Donald Trump criminalised Cuba’s medical brigade and shot down USAid – however Cuba’s biotechnology business might step in relating to HIV/Aids.
With the stroke of a pen, US President Donald Trump issued a twin assault on international well being infrastructure this month. The primary was an 83% lower to USAid funding that administered the vast majority of Pepfar (President’s Emergency Plan for Aids Aid) initiatives — HIV/Aids therapy infrastructure that’s credited with saving practically 25 million lives worldwide. The second was the criminalisation of Cuba’s historic medical brigades, missions which have deployed 600 000 healthcare employees throughout 160 nations since 1960.
Of Trump’s targets, one can save the opposite.
Activists around the globe are pleading with the Trump administration to rescue Pepfar from the crushing cuts, declaring the plain — in terms of a virus, no one is protected till everyone seems to be protected.
The instant cruelty of the Pepfar determination lies in its abruptness, with tens of millions waking as much as discover their native clinics gutted and susceptible populations, such because the queer neighborhood, particularly in nations like Uganda with strict anti-homosexuality legal guidelines, and intercourse employees left with no authorized choices to entry care.
However zoom out from this second and a permanent disaster comes into focus — the very structure of a system the place such unilateral, abrupt and dangerous cuts are doable.
Nations like Tanzania and Côte d’Ivoire, smaller economies, host HIV programmes which might be practically 90% Pepfar-funded and even South Africa, the continent’s most superior economic system, with the world’s largest HIV inhabitants, depends on Pepfar for 17% of its HIV response. The lives and deaths of tens of millions of individuals, significantly these in sub-Saharan Africa, are fully susceptible to the whims of a overseas energy.
That is no coincidence. Whereas the rhetoric of “African options to African issues” has lengthy echoed via continental boards, the worldwide well being financing structure has paradoxically weakened African capability by centring donor priorities somewhat than native wants.
Solidarity at the price of sovereignty is, in different phrases, subjugation by design. Amid the lethal Covid-19 pandemic, a coalition of pharmaceutical corporations and International North governments blocked patent waivers, refused to share vaccine applied sciences and underfunded multilateral responses. Because the world waited with bated breath for vaccines, Trump pulled the US out of the World Well being Organisation and Invoice Gates reportedly reversed Oxford’s determination to make the AstraZeneca vaccine open-source. That vaccine, when it lastly reached Africa, arrived at a steep premium — Uganda paid $7 a dose, greater than thrice what the EU paid.
International monetary flows are even starker. International help from the International North is a pittance in comparison with the online flows from the International South, whether or not via worth differentials in worldwide commerce, low-cost labour, tax evasion by multinational companies or debt pursuits. Some consultants estimate the drain from the South prices greater than $10 trillion a 12 months, in different phrases, that the “South’s losses outstrip their help receipts by an element of 30”.
“Our expertise with the Covid-19 pandemic taught us that we should turn out to be self-reliant or face being on the mercy of wealthy nations within the West who proved themselves able to acts like hoarding life-saving vaccines and giving us, as Africans, the leftovers,” declared Ronald Lamola, South Africa’s minister of worldwide relations and cooperation, in a fiery speech to parliament after the US determination. “It should not occur once more. It is not going to occur once more.”
To construct an alternate, Lamola want solely look to Trump’s second goal — Cuba. Since 1963, when Cuban medical professionals first arrived in newly impartial Algeria, Cuba has demonstrated a basically totally different strategy to worldwide well being solidarity. Not like conventional donor fashions that create dependency, Cuban-style cooperation builds capability and emphasises information switch.
Cuban missions prepare foreigners in their very own nations, when services can be found, and in Cuba when they aren’t. By 2016, Helen Jaffe, famend scholar of Cuba notes, “73 848 overseas college students from 85 nations had graduated in Cuba” alongside “12 medical colleges abroad, largely in Africa, the place over 54 000 college students have been enrolled”.
Much less recognized, nonetheless, is Cuba’s biotechnology business. Regardless of, or somewhat due to, financial sanctions and restricted international market entry, Cuba has created a outstanding ecosystem with about 1 200 worldwide patents and medical exports to over 50 nations. The nation produces greater than 60% of its pharmaceutical wants domestically and has maintained a optimistic commerce steadiness on this sector.
It’s no shock then that, through the Covid-19 pandemic, Cuba emerged self-reliant, producing two profitable vaccine candidates and main “vaccine internationalism” — open collaboration over applied sciences, solidarity pricing and pooled manufacturing capability — alongside nations like Mexico and Argentina.
In the meantime, the Henry Reeve Brigade, a bunch of Cuban medical professionals with a mission of “medical internationalism”, served 35 nations, together with vital contingents throughout Africa.
That mannequin is now underneath direct assault. On 25 February, US Secretary of State Marco Rubio introduced restrictions on visas for presidency officers in Cuba and any others worldwide who’re “complicit” with these medical help programmes, including to the 20 January order declaring Cuba a “state sponsor of terrorism”.
Washington’s technique is devastatingly clear — dismantle Western-funded well being methods with one hand whereas crushing South-South alternate options with the opposite. This coordinated assault leaves Africa with a stark alternative that Lamola has already made: “We’re dedicated to participating in international well being diplomacy from a place of power, not weak point.”
A number of Caribbean governments have performed simply that. Barbados’s Prime Minister Mia Mottley was fierce in her response to Rubio’s coverage, noting that Barbados “couldn’t have gotten via the pandemic with out the Cuban nurses and the Cuban docs”. Alongside her, the prime ministers of Trinidad and Tobago and of St. Vincent and the Grenadines, have publicly protested the brand new coverage and declared they’d be prepared to lose their US visas.
That spirit of worldwide solidarity, mixed with progressive home coverage, might herald an altogether new paradigm. The African Union’s 2022 New Public Well being Order, which requires strengthened public well being establishments, home useful resource mobilisation, native manufacturing and well being workforce improvement, provides such a blueprint, however lacks a pacesetter.
The South African authorities might carry that imaginative and prescient to life, with three strategic imperatives.
First, strengthen home healthcare. The Pepfar disaster demonstrates that even beneficiant exterior funding undermines sovereignty when donor politics comes into play. That is already in movement — the latest funds elevated well being allocation to R298.8 billion in 2025-26, with a projected improve to R329 billion by 2027-28. However, funding alone is not going to suffice; healthcare have to be public and common.
Second, pursue southern diplomacy. Cuba has succeeded in offering comparable well being outcomes to developed nations however at one-tenth the per capita spending of the US. This provides useful classes for African nations going through related useful resource constraints. A biotech hub, Cuba is widely known by the World Mental Property Organisation as “a mannequin for native manufacturing, licensing and know-how switch” that might act as a “blueprint for well being emergencies”. A complete biotechnology partnership between South Africa and Cuba, that transcends the prevailing physician alternate programmes, might obtain simply that.
Third, advance regional integration. Africa, particularly Southern Africa, may benefit from collective pricing, buying and manufacturing methods. Latin America provides promising fashions: the “Medication Value Financial institution” launched by the Union of South American Nations in 2016 — a easy database of drug costs — allowed governments to drive down prices on the negotiating desk whereas difficult Large Pharma’s contractual secrecy.
The transition towards well being sovereignty requires troublesome however needed decisions. Rising home financing means reprioritising budgets. Constructing pharmaceutical sovereignty means difficult highly effective multinational pursuits. Deepening cooperation with Cuba means doubtlessly going through additional antagonism from Washington.
But the implications of continued dependency have been made clear. As each Pepfar and Cuban medical missions face unprecedented threats, South Africa and Cuba confront a historic alternative to reconfigure the worldwide healthcare structure — and forge a brand new path centered on sovereignty and sustainability.
“We must always not bemoan america of America’s determination,” declared Lamola, “however seize this second as a catalyst for change.” For the tens of millions throughout Africa whose well being safety hangs within the steadiness, South Africa’s management has by no means been extra strategically very important.
Varsha Gandikota Nellutla is the final co-coordinator of the Progressive Worldwide and a public affairs graduate of Princeton College.
Nontobeko Hlela is a analysis fellow with the Institute for Pan African Thought and Dialog on the College of Johannesburg.