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South Africa at a crossroads: Can it keep up with a changing global health system?
JOHANNESBURG - South Africa is facing a pivotal moment in its public health history.
As traditional global health funding models falter, the country must urgently rethink how it sustains its healthcare systems, continues its gains against HIV/AIDS, and ensures future generations are equipped to meet emerging challenges. This as foreign aid is shrinking and the need for domestic resilience is greater than ever.
From US support to uncertainty
For years South Africa was one of the largest beneficiaries of US health funding. Programmes like PEPFAR and NIH-backed research collaboration played a central role in expanding HIV/AIDS treatment, building public health infrastructure, and fuelling scientific discovery.
But in US President Donald Trump's second term, the US has frozen nearly $900-million in global health funding, abruptly halting critical support to South Africa and other African nations. The results were immediate and devastating: Over 15,000 healthcare workers lost their jobs, and communities that had gained access to life-saving treatment suddenly found themselves cut off from care.
UNAIDS: 'The world is off-track'
Despite these setbacks, UNAIDS executive director Winnie Byanyima is urging countries like South Africa not to lose sight of the ultimate goal—zero new HIV infections by 2030.
Speaking from Johannesburg, Byanyima acknowledged that global funding cuts have derailed progress in key regions. South Africa, once a leader in HIV/AIDS reduction, now faces mounting pressure to bridge the gap left by funding cuts. She pointed to Namibia, where more than 90% of HIV programmes were donor-funded. Without similar investments or domestic replacements, gains are being reversed.
But she also highlighted that sub-Saharan Africa is still outperforming the global average in reducing both infections and deaths—proof, she said, that the continent can still succeed if backed by sustained support.
Academic institutions under strain
The health crisis has spilled into South Africa's universities and research hubs. Institutions that once hosted major NIH- and PEPFAR-linked studies are now struggling to survive. Without international funding, global research partnerships are suspended, and leading scientists and postgraduate researchers have been laid off.
Universities, led by Wits, have asked National Treasury for R2-billion to prevent a collapse of research infrastructure. But that support remains limited—and temporary. The long-term danger? A skills vacuum.
Universities are where South Africa trains its future doctors, researchers and epidemiologists. Without strong academic infrastructure, the country risks falling behind on innovation and health leadership for decades to come.
Health emergencies meet systemic weakness
At the same time, South Africa must brace for new health emergencies. Climate-linked diseases, increased migration, and pandemics demand a robust, self-sufficient health system.
If not addressed urgently, the erosion of key services could leave South Africa vulnerable to regional outbreaks, system collapse, and deeper health inequalities.
Innovation offers a glimmer of hope
UNAIDS is now in talks with global pharmaceutical companies like Gilead Sciences, which has developed lenacapavir, a twice-yearly injectable proven to be 100% effective in preventing HIV transmission. Priced at around R720 a patient per year, the treatment holds massive potential for countries like South Africa—but only if it becomes widely licensed and locally produced. UNAIDS is urging Gilead to open licensing to more manufacturers to reduce costs and accelerate access.
Can South Africa keep up?
The challenge now is stark: Can South Africa keep pace with the transformation of the global health landscape? As donor funding shrinks and international priorities shift, the country must rapidly build internal capacity—not only to respond to today's emergencies but to future-proof its health system.
That means investing in people, protecting academic research, and creating health financing models that are resilient and locally anchored. The window to act is narrowing.
Conclusion: Time to lead
The global health system is shifting and South Africa must choose how it responds. The loss of US funding has exposed dangerous dependencies, but also an opportunity to build something more sustainable, inclusive, and home-grown.
Can the country develop health systems strong enough to endure future crises, empower the next generation of scientists, and deliver care to those who need it most?
If so, South Africa could emerge as not just a survivor but as a global leader in health innovation and equity. If not, the nation risks trading its hard-won gains for a long and costly road to recovery.
By: Zinhle Dlamini
