US aid cuts: Africa must make its own medicine

Over the past 16 months, the Kikuyu proverb “when elephants fight, it is the grass that suffers” has been referenced frequently across column inches, radio call-in shows, social media tirades and official statements from civil society and industry leaders. 

Worryingly, the reality of such indifference to collateral damage has grown increasingly relevant, evolving from sage, cautionary advice to a sobering diagnosis of an increasingly destructive brand of realpolitik, insular thinking and global apathy.

Donald Trump’s election in November 2024 was always expected to have consequences for the world but, instead of merely sending ripples through the international community, the US president has sought to cannonball into an already fragile global ecosystem. For those relatively well-off or in positions of power, the barrage of unilateral declarations might be annoying but ultimately bearable. However, for millions of others, this could prove, without exaggeration, catastrophic. In the wake of a presidential flurry of executive orders and hostile posturing, the lives of everyday people risk being trampled and uprooted in a way not seen for decades.

Nowhere is this more depressingly true than in the Potus’s war with USAid. The decision to cripple the institution has set the stage for the seemingly inevitable dismantling of a truly benevolent force in the world, leaving hundreds of vital programmes teetering on the edge of extinction. 

While USAids is undoubtedly a tool of US foreign policy, often drawing ire and reluctant acceptance from those wary of associating with the “leader of the free world”, its staff consists of technical experts and professionals, not political agents. 

Even USAid’s staunchest critics cannot deny that, at the end of the day, the people in most dire need of assistance are simply grateful for the lifeline offered. Whether it is drought relief, humanitarian aid after natural disasters, food assistance or medical intervention, the recipients — the most vulnerable communities worldwide — risk becoming casualties of personal ideology.

Although the saga is ongoing, with legal proceedings constantly swinging USAid back and forth over the abyss, the episode has made it abundantly clear that reliance on the goodwill of foreign actors can only go so far. 

South Africa, an unexpected target of the US executive branch’s ire, remains a country at war with disease. More than half of the world’s HIV/Aids infections are concentrated in Southern Africa, with South Africa itself home to nearly a quarter of the global cases. Although nowhere near where it needs to be, progress has been made thanks to public health campaigns and the rollout of antiretroviral drugs that halt the virus’s ability to ravage the body’s immune system and lower its transmission. However, letting up now would send the country careening back towards uncertainty.

The United States President’s Emergency Plan For Aids Relief (Pepfar), launched in 2003 by the Bush administration and implemented by, among others, USAid, has been a vital component of the gains made over the past 15 years. While Pepfar is not the only policy initiative aimed at combating the Aids pandemic in South Africa, it has undeniably been central to the improvements seen since 2008, when the death rate associated with Aids began to decline, and new infections have steadily decreased. Through initiatives aimed at care, prevention and treatment, Pepfar has given South Africa the means to combat HIV/Aids effectively.

The continued and steady provision of antiretrovirals is critical to South Africa’s march towards the eradication of the disease within its own borders. But should such a monumental and essential humanitarian effort be left exposed to the whims of international relations?

In the business world, Africa’s reliance on foreign supplies of medicine, expertise and capital to improve the health of its most vulnerable citizens would be viewed as a “concentration risk”. The most obvious route to mitigating such risk is diversifying the supply chain, ensuring that no one source can dominate and dictate the needs of Africa’s most at-risk populations. 

In theory, any entity capable of manufacturing and supplying the necessary medications would be considered, but as demonstrated by the geographic and political risks facing Pepfar, pharmaceuticals must be treated as matters of national (or even continental) security. This doesn’t mean abandoning foreign-produced treatments and drugs entirely but rather not placing all the continent’s healthcare needs in a basket that can be easily upended by external forces.

What is urgently needed, and has been acknowledged across industry and policy circles alike, is a solid African pharmaceutical production base as well as a sustainable source of funding to purchase and distribute the products. 

South Africa, for one, has access to the capital and expertise to ignite an African pharmaceutical revolution but would require concerted efforts to scale up production capabilities. Building such drug-production infrastructure would not only reduce dependence on external suppliers but also enhance Africa’s self-sufficiency in health matters, allowing the continent to respond more swiftly to health crises. 

Moreover, investing in local pharmaceutical production would provide valuable insulation against external shocks, which, lest we forget, disproportionately affect those who are most vulnerable. 

While African wisdom regarding the plight of everyday people has often been overlooked, other forms of indigenous knowledge highlight the strength of community. It is time to start listening to our own lessons, acknowledging the value of human connections and the importance of putting people’s lives first.

Michael Mynhardt is the co-founder and chief executive of MMH & Partners Africa.