Latest news with #PEPFAR
Scoop
3 days ago
- Health
- Scoop
U.S. Aid Cuts Lead To Preventable Deaths, Medicine Shortages, Health Worker Layoffs In Kenya And The DRC
July 24, 2025 The abrupt and sweeping cuts to U.S. global health support has led to preventable deaths, shortages of medicines, and reduced access to services for vulnerable communities in both Kenya and Democratic Republic of the Congo, according to two new research briefs published today by Physicians for Human Rights (PHR). 'Sexual violence survivors unable to access post-rape care. Stockouts and shortages of life-saving HIV, TB, and malaria medications. Uterine ruptures and maternal deaths. The emerging impacts of the Trump administration's global health cuts are both devastating and wholly preventable,' said Thomas McHale, SM, director of public health at Physicians for Human Rights (PHR). 'With its sudden cuts, the United States pulled the rug out from under some of the most vulnerable children and adults in the world. National governments, health workers, and other donors did not have a chance to plan or make alternative arrangements. We are now seeing the deadly consequences of the Trump administration's cruelty.' PHR calls on the United States to reverse the cuts and on the national governments of Kenya and DRC to prioritize health services. Other donor governments should also scale up assistance. PHR's new evidence on the aid cuts impacts in Kenya and DRC, and a recently published research brief on Ethiopia, comes as the Court of Appeals for the District of Columbia Circuit considers AIDS Vaccine Advocacy Coalition v. U.S. Department of State, a lawsuit brought by global health NGOs against the U.S. government. The NGOs argue that the Trump administration did not have the authority to cut nearly all congressionally approved foreign aid and dismantle USAID. While the United States President's Emergency Plan for AIDS Relief (PEPFAR) was excluded from the recissions package, Congress must monitor that previously authorized funding is spent in advance of PEPFAR renewal in the fall. PHR's new Kenya research brief ('The System is Folding in on Itself': The Impact of U.S. Global Health Funding Cuts) is informed by 30 interviews with clinicians, nurses, peer educators, survivor advocates, and community-based organizations across 10 counties in Kenya, conducted in May-June 2025. The DRC research brief (Abandoned in Crisis: The Impact of U.S. Global Health Funding Cuts in Democratic Republic of the Congo) is informed by interviews with 15 medical professionals, humanitarian actors, and staff implementing projects in the conflict-affected North Kivu, South Kivu, and Kasaï regions of the DRC, conducted from May-July 2025. In Kenya, impacts of the U.S. funding cuts include: Widespread stockouts of essential medicines, with health workers across all 10 counties reporting frequent and prolonged shortages of critical items, including antiretrovirals (ARVs), HIV test kits, nevirapine for the prevention of mother-to-child transmission, early infant diagnostic kits, tuberculosis (TB) reagents, sexually transmitted infection medications, and routine childhood vaccines. Mass layoffs of health care personnel, with tens of thousands of workers furloughed and extreme pressure on remaining health workforce. Marginalization of vulnerable groups, as programs are cut that served LGBTQ+ individuals, children with disabilities, people living with HIV, and survivors of sexual and gender-based violence. Reversing progress on HIV and TB, including increasing mother-to-child HIV transmission. 'We are seeing new cases among newborns – something we had virtually eliminated just a few years ago,' a nurse in Uasin Gishu County told PHR. TB programs include case-finding efforts have ground to a halt, risking unchecked spread of TB across borders. Childhood immunization programs are struggling, with 12 out of 47 counties in Kenya reporting complete stockouts of polio and measles vaccines. The brief finds that 'the health crisis unfolding in Kenya is not an isolated effect of global health aid cuts; it is emblematic of the widespread impacts and a warning sign of broader fragility that threatens to reverse decades of progress in public health. PHR's data show that that abrupt U.S. aid cuts have disrupted essential services, destabilized HIV programs, weakened disease surveillance, and left marginalized populations without the care they need.' In DRC, where conflict and displacement have affected the eastern part of the country for years, PHR's new brief finds that aid cuts are compounding health crises for the region's civilians: Clinicians report additional uterine ruptures, maternal deaths, and cervical cancer cases. Many patients must choose to pay for services out-of-pocket or leave health care facilities untreated, pushing a trend of delayed access to care. Previously free treatment for obstetric fistula patients, including surgical care and hygiene kits, has been halted. Medical and public health experts interviewed by PHR report increased threats from mpox, malaria, and tuberculosis due to the suspension of vaccination campaigns and the loss of free treatment. In a region that has seen a massive influx of conflict-related sexual violence, survivors are no longer able to access the full suite of care, including access to post-exposure prophylaxis (PEP) kits, which contain emergency contraception, HIV medication to prevent infection within 72 hours, testing kits, treatment for sexually transmitted infections, a forensic documentation form, and other items essential for caring for survivors of sexual violence. Many health clinics have run out of PEP kits. The research brief finds: 'Health care workers in North Kivu, South Kivu, and Kasaï have been left without the tools and resources they need to save lives. The cuts were not accompanied by meaningful transition plans to ensure continuity of services. The impacts of the funding cuts can already be seen in preventable deaths, untreated infections, and irreversible harm to survivors of sexual violence who are not able to access treatment for sexually transmitted infections and life-saving medicines to prevent HIV infection and pregnancy. 'By abruptly cutting global health funding, the United States has triggered a global human rights crisis that is harming the most vulnerable populations. DRC and Kenya must step-in to provide available, accessible, acceptable, and quality health services,' said McHale. 'Our new findings show that restoring global health funding is an ethical imperative and a life-saving necessity. The stakes could not be higher – millions of lives hang in the balance. It is not too late to save lives.'
NBC News
6 days ago
- Health
- NBC News
A global HIV/AIDS program that saved millions of lives faces cuts under the Trump administration
WASHINGTON — The Trump administration is considering a dramatic cutback and eventual phasing out of the President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. program to combat HIV/AIDS in developing countries that has been widely credited with saving 26 million lives since its inception in 2003, according to multiple congressional and administration officials. Created during the George W. Bush administration, PEPFAR was launched with star-power support from U2 frontman and advocate for developing countries, Bono, as well as the Bill and Melinda Gates Foundation and the World Bank. In the two decades since, it enjoyed strong bipartisan support in Congress. But as the Trump administration has sought to cut costs across the U.S. government, particularly for global aid programs, PEPFAR has come up on the chopping block. The administration initially proposed a cut of $400 million from next year's budget, but that funding was restored at the last minute by the Republican-led Senate last week, keeping it going in the short term. Four congressional aides told NBC News that the program was virtually frozen, along with most funding for USAID, in early February. Contracts with providers were put on hold and funding was reduced to what they called a 'trickle.' They said that most promised State Department waivers for critical care did not materialize, and that 51% of current PEPFAR appropriations were either terminated or were not functional. 'They're sitting on the money,' congressional officials said. 'We're not seeing it in the field.' According to the aides, in April, the State Department's then-director of the Office of Foreign Assistance, Peter Marocco, working with Elon Musk's DOGE team to dismantle foreign aid, briefed Congress that PEPFAR would refocus on maternal and child HIV transmission, excluding LGBT individuals and most preventative care that the program has done for decades. Earlier this month, a senior State Department official told reporters, 'The program was actually drowning in too much money, in some cases, you know, sort of going beyond its core mandate.' The official said, 'So instead, we're going to focus on that lifesaving care' and 'work with countries on self-reliance' to ensure there is not a gap in coverage. The senior official said that Secretary of State Marco Rubio is drawing a distinction between people who have HIV and need lifesaving direct treatment, and preventative care for sex workers as well as bisexual and gay men. The State Department official also said, 'It doesn't mean that the United States has to pay for every single thing around the world." "A lot of these countries, they've graduated to the point where their HIV rates are low enough and their economy is healthy enough that they can continue to pay for some of these things. We can get in, make positive change and then get out rather than paying forever so that every sex worker in Africa has PrEP," the official said, referring to HIV medication. Deputy Secretary of State for Management and Resources Michael Rigas testified to Congress last week that, overall, in the administration's budget request for the next fiscal year there is a 54% cut in PEPFAR's administrative, nondirect care funds. That is in addition to a 15% cut in the department's budget request for direct care in the same budget request. A global health staff of 700 people plus contractors in the field prior to President Donald Trump taking office has been reduced to 80 people after recent firings. Last month, White House budget director Russell Vought told a Senate committee, without providing evidence, that PEPFAR spent $9.3 million 'to advise Russian doctors on how to perform abortions and gender analysis.' Democratic Sen. Chris Coons of Delaware, a senior member of the Foreign Relations Committee and former chairman of the Africa Subcommittee, told NBC News that PEPFAR had always planned to get countries that had developed their own hospitals and health care systems, such as South Africa, to take over funding the program by 2030. According to Coons, that transition is already underway. But he and other critics of the current budget cuts said that it is not possible in low-income conflict zones, such as South Sudan, the Democratic Republic of Congo and Haiti, to replace the U.S program anytime soon. Still, according to a draft planning memo reported by The New York Times, the State Department would shut down U.S. support in Botswana, Namibia, South Africa and Vietnam within two years. Nations with high HIV infection rates, including Kenya, Zimbabwe and Angola, would get three to four years, the Times reported, while lower-income countries would get up to eight years under the proposal. NBC News has not viewed the draft plan and a State Department official told NBC News it has not been finalized. Dr. Robert Black, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, who evaluated PEPFAR for Congress, told NBC News, 'I think two years for a number of countries, for many countries in Africa, would be too short,' adding, 'I just can't imagine two years would be an effective transition.' Black also said maintaining prevention is 'clearly important" and that withdrawing funding for prevention, which is contemplated under the Trump plan, would increase HIV rates and expand the burden. Rubio, who as a senator supported PEPFAR and other foreign aid, defended $20 billion in overall proposed budget cuts to the Senate Foreign Relations committee in May, citing 'duplicative, wasteful and ideologically driven programs.' Asked last week about the PEPFAR cuts, former Secretary of State Condoleezza Rice, who served in the Bush administration when PEPFAR was launched, told NBC News at the Aspen Security Forum, 'I do think PEPFAR is going to not only survive, I think it's going to be just fine. ... There will be some scaling back, and it's probably worth it to take a look at focusing on what we really need to focus on. We've become pretty dispersed and diffuse in the kinds of programs that we were running.' But, she added, 'what makes America different as a great power is that we have not led just with power, but we've also led with principle.' Later at the conference, Rice said launching PEPFAR was 'the proudest moment' in all of her government service. But she added that the U.S. also wants to build other countries' capacity and health care systems to sustain themselves. Former President Bush, in rare criticism of Trump's policies, praised fired foreign aid workers in a video last month. He told the State Department employees who had been fired, 'You've shown the great strength of America through your work, and that is our good heart.' Citing PEPFAR'S lifesaving work, Bush said, 'Is it in our interest that 25 million people who would have died, now live? I think it is. On behalf of a grateful nation, thank you for your hard work, and God bless you.' In a video, Bono told the foreign aid staff in verse, 'They called you crooks — when you were the best of us, there for the rest of us. And don't think any less of us, when politics makes a mess of us. It's not left-wing rhetoric to feed the hungry, heal the sick. If this isn't murder. I don't know what is.'
Vox
6 days ago
- Politics
- Vox
It's surprisingly hard to know just how many people will die because of USAID cuts
is a senior writer at Future Perfect, Vox's effective altruism-inspired section on the world's biggest challenges. She explores wide-ranging topics like climate change, artificial intelligence, vaccine development, and factory farms, and also writes the Future Perfect newsletter. How many people are going to die because of the so-called Department of Government Efficiency's abolition of USAID, and the Trump administration's apparently-under-consideration plans to destroy PEPFAR, the landmark George W. Bush-era program to end the global AIDS epidemic? Millions — everyone agrees on that. But how many millions is an extraordinarily difficult question to answer. Two factors make it particularly difficult. First, the Trump administration's plans are constantly shifting. And second, other actors change their behavior in response to US policy. The Gates Foundation, for example, plans to accelerate its spending to help fill the void left by the US; I know of other, smaller funders trying to do the same thing. Aid recipients, too, can change their behavior: While some will die without their medication, others will find a way to pay for the medication at the expense of other necessities. Between the uncertainty of the cuts and the unpredictable responses, it's a real challenge to estimate the cost in human lives. But getting these numbers right is crucial. Since the Trump administration began demolishing USAID earlier this year, experts have made various attempts to quantify the impact. Some of them have been more careful than others. One new analysis in the prominent medical journal the Lancet, for example, estimates that if all USAID work stops, between 8.5 million and 20 million people will die by 2030 — a mind-boggling sum even on the low end. The lower-end estimate is in line with other estimates — and even the higher end, it isn't necessarily impossible, if no other actors step in. This story was first featured in the Future Perfect newsletter. Sign up here to explore the big, complicated problems the world faces and the most efficient ways to solve them. Sent twice a week. But there were limitations to the paper's approach that make it a bad idea to take those numbers at face value. The analysis drew criticism from some development economists, who warned that its approach was insufficiently rigorous, given the stakes of getting this right. Its design meant that the death toll estimate didn't account for the potential impacts of other governments or aid agencies stepping in to help make up for cuts to USAID, among other issues. It also claimed that USAID had saved up to 90 million people over the last few decades, which would, implausibly, credit the agency with the entire fall in global mortality over the last 20 years. All that is an immense shame — it's already hard enough to get Americans to pay attention to desperately needed aid going to some of the poorest people in the world. Overestimates undermine the credibility of the entire effort to fix this crisis — credibility that it can't afford to lose. Counting the dead During the chaotic initial months, as DOGE implemented cuts by unilaterally blocking payments, it was almost impossible to distinguish what was an intended cut and what had been cut off accidentally. At the time, I sent questions about the situation to the State Department, which answered only with copy-pasted statements unrelated to my questions. Often the only way to learn whether a PEPFAR clinic was operating was to ask a volunteer to go there and look — and volunteers in Nigeria did precisely that for me at one point. As I tried to report on which programs were operating, I spoke with people whose programs were canceled and then uncanceled and then sometimes recanceled. We're now out of that initial chaos. But determining what's going on remains a huge challenge. By far the most important single question for how many people die as a consequence of aid cuts is whether PEPFAR is gutted or continues to function. Last week, we got good news on that front: Congress exempted PEPFAR from a recent package of spending cuts that had been pushed by the White House. This week, we got bad news: The State Department, according to documents obtained by the New York Times, is developing a plan to shut down the program anyway. The department has since distanced itself from the plan, stating that the document 'is not reflective of the State Department's policy on PEPFAR.' Related Bill Gates shows what the end of perpetual philanthropy looks like Any death toll estimate has to assume a specific scenario — anywhere from 'everything is canceled' to 'only certain announced cancellations will go forward, and everything else proceeds as before.' And it also has to make difficult methodological assumptions. As a recent analysis by development economists Charles Kenny and Justin Sandefur put it, we need to know both 'gross lives saved' — how many lifesaving medications were given out to patients who then survived? — and 'net lives saved' — how many of those people are alive today who would have been dead but for the program? Gross lives saved are relatively easy to measure. Net lives saved are much trickier — they're often estimated by comparing deaths in countries that benefitted from US aid to those in countries that did not. But since those countries weren't identical to begin with, and the US hardly chooses where it operates at random, deciding what differences between the countries to control for introduces a lot of potential for error. The more variables you control for, the easier it is to accidentally control for something that you would have actually wanted to consider in your results. The Lancet study, for example, controlled for health spending by country. But controlling for that variable makes it impossible to look at cases where US aid spending displaced a country's own national spending on health — meaning that it's impossible to see how much US aid was actually improving the total health situation or just substituting for local money. And that was just one concern with the study, representative of just how hard it is to do this research. Why this really, really matters According to the State Department's own estimate, PEPFAR has saved about 25 million lives since it began operating in 2004. Earlier this year, some friends and I, hoping to better understand that estimate, ran a hackathon to create our own analysis, estimating that the program has saved between 19 million and 30 million lives. Meanwhile, Kenny and Sandefur estimate that all US aid programs as a whole saved between 2.3 million and 5.6 million lives per year, the bulk of that from PEPFAR. What we know for sure is this: More people will die than you or I could ever meet. Even with the most rigorous research standards, the range of uncertainty is very large, and the numbers hinge on hard-to-communicate assumptions. Do you exclude data from the peak of the Covid-19 pandemic, given its confounding effects? Do you treat saving a child and saving an adult as the same? Do you assume drug prices would have fallen and made medication more accessible even without US aid? And do you report your conservative estimate or your high-end estimate? This isn't just an academic exercise. Because for the most part, you get one shot at communicating with the general public. There's a lot happening in the world, and most people simply aren't going to read five news stories about the nuances of foreign aid. Having an authoritative number would be invaluable for conveying the scale of the impending crisis — and it must be a reliable one, because an unrigorous overestimate just hands opponents an excuse to dismiss the entire foreign aid project as one run by politically motivated liars. But the sheer chaos of the dismantlement, the lack of clarity about what the plan really is, and the difficulty in guessing how other governments and nonprofits will react (when they're dealing with the same lack of clarity from the US) makes it hard to give a single answer. And it's really hard to advocate for a program's continuation when it's impossible to keep track of the government's plans for it. I strongly suspect that's intentional: The White House has repeatedly lost when seeking congressional approval to dismantle our best-performing life-saving programs. So the administration has resorted to doing it piecewise and, as much as possible, avoiding a public debate. What we know for sure is this: More people will die than you or I could ever meet. It's enough people that I am pretty sure we'll be able to see a Trump-era spike on global child mortality graphs the way we can see the impacts of major wars. Most of the dead will be children whose lives could be saved at very little cost. And whether we save their lives next year is apparently, somehow, still under discussion.
CBS News
24-07-2025
- Business
- CBS News
Trump signs rescissions bill clawing back foreign aid, NPR and PBS funding
Washington — President Trump signed legislation to claw back $9 billion in foreign aid and public broadcasting funding, the first time in decades that Congress has approved a president's request to rescind previously approved funding. White House spokesperson Harrison Fields said Thursday that the package was "officially signed." Both the Senate and House passed the legislation, known as a rescissions request, in overnight votes last week before a July 18 deadline. Each chamber ran into different hurdles in getting it over the finish line ahead of the deadline, after which the funds would have had to be spent as Congress originally intended. The bill targets roughly $8 billion for foreign assistance programs, including the United States Agency for International Development, or USAID. The package also includes about $1 billion in funding cuts for the Corporation for Public Broadcasting, which supports public radio and television stations, including NPR and PBS. Though all but two Republican senators ended up supporting final passage in the upper chamber, some said they had reservations about doing so, especially because they had not received details from the administration about how the broader cuts would impact specific programs. Two major points of contention were funding for a global AIDS prevention program and radio and broadcast stations in rural and tribal areas, which play a critical role in communicating emergency alerts and other information to residents. The final version of the package removed $400 million in cuts to the President's Emergency Plan for AIDS Relief, also known as PEPFAR, in an effort to appease some critics. The administration promised to find funding elsewhere to alleviate the cuts to the rural stations to win over others. Two House Republicans also opposed its passage in the lower chamber. Republicans said they expect it will be the first of multiple packages to claw back funding that they have characterized as "waste, fraud and abuse." Any future request is sure to spark another battle with lawmakers, some of whom have criticized the legislative body for giving up its budget oversight and ceding to the president's demands.
New York Times
23-07-2025
- Health
- New York Times
U.S. Quietly Drafts Plan to End Program That Saved Millions From AIDS
The federal program to combat H.I.V. in developing nations earned a reprieve last week when Congress voted to restore $400 million in funding. Still, officials at the State Department have been mapping out a plan to shut it down in the coming years. Planning documents for the President's Emergency Plan for AIDS Relief, obtained by The New York Times, call for the organization to set a new course that focuses on 'transitioning' countries away from U.S. assistance, some in as little as two years. PEPFAR, as the program is called, would cease to exist as an initiative to provide medicines and services needed to treat and prevent the spread of H.I.V. in low-income countries. It would be replaced by 'bilateral relationships' with low-income countries focused on the detection of outbreaks that could threaten the United States and the creation of new markets for American drugs and technologies, according to the documents. 'With targeted investment, PEPFAR's H.I.V. control capabilities in these countries could be transformed into a platform for rapid detection and outbreak response to protect Americans from disease threats like Ebola,' the plan says. A State Department spokeswoman said the document had not been finalized. 'The referenced document is not reflective of the State Department's policy on PEPFAR and was never cleared by Department leadership,' she said. Want all of The Times? Subscribe.
