NEW DRUG PROVEN TO PREVENT AIDS, BUT U.S. CUTS FUNDING TO DELIVER IT. Stephanie Nolan reports.

A new drug that gives almost complete protection against the virus was to be administered across Africa this year. Now, much of the funding for that effort is gone.

EXCERPTS FROM THE NY TIMES

This was supposed to be a breakthrough year in the 44-year-long struggle against H.I.V. A breakthrough preventive drug, lenacapavir, a twice-yearly injection that offers total protection from H.I.V., was to be rapidly rolled out across eastern and southern Africa. The main target: young women. About 300,000 of them were newly infected with the virus last year — half of all new infections worldwide…

There is more potential than ever before to end the H.I.V. epidemic, scientists and public health experts say. But now, H.I.V. programs across Africa are scrambling to procure drugs that the United States once supplied, replace lost nurses and lab technicians, and restart shuttered programs to prevent new infections.

“We imagined we would be in a different world right now,” said Dr. Leila Mansoor, a senior research scientist at the Centre for the AIDS Program of Research in Durban, South Africa. She had planned to spend 2025 analyzing data from one H.I.V. prevention trial, preparing for another and tracking how lenacapavir was transforming the epidemic — alongside colleagues testing new vaccines and cure strategies.

“And instead we’re moving backwards at warp speed,” she said…

Already, there are fears that H.I.V. infection rates are rising in the hardest-hit countries, but there is no clear way to measure the damage because data collection was mostly reliant on the terminated U.S. funding. Stocks of prevention drugs once supplied by the U.S. are running out across Africa.

The Trump administration says that too much foreign aid is wasted by corrupt governments and bloated programs. The president and his allies have repeatedly said that the United States has shouldered an unfair share of responsibility for global health support and that other countries must do more…

Among the prevention programs cut is U.S. support for an ambitious plan to distribute lenacapavir, which the U.S. Food and Drug Administration approved this week. Rapid rollout of the new injection is seen by many public health experts as the best opportunity the world has yet had to stop the spread of H.I.V. in the United States and abroad.

Lenacapavir was supposed to be the product that showed that the world was finally doing things differently, said Dr. Linda-Gail Bekker, director of the Desmond Tutu H.I.V. Centre at the University of Cape Town, who was a principal investigator in the trial that proved the drug’s extraordinary effectiveness.

The company that makes the drug, Gilead Sciences, applied for regulatory approval in African countries where it was tested at the same time as in the United States. The company also issued a voluntary license to makers of generics, including companies in India and Egypt, so that an affordable product would be available in a few years.

To bridge the gap until that time, Gilead committed to producing enough of the drug to protect two million people over three years, to be sold at “a no-profit price.”

However, about half of those doses from Gilead were supposed to be purchased by the President’s Emergency Fund for AIDS Relief, known as PEPFAR. But the Trump administration has decided that PEPFAR should no longer support H.I.V. prevention for anyone except pregnant and breastfeeding women, and will most likely fund only a sliver of the planned Gilead purchase. The other half of the doses were meant to be bought by the Global Fund to Fight AIDS, Tuberculosis and Malaria, a multilateral donor agency to which the United States has historically been the largest funder. But the Trump administration is also cutting deeply into its support to the Global Fund…

“The promise of lenacapavir for prevention was — everybody thought this is the last stage to bring the H.I.V. epidemic down to its knees, and there was such enthusiasm for what we would see,” said Dr. Ntobeko Ntusi, the chief executive of the South African Medical Research Council. “That’s now all up in the air.”

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THE WASTE MUSK CREATED. Nicholas Kristof of NY Times reports from Africa.

Excerpts from original NY Times article

I’ve been traveling through Sierra Leone and Liberia to gauge the impact of Trump’s closing of U.S.A.I.D., to see how bad things have gotten. Here’s what I see: Children are dying because medicines have been abruptly cut off, and risks of Ebola, tuberculosis and other diseases reaching America are increasing — while medicines sit uselessly in warehouses…

Join me in the village of Kayata, Liberia, where in April a pregnant mother of two, Yamah Freeman, 21, went into labor. Freeman, a lively woman known for her friendliness to all, soon hemorrhaged and began bleeding heavily, so villagers frantically called the county hospital to summon an ambulance. U.S.A.I.D. previously supplied ambulances to reduce maternal mortality, but this year the U.S. stopped providing fuel, leaving the ambulances idle. Ambulance crew members said they’d be happy to rescue Freeman, if someone would only come and buy them gas.

It’s more than 10 miles through the jungle on a red mud path from Kayata to the hospital, but villagers were determined to try to save Freeman’s life. The strongest young men in the village bundled her in a hammock and then raced down the path, shouting encouragement to her as she lay unconscious and bleeding. They didn’t make it: She died on the way, along with an unborn son.

So when I hear glib talk about waste and abuse in U.S.A.I.D., I think of how we American taxpayers purchased ambulances for Liberia at a cost of more than $50,000 each and then abruptly cut off gasoline funds, leaving a young mom to bleed to death…

Come also to the village of Vonzua in western Liberia, where a woman named Bendu Kiadu is mourning her child Gbessey, who was just 1 year old.

Gbessey caught malaria in March. In normal times, a community health worker would have administered simple medicines for malaria, and the United States noted just last year that it provided “vital” and “critical” support to fight malaria in Liberia. But the closing of U.S.A.I.D. led to the collapse of some supply chains, so health workers had no malaria medicine to offer Gbessey.

Kiadu rushed the child to a clinic, but it, too, had run out of malaria medicine. The next day, Gbessey died…

How often does this happen? The Trump administration is also dismantling data collection, making it difficult to count the deaths it is causing. By one American economist’s online dashboard, about 350,000 people worldwide have died so far because of cuts in American aid. My guess is that the figure isn’t so high, partly because it takes time for children to weaken and die, but that the rate of deaths will accelerate.

We can’t save every child in the world, I realize, and it’s fair to note that not every U.S.A.I.D. program was brilliant and lifesaving. The agency could have used reforms. Yet it’s also true that at a cost of only 0.24 percent of gross national income, we provided humanitarian aid that saved about six lives every minute around the clock, based on rough estimates from the Center for Global Development. That is what we have undone.

One of America’s most heroic achievements in the past half-century was turning the tide of AIDS and saving, so far, some 26 million lives through the President’s Emergency Plan for AIDS Relief, or PEPFAR, started by President George W. Bush in 2003. In particular, PEPFAR made much less common the horror of H.I.V.-positive women inadvertently infecting their babies during childbirth.

And now mother-to-child transmission may be rising again…

In Totota, Liberia, midwives are caring for three pregnant women with H.I.V. but have only enough medicine to prevent mother-to-child transmission for one of them. They don’t know what they will do or what to tell H.I.V.-positive people worried about whether antiretrovirals will continue to be available.

“I asked my supervisor what to do,” said Telmah Smith, one of the midwives. “And he said, ‘Pray that U.S.A.I.D. will come back.’”

Some readers may think: Of course it’s sad that children are dying, but why is it our job to save their lives?

To those unmoved by moral arguments, I’d note that President John F. Kennedy created U.S.A.I.D. in 1961 to advance our interests as well as our values. Aid programs also protect Americans from a threat that aircraft carriers are helpless to combat: disease. U.S.A.I.D. and the World Health Organization (which the United States is now withdrawing from) track outbreaks of diseases like Ebola to extinguish them before they can spread.

So aid cuts are at a level where they undermine our national interest as well as corrode our souls. They are a braid of recklessness, incompetence and indifference — and “indifference” is generous, for the disregard is so deliberate that it bleeds into cruelty.

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