Of Trump's targets, one can save the other

There is an urgent need to build health sovereignty and sustainability to break dependence on donations

- Nontobeko Hlela & Varsha Gandikota Nellutla

With the stroke of a pen, US President Donald Trump issued a dual attack on global health infrastructure this month.

The first was an 83% cut to USAID funding that administered the majority of Pepfar (President’s Emergency Plan for Aids Relief) initiatives — HIV/Aids treatment infrastructure that is credited with saving nearly 25 million lives worldwide. The second was the criminalisation of Cuba’s historic medical brigades, missions that have deployed 600 000 healthcare workers across 160 countries since 1960.

Activists around the world are pleading with the Trump administration to rescue Pepfar from the crushing cuts, pointing out the obvious — when it comes to a virus, nobody is safe until everyone is safe.

The immediate cruelty of the Pepfar decision lies in its abruptness, with millions waking up to find their local clinics gutted and vulnerable populations, such as the queer community, especially in countries like Uganda with strict anti-homosexuality laws, and sex workers left with no legal options to access care.

But zoom out from this moment and an enduring crisis comes into focus — the very architecture of a system where such unilateral, abrupt and perilous cuts are possible.

Countries such as Tanzania and Côte d’Ivoire, smaller economies, host HIV programmes that are nearly 90% Pepfar-funded and even South Africa, the continent’s most advanced economy, with the world’s largest HIV population, relies on Pepfar for 17% of its HIV response.

The lives and deaths of millions of people, particularly those in sub-Saharan Africa, are entirely vulnerable to the whims of a foreign power.

This is no coincidence. While the rhetoric of “African solutions to African problems” has long echoed through continental forums, the global health financing architecture has paradoxically weakened African capacity by centering donor priorities rather than local needs.