NIH Funding Cuts Threaten Global HIV and TB Research: South Africa Faces Collapse of Clinical Trials and Scientific Workforce

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In a decision sending shockwaves through the global health community, the U.S. National Institutes of Health (NIH) have abruptly terminated their funding mechanisms for international research collaborations, bringing decades of critical HIV and tuberculosis (TB) research in South Africa to a sudden halt. This action, rooted in a new prohibition on “subawards” to foreign entities, has triggered the mass cancellation of NIH-supported clinical trials in South Africa, leaving research teams, patients, and institutions in crisis.

South Africa stands at the epicenter of this upheaval. With one of the highest burdens of HIV and TB worldwide, the country has long served as a vital hub for global clinical research. At least 39 clinical research sites and nearly 50 trials—including 27 HIV trials and 20 TB trials—are now in jeopardy. These trials, many of which are multinational in scope, are not only instrumental to South Africa but are also foundational to international treatment strategies and public health outcomes.

What’s at Stake: A Global Scientific Setback

The termination of NIH subawards has immediate and far-reaching consequences. According to an analysis by the Treatment Action Group (TAG) and Médecins Sans Frontières (MSF), the cancellation of these trials could derail crucial advancements in:

• TB treatment innovations, such as vaccines, improved drug regimens, and life-saving therapies for TB meningitis.

• HIV prevention and cure research: including work on broadly neutralizing antibodies (bNAbs), HIV vaccines, pre-exposure prophylaxis (PrEP), and interventions tailored for women and children.

South Africans constitute 30–50% of global trial participants, and in studies involving pregnant women and children, they make up an even larger share—50–90%. These numbers reflect not just the country’s burden of disease but also its central role in advancing global medical research.

Each clinical trial participant represents an average investment of $12,000, and many studies have been ongoing for several years. Abrupt discontinuation risks squandering hundreds of millions in sunk costs, compromising long-term datasets, and potentially endangering patient safety due to unfinished treatment protocols.

Research Institutions in Crisis

Beyond the immediate implications for patients and data, the NIH cuts could cause a financial collapse in South Africa’s research ecosystem. Up to 30% of annual institutional income for universities and research centers may vanish, leading to mass retrenchments and operational paralysis.

Professor Ntobeko Ntusi, head of the South African Medical Research Council (SAMRC), highlighted the particularly harsh impact on South African institutions, noting that they were selected for this research not through aid or charity but through competitive NIH grant processes based on scientific excellence.

“We are already witnessing large-scale retrenchments,” Ntusi warned. “This is not just a funding issue—it’s an existential crisis for a generation of emerging scientists.”

The ripple effect extends to hundreds of postgraduate and postdoctoral researchers, whose work and livelihoods are now uncertain. Without stable funding, their academic and professional futures are in peril.

An Ethical and Regulatory Quagmire

The sudden termination of grants poses an “ethical nightmare”, according to Professor Ian Sanne, co-principal investigator at the Wits HIV Research Group Clinical Trials Unit. Not only has his unit lost upwards of $180 million in NIH funding, but it must also comply with South African labor laws that prohibit abrupt staff dismissals, depleting reserves in the absence of transitional support from U.S. funders.

In KwaZulu-Natal, one USAID-funded trial was ended without notifying participants, who were using ARV-infused microbicide rings for HIV prevention. The abrupt withdrawal of care presents severe ethical challenges, particularly for women at high risk of infection who were left without alternative interventions or follow-up care.

Losing Infrastructure Built Over Decades

South Africa’s research infrastructure has been developed over three decades with a cumulative NIH investment of nearly $2 billion. Leading institutions, such as the Desmond Tutu HIV Centre at the University of Cape Town, now face devastating losses. Its director, Prof. Linda-Gail Bekker, noted that her centre stands to lose $6.9 million of its current $10 million NIH funding and already forfeited a $45 million HIV vaccine grant from USAID earlier this year.

“This funding loss threatens not only our staff—up to 50% of whom may be laid off—but also the global pipeline of new treatments and vaccines,” said Bekker, who recently presented pioneering work on long-acting injectable ARVs that demonstrated 100% efficacy in trial participants.

The scale and quality of South African clinical research institutions have made them critical assets in global public health. Their rapid pivot to COVID-19 vaccine testing demonstrated their adaptability and capacity under crisis, offering a model for agile, high-quality research under pandemic conditions.

Implications for Africa and Beyond

The impact of South African science extends far beyond its borders. Dr Tom Ellman, director of MSF’s Southern Africa Medical Unit, emphasized that innovations developed in South Africa have been scaled across low-resource settings in Africa. From the Democratic Republic of Congo to Kenya, South African-derived treatment regimens have provided lifesaving care under the most difficult conditions.

“The research we’ve used in Kinshasa and conflict zones like South Kivu wouldn’t have been possible without South African science,” said Ellman. “Losing this capability now, just when we are on the brink of ending the HIV and TB pandemics, is particularly cruel.”

A Call for Immediate Action

In response to the crisis, TAG, MSF, and the SAMRC have called for emergency support from global donors, foundations, and governments to prevent the collapse of essential research.

While some funding entities have expressed willingness to help, most are staying anonymous for now. The priority, according to researchers, is to safeguard participant care, complete trials ethically, and preserve critical data. Any lapse in care, especially in interventions dealing with drug resistance or long-term outcomes, could lead to patient harm and compromise scientific integrity.

“South African trial participants must be supported to complete treatments safely, and research sites must be able to complete data analysis,” TAG and MSF emphasized in their joint statement.

Conclusion

The NIH’s withdrawal of support from South African institutions has illuminated the fragile foundation upon which global health research is built. While South Africa has long carried the weight of global TB and HIV research, this decision threatens to upend not only years of scientific progress but the lives and health of millions worldwide.

The urgency now is twofold: rescue the infrastructure that has supported decades of progress, and ensure that scientific collaboration across borders is not a casualty of shifting bureaucratic or political agendas.