The cuts to foreign aid ordered by the United States government have left a trail of devastation in the fight against hepatitis in Africa. From the closure of clinics dedicated to the care of hepatitis B and C and the dismissal of thousands of assistants who administered free diagnostic tests to interruptions in the supply of medications. The impact on the 72.5 million hepatitis B and hepatitis C patients in Africa is difficult to quantify with precision because the United States Agency for International Development (USAID) and other institutions did not allocate a specific budget for the fight against these diseases. These resources, however, reached organizations through programs related to HIV, because both conditions are transmitted through blood and sexual contact.
Therefore, when the Donald Trump administration suspended USAID and temporarily paused the U.S. President’s Emergency Plan for AIDS Relief (Pepfar), it also caused “high impacts” on up to 40% of organizations dedicated to fighting hepatitis, according to a survey conducted by the Coalition for Global Hepatitis Elimination (CGHE), the World Hepatitis Alliance (WHA), and the team from the Hepatitis Elimination Lab (Plan-B). The main findings have been published in a column in The Lancet late this Tuesday.
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Marion Delphin, one of the authors of the publication and a postdoctoral researcher at the Francis Crick Institute in London, states that they received alarming reports from several African countries. “In Malawi, more than 1,500 testing assistants were laid off at the end of 2025. This stopped community tests and forced clinics to close, leaving people without the possibility of care or prevention,” Delphin tells this newspaper via email. “We have numerous reports about the shortage of antivirals in several countries and about community associations and support groups severely affected by the loss of funding due to the reorganization of priorities,” she adds.Hepatitis is an inflammation of the liver that, if not diagnosed in time or treated correctly, can lead to serious liver damage or cancer. There are five strains of the virus that causes this disease, but, in particular, types B and C affect 304 million patients worldwide and kill 1.3 million people each year. Of the fatalities, 943,000 are in Africa, according to the WHO. However, before the cuts, the fight against this ailment was already in critical numbers on the continent. Less than 5% of people with hepatitis B have been diagnosed and, of them, only 5% have received treatment. Africa also has the lowest coverage of vaccination against the B variant at birth: it is barely 8%. In Spain, for example, it is part of the systematic childhood calendar. In this context of extreme fragility, the decline in attention to hepatitis coincides with a broader shift in US health policy. In December, the Advisory Committee on Immunization Practices, with experts appointed by the Secretary of Health, Robert F. Kennedy Jr., voted to advise against universal hepatitis B vaccination in newborns. The Government also supported a controversial study in Guinea-Bissau that proposed leaving some babies unvaccinated, an initiative that was blocked after ethical objections from the WHO. The problem, organizations warn, is that the reduction in screening tests, the interruption of treatments, and the decrease in vaccination could lead to an increase in cases, the worsening of patients with more aggressive liver ailments, and the emergence of drug resistance. Delphin explains that the interruption of treatment, in the case of chronic hepatitis B, can cause in a patient “a viral rebound, inflammation and hepatic decompensation and, in severe cases, death.” If vaccination at birth is reduced, he adds, the risk of mother-to-child transmission increases, the main route of transmission of hepatitis B in sub-Saharan Africa.In Malawi, more than 1,500 test assistants were laid off at the end of 2025. This stopped community testing and forced clinics to close, leaving people without the possibility of care or prevention. Marion Delphin, postdoctoral researcher at the Francis Crick Institute in London
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If preventive services are limited, the burden on healthcare systems continues to increase as they have to deal with liver failure, cancer care, hospitalizations, and transplants. “We needed to increase testing, promotion, and access to care, not reduce it,” insists Delphin.Do the possible with fewer resources
The NGO Kiraay, which operates in Senegal, has been one of those affected. Until now, this organization had functioned under the umbrella of large coalitions of community organizations in Senegal that received funding for the fight against HIV. With those resources, the NGO cared for patients with this virus and, also, those who had related ailments such as hepatitis. But with the cuts, the little that it could do is on the ropes. “We have advocated for the inclusion of hepatitis in the priorities of the Global Fund [which also suffered cuts]”, says Fatou Poulh Sow, leader of Kiraay, via WhatsApp. At the same time, they have tried to seek resources from regional donors, but have not yet received a response. David Irinam, leader of the NGO Bekwarra Hepatitis B Support in Nigeria, regrets working “with his fingernails” in a country where more than 14.3 million people live with chronic hepatitis B and 1.3 million with chronic hepatitis C. Since 2023, this organization has been leading awareness campaigns, free tests, and referral of hepatitis patients to health centers in Cross River State (four million inhabitants), where a high prevalence has been detected. “Donald Trump’s foreign policy greatly affected us, services were disrupted, and we couldn’t continue our community impact programs. We couldn’t examine the inhabitants of some communities we planned to go to, which are very difficult to access,” says Irinam, from Bekwarra, via a phone call. In one campaign, for example, they had planned to do 12,000 tests, but only completed 6,000 because there wasn’t enough money to travel to remote villages. Irinam, who is a microbiologist and pharmacist dedicated to the fight against hepatitis in Nigeria, adds that the cuts have also made it difficult for patients to get medicines at lower prices. “In this region, an average citizen lives on less than a dollar a day. And antiretrovirals cost about 30,000 nairas a month ($22 or 18 euros). People can’t afford that cost and also what it costs to travel to see the doctor,” he explains. Although last December, Bekwarra received support from the Hepatitis B Foundation USA and the African Hepatitis B Advocacy Coalition (ABAC), for awareness activities and free tests, he affirms that it is not enough for the dimension of the problem. “That is why we advocate for the Government to intervene [in Cross River],” he adds.You can read more
Prince B. Okinedo, co-founder of ABAC, launched a year ago, explains that the Coalition was able to deliver grants to 11 community organizations, including Bekwarra. “It was the first time some of them received grants [for hepatitis programs,” Okinedo highlights, in a video call. “But there could have been many more,” he acknowledges. With the change in US global health policy, which leans more towards bilateral agreements with countries, he fears that hepatitis will remain outside the priorities. “I don’t know how we are going to solve this, it will be a great challenge if things continue like this,” he laments.I don’t know how we’re going to solve this, it will be a great challenge if things continue like thisPrince B. Okinedo, co-founder of African Hepatitis B Advocacy Coalition (ABAC)
