Trump's policy hits Kenyan HIV and health initiatives

US president-elect Donald Trump after a meeting at The Elysee Presidential Palace in Paris on December 7, 2024. Trump makes his first international trip since his election win, preparing for a day of intense diplomacy before attending the reopening ceremony for the Notre Dame cathedral restored after the 2019 fire.[AFP] The impact of US President Donald Trump's decision to slash foreign aid funding is now being felt in Kenya, with several agencies beginning to suspend their programmes. PEPFAR has written a memo to all countries where it runs programmes. According to the memo, all funding, including new and existing, will be suspended for at least 90 days to allow for an evaluation. Globally, the PEPFAR programme operates in 54 countries, primarily in Africa, providing critical, life-saving daily services to people living with HIV. In Kenya, the US has been the leading supporter of HIV programmes through PEPFAR since 2014. Nelson Otwoma, the Director of the National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK), expressed concern over the suspension of the programmes, stating that it would negatively impact healthcare. "This decision will disrupt ongoing programmes. Even facilities with medicines may lack staff to dispense them," Otwoma told The Standard. President Trump had previously withdrawn the US from the World Health Organisation (WHO), accusing it of mismanaging the COVID-19 pandemic and promoting China's disinformation, which he claimed worsened the virus's spread. However, a week later, he suggested the possibility of rejoining the WHO, citing the 500 million US dollars in annual contributions compared to China's 39 million US dollars, despite China's population of 1.4 billion. He proposed reducing the US contribution to match China's. As the largest financier, the US accounts for 18 percent of WHO's funding. Otwoma attributed Trump's reversal to his "America First" strategic self-interest. The NEPHAK director noted that America has lobbyists, including Bill Gates, who work closely with WHO on health matters. "Big pharmaceutical companies market their drugs and vaccines using WHO. WHO also approves most research conducted by Americans and researchers across the globe. So, the US needs WHO more," observed Otwoma. WHO operates globally, promoting health, ensuring safety, and serving vulnerable populations while facilitating access to Universal Health Coverage (UHC). The organisation trains healthcare workers, provides research grants, and runs health programmes. In emergencies, WHO identifies, mitigates, and manages risks while offering guidelines for effective responses. During the Covid-19 pandemic, WHO-led efforts mobilised vaccines, trained healthcare providers, issued containment guidelines, and distributed personal protective equipment (PPE). It also approves medicines and vaccines for global distribution, many of which are manufactured in the US. However, Professor Omu Anzala, Director of the Kenya AIDS Vaccine Initiative-Institute of Clinical Research (KAVI), said there was excessive panic surrounding Trump's presidency without clear reason. In an interview with The Standard, Prof. Anzala stated, "It is just going to take a little bit of time to restructure WHO, and the US will be back." Nevertheless, he maintained that the situation presents a challenge for African countries to strengthen the Africa Centres for Disease Control and Prevention (Africa CDC) for public health and emergency matters. "It is unfair to keep crying that the US must be there. It is a wake-up call for us to look at ourselves. We cannot constantly rely on the US and other external agencies to carry out research and support our health systems," observed the researcher. Dr Margaret Lubale, Executive Director of the Health NGO Network (HENNET), said Trump's decision to reconsider pulling the US out of the WHO could stem from several factors, including geopolitical, domestic, and public health considerations. Global health crises and epidemics, such as Covid-19, require international cooperation for an effective response, and WHO is a key player in coordinating such efforts. "What Trump is doing is simply weakening the influence of the US in global health policymaking and leaving a leadership vacuum that geopolitical competitors like China might fill," observed Dr Lubale. Lubale added that broader geopolitical tensions between the US and China inevitably spill over into the global health arena. For instance, the US has previously expressed suspicion about China's handling of health pandemics and crises, such as Covid-19 and SARS. "The origin of Covid-19 remains a mystery, with questions around a lab leak in Wuhan," said Lubale. "China was not and is still not forthcoming on Covid-19-related data and has been reluctant to allow independent international investigators into the origin of the virus." She continued, "Lack of transparency by China is a clear concern to the US. I can see how this would make Trump jittery over his decision to leave WHO, especially when you understand that China is the second-largest contributor to the WHO after the US. The more you contribute, the more influence you have in global health." Furthermore, Lubale observed that scientists and health experts were concerned about not receiving real-time surveillance data in the event of a virus similar to Covid-19 crossing borders. Failure to have clear data, she noted, would slow down the US's response to the virus, leading to unnecessary suffering and loss of life. "I believe there could be a lot of pressure on Trump from health experts to reconsider the importance of WHO in surveillance and vaccine distribution, among other critical functions," observed the health advocate. Lubale concluded that while Trump blamed WHO for mishandling Covid-19, it would be more prudent to work from within to reform it, rather than withdrawing completely.

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