Cancellation letters, which end billions of rands of South African universities' US-government-funded HIV and TB research grants with immediate effect, started to roll in over the weekend — and according to one affected researcher it's anticipated that over 300 such grants will be ended before the end of Sunday, holding massive implications for tertiary learning and research institutions, such as substantive job losses.
Some experts estimate that as much as 70% of South Africa's medical research, or up to $400-million (about R7.2-billion) when both direct and subgrants are considered for the past financial year, is funded through the National Institutes of Health (NIH), which is made up of 27 institutes and centres that each focuses on a specific area of research. The NIH finances about three-quarters of biomedical research worldwide.
On Friday evening, the University of the Witwatersrand's Wits Health Consortium , the unit through which the institution runs its clinical trials and donor-funded projects, received cancellation letters for all components of a grant of $2.5-million (about R460-million , which ends in November 2027. The grant was awarded through the NIH's National Institute for Allergies and Infectious Diseases .
Cancellation letters, sent on behalf of the chief grants management officer of USAID, Emily Linde, seem to be standard and tell researchers that "they do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness" and accuse them of harming "the health of Americans".
The Wits project was run by chief investigators Helen Rees, the head of the Wits Reproductive Health Institute , and Ian Sanne, heading the Clinical HIV Research Unit, who now also works for the international development group, Palladium as its chief medical officer .
"Ironically, our grant ended on Human Rights Day. That day is there to help and protect the vulnerable. Now the US government is forcing us to do the opposite," Sanne told Bhekisisa . "Trial volunteers will be put at risk if studies are stopped abruptly. Is this compliant with international standards of human ethics?"
The research, which has been running since 2007, fell under the Wits Research Group Clinical Trials Unit, and conducted HIV and TB prevention and treatment studies, as well as trials for hepatitis and HIV-related cancers.
Termination letters received on Human Rights Day
Other grants that have, so far, reportedly been ended include research projects at the Centre for the Aids Programme of Research in South Africa, Caprisa, headed up by Salim and Quarraisha Abdool Karim.
Some South African universities, that were subgrantees of health research awards from US universities such as Columbia University in New York, were sent stop-work orders on Friday, after the US institutions lost their own grants. The SA institutions prefer to not be named at this stage.
Science magazine reports that the former head of the South African Medical Research Council, Glenda Gray "received notice that her $3.1-million (about R56.5-million) grant for a clinical trial unit in Soweto [run through Wits] has moved from an approved to a pending status".
The Centre for the Aids Programme of Research in South Africa , Caprisa, headed up by Salim and Quarraisha Abdool Karim, which receives considerable NIH funds, is on red alert: "We have not received any NIH grant termination letters yet. We are expecting them anytime," Salim Abdool Karim told Bhekisisa on Sunday morning.
TB grants are ended at a time when the US faces TB outbreaks
Over the years, some of the HIV prevention studies at Sanne's and Rees's project were carried out on groups of people with a higher chance of getting HIV, such as teen girls and young women in Africa, transgender people and female sex workers.
Their cancellation email stated their "award no longer effectuates agency priorities" and that " research programmes based primarily on artificial and non-scientific categories, including amorphous equity objectives, are antithetical to the scientific inquiry, do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness".
Worst of all, the note said, "so-called diversity, equity, and inclusion ("DEI") studies are often used to support unlawful discrimination on the basis of race and other protected characteristics, which harms the health of Americans. Therefore, it is the policy of NIH not to prioritise such research programmes.
The letter's references to diversity, equity and inclusion likely refer to the Wits unit's research on transgender people and female sex workers, groups that the Trump administration doesn't like.
On the night of his inauguration, on January 20, the president signed an executive order banning people's right to identify as transgender or non-binary individuals. There are only two genders, the executive order declared: male and female.
But Sanne says the references to DEI in their letter don't make sense; although some of their research has focused on groups such as transgender people and sex workers, a large part of their work is focused on finding effective TB treatment for children and better medicine for people with multidrug-resistant TB, as well as preventive TB treatment.
"In many ways, our work ticks every box of President Trump's 'let's make America great' boxes. It makes America safer, stronger and more prosperous, because it will protect people against falling ill from TB and most of the patents and intellectual property of new medicines that we test lie with US companies."
Experts weigh in
Linda-Gail Bekker, who heads up the Desmond Tutu Health Foundation at the University of Cape Town, and also receives NIH funding, warns the additional body blow to our clinical research enterprise comes at a time that new TB infections " are the highest it's been for a long time in the USA ".
The state of Kansas is currently seeing the largest TB outbreak that the US has seen in the past 30-40 years (TB is a disease that has been under control in the US for decades). More than 60 TB disease cases and also two deaths have been reported .
By Saturday, Bekker had not received a cancellation letter for her grant, but says: "Bringing the HIV and TB epidemics to a place where they no longer bear a public health threat is of global concern. South Africa has played a significant role and contributed to our understanding and progress in that quest."
Yogan Pillay, the head of HIV and TB delivery at the Gates Foundation, which also funds HIV and TB research, and whose work the US government's funding cuts is likely to impact, warns: "The cuts mean that innovation on preventing and treatment of HIV will stall and eliminating or ending Aids will now be but a dream, and HIV will continue to spread.
"It's absolutely tragic."
Trump: "No corrective action is possible here"
The Wits project did important TB research. One study, published in February and included on the NIH website, looked at how well doubling doses of the antiretroviral drug, dolutegravir works for TB patients.
Previous trials looked at how safe it was for pregnant women with HIV to take preventive TB medicine , at how well long-acting, injectable forms of antiretroviral therapy worked for teens and how well the two-monthly anti-HIV jab worked .
Sanne says "it is inconceivable that [Elon Musk's so-called] department of government efficiency [which is leading cuts on US government spending], does not understand that there is more than just DEI activities happening through HIV and other research".
The email said: "Although NIH generally will suspend (rather than immediately terminate) a grant and allow the recipient an opportunity to take appropriate corrective action before NIH makes a termination decision, no corrective action is possible here.
"The premise of this award is incompatible with agency priorities, and no modification of the project could align the project with agency priorities.'"
Terminations not unexpected
But the grant terminations were not unexpected — or at least not since last week .
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On March 12, Science magazine reported that the NIH's acting director, Matthew Memoli, asked officials at the Institutes to compile lists of South Africa-related grants. The email had similar wording to other NIH requests for information that led to the termination of dozens of grants involving transgender health, vaccine hesitancy, and other topics the administration does not support."
At least 300 US university projects have also had their grants terminated by the Trump administration, many of them US universities, leading to protests across America .
The terminations come as part of what the Trump administration considers cost-savings or research not adhering to its ideologies and are likely to continue around the world.
SA researchers have started talks with philanthropic foundations and the government to step in with funding, Sanne says, "but there are not yet clear outcomes".
Projects in South Africa that received cancellation letters were told that they could "object and provide information and documentation challenging" their terminations.
But they first have to follow a "first-level grant appeal procedure that must be exhausted" before they're allowed to "file an appeal with the departmental appeals board."
Should projects choose to appeal, they have to submit a request within 30 days after receiving their terminations.
Sanne says he plans to make use of the appeal process and if unsuccessful, at the very least negotiate a way to terminate trials ethically and responsibly. "Our research saves lives and the NIH has helped us to do that," he explains. "What we now need to do is to convince them of the value of that rather than to terminate decades of investments that will result in the loss of lives."
The Gates Foundation is mentioned in this article. Bhekisisa receives funding from the Foundation, but is editorially independent of the foundation.
This story was produced by theBhekisisa Centre for Health Journalism. Sign up for thenewsletter.
