TRUMP CARD: WILL GOVTS, NGOS, THOSE ON ART SURVIVE FREEZE?

Before I address the topic for today, I would like to extend profound gratitude to the South African soldiers who lost their lives while in a mission in the Democratic Republic of Congo (DRC) to not fight, but maintain peace. They have lost their lives in a Southern African Development Community (SADC) mission to prevent loss of lives for the Congolese people who have endured violence since colonial times.  It is indeed sad that efforts to resolve the Eastern DRC conflict have, on a number of occasions, collapsed. Unfortunately, it is the civilians who bear the brunt of this conflict with the most vulnerable, children, women and elderly, being the worst affected.  It is my plea that the African leaders should never give up on efforts to find a lasting solution in DRC. Back to the topic of today, on January 20, 2025, President Trump signed an executive order initiating the United States’ (US) withdrawal from the World Health Organisation (WHO). 

Additionally, this decision has been followed with a funding freeze on global health programmes, including those funded by President’s Emergency Plan for AIDS Relief (PEPFAR). 
Subsequently, the US State Department announced a comprehensive freeze on new funding for most foreign aid programmes worldwide, excluding emergency food aid and military assistance to Israel and Egypt. This suspension affects billions of dollars allocated for health, education, development and other aid initiatives, with no exemptions for critical health programmes like PEPFAR.  Humanitarian organisations have expressed alarm, noting that the freeze could halt many US-funded projects in health and other sectors. The International AIDS Society (IAS) has warned that the immediate halting of funding to PEPFAR, including a stop-work order for existing grants and contracts, places millions of lives in jeopardy. 

More than 20 million people living with HIV globally, including 550 000 children under 15, depend on daily services provided with support from the PEPFAR programme. These actions have led to widespread concern among global health experts and organisations about the future of HIV/AIDS programmes and the potential reversal of progress made in combating the epidemic.This unprecedented decision by the American new administration has sent global shockwaves.  Yet during his campaign, the American president has been clear that his policies will be inward looking, with his popular call for America first agenda. The freezing of aid has caught governments, NGOs and beneficiaries by surprise.

PEPFAR background

In May 27, 2003, the United States Leadership Against Global HIV/AIDS, Tuberculosis, and Malaria Act of 2003 was signed into law.  This created PEPFAR, the largest health programme worldwide for a single disease. In his 2003 State of the Union Address, President Bush announced PEPFAR to combat global HIV/AIDS. Later that year, President Bush signed the initial 5-year, US$15 billion authorising legislation that had been approved with strong bipartisan support.  Since then billions of Dollars have been invested, saving millions of lives ravaged by HIV/AIDS, malaria and TB.

The impact of freezing of aid globally

The President Trump Executive Order, if implemented, will cause serious health disruptions globally. The governments, including that of Eswatini, have been reliant on US Government funding for many years as PEPFAR supported their countries health systems, halting the spread of HIV/AIDS, malaria and TB, which was devastating their countries’ population. The most to be affected by this decision are millions of the HIV infected who are already enrolled in programmes funded through PEPFAR, especially those reliant on Anti-Retroviral Therapy (ART), who should not default treatment. Eswatini, for example, has been credited as having achieved the 2030 target of 90-90-90 targets - that is awareness of HIV-positive status, receipt of antiretroviral (ARV) therapy and viral load (VL) suppression among those on ARVs.  It is clear that without the American funding, Eswatini would not have achieved such positive outcomes.  

Risking reversal of these gains is really not an option for Eswatini and many other affected countries globally. It is also regrettable that the NGO sector, which is a critical force for change regarding fighting the three diseases, will bear the brunt of the freeze. The NGO workers and thousands of community carders face an uncertain future because NGOs may not have sufficient reserves to cushion their staff and community cadres to mitigate effects of the 90 days’ financial freeze.

What should governments do?

The governments, including Eswatini, needs to re-organise their national budgets - to ensure that ART programmes are never disrupted.  It is commendable that the Eswatini Government has been procuring ARVs.  NGOs also must be provided with short-term funding to prevent job losses. Governments bear the primary responsibility for development. The generosity of the American people cannot be forever. SADC and African Union should help countries to finance their development than rely on donors.
May this shock be a wakeup call!

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