South Africa: Does South Africa Need a COVID-like Ministerial Advisory Committee to Deal with HIV Funding Cuts?

Health Minister Aaron Motsoaledi told Bhekisisa 's TV show, Health Beat, in July , that he "would strongly consider" a ministerial advisory committee (MAC), like the one we had during the COVID pandemic for which scientists advised the health department on what to do. No MAC or emergency think tank with input beyond government structures has since been announced, despite scientists calling for a thinktank.

Increase health taxes . Roll out the twice-a-year anti-HIV jab lenacapavir to stop HIV from spreading. Use artificial intelligence (AI) to do more with less. Convene a ministerial advisory committee.

Some of the things that have surfaced as potential solutions to fill the huge gap that United States (US) President Donald Trump's administration's sudden funding cuts in February have left .

But would they work — and are they doable? Only if we move fast, and get lots of each thing, it seems.

"There's nothing wrong with establishing a MAC [to deal with funding cuts]," Motsoaledi admitted ... but we've not yet established anything like that for [the funding crisis]."

No MAC or emergency think tank with input beyond government structures has since been announced by the health department. But scientists warn such a committee should be an important part of the country's response to the crisis.

" We need to urgently convene a national think tank," medical doctor and the head of Wits RHI, Helen Rees, cautions . "There are some really superb people who've been working in the programmes closely and well with the health department who could contribute their ideas and experience ... [and help figure out] what [strategies] can we [the health department] retain that aren't hugely expensive."

In Johannesburg, research released at the Conference on HIV Science in Kigali in July, shows HIV testing between January and March 2025 was 8.5% lower than the same time last year (before the funding cuts), and 31% less people were diagnosed with HIV in 2025. During the same period, there was also a 30% reduction in people who tested positive, who started on antiretroviral treatment, compared to 2024.

So what has SA done so far?

Motsoaledi has managed to raise a small amount of extra funding — R735-million — from the treasury through the Public Finance Management Act . But it's less than 10% of the R7.9-billion we've lost (and are in all likelihood about to lose in September, the end of the US financial year).

The country is, however, starting to make progress with the roll-out of lenacapavir, an injection that is taken once every six months, that provides near complete protection against HIV infection . Around 170 000 people got newly infected with HIV in 2024 , according to the latest Joint United Nations Programme on HIV and Aids report .

A modelling study has shown if between two and four million people in the country take the jab, each year, for the next eight years, South Africa could end Aids as a public health threat by 2032.

SA's medicines regulator, the South African Health Products Regulatory Authority, has told Bhekisisa the shot will be registered in the country before the end of the year.

And, at a presentation at the Kigali conference, health department consultant Hasina Subedar said, if all goes well, the department will start to roll out the jab in April 2026.

In July, the health department accepted an offer from the Global Fund for Aids, TB and Malaria, to reallocate R520-million of its funds to buy lenacapavir from its maker, Gilead Sciences, over the next three years until cheaper generic versions become available. The funds will become available in October.

But, if the health department budgets for the $60 per patient per year that the Global Fund has told them to , the grant is only enough to put about 400 000 people on preventive treatment for three years — about 10% of what is needed to end Aids by 2032.

One more way to generate "a stable and predictable funding stream" without donors, according to a July report by the public health organisation Vital Strategies, is to increase taxes on tobacco, alcohol and sugary drinks to a level where taxes constitute 50% of the selling price of the products. That money can then be used, among other things, to improve health infrastructure.

According to the report, 45.7% of the price of a box of cigarettes, 27.6% of a bottle of beer and 3.4% of sugar-sweetened carbonated drinks currently goes towards taxes in South Africa.

Mia Malan recently asked Wits RHI's Helen Rees how the country should go about to find solutions to the HIV and TB funding crisis. Following is an edited version of the full TV interview.

Mia Malan (MM): Are we acting fast enough on the funding crisis? How should we navigate it?

Helen Rees (HR): That's the big question that many people — academics, clinicians, programme people, the health department — are trying to answer. We all anticipated that Pepfar was reducing and the plan was that it would stop. We were thinking, one, two or three years hence with a reduced amount of funding which would have allowed adaptation and absorption into the system.

What has really caused the crisis is this sudden stop . For HIV and TB, it's critically important that people who are on treatment stay on treatment. If they don't stay on treatment, obviously what you get is people getting very sick . Secondly, you get a growth in the numbers of people who are infected with HIV or tuberculosis (TB) because you've got more infectious people . Then you are going to put a huge burden on an already overstrained health service.

We have to say, first and foremost, how do we keep patients in care and how do we keep them on antiretrovirals (ARVs)? Secondly, how do we keep testing people? Because if we stop testing, we're going to get more new infections that we don't know about and are not linked to care. Thirdly, how do we also keep our TB patients in care, and how do we test?

MM: Wits RHI received a lot of Pepfar funding. How have you seen the impact of funding cuts play out?

HR: We had significant funding from a USAID grant, which was stopped suddenly. That was for a rural area ( Lejweleputswa district in the Free State ), but it was also a grant that supported what we call key populations (groups of people with a higher chance to contract HIV than the general population) , particularly (tailor-made) services for sex workers, for men who have sex with men and the transgender community.

Part of that grant was also a national schools programme where we had mobile units going out to schools and encouraging young people who were sexually active to test for HIV, to have pre-exposure prophylaxis (taking medication that stops HIV infection) , contraceptive services, counselling and mental health services. All of that stopped completely.

At the moment, we're fortunate that we have another part of the Pepfar grant, which is funded by US Centres for Disease Control (CDC) that's supporting two large metropolitan areas. But we don't know when that will stop. (Both USAID and CDC grants were stopped in February , but CDC grants then continued shortly thereafter because a court ordered the Trump administration to do so).

MM: That programme paused for two weeks when we weren't sure whether the CDC-funded Pepfar projects were going to continue. How did that affect your work?

HR: For those two weeks we were quite alarmed, because in those two metropolitan areas where we're working, we saw a loss of 8 000 people we had to follow up with. These are 8 000 people that would have normally come back for care, for antiretrovirals and for viral load testing in that two-week period.

They are the most vulnerable people ( key populations ) who find it hard to attend general clinics because they face discrimination . We were able to reach out to them when we had the Pepfar programme. We used outreach services, such as mobile clinics that go into communities to find people who defaulted on treatment, send text messages, knock on doors, bringing them back in for treatment when they defaulted.

But because the Pepfar staff also supported monitoring and evaluation it could be that they just weren't [counted]. But it could be that the significant numbers did not return. The fact that the National Health Laboratory Service (NHLS) has also seen a significant decrease in the number of viral load testing that they're doing by about a fifth (the NHLS didn't confirm the drop in testing in public, but Reuters reported on it and several experts confirmed in the media that they had seen the figures) , it suggests that we are definitely losing a proportion of people that [we need to] follow up with.

MM: What are the ways to go ahead now that we don't have these Pepfar workers who did the outreach services?

HR: We need to urgently convene a national think tank. There are some really superb people who've been working in the programmes closely and well with the health department who could contribute their ideas and experiences and, together with the health department and the provinces, we could say, what have we learned? What can we retain that isn't hugely expensive but that we've learned really does work?

MM: For a national think tank, are you suggesting a ministerial advisory committee, like we had during COVID?

HR: I hadn't thought about that. But you're right, we had a ministerial advisory committee during COVID. So I agree, what we could think about is what would be useful urgently now so that we do short-term remedies so that we don't lose tens of thousands of people to follow-up. That could be a starting point.

MM: What should we do in the medium term?

One of the suggestions prior to the Pepfar stopping was that we should be giving longer durations of treatment, instead of having people come back every month to wait in clinics. (South Africa will start to give people with HIV who are stable on their medication, six-month supplies from this month. Find out how two Western Cape clinics started to do this already in January.)

What we're hoping for now, and it's in the process of being registered, is that there are new drugs in the pipeline that we think are going to revolutionise HIV prevention.

The one drug in particular is the HIV prevention drug lenacapavir , which is a twice-a- year-injection (that can stop HIV-negative people from getting infected with HIV through sex; the US regulator, the Food and Drug Administration, registered lenacapavir as medicine for HIV prevention on June 18 and on July 25 the European Medicines Agency granted the medicine market authorisation; SA is likely to register lenacapavir before the end of the year ) .

We've done a lot of research on this, and many people in South Africa say they would prefer a long-acting injection to the daily tablets we currently dispense. So we already know that there could be a demand and we also know from cost-effectiveness modelling that the introduction of lenacapavir would be cost-effective in preventing HIV infections.

MM: Researchers say we would need over R5-billion extra a year if we give it to between 2 and 4-million people a year. If you were in a decision-making capacity in the health department, would you go and find that R5-billion?

HR: I would. If we don't do that the numbers of people living with HIV are going to just keep increasing. It's already one of the most common chronic diseases . We're going to have an ageing population with HIV, and they're going to get other noncommunicable diseases , like hypertension and diabetes. Those chronic diseases are going to cripple health services.

We should look at innovative ways to raise funds for health services, like sin taxes — tobacco, alcohol and sugar taxes . There's suggestions that you could even look at taxes on new technologies like cellphone networks or airline tickets .

MM: With budgets, you always need to compromise something. What would be the compromise for you?

HR: We need a very serious rethink about how we run health services, we're not getting the return we should. Could we, for example, use AI to assist nurses and doctors to help with diagnosis ? Could it help with surveillance and help identify more accurately clinical cases and report, for example, a measles outbreak much earlier so that we could intervene?

In the medium term, we should see what technologies are available for us to have smarter health services. Because we aren't doing it at the moment. That would include digitalisation of data ( for electronic patient records in the public health system) , which is an ambition of the health department. Can we accelerate that?

We cannot continue with the paper-based system that we have. Digitisation will improve individual health management. It will improve training for healthcare workers. It will improve surveillance. It will improve planning for responses and long term planning as well.

Streamlining health services and using new technology is going to be critical. It's not just about more money in — it has to be a smarter way to use those funds.

MM: What would you recommend we do to keep people on treatment and keep HIV prevention services intact over the next six months?

HR: We need to monitor to see if we're losing people to follow up, are there certain districts or groups of people where we're losing people to follow up in particular.

We've got lots and lots of ( formerly Pepfar-funded ) mobile clinics. They are sitting in garages being unused now because they were used for Pepfar. We should consider using those mobile clinics and employing staff to reach out to vulnerable areas and vulnerable groups.

And we should be planning for the introduction of lenacapavir .

What has also worked is allowing people to pick up their drugs without having to go into a clinic , sending messages on cellphones, phoning people who default and having some dedicated services for people that you know are going to default.

But really recognising what has worked and what is going to be most cost-effective in terms of returns in the short term while we give ourselves space to plan for the medium term.

MM : From this funding crisis, what have we learned about being so dependent on donors?

HR: We must look at our own resources, and that's why I say innovative financing, other sources of financing, smarter health services, new technologies that reduce the loads on services and improve efficiencies.

All of those in the medium term are the things that we need to look at, rather than saying, is there another funder out there? Because there isn't another funder out there that's going to replace Pepfar.

This story was produced by the Bhekisisa Centre for Health Journalism . Sign up for the newsletter .

South Africa: Does South Africa Need a COVID-like Ministerial Advisory Committee to Deal with HIV Funding Cuts?

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