The United States is fundamentally changing how it delivers medical supplies for diseases such as HIV and malaria to lower-income nations, raising concerns about potential disruptions to critical health services. Since 2016, the Global Health Supply Chain Program – Procurement and Supply Management, operated by the private contractor Chemonics, has managed over $5 billion in HIV and malaria products distributed across 90 countries, primarily in sub-Saharan Africa and Asia.
However, this program was halted early last year when President Donald Trump froze international aid on his first day in office, leaving millions of dollars’ worth of supplies stranded in ports and warehouses. These included essential HIV medications and insecticide-treated bed nets. Although much of the work resumed after the US issued waivers for life-saving products, the program’s future has remained uncertain amid a broader restructuring of foreign aid. This includes dismantling the US Agency for International Development (USAID), budget cuts, and a shift from contractor management to bilateral agreements with recipient countries.
In a significant development, the US State Department instructed its staff in 17 African countries and Haiti to stop implementing the supply program by May 30. The contract with Chemonics is set to end on September 30, aligning with the expiration of all USAID awards, despite an official end date in November. The communication warned of potential immediate risks to service continuity if the transition is rushed or incomplete, yet it did not provide a detailed transition plan. Instead, it tasked each US country office with outlining how it would manage the handover and report any risks or requests for additional time.
Meanwhile, the State Department clarified it had not given Chemonics any technical directive to cease operations by May 30 or any other date. Chemonics declined to comment on the situation.
Discussions are reportedly underway between the US and the Global Fund to Fight AIDS, Tuberculosis and Malaria about potentially using the Fund’s supply platform for future procurement and delivery of global health products. The Geneva-based Global Fund currently manages approximately $2 billion annually in health product purchases for these diseases and operates an online procurement platform used by partner organizations. Earlier talks had considered a transition by November 2027, but sources indicate this timeline is now seen as unrealistic, given that ordering medical supplies for remote areas can take up to a year, far longer than the weeks currently being planned for the transition. The Global Fund has not commented on these discussions.
The State Department did not directly address whether it is negotiating with the Global Fund but stated it intends to use available pooling mechanisms to procure supplies at the lowest prices from private manufacturers.
Last year, the Trump administration announced a shift in global health strategy, emphasizing funding for frontline health supplies, workers, and technicians, and favoring direct partnerships with individual countries. The America First Global Health Strategy, released in September, criticized contractors as sources of inefficiency and waste that the administration aimed to eliminate.
However, the rapid changes in aid delivery have already led to challenges worldwide, including shortages of malaria drugs for children and gaps in HIV prevention efforts. A State Department spokesperson described the existing system as “a bloated piece of an obsolete development model” that prioritizes the interests of large US-based development firms over American taxpayers. The US government has since signed 28 bilateral health agreements with recipient countries and plans to rely primarily on private logistics companies for supply distribution.
Recently, Washington has committed to providing funding directly to governments in countries such as Kenya, Rwanda, and Uganda, alongside pledges to increase national health spending. Nevertheless, these arrangements are still being finalized. For instance, the Kenya agreement faces legal challenges from activists concerned about data privacy, while negotiations with Zambia have experienced delays.
