The United States is reshaping how it delivers life-saving medical supplies to poorer nations, a shift that officials and aid sources warn could disrupt treatment for millions battling HIV and malaria.
For nearly a decade, Washington relied on the Global Health Supply Chain Program, run by contractor Chemonics, to move critical drugs and prevention tools across the developing world.
Between 2016 and 2024, the program delivered more than $5 billion in HIV and malaria commodities to 90 countries, largely in sub-Saharan Africa and Asia, forming a backbone for frontline health systems.
That system jolted to a halt when President Donald Trump froze international aid at the start of his presidency, leaving shipments stranded in ports and warehouses.
Essential supplies, from antiretroviral drugs to insecticide-treated bed nets, were caught in limbo.
A later waiver allowed some life-saving deliveries to resume, but stability never fully returned.
Now, a deeper overhaul is underway.
An internal State Department email, confirmed by multiple sources, instructs U.S. missions in 17 African countries and Haiti to stop implementing the supply program by May 30.
The contract with Chemonics is set to end September 30, aligning with a broader wind-down of U.S. Agency for International Development operations, even though the agreement officially runs until November.
The warning signs are clear.
The same email acknowledges “immediate risks to service continuity” if the transition is rushed or incomplete.
Yet it offers no detailed roadmap, leaving country offices to design their own exit strategies and flag potential gaps.
Aid experts say the timeline is tight and the stakes are high.
Five sources told Reuters that accelerating the shift could trigger shortages, especially in regions where supply chains are fragile and delivery windows stretch months.
In remote areas, ordering and distributing medical products can take up to a year, far longer than the compressed schedule now in play.
Behind the scenes, Washington is exploring a new model.
Discussions are underway with the Global Fund to Fight AIDS, Tuberculosis and Malaria, a Geneva-based organization that already manages about $2 billion in annual procurement for the three diseases.
Its pooled purchasing system and digital platform could serve as a future channel for U.S.-funded supplies.
Earlier talks reportedly pointed to a gradual transition by late 2027. The new, accelerated timeline has raised doubts about whether systems on the ground can keep pace.
The overhaul reflects a broader policy shift. Under its America First Global Health Strategy, the administration is moving away from contractor-led programs, arguing they are inefficient and costly.
Instead, it aims to fund frontline services directly, partner with national governments, and rely on private logistics firms for distribution.
Officials say the goal is to cut waste and deliver better value for American taxpayers.
So far, the U.S. has signed 28 bilateral health agreements and pledged direct funding to countries including Kenya, Rwanda and Uganda, though several deals remain under negotiation or face legal scrutiny.
On the ground, the transition is already being felt.
Health workers in some regions report gaps in HIV prevention programs and shortages of malaria treatments for children, early signs of strain in a system under redesign.
With millions dependent on consistent access to medicines, even short disruptions can carry lasting consequences.
