On February 6, 2025, The New York Times reported that clinical trials backed by the U.S. Agency for International Development (USAID) had been abruptly shut down following an executive order by President Trump, freezing all foreign aid for at least 90 days. This sweeping order has left thousands of clinical trial participants stranded, many with experimental drugs or medical devices in their bodies, without access to follow-up care or monitoring. The shutdown not only jeopardizes individual patients but also derails critical research efforts that could have led to breakthroughs in infectious disease treatments, maternal and child health, and vaccine development.
The Human Cost of Abandoning Clinical Trials
In Vulindlela, South Africa, 22-year-old Asanda Zondi received an urgent call from a health clinic, instructing her to come in immediately for the removal of a vaginal ring that was part of an HIV prevention study. The research, funded by USAID, had been abruptly halted, and participants were left with no further guidance. Similar scenes are playing out across the globe as trials studying treatments for malaria, tuberculosis, cholera, and malnutrition have been frozen mid-course (The New York Times).
According to The Guardian, the stop-work order has dismantled decades-long efforts to develop next-generation malaria vaccines, a field in which USAID has been a key financial and logistical supporter. Malaria still kills over 600,000 people annually, disproportionately affecting children in sub-Saharan Africa. Trials meant to improve existing vaccines and protection rates have now been thrown into limbo, erasing years of progress.
A similar fate has befallen a tuberculosis treatment study in Uganda, which was testing a promising new regimen for pediatric tuberculosis patients. The abrupt withdrawal of USAID funding means that children in the trial are now left without access to the very medications they were being studied for, raising ethical and medical concerns about abandoning vulnerable patients in the middle of treatment.
A Crisis of Ethics and Trust
The shutdown of these trials raises profound ethical questions. The United States is a signatory to the Declaration of Helsinki, which mandates that researchers provide continued care for clinical trial participants. Yet, the executive order has effectively made it illegal for researchers to continue their work, leaving participants at risk.
Dr. Leila Mansoor, a scientist with the Centre for the AIDS Programme of Research in South Africa (CAPRISA), was among those forced to defy the stop-work order to remove devices from participants' bodies. "For me, ethics and participants come first. There is a line," she told The New York Times. Many researchers now face an impossible choice: either abandon trial participants or risk violating the terms of the government’s order.
Moreover, trust in international clinical research has been deeply damaged. In many low-income countries, where historical injustices have made medical research a contentious issue, such an abrupt cessation of trials fuels skepticism and conspiracy theories about Western-backed medical interventions. It has taken decades to build community relationships and trust in experimental treatments, and that trust has now been shattered.
Impact on the Biopharmaceutical Industry
The consequences of this halt extend far beyond public health. USAID-funded trials have been instrumental in the early-stage development of many drugs and vaccines that later receive private-sector investment. Biopharma companies partner with USAID to de-risk investments in emerging market treatments, particularly for diseases like malaria, tuberculosis, and HIV/AIDS, which primarily affect lower-income nations.One significant casualty is the CATALYST trial, which was testing the long-acting injectable HIV prevention drug cabotegravir in five countries. Without regular injections, participants may develop drug-resistant strains of HIV, potentially undermining the efficacy of one of the most promising new preventative treatments. The trial was a key initiative in expanding the global reach of HIV prevention drugs, and its suspension poses risks not only to those enrolled but to future treatment accessibility.
Pharmaceutical companies, which often rely on public-private partnerships to test and validate new drugs, are now facing uncertainty in conducting trials in global markets. Dr. Sharon Hillier, a leading infectious disease researcher, told the New York Times that this decision "has made it impossible for pharmaceutical companies to do research in these countries." Many firms may now be hesitant to invest in collaborations with U.S.-funded programs, fearing that political instability could upend their efforts.
The Geopolitical Consequences
The decision to freeze USAID’s global health initiatives is also a geopolitical setback for the U.S. For decades, USAID has been a pillar of American soft power, fostering goodwill and strengthening alliances through its health and development programs. With its sudden dismantling, U.S. influence in global health governance is waning, creating an opportunity for other countries—particularly China—to step in and fill the void.
Beijing has been expanding its Belt and Road Initiative into healthcare, funding medical infrastructure and vaccine development in many of the same countries affected by the USAID freeze. Experts warn that the U.S. retreat from global health leadership could shift strategic alliances, as nations increasingly look elsewhere for support in tackling pressing health challenges.
The Far-Reaching Consequences of Freezing Foreign Aid
Beyond the immediate risks to clinical trial participants, freezing foreign aid disrupts global health programs, economic stability, and scientific progress. Many low-income countries rely on foreign aid not just for research but for basic healthcare services such as vaccinations, maternal and child health programs, and infectious disease prevention. The sudden halt of funding jeopardizes essential medical treatments, leading to rising mortality rates and an increased burden on already overstrained healthcare systems. Malaria prevention programs, tuberculosis treatment initiatives, and childhood nutrition interventions could collapse, reversing decades of progress in disease control and public health.
The disruption of USAID-funded clinical trials also has significant consequences for the global pharmaceutical industry. Many biopharmaceutical companies rely on public-private partnerships to conduct trials in low- and middle-income countries, where diseases like malaria and tuberculosis are most prevalent. Without these studies, companies lose critical data necessary for advancing drug development and securing regulatory approval. The long-term economic ramifications include a slowdown in research pipelines, reduced pharmaceutical exports to affected regions, and increased costs for developing new treatments. Furthermore, clinical trials that depend on USAID-supported healthcare infrastructure — such as hospitals, laboratories, and supply chains — are now at risk, even if they were not directly funded by the agency.
The halt in funding has also created an ethical and legal quagmire. Many trials require long-term monitoring of participants, particularly those involving experimental drug regimens or medical devices. Without continued oversight, trial participants could suffer severe health consequences, and researchers could face legal liabilities for failing to provide necessary care. The loss of trust in research institutions may discourage future participation in clinical trials, hampering medical innovation and delaying the development of life-saving therapies.
Finally, this disruption affects global health security. Infectious disease research plays a crucial role in pandemic preparedness, and the cessation of USAID-backed studies weakens early warning systems for emerging health threats. Without sustained investment in global health, new infectious diseases may go undetected longer, increasing the risk of outbreaks that could spread worldwide. The interconnected nature of modern medicine means that neglecting global health challenges ultimately poses risks to public health everywhere.
A Call to Action
The abrupt shutdown of USAID-funded trials is a crisis that demands urgent redress. Scientists, healthcare organizations, and global health advocates are calling on the administration to reinstate funding for ongoing trials, at the very least to allow researchers to complete the work already underway. The suspension of these studies not only jeopardizes the health of thousands but also erases billions of dollars in research investments, delaying or even permanently halting the development of life-saving treatments.
Organizations such as the International AIDS Society and the Global Fund to Fight AIDS, Tuberculosis, and Malaria are urging the U.S. government to honor its commitments to global health. Additionally, biopharma industry leaders must step up to fill the gap, leveraging private funding and advocacy to keep critical research afloat.
The coming months will determine whether this decision is a temporary setback or a lasting blow to global health and biopharmaceutical progress. One thing is clear: the world cannot afford to let political decisions override ethical obligations and scientific progress. Lives—and the future of global health—are at stake.
