US upends global supply programme for malaria and HIV amid warnings of gaps

NAIROBI/LONDON - The US is upending the way it delivers medical supplies for HIV and malaria to lower-income countries, according to seven sources and an internal e-mail, risking a second dislocation of life-saving services in just over a year.

The US has until now managed its medical donations through the Global Health Supply Chain Programme – Procurement and Supply Management – run by the private contractor Chemonics.

From its establishment in 2016 to 2024, it delivered a total of more than US$5 billion (S$6.4 billion) of HIV and malaria products to 90 countries, mostly in sub-Saharan Africa and Asia.

That programme was halted when US President Donald Trump froze international aid on the first day of his presidency in January 2025, stranding millions of dollars of supplies in ports and warehouses – from drugs for HIV, which causes AIDS, to insecticide-treated bed nets.

Much of that work restarted after the US issued a waiver for products that were life-saving.

However, its future has been up in the air as the administration has reduced and reshaped foreign aid, dismantling the US Agency for International Development (USAID), cutting budgets, and switching from management by contractors to bilateral agreements with other countries.

Five sources said the speed of the change could cause shortages or gaps in the provision of life-saving products in some countries, with grave impacts.

The US State Department asked US staff in 17 African countries and Haiti in an e-mail on March 31 to cease implementing the supply programme by May 30.

It said the contract with Chemonics was ending on Sept 30, in line with all USAID awards – although its official end date is in November.

The e-mail, seen by Reuters and verified by two sources, also said there could be “immediate risks to service continuity if (the) transition is rushed or incomplete”.

It did not lay out a clear transition plan, instead asking each US country office to set out how it would implement the handover, and to inform Washington of any risks or need for more time.

A spokesperson said the State Department had “not provided any technical direction to Chemonics to cease operations by May 30 or any other date”.

Chemonics declined to comment.

Six sources said the US was talking to the Global Fund to Fight AIDS, Tuberculosis and Malaria about using its supply platform to procure and deliver donations of global health products in future.

The Global Fund, a Geneva-based health initiative, already manages the purchase and supply of around US$2 billion a year in health products for the three deadly infectious diseases, alongside partner organisations in the countries where it works.

It also has an online procurement platform used by partners.

Two of those sources said earlier discussions between the organisation and the US government had focused on a November 2027 transition.

They said the new timeline was unrealistic as ordering medical products for use in hard-to-reach locations could take up to a year, rather than the matter of weeks now being envisaged.

The Global Fund declined to comment.

The US State Department did not respond to specific questions on whether it was talking to the Fund, but said it would use available pooling mechanisms to buy supplies at the lowest prices from private manufacturers.

America first aid

The Trump administration said in 2025 its global health plans would prioritise funding frontline health supplies, health workers and technicians, and working directly with individual countries.

The America First Global Health Strategy, published in September, said contractors were part of the “significant inefficiency and waste” that it was trying to root out of the system.

But the speed of the changes to how the US delivers aid has already caused problems around the world, including shortages of malaria drugs for children and gaps in HIV prevention.

The State Department spokesperson said the current system was “a bloated piece of an obsolete development model” that “does not put the American taxpayers first and instead helps to line the pockets of large US-based development firms”.

They said the US government had now signed 28 bilateral health pacts with recipient governments, and would mostly use private logistics firms to distribute supplies.

In recent months, Washington has pledged to provide funding directly to the governments of countries including Kenya, Rwanda and Uganda, alongside promises of increased national spending.

But details are still being hammered out.

The Kenya agreement faces a court challenge by Kenyan activists over data privacy concerns, while negotiations with the Zambian government have been delayed. REUTERS