The sudden freezing of USAID funds is jeopardising the goal of eliminating viral hepatitis by 2030. In an editorial published 14 February, the Lancet Gastroenterology & Hepatology said efforts to scale up testing for hepatitis B and hepatitis C are at most immediate risk.
The editorial pointed out that USAID distributes half of US foreign aid, and its shuttering has had abrupt effects around the globe. Communities are still coming to grips with the repercussions of actions that include withdrawing from WHO, instructing agencies to pause external communications and collaborations, freezes to foreign aid, cuts to funding from the National Institutes of Health (NIH), and a backslide on efforts to improve inclusivity, the editorial said, posing the question:
“What are their implications for viral hepatitis elimination, for which progress has already stalled?”
Funding for viral hepatitis is already scarce. Rollback of international support might see governments pivot limited resources to focus on diseases that are deemed a higher priority
It said although The Global Fund has recently broadened support for viral hepatitis, reductions to its funding may see it “revert to solely focusing on closing gaps in treatment and prevention for its core diseases.”
It noted that USAID was a major donor to the Vaccine Alliance, Gavi, which only launched its hepatitis B birth-dose vaccination program in June 2024, and adding that speculation that the UK may also be planning to cut support to Gavi was deeply alarming.
“Funding for viral hepatitis is already scarce. Rollback of international support might see governments pivot limited resources to focus on diseases that are deemed a higher priority.”
On a broader level, it said, reduced contributions to WHO and less international collaboration put other crucial activities, such as disease surveillance, drawing up elimination plans and tracking progress towards elimination.
The editorial follows a letter to the Lancet from a group of prominent health researchers and advocates, published on 6 February, warning of a new threat to global health. The authors called for “immediate practical action to protect individuals and communities, preserve data, and defend public health systems, by supporting, restoring, and resourcing crucial activities that protect and preserve health for all”.
“Many people have little awareness of the complex national and international systems that provide them with safe water, food, diagnostics, medications, blood products, and vaccines,” the letter said. “They are protected by global programs and collaborations that have pre-empted or ended epidemics, preventing mass morbidity and mortality. There are extensive data and reporting systems that contribute to identifying and confronting public health threats, from viral hepatitis to cancer.”
Dr Su Wang, one of the letter’s authors, said in an interview with Contagion Live that on top of the shuttering of USAID, the US withdrawing from the World Health Organisation (WHO) was very concerning for the health community because there was a lot of collaborative work being done between the CDC and the WHO, and not only did the US withdraw from the WHO, but CDC staff were not allowed to communicate with the WHO.
There are no boundaries. You may have a boundary on a map, but it doesn’t happen in real life.
“We need people to realise that our global health ecosystem really relies … on these collaborations, collaborations that require input from people from different countries, and that collaboration is really core to our safety across the world,” she said.
Such collaboration, she added, helps to identify outbreaks, and have an immediate response so that these outbreaks don’t go out of control.
“We feel like it’s not happening in our country, it won’t affect us but we saw what’s happening with Ebola. People travel to these places and bring them back.
“There are no boundaries. You may have a boundary on a map, but it doesn’t happen in real life. So this is very concerning to us, this break in the global health ecosystem.”
Dr Wang raised the issue of the sudden withholding of regular CDC reports such as the Flu Surveillance Report and the Morbidity and Mortality Weekly Report (MMWR).
“The MMWR which had been around since the 1800’s and put out weekly since the 1950’s, for the first time did not have a publication,” she said. “It is concerning because that publication is used to convey what is happening in a timely way, such as what is happening with Avian Influenza…
As a scientific medical community we have to keep on top of these things because … we still need access to … reliable information.”
“Without these reports, we are operating in the dark.
“Besides that, there are other databases suddenly not available. Fortunately we heard that some scientists had archived some of these pages, so we have still access to them for reference.
“As a scientific medical community we have to keep on top of these things because during the middle of this transition, we still need access to … reliable information.”
Dr Wang also spoke of the need for the medical community to rise to the occasion to fill in the sudden gap in services for vulnerable, at-risk communities. This reflects the joint letter which said, “The sudden sabotage of disease control efforts has profound and immediate effects, especially among marginalised and under-served groups who already experience health and social inequities.
“We know that—along with infectious diseases—reproductive health, migrant health, global health, and activities focused on advancing equity are among the most vulnerable targets. But in fact, no one is safe; in our interconnected world, status does not insulate individuals or countries from public health threats.”
“If there is a shift in prioritisation and funding,” they said, “there are ways of transitioning with transparent dialogue, rather than this abrupt and wholesale closure of lifesaving programs that leads to the abandonment of many stakeholders and recipients.
“The current catastrophic threat to global health infrastructure must be stopped.”
The following are the authors of the letter:
- Su Wang, Past President World Hepatitis Alliance, and Medical Director of Viral Hepatitis Programs, Center for Asian Health, Cooperman Barnabas Medical Center
- Mark Harrington, Executive Director of Treatment Action Group
- Camilla Graham, Infectious disease specialist, Beth Israel Deaconess Medical Center
- Louise Downs, Infectious Diseases Physician, KEMRI-Wellcome Trust
- Nancy Kagwanja, Health Policy & Systems Researcher, KEMRI-Wellcome Trust
- Anthony Etyang, Head of Epidemiology and Demography, KEMRI-Wellcome Trust
- Collins Iwuji, Professor of Global Health and HIV Medicine, University of Sussex
- Thumbi Ndung’u, Director for Basic and Translational Science, Africa Health Research Institute, KwaZulu-Natal
- Benjamin Cowie, infectious diseases physician and epidemiologist, WHO Collaborating Centre for Viral Hepatitis, and Professorial Fellow, Department of Infectious Diseases, University of Melbourne
- Kenneth Kabagambe, Executive Director, National Organisation for People Living with Hepatitis B, Uganda
- Philippa Matthews, Clinician and Academic, Francis Crick Institute and University College London.
Last updated 26 February 2025
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