After nearly two months of disruption that paralysed hundreds of global health research projects, the U.S. National Institutes of Health (NIH) has issued a quiet reversal of parts of its controversial May 1 funding freeze on international subawards, offering a lifeline to stalled clinical trials in South Africa and other countries.
The abrupt policy—originally introduced under a Trump-era directive—halted over $400 million in foreign research funding, disproportionately affecting HIV and tuberculosis trials in South Africa. At least 27 HIV and 20 TB trials were suspended mid-course, triggering layoffs, regulatory chaos, and potential harm to study participants.
Now, in a limited but critical move, NIH has unveiled an alternative payment scheme. Certain international subawards can now be restructured into direct “supplement” grants, still routed through U.S. prime awardees but paid directly to the foreign partners, enabling paused human clinical trials to cautiously restart.
“The sudden stop created a major ethical and regulatory nightmare,” said Prof. Ian Sanne, co-lead of the Wits HIV Research Group. “We lost time, participants, and credibility.”
An internal NIH memo dated June 27 and a subsequent public guidance released June 30 confirmed that roughly 100 NIH-funded projects in South Africa are now cleared to resume under the supplemental structure. The workaround, however, is temporary and applies only to active human trials.
For researchers like Dr. Glenda Gray, Chief Scientific Officer at the South African Medical Research Council, the damage is already done.
“While the restart is welcome, we’ve lost data, staff, and momentum,” she said.
The initial freeze, linked to Trump-era mandates aimed at tightening U.S. research oversight, impacted over 2,000 NIH grants, some of which focused on politically sensitive areas like gender, reproductive rights, and international collaboration. The NIH has yet to publish full clarity on the future of international funding under its evolving structure.
The long-term plan appears to involve shifting foreign collaborators from subaward recipients to direct applicants, with a new NIH international funding mechanism expected by September 30. However, researchers warn of fresh bureaucratic barriers that may hinder collaboration.
“We are grateful,” said Dr. Monica Gandhi of UCSF, whose team runs NIH-backed projects in South Africa. “But two months of paralysis in global health research is something we can’t afford again.”
South Africa remains a cornerstone of global HIV and TB clinical research due to its high disease burden and robust scientific infrastructure. In 2024, NIH issued over 3,600 subawards to global partners, with South African institutions among the largest recipients.
While the current workaround offers temporary relief, experts caution that it is not a permanent solution. Until NIH fully outlines its new international funding policy, the stability of global health partnerships remains at risk, just as the world looks to collaborative science to confront pandemics, drug resistance, and emerging diseases.
Article by RB Correspondent
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