If all of its National Institutes of Health funding falls away, the country could lose 70% of its medical research capacity
R6.65 billion — or $350 million. That’s how much South Africa receives in annual funding from the US government’s National Institutes of Health (NIH) when the totals of direct grants, subgrants and funding from network studies are added up, numbers from the South African Medical Research Council and Bhekisisa’s calculations show.
For direct grants, SA researchers are the main grant holders for a project and are responsible for its budget. In the case of subgrants, SA projects get research money from projects where the principal investigator is elsewhere (probably at a US institution) and network studies mean SA researchers who are part of a unit that runs clinical trials get awarded money for a study through that network.
The bulk of the NIH’s budget supports scientists in the US — whether in-house at the NIH’s headquarters in Bethesda, Maryland, or at universities and independent research facilities elsewhere in the country, and only a sliver is paid directly to grant holders in other countries.
However, many of the projects with US scientists as the primary grant holders have extensive collaboration with researchers elsewhere. This means that a large part of the NIH funding awarded to US institutions is paid as subgrants to colleagues in other parts of the world — including South Africa — to set up studies for data collection and analysis, which bolsters research efforts in those countries.
If South Africa loses all of its NIH funding, the country could — conservatively — lose 70% of its medical research capacity, our sums reveal.
An NIH memo leaked in March, on which Bhekisisa and the science journal Nature reported, instructed officers to hold “all [research] awards to entities located in South Africa” and listed SA as a “country of concern”, along with China. However, so far, no action has been taken.
Losing 70% of our research capacity would be a massive blow for South Africa — yet it would make less than a 1% difference to the NIH budget in the US (assuming that it would be similar to that over the past couple of years).
Close to three-quarters of the grants South African principal researchers were awarded by the NIH in 2023/24 were for projects linked to HIV or tuberculosis (TB).
Moreover, as Bhekisisa reported last week, figures that the health department obtained from the US government’s Aids fund, Pepfar, show that Pepfar-supported HIV and TB implementation projects that President Donald Trump’s administration defunded in February, come to a total loss of R4.45 billion for this financial year.
Adding the potential losses to research grants could have grave consequences for ending these diseases as public health threats by 2030.
South African scientists produced the third most journal articles on HIV and TB between 2014 and 2018.
Getting a total of how much money for biomedical science comes to South Africa through NIH funding is not easy, though.
But we trawled through the numbers to put an estimate together, based on what we think are reasonable assumptions and given what experts have shared with us. Here’s our thinking.
Number games
The data on NIH funding to researchers that is publicly available at the moment shows only amounts awarded to principal investigators — researchers who are the main grant holder for a project and are responsible for its budget.
Over the past eight years, the total amount paid to such research leads based in South Africa was, on average, around $45 million (about R850 million) a year.
“Getting to that point is hard work,” says Linda-Gail Bekker, head of the Desmond Tutu Health Foundation, which has received NIH funding for many years.
“A grant is never just ‘given’ — each application is reviewed by a panel of experts and only if they find the proposed project has merit and so will be worth investing in, will they award the money.”
Grant holders also have to pass a clean audit every year, done to US rules, to prove that they’re spending the funds responsibly, she adds.
As explained in our intro, scientists can also be funded through being subgrantees on projects where the principal investigator is (probably) at a US institution (and went through the same strict application process) or by being part of a network study. Bekker explains that getting funding through a network study means a researcher who is part of a unit that runs clinical trials gets awarded money for a study.
Ntobeko Ntusi, CEO of the South African Medical Research Council (SAMRC), the local equivalent of the NIH and the biggest funder of medical research in South Africa, told Bhekisisa that “before January 20, there was a second portal of the NIH that hit that level of granular detail [amounts linked to subgrants], which has [since] been disabled”.
However, Ntusi explains that roughly $100 million of NIH funding (about R1.9 billion, at the current exchange rate) is awarded to South African researchers through subgrants every year and about $50 million (about R950 million) through direct awards to principal investigators. A further $200 million (R3.8 billion) or so sits in funding from network studies, which brings the total to around $350 million (R6.65 billion).
A case of David and Goliath
For our analysis, and to be able to make qualified comparisons, we focused only on amounts local researchers may have had through direct grants and being subgrantees, specifically in the 2023-24 financial year.
We know that the amount of funding made available through subgrants is about double that from direct awards. If we take the roughly $47 million (R870 million) from direct awards plus an estimated amount twice that for the funding flowing to researchers through subgrants, those two avenues of NIH support give just over R2.6 billion.
From these numbers alone, we estimate that if NIH funding to South African scientists were stopped, the country could lose — conservatively — 70% of its medical research capacity.
This would be a massive blow for South Africa — yet it would make less than a 1% difference to the NIH budget in the US (assuming that it would be similar to that over the past couple of years).
To get to this slice, we worked on about $46 billion (R851 billion) being available as the NIH’s research budget. (According to the agency’s website, 6% of their total budget — which our sums show would have been about $49 billion in the period we looked at — covers admin, building maintenance and other operational costs.) We then subtracted the total amount awarded to all principal researchers outside the US, along with the estimated amount that South African researchers would have gotten through subgrants.
Together, this makes up 0.7% of the total NIH research budget, meaning about $45.7 billion would have been available to scientists in the US.
Converting these amounts to rand, at an exchange rate of R18.50 to the dollar, shows that a total of about R2.6 billion in NIH funding would have been available to South African research groups, combined from direct grants and subawards.
The SAMRC’s revenue from grants, including both foreign and local funders, together with the amount it gets from the government, was close to R1.35 billion in 2023-24. (We assume that all of it supports research.) We subtracted R237 million from that amount, as SAMRC figures shared with Bhekisisa show that this was how much they received through NIH funding in 2024, and we therefore assumed it could have been a similar figure the previous year.
That brought us to a total of around R3.71 billion being available for medical research in South Africa in 2023-24, of which about 70% was from NIH backing, either to local research leads directly or through subgrants.
A blow to South Africa is a blow to the world
Close to three-quarters of the money South African principal researchers were awarded by the NIH in 2023/24 was for projects linked to HIV or TB. That works out to just over $34.3 million — about R635 million. Almost a fifth of that was directed to clinical trials.
Last week, Bhekisisa reported that figures that the health department obtained from the US government’s Aids fund, Pepfar, show that Pepfar-supported HIV and TB implementation projects that the Trump administration defunded in February, come to a total loss of R4.45 billion for this financial year.
Adding the potential losses to research grants could have grave consequences for ending these diseases as public health threats by 2030.
Take, for example, the studies on the six-monthly anti-HIV prevention drug lenacapavir, in which Bekker and her colleagues played an important part. Results released since July last year show that the jab was 100% effective in preventing HIV infection in cisgender women between 18 and 25 and works just as well in 16–17-year old girls, cisgender men and transgender people.
If South Africa were to roll out the medication soon, it could stop enough new infections that Aids would practically end being a public health threat in the country by 2032, a modelling study shows.
But progress like this doesn’t happen overnight; it follows from years and years of prework.
Although the lenacapavir clinical trials weren’t directly funded by NIH money, they were done at research sites of which many have grants from the US agency — and have had for years, says Bekker. This type of backing lays the foundation for future research, like setting up facilities, paying scientists’ salaries and training young researchers.
‘An opportunity to reimagine research’
“Great science is done in collaboration with the US and, if that stops, it will create a huge [research] gap,” says Bekker.
Indeed, South African scientists produced the third most journal articles on HIV and TB between 2014 and 2018, most of which came out of research groups at the University of Cape Town and Wits. Moreover, almost three-quarters of these two institutions’ HIV and TB papers were written in collaboration with overseas scientists.
Ntusi agrees, saying that the US investment over decades, which has helped to build high-calibre research capacity in South Africa, should not be forgotten.
“Seminal contributions from our scientists have been good, not only for the country, but also for the world. At the same time, we should continue to express solidarity with our peers in the US, who are similarly affected as we are. Many of them are losing their jobs, have had their grants terminated and are feeling overwhelmed.”
Yet the US “will remain a really important player in global health”, Ntusi says, and despite the current upheaval, there’s “an opportunity [for scientists] to reimagine their research operations”.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
