Asanda Zondi, a 22-year-old participant in a health study in Vulindlela, South Africa, received a surprising call last Thursday. She was instructed to immediately go to a local health clinic. Upon arrival, she learned that her involvement in a trial for a new device aimed at preventing pregnancy and HIV infection was abruptly ending. The U.S. Agency for International Development (USAID), which had funded the study, abruptly withdrew financial support in response to an executive order freezing foreign aid for 90 days.

The ripple effect of immediate funding cuts

Zondi’s trial is one of many global studies abruptly halted. The U.S. government’s move follows a broader plan to dismantle USAID entirely. Participants are left in limbo, cut off from the researchers monitoring their health. This situation has generated significant suspicion and fear among volunteers and ethical concerns among scientists.

Dr. Leila Mansoor, a scientist with CAPRISA, took ethical responsibility, deciding to ignore the stop-work orders and help participants remove the rings. She explained, “My first thought when I saw this order was, There are rings in people’s bodies and you cannot leave them. For me ethics and participants come first.”

Implications for global health research

USAID’s abrupt closure has affected over 30 studies worldwide. The frozen projects include testing treatments for malaria in Mozambique, cholera in Bangladesh, cervical cancer screening in Malawi, tuberculosis treatment in Peru and South Africa, among others. The ethics of such an abrupt stop have been widely debated, particularly since the United States is a signatory to the Declaration of Helsinki, which mandates continued care for study participants.

The long-term impacts of leaving study volunteers without follow-ups can be severe. For example, in England, about 100 participants in a malaria vaccine trial now lack access to clinical trial staff in case of adverse reactions. If nations’ health research is undermined, global health security is put at risk.

Collateral damage to scientific progress

Dr. Sharon Hillier, director of a five-year, $125 million HIV prevention study until the shutdown, expressed deep concern. “We have betrayed the trust of ministries of health and the regulatory agencies in the countries where we were working and of the women who agreed to be in our studies,” she said. The stop-work order prohibits any implementing agency from publicly discussing what has transpired, further complicating efforts to resolve the situation.

Even studies not directly funded by USAID suffer repercussions, as they rely on the agency’s infrastructure. This halt poses ethical issues, financial losses, and operational disruptions for pharmaceutical companies, development organizations, and researchers.

Failure to follow-through on ethical obligations

The long-term consequences of USAID’s move include potential drug resistance and lack of proper treatment continuation. For instance, a trial in Uganda testing a new regimen for tuberculosis treatment for children is now impaired. And in another trial, thousands of volunteers across five countries participating in an injectable HIV prevention drug regimen face uncertain health outcomes.

According to Dr. Kenneth Ngure, president-elect of the International AIDS Society, if participants do not receive regular injections or a controlled end to the drug use, they risk becoming reservoirs for drug-resistant HIV mutations. This situation highlights the significant ethical implications of abruptly halting such critical research.

A call for action

This crisis underscores the critical importance of transparent, ethical, and accountable oversight of global health research. The abrupt halt to these studies has cut off essential support for thousands of volunteers globally and interrupted critical health research needed to combat major diseases.

The scientific and ethical fallout from USAID’s actions should serve as a wake-up call to policymakers. The well-being of research participants must always take precedence over political agendas or short-term financial considerations.