Health advocates fight back: Legal battle over US foreign aid cuts

ONCE a child is born HIV-positive or a malnourished infant dies, no restoration of funds can undo the loss. Each day of suspended aid compounds the toll: vaccination gaps fuel outbreaks; treatment lapses seed drug-resistant strains; and shuttered clinics sever lifelines for survivors of violence and displacement.

This is among the warnings contained in  court documents filed by several health advocacy groups in an ongoing legal challenge to the Trump administration’s suspension of nearly all foreign aid and the effective dismantling of the US Agency for International Development (USAID).

Recently, a three-judge panel of the US Court of Appeals overturned a lower court’s temporary block on the aid freeze, ruling that the case lacked a valid legal basis as currently presented. However, one judge dissented, cautioning that Trump's actions may have violated constitutional principles. 

In response, the organisations have urged the full court to rehear the case, arguing that the block (injunction) should be reinstated to prevent further irreparable harm while the court fully addresses the legal and constitutional questions.

Among those filing a new amicus curiae brief are Physicians for Human Rights (PHR), the Open Society Justice Initiative (OSJI), health professionals, and affected individuals from Kenya and South Africa, including renowned South African physician Dr. Salim Abdool Karim.

The amicus brief draws on research and documentation of the emerging harms of the US aid cuts, including PHR’s recent research in Ethiopia, Democratic Republic of the Congo, and Kenya, plus insights from global health experts (Dr. Salim S. Abdool Karim, FRS, Dr. Dvora Joseph Davey) and a Kenyan woman (Mary “Doe”) raising a child living with HIV. 

“Maternal-health programs reaching 93 million women and children have been cut by 92 percent; water and sanitation initiatives slashed by 86 percent; and vaccine programs halted threatening 500 000 preventable deaths annually.  The freeze has derailed USAID-funded HIV prevention trials, abandoning participants mid-study and raising the risk of drug-resistant HIV, which experts warn will be “catastrophic” for global health. For amici, these projections are daily reality,” the PHR brief read. 

In an example close to home, court papers cite research by Dr. Dvora Joseph Davey who has led a study since 2003 on rolling out PrEP (medication taken to prevent acquiring HIV) in eight maternity clinics across Cape Town.  In 2024, only three babies in the study were born with HIV; in the first five months of 2025, there were already three.

"In Tigray, Ethiopia, health workers reported to amicus PHR that in one camp alone, eight internally displaced people, including a pregnant woman, died when USAID-supported care was cut off. In the DRC, clinicians have reported severe maternal cases, including uterine ruptures and deaths from unattended home births following the loss of USAID-supported services."

Karim, who is chair of the Africa CDC’s Emergency Consultative Group, said he had witnessed the Mpox vaccination program grind to a halt overnight when USAID staff managing vaccine storage in the DRC were barred from releasing supplies locked in USAID storerooms. 

“Several hundred new Mpox cases are now reported each week in the DRC, with a death rate just over 1%.” 

Doe, whose 15-year-old daughter is HIV-positive, explained that as a result of the sudden withholding of aid, it has become increasingly difficult to obtain the antiretroviral treatments needed to treat her daughter’s HIV infection.

“In one Ugandan clinic, five of 20 babies delivered between mid-January and mid-April were born HIV positive, a devastating reversal after years of near elimination of mother-to-child transmission.”

The health advocates further contend that “prevention is cheaper than response”. 

“History confirms the danger: “reductions in funding for global health initiatives… correlate with surges in disease.” 

By contrast, USAID’s surveillance was the reason the deadly 2014 Ebola outbreak was contained to West Africa, with only 11 cases reaching US soil, thereby averting a domestic catastrophe. USAID has added more than 30 years to U.S. life expectancy. Those gains now hang in the balance, as the abrupt cessation of aid threatens to unleash new threats to the American public.  Then-Senator Marco Rubio (now Trump’s Secretary of State)  agreed: “We don’t have to give foreign aid. We do so because it furthers our national interest.”

In their bid to reverse the funding freeze, organisations said: “The real-world harms at issue are immediate and irreversible,  lives lost, children harmed, and heightened threats to Americans’ health and fiscal interests, including from the spread of infectious diseases”.

“For these reasons, amici respectfully urge the Court to grant rehearing en banc (full bench) and preserve the district court’s injunction.”

Cape Times