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US president Donald Trump’s decision to withdraw the US from the World Health Organization is threatening funding for critical health programmes like HIV/Aids and tuberculosis in different parts of the world, including Nigeria. The Conversation Africa’s Adejuwon Soyinka asked professor of virology and former WHO Africa regional virologist Oyewale Tomori why Nigeria is heavily dependent on US funding for some of its health programmes, what’s at risk and how to mitigate the impact. How dependent is Nigeria on US funding for health?Sadly, Nigeria and many African countries are too dependent on US funding and other donor funding for basic health activities and interventions. These activities are the normal function of a good and responsive government which is committed to the welfare of citizens. According to a US embassy publication, since 2021, the US has committed to providing nearly US$20 billion in health programmes in Africa. The report says in 2023 alone, the US invested over US$600 million in health assistance in Nigeria. That is about 21% of Nigeria’s 2023 annual health budget. Nigeria has, over the years, allocated on the average about 5% of the national budget to health. Three quarters of that covers recurrent expenditure like salaries. Nigeria’s proposed 2025 budget is ₦49.74 trillion (US$33 billion), of which ₦2.4 trillion (US$1.6 billion) (4.8%) is allocated to health. This is lower than the 5.15% allocated to health in the 2024 budget. The private sector plays a significant role in the Nigeria’s healthcare system, providing close to 60% of healthcare services. In recent years, traditional medicine is increasingly offering complementary and alternative medicine in support of the services provided by the federal, state and local government areas levels. What health programmes does the US fund in Nigeria?The US support is focused on preventing malaria, under the US President’s Malaria Initiative; ending HIV, through the US President’s Emergency Plan for AIDS Relief; and delivering vaccines (COVID, polio, rotavirus, IPV2 and HPV). Malaria is a major public health concern in Nigeria. In 2021, there were an estimated 68 million cases of malaria and 194,000 deaths. Nigeria has the highest burden of malaria globally, nearly 27% of the global malaria burden. Nigeria has a high burden of HIV – fourth in the world. A large number of Nigerians live with the virus. The national agency responsible for AIDS control reported a rate of 1,400 new HIV cases per week in 2023. Nigeria has experienced outbreaks of yellow fever, meningitis, cholera, Lassa fever and COVID-19. In addition to helping with managing these major diseases, the US government also provided funds to strengthen the country’s ability to prevent, detect, respond to and recover from emerging public health threats. With these funds, a Public Health Emergency Management Programme was established and national disease surveillance systems were upgraded. Nigeria’s laboratory diagnostics were enhanced to test for Ebola, mpox, yellow fever, measles, Lassa fever, cholera and cerebrospinal meningitis. Other countries (Japan, Germany, Canada, the UK) also provided support through building and equipping laboratories and training health workers. What’s most at risk?Interventions most at risk are those of which the Nigerian government has abdicated its responsibilities to the donors. They include provision of rapid diagnostic tests for malaria, insecticide-treated bed nets, malaria preventive treatments in pregnancy, provision of fast acting malaria medicines and insecticide for home spraying. The following HIV interventions are likely to be adversely affected: HIV counselling and testing services, especially for pregnant women to prevent mother-to-child transmission of HIV, and the care of people living with HIV with TB/HIV services, as well as care and support for orphans and vulnerable children. Sustaining laboratory capacity for rapid disease diagnosis will suffer a major setback with reduced or lack of reagents and consumables. A huge amount of laboratory equipment is provided by donors. Servicing and replacement of equipment will be affected. The Nigerian health sector’s challenges include inadequate funding, shortage of healthcare professionals, poor access to healthcare due to cost, poor infrastructure, and high prevalence of preventable diseases. Cutting off US money is not likely to affect the shortage of healthcare professionals, as the major reason for the shortage is their deteriorating work environment and unsafe social environment. This environment was created by years of economic downturn and social insecurity in Nigeria. Why is Nigeria still so reliant on US funding?I think Nigeria lacks national pride as it begs for assistance to provide what it already has the resources for. The government seems to place the well-being of the citizens on a secondary status. Many African governments assume the world owes Africa compensation for colonial activities. But to me, the danger to Nigeria’s freedom from dependency is not truly knowing what we are, who we are, and how endowed we are. The world describes Nigeria as “resource limited” and, without thinking, Nigerians accept such name calling. Nigeria is not resource-limited, it is resource wasteful. Nigeria is not resource constrained; it is corruption constrained. Until Nigerians know who and what we are, we will never find the solution to our problems. Nigeria’s acceptance of the tag “resource-limited” drives it to beg for assistance even in areas of its highest capability, capacity and competence and where it has highly trained people. Like disease prevention and control. Africa has since the 1960s experienced numerous outbreaks of diseases and has acquired significant expertise in disease prevention and control. An example is the 2014 Ebola outbreak in Nigeria, which was brought under control within three months with only 20 cases and eight deaths. This was a disease that raged for three years and ravaged three countries: Guinea, Liberia and Sierra Leone. It was reported in seven others with 28,600 cases and 11,326 deaths. In Nigeria, the country coordinated response activities which were anchored on the participation of the community. The community was part of disease investigation, contact tracing, isolation of cases and adoption of infection, prevention and control interventions. How can Nigeria mitigate the impact?Nigeria must immediately provide emergency funds to cover the shortfall arising from the action of the US government. What

Trump last week ordered a suspension of foreign assistance, while his billionaire ally Elon Musk has boasted he is putting the vast US humanitarian agency USAID “through the woodchipper”. That has included a 90-day suspension of all work by the President’s Emergency Plan for AIDS Relief (PEPFAR), which alone supports more than 20 million HIV patients and 270,000 health workers, according to an analysis from the Foundation for AIDS Research (amfAR). Among its programmes, PEPFAR currently provides anti-retroviral treatments to 679,936 pregnant women living with HIV both for their own health and to prevent transmission to their children, the analysis said. “During a 90-day stoppage, we estimate that this would mean 135,987 babies acquiring HIV,” it said. Advertising US Secretary of State Marco Rubio, who has been named acting head of USAID, has said “life-saving treatments” would be exempt from the freeze. But frontline workers in Africa say facilities have already shut down. Trump has frozen aid programmes, while his billionaire ally Elon Musk has boasted he is putting USAID ‘through the woodchipper’Trump has frozen aid programmes, while his billionaire ally Elon Musk has boasted he is putting USAID ‘through the woodchipper’ © Frederic J. BROWN, Brendan SMIALOWSKI / AFP/File“As we speak nothing is going on,” said Aghan Daniel, head of a USAID-funded team of Kenyan science journalists providing information on health issues. He told AFP research projects had abruptly stopped, even for patients midway through experimental treatment programmes. He highlighted the MOSAIC (Maximizing Options to Advance Informed Choice for HIV Prevention) project, funded under PEPFAR, which tests new drugs and vaccines. “The people who were the study candidates are going to have adverse health results because the study has just stopped all of a sudden,” Daniel told AFP. His own team of six science journalists have all lost their jobs, too. “A lot of people are going to die because of lack of knowledge,” he said. “One of the key approaches to bringing down HIV numbers in Africa is through provision of information. This includes raising awareness about sex, as well as treatments like lenacapavir (an antiretroviral), pre- and post-exposure prophylaxis and other drugs.” ‘Life and death’Founded in 1961, USAID has an annual budget of more than $40 billion, used to support development, health and humanitarian programmes around the world, especially in poor countries. It is not just HIV programmes that have shuttered. A staff member of a USAID-funded programme in Kenya said Trump’s decision had landed “like a bombshell”, throwing people “into panic mode”. “We will have more people succumbing to these diseases like tuberculosis, cholera,” the source said. The charity itself is now unable to pay rent or salaries, with employees put on compulsory unpaid leave. At a USAID office in Addis Ababa, Ethiopia, AFP saw people clearing out their desks on Wednesday. Despite Rubio’s waiver, “a lot of uncertainty remains,” said a staff member at an NGO working on food security in conflict zones, who asked to remain anonymous. “What constitutes life-saving work? Are vaccines life-saving, or nutrition programmes for the severely malnourished?” he said. “Stopping some of these programmes even for a few days could make the difference between life and death for some of the people we serve,” he said. Like others, Daniel said the impact could have been tempered with adequate notice. “We have too many emergencies in the world -– we didn’t need to add another one,” he said.

In what will be seen as a signature act of the new Trump administration, the president and his team have denounced and dismembered the US government’s international assistance arm, USAID, in a matter of three weeks. It is a decision that will have serious, real-world consequences – and the impact is already being felt in countries such as Uganda. The health ministry in Uganda has announced its intention to shut all dedicated HIV/AIDS and tuberculosis (TB) clinics in the country. Stand-alone pharmacies supplying antiretroviral drugs will also be closed. These facilities provide HIV treatments and preventative therapies to millions of people in Uganda, including an estimated 1.5 million currently living with the virus. An official said the closure of HIV clinics was a necessary response as the country grapples with the loss of funding from USAID. A medical clinic officer examines an unidentified transgender and LGBTQ member, who is one of their patients at the Ice Breakers Uganda (IBU) clinic in Makindye that supports HIV/AIDS programmes and treatment for the LGBTQ community in Salaama road, Kampala, Uganda June 1, 2023. REUTERS/Abubaker Lubowa/File PhotoImage:A medical officer examines a member of the LGBT+ community who is a patient at a clinic in Uganda. File pic: ReutersDirectors and staff at the country’s public hospitals have been instructed to offer the same services at their outpatients and chronic care departments. A USAID initiative called the President’s Emergency Plan For AIDS Relief – or PEPFAR – has bankrolled much of Uganda’s HIV/AIDS relief plan and it’s an initiative that has wielded impressive results. Specially trained staff and dedicated clinics are credited with bringing infection rates down from 19% in the late 1990s to 5% in 2024. ‘We are still reeling’ Flavia Kyomukama, from the National Forum of People Living with HIV/AIDS Networks Uganda (NAFOPHANU), said she was stunned by Donald Trump’s decision. “We are still reeling from the shock of what they have done, it is very difficult to understand,” she said. “There was a memorandum of support [between both countries], there was roadmap [towards zero infections] and they make this decision in a day.” Flavia Kyomukama, from the National Forum of People Living with HIV/AIDS Networks in Uganda Shifting HIV/AIDS-related care to public hospitals is deeply problematic, Ms Kyomukama added. These facilities are often overwhelmed, and they offer little, or no, privacy. It is a serious issue in a country where those carrying the virus are badly stigmatised. “Surveys show 30% of health workers have a negative attitude towards people with HIV,” Ms Kyomukama said. “So, we’re going to see [patients] dropping out [of their treatment plans], drug resistance will increase and we will see more violence in hospital as people with HIV get attacked.” World is worryingly dependent on US – it now faces a major shock and impossible choicesJohn Sparks – Africa correspondentJohn SparksInternational correspondent @sparkomatThe Trump administration’s destruction of USAID will bring about the virtual collapse of the international aid and development system, experts have warned. The US government puts far more money into humanitarian assistance than any other country. In 2023, the most recent year for which data is largely complete, the Americans disbursed $71.9bn (£57bn) in foreign aid, representing 1.2% of total US government spending. It is a spending commitment that has remained remarkably consistent over the years. The Americans underwrite programmes in 177 individual countries with Ukraine registering as the biggest recipient in 2023. It received $16.6bn (£12.9bn) to maintain government services after the Russian invasion. PEPFAR, USAID’s best-known initiative, provides antiretroviral treatments to 20 million people infected with HIV/AIDS. The initiative supports NGO-run groups with an extended workforce of 350,000 people – with many employed at local clinics. The US also bankrolls key UN organisations, such as the refugee agency (UNHCR). Its total budget of $4.8bn (£3.8bn) is propped up by the Americans, who put in US$2bn (£1.6bn). Without this funding, it is difficult to see how UNHCR can continue to support tens of millions of refugees in countries including Sudan, Syria, Turkey and the Democratic Republic of Congo. If the residents of refugee camps are not supported with basic services, they are likely to move. The question then is how US funding compares to other donors – and the answer is startling. According to the UN’s real-time financial tracking service, Germany contributed funds in 2024 representing 8% of total humanitarian aid contributions, as did the European Union, with the United Kingdom at 6%. The world, then, is worryingly dependent on the United States. Former international aid worker turned consultant Thomas Byrnes said: “The modern humanitarian system has been shaped by a long-term commitment from the US. “For decades, organisations like the UN agencies have relied on this predictable funding stream to address global crises. “The world faces a major shock and I don’t think anyone is prepared for it.” To alleviate the situation, Mr Byrnes said other donors – such as the UK and Germany – will need to make up the funding shortfall from USAID. But that is highly unlikely to happen. The United Kingdom, currently contributing $2.1bn (£1.7bn), would need to contribute an additional $1.5bn (£1.2bn) – representing a 74% increase. For Germany, the required extra contribution would be $1.8bn (£1.5bn), representing a substantial increase of 70%. Furthermore, Trump’s move comes at a time when Germany, France, Sweden and others are planning deep cuts to international aid. The world is looking at a colossal funding gap – and a colossal crisis – as the number of people in need of humanitarian assistance rises to 305 million people, Mr Byrnes added. “We’re facing a perfect storm,” he said. “The brutal math means we’re heading toward humanitarian aid of just 17 cents per person per day. “This isn’t a funding dip – it’s a systemic shock that will force impossible choices about who receives help and who doesn’t. People will die as a result of this.” ‘It’s total panic right now’ Brian Aliganyira is the director of Ark Wellness Hub, a busy health clinic for