In January, clinics in Uganda and Zambia were selecting people living with HIV to take part in a phase 1 trial of an experimental vaccine. But the project, meant to inform new ways to protect uninfected people from the virus, was funded by the U.S. Agency for International Development (USAID). Within days of taking office, President Donald Trump’s administration imposed a 90-day freeze on USAID funding and work.
This presented organizers of the trial with a dilemma: They would not be able to finish the clinical research portion of the study before the vaccine expired. “We couldn’t properly continue the study knowing that we wouldn’t be able to complete it,” says Mark Feinberg, president and CEO of IAVI, an international nonprofit overseeing the work.
Instead, they reluctantly canceled the trial. “I’ve seen studies stopped because of futility and I’ve seen studies stopped early because of better than expected efficacy,” Feinberg says. “I’ve never seen a study stopped because the funding for the program was suspended.”
The project is one of many casualties of the funding freeze and the dismantling of USAID, the 63-year-old agency whose $40 billion annual budget has not only provided food and medicines, but also supported clinical trials and other types of research around the world. Since the beginning of this month, the vast majority of USAID staff have been placed on leave, and its website has gone dark.
Public health experts have warned of the dire effects of withdrawing health care and humanitarian assistance. “This is going to kill a lot of people,” says Jeremy Konyndyk, who directed USAID’s COVID-19 Task Force under former President Joe Biden’s administration and now leads Refugees International. But the freeze has also presented ethical challenges for scientists carrying out USAID-supported clinical trials. Researchers have had to tell trial participants they’re no longer needed and have scrambled for ways to protect volunteers’ health after medical services provided through the studies ended. Some have been unable to pay local collaborators and have had to lay off staff after years of trust building.
“I feel ashamed because people agreed to work with me and they’ve been screwed,” says Sharon Hillier, an infectious disease researcher at the University of Pittsburgh who had to halt an observational study that had enrolled 11 pregnant women in Lesotho. Hillier feels terrible for participants as well: “They signed an agreement that we would provide ultrasounds, syphilis testing, and other things, and we would follow their infants for 6 months. And … we have reneged on this contract,” she says.
