Treat the funding cuts like the humanitarian disaster that they are.

On February 26th, the US government issued around 5,200 termination letters to programmes worldwide funded by the US Agency for International Development (USAID) and 4,100 funded by the Department of State and the President's Emergency Plan for AIDS Relief (PEPFAR). These programmes were ordered to shut down operations immediately and permanently.

Many provided essential and lifesaving healthcare services for malaria, Ebola, malnutrition, sexual and reproductive health (SRH), HIV and tuberculosis (TB), and vaccination, among other critical health issues. These abrupt terminations came after more than a month of chaos and devastation for hundreds of organisations working in these sectors since the initial foreign assistance freeze was enacted in late January. 

Doctors Without Borders (MSF) is deeply saddened and angered by the casual inhumanity of these decisions, which will inevitably lead to deaths, suffering, exclusion from healthcare, and the resurgence of preventable diseases. Global health was already drastically under-resourced and now the situation has worsened, leaving almost every partner and community group that we work with deeply affected – many have simply ceased to exist. 

We hear from countless scared and confused patients and research study participants who no longer know where to turn to for care. Healthcare professionals who have lost their jobs reach out to us, still distressed about the wellbeing of their communities. We are seeing the fear in the eyes of our partners previously in USAID/PEPFAR-funded community organisations and NGOs as they fight for the survival of their programmes and their patients.  

In Khayelitsha, South Africa, where MSF supported HIV and TB programmes for over 20 years, contracts of data capturers, community health workers, counsellors, nurses, and doctors have been interrupted, according to our longstanding partner, the Treatment Action Campaign. A similar situation is taking place in many other health facilities in the country.  It is now difficult to know who has visited a clinic for a medication refill and who has missed their appointment. Patients are now waiting long hours in clinics for HIV tests, and no counsellors remain to support linkage to care. 
 

In Zimbabwe, reports from our teams indicate that while some PEPFAR-funded organisations have managed to sustain HIV services, the provision of pre-exposure prophylaxis (PrEP) remains limited. Currently, PrEP is only available to existing clients within these programs, with no new initiations being conducted. As a result, access to this critical HIV prevention intervention is restricted to specific groups, leaving a gap in broader service delivery.

Our teams in the Democratic Republic of Congo say that they have not received antiretroviral supplies at the MSF-run CHK Hospital in Kinshasa since 20 January, leaving over 2,000 HIV/TB patients at risk of developing drug resistance, advanced HIV and dying, if supplies are not resumed immediately.  In addition, if ARV supplies are not replenished soon, around 8,200 patients relying on ART community-based distribution points (PODIs) risk losing access to their treatment.  

These are just a few examples of severe disruptions from countries where we work.
 

MSF has long-standing experience treating HIV and TB in challenging environments, including conflict settings. We are accustomed to disruptions in care and responding to emergencies. However, the scale of this global disruption is unlike anything else we have witnessed. While preparedness is key in emergency situations, the suddenness of this has not allowed programmes, organisations or governments to adequately plan. 

The US is the world’s single largest funder of foreign assistance—accounting for an estimated 40 per cent of all humanitarian aid. Approximately 70% of global HIV funding, along with a third of international assistance for TB and of malaria, comes from the US. Policymakers making these drastic cuts may have assumed that humanitarian organisations could bridge the gaps. The reality is stark: MSF is one of the world’s largest humanitarian organisations, yet our capacity is nowhere near enough to offset the scale of these reductions. Without reversing these cuts, countless lives will be lost.

The termination of this funding threatens to undoing years of incredible progress against HIV and TB, with immediate and long-term consequences. In the short term, treatment is lifesaving for those in need, but in the longer term, care is a cornerstone for prevention. Without this, the number of new infections, including in babies, will increase dramatically.  The cuts will also increase the need for advanced HIV care. UNAIDS estimates that if PEPFAR were permanently discontinued without alternatives, this could result in an additional 6.3 million AIDS-related deaths and 8.7 million new HIV infections among adults globally by 2029.
 

MSF stands in solidarity with the millions affected by these decisions, including people living with HIV and/or TB, pregnant women, children, adolescents and young people with sexually transmitted infections. We are also concerned about the negative impact and the risk of lives of specific vulnerable populations, such as sex workers, people who use drugs, and the LGBTQIA+ community, often criminalised or excluded from healthcare. 

These cuts must be reversed. New funders must step in, and existing funders must step up.  Affected governments must adapt quickly to mitigate these disruptions and fill critical gaps. The community’s voice and action are critical for maintaining continuity of service delivery.  Their efforts in advocacy, monitoring, and delivery of de-medicalised services must be preserved. 
 

Over the past two decades, alongside countless organisations and dedicated individuals, we have seen a health crisis brought under control. We cannot undo the hard work that has saved millions of lives.

MSF is clear: the threat facing us today is not only a global public health crisis, but also a full-scale humanitarian catastrophe and it demands immediate action, cooperation and a global approach that prioritises the lives of people above all else.

By Dr Esther C. Casas, senior HIV/TB advisor, Southern Africa Medical Unit (SAMU) and Claire Waterhouse, head of Operations Support Unit/regional advocacy coordinator