Millions of drugs used to treat debilitating and disfiguring tropical diseases risk going to waste after US aid cuts stalled treatment campaigns, leaving vital medication to expire in warehouses.
Experts fear the funding crisis could sabotage hard-won progress in the global fight against conditions such as river blindness and intestinal worms that blight the world’s poorest.
“This has been a major blow,” said Albis Gabrielli, a disease expert at the World Health Organization (WHO).
“It could lead to diseases resurging and derail progress in countries close to eliminating them.”
Since 2006, the United States has invested more than US$1.4 billion in tackling what are known as neglected tropical diseases (NTDs), helping 14 countries end at least one disease.
But the programme was axed this year after President Donald Trump slashed foreign aid.
In Africa alone, about 1.6 million medicines – mainly tablets – have already expired, 8 million more are set to by year-end, and another 90 million by May 2026, according to WHO figures provided to Context.
The WHO is working with African countries and health partners to save drugs close to expiry, piggy-backing deliveries onto other community health services such as vaccination drives.
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Diseases don’t understand borders. The cuts could threaten the long-term success of the wins we’ve had, if we take our eye off the ball.
Solomon Zewdu, CEO, END Fund
There are 21 NTDs which affect more than a billion people in Africa, Asia and Latin America.
They afflict the poorest communities, and the sickness and disabilities they cause only deepen that poverty by leaving people unable to work.
Experts estimate the global toll in terms of lost wages and health expenses amounts to at least US$33 billion annually.
“Investing in NTDs is not just treating diseases, it also helps free communities from poverty,” Gabrielli said.
USAID, the now defunct US aid agency, targeted five of the most common diseases: schistosomiasis, river blindness, elephantiasis, trachoma and intestinal worms.
Trachoma, which can turn eyelashes inwards so they scrape against the eye, is the leading infectious cause of blindness worldwide.
Elephantiasis, a stigmatising condition that causes the legs and genitalia to balloon, often leaves sufferers ostracised.
Many of the diseases are ancient.
Evidence of schistosomiasis has been found in Egyptian mummies. The parasitic worms, which stunt growth and can lead to bladder cancer, affect about 250 million people.
Drug donations
Before its termination, USAID worked with 26 countries, most in Africa, supporting the delivery of billions of drugs provided for free by major pharmaceutical companies.
Every US$1 invested by the United States leveraged US$26 in donated medicines, according to a USAID factsheet.
Most are used in “mass drug administrations” which treat everyone in a given area, infected or not. The WHO said the US cuts had delayed 47 treatment campaigns.
The crisis has also cost jobs – in Sierra Leone alone, 30,000 community drug distributors have lost work.
Pharmaceutical companies are keeping a close watch.
Merck Group, which provides up to 250 million doses of praziquantel a year to treat schistosomiasis, has already cut production for 2026, although it remains ready to scale back up.
“We can’t risk delivering drugs with a relatively short shelf life into countries which don’t have funding to deliver them,” said Johannes Waltz, head of Merck’s schistosomiasis elimination programme.
He said there had been “a lot of fire-fighting” to prevent treatments going to waste, but there were still drugs sitting in warehouses with no guarantee they could be distributed.
“These worms lay hundreds of eggs a day so even one missed treatment could lead schistosomiasis to explode, wiping out years of progress,” he added.
Diseases eliminated
The cuts could undermine a WHO goal of 100 countries eliminating at least one disease by 2030.
So far, 57 countries have reached that target, with some ending three or four.
In January, Niger became the first country in Africa to be declared free of river blindness, a disease causing intense itching, disfiguring skin conditions and vision loss.
Other successes this year include the elimination of sleeping sickness in Kenya and Guinea, and trachoma in Senegal, Burundi, Mauritania and Papua New Guinea.
But Trump is not the only donor to turn away.
Britain ended its NTD programme in 2021, while recent reductions in global aid have further squeezed funding.
Following the US cuts, 50 African countries met in June to hammer out plans to target the most pressing NTDs. A key goal is to fold NTD treatments into domestic health services.
The Africa Centres for Disease Control and Prevention said nearly US$700 million was needed to tackle NTDs on the continent over the next two years.
Drug treatments are only part of the picture.
Preventing diseases requires investment in water and sanitation – another sector hit by aid cuts – and robust monitoring to stop any resurgence.
Solomon Zewdu, CEO of the END Fund, a philanthropic organisation focused on NTDs, warned the cuts could have consequences down the line if surveillance is neglected.
Ridding Niger of river blindness has been hailed as a beacon of hope – but the black fly that spreads it can travel 400 km (250 miles) a day.
“Diseases don’t understand borders,” Zewdu said.
“The cuts could threaten the long-term success of the wins we’ve had, if we take our eye off the ball.”
This story was published with permission from Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, climate change, resilience, women’s rights, trafficking and property rights. Visit https://www.context.news/.
