The US's NIH funds R6.65 billion of research in South Africa

Mail & Guardian

30-04-2025

If all of its National Institutes of Health funding falls away, the country could lose 70% of its medical research capacity
R6.65 billion — or $350 million. That's how much South Africa receives in annual funding from the US government's National Institutes of Health (NIH) when the totals of direct grants, subgrants and funding from network studies are added up, numbers from the South African Medical Research Council and
Bhekisisa
's calculations show.
For direct grants, SA researchers are the main grant holders for a project and are responsible for its budget. In the case of subgrants, SA projects get research money from projects where the principal investigator is elsewhere (probably at a US institution) and network studies mean SA researchers who are part of a unit that runs clinical trials get awarded money for a study through that network.
The bulk of the NIH's budget
However, many of the projects with US scientists as the primary grant holders have extensive collaboration with researchers elsewhere. This means that a large part of the NIH funding awarded to US institutions is paid as subgrants to colleagues in other parts of the world — including South Africa — to set up studies for data collection and analysis, which bolsters research efforts in those countries.
If South Africa loses all of its NIH funding, the country could — conservatively — lose 70% of its medical research capacity, our sums reveal.
An
Losing 70% of our research capacity would be a massive blow for South Africa — yet it would make less than a 1% difference to the NIH budget in the US (assuming that it would be similar to that over the past couple of years).
Close to three-quarters of the grants South African principal researchers were awarded by the NIH in 2023/24 were for projects linked to HIV or tuberculosis (TB).
Moreover,
Adding the potential losses to research grants could have grave consequences for
South African scientists produced the
Getting a total of how much money for biomedical science comes to South Africa through NIH funding is not easy, though.
But we trawled through the numbers to put an estimate together, based on what we think are reasonable assumptions and given what experts have shared with us. Here's our thinking.
Number games
The
Over the past eight years, the total amount paid to such research leads based in South Africa was, on average, around $45 million (about R850 million) a year.
'Getting to that point is hard work,' says Linda-Gail Bekker, head of the
'A grant is never just 'given' — each application is reviewed by a panel of experts and only if they find the proposed project has merit and so will be worth investing in, will they award the money.'
Grant holders also have to pass a clean audit every year, done to US rules, to prove that they're spending the funds responsibly, she adds.
As explained in our intro, scientists can also be funded through being subgrantees on projects where the principal investigator is (probably) at a US institution (and went through the same strict application process) or by being part of a network study. Bekker explains that getting funding through a network study means a researcher who is part of a unit that runs clinical trials gets awarded money for a study.
Ntobeko Ntusi, CEO of the
Bhekisisa
that 'before January 20, there was a second portal of the NIH that hit that level of granular detail [amounts linked to subgrants], which has [since] been disabled'.
However, Ntusi explains that roughly $100 million of NIH funding (about R1.9 billion, at the current exchange rate) is awarded to South African researchers through subgrants every year and about $50 million (about R950 million) through direct awards to principal investigators. A further $200 million (R3.8 billion) or so sits in funding from network studies, which brings the total to around $350 million (R6.65 billion).
A case of David and Goliath
For our analysis, and to be able to make qualified comparisons, we focused only on amounts local researchers may have had through direct grants and being subgrantees, specifically in the 2023-24 financial year.
We know that the amount of funding made available through subgrants is about double that from direct awards. If we take the roughly $47 million (R870 million) from direct awards plus an estimated amount twice that for the funding flowing to researchers through subgrants, those two avenues of NIH support give just over R2.6 billion.
From these numbers alone, we estimate that if NIH funding to South African scientists were stopped, the country could lose — conservatively — 70% of its medical research capacity.
This would be a massive blow for South Africa — yet it would make less than a 1% difference to the NIH budget in the US (assuming that it would be similar to that over the past couple of years).
To get to this slice, we worked on about $46 billion (R851 billion) being available as the NIH's research budget. (According to the agency's website,
Together, this makes up 0.7% of the total NIH research budget, meaning about $45.7 billion would have been available to scientists in the US.
Converting these amounts to rand, at an exchange rate of R18.50 to the dollar, shows that a total of about R2.6 billion in NIH funding would have been available to South African research groups, combined from direct grants and subawards.
The SAMRC's revenue from grants, including both foreign and local funders, together with the amount it gets from the government, was
Bhekisisa
show that this was how much they received through NIH funding in 2024, and we therefore assumed it could have been a similar figure the previous year.
That brought us to a total of around R3.71 billion being available for medical research in South Africa in 2023-24, of which about 70% was from NIH backing, either to local research leads directly or through subgrants.
A blow to South Africa is a blow to the world
Close to three-quarters of the money South African principal researchers were awarded by the NIH in 2023/24 was for projects linked to HIV or TB. That works out to just over $34.3 million — about R635 million. Almost a fifth of that was directed to clinical trials.
Last week,
Adding the potential losses to research grants could have grave consequences for
Take, for example, the studies on the six-monthly anti-HIV prevention drug
If South Africa were to roll out the medication soon, it could stop enough new infections that Aids would practically end being a public health threat in the country by 2032,
But progress like this doesn't happen overnight; it follows from years and years of prework.
Although the
'An opportunity to reimagine research'
'Great science is done in collaboration with the US and, if that stops, it will create a huge [research] gap,' says Bekker.
Indeed, South African scientists produced the
Ntusi agrees, saying that the US investment over decades, which has helped to build high-calibre research capacity in South Africa, should not be forgotten.
'Seminal contributions from our scientists have been good, not only for the country, but also for the world. At the same time, we should continue to express solidarity with our peers in the US, who are similarly affected as we are. Many of them are losing their jobs, have had their grants terminated and are feeling overwhelmed.'
Yet the US 'will remain a really important player in global health', Ntusi says, and despite the current upheaval, there's 'an opportunity [for scientists] to reimagine their research operations'.
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