Donald Trump criminalised Cuba’s medical brigade and shot down USAid - but Cuba’s biotechnology industry could step in regarding HIV/Aids.
With the stroke of a pen, US President Donald Trump issued a dual attack on global health infrastructure this month. The first was an 83% cut to USAid funding that administered the majority of Pepfar (President’s Emergency Plan for Aids Relief) initiatives — HIV/Aids treatment infrastructure that is credited with saving nearly 25 million lives worldwide. The second was the criminalisation of Cuba’s historic medical brigades, missions that have deployed 600 000 healthcare workers across 160 countries since 1960.
Of Trump’s targets, one can save the other.
Activists around the world are pleading with the Trump administration to rescue Pepfar from the crushing cuts, pointing out the obvious — when it comes to a virus, nobody is safe until everyone is safe.
The immediate cruelty of the Pepfar decision lies in its abruptness, with millions waking up to find their local clinics gutted and vulnerable populations, such as the queer community, especially in countries like Uganda with strict anti-homosexuality laws, and sex workers left with no legal options to access care.
But zoom out from this moment and an enduring crisis comes into focus — the very architecture of a system where such unilateral, abrupt and perilous cuts are possible.
Countries like Tanzania and Côte d’Ivoire, smaller economies, host HIV programmes that are nearly 90% Pepfar-funded and even South Africa, the continent’s most advanced economy, with the world’s largest HIV population, relies on Pepfar for 17% of its HIV response. The lives and deaths of millions of people, particularly those in sub-Saharan Africa, are entirely vulnerable to the whims of a foreign power.
This is no coincidence. While the rhetoric of “African solutions to African problems” has long echoed through continental forums, the global health financing architecture has paradoxically weakened African capacity by centring donor priorities rather than local needs.
Solidarity at the cost of sovereignty is, in other words, subjugation by design. Amid the deadly Covid-19 pandemic, a coalition of pharmaceutical companies and Global North governments blocked patent waivers, refused to share vaccine technologies and underfunded multilateral responses. As the world waited with bated breath for vaccines, Trump pulled the US out of the World Health Organisation and Bill Gates reportedly reversed Oxford’s decision to make the AstraZeneca vaccine open-source. That vaccine, when it finally reached Africa, arrived at a steep premium — Uganda paid $7 a dose, more than three times what the EU paid.
Global financial flows are even starker. Foreign aid from the Global North is a pittance compared to the net flows from the Global South, whether through price differentials in international trade, cheap labour, tax evasion by multinational corporations or debt interests. Some experts estimate the drain from the South costs more than $10 trillion a year, in other words, that the “South’s losses outstrip their aid receipts by a factor of 30”.
“Our experience with the Covid-19 pandemic taught us that we must become self-reliant or face being at the mercy of rich nations in the West who proved themselves capable of acts like hoarding life-saving vaccines and giving us, as Africans, the leftovers,” declared Ronald Lamola, South Africa’s minister of international relations and cooperation, in a fiery speech to parliament after the US decision. “It must not happen again. It will not happen again.”
To build an alternative, Lamola need only look to Trump’s second target — Cuba. Since 1963, when Cuban medical professionals first arrived in newly independent Algeria, Cuba has demonstrated a fundamentally different approach to international health solidarity. Unlike traditional donor models that create dependency, Cuban-style cooperation builds capacity and emphasises knowledge transfer.
Cuban missions train foreigners in their own countries, when facilities are available, and in Cuba when they are not. By 2016, Helen Jaffe, renowned scholar of Cuba notes, “73 848 foreign students from 85 countries had graduated in Cuba” alongside “12 medical schools overseas, mostly in Africa, where over 54 000 students were enrolled”.
Less known, however, is Cuba’s biotechnology industry. Despite, or rather because of, economic sanctions and limited global market access, Cuba has created a remarkable ecosystem with about 1 200 international patents and medical exports to over 50 countries. The nation produces more than 60% of its pharmaceutical needs domestically and has maintained a positive trade balance in this sector.
It is no surprise then that, during the Covid-19 pandemic, Cuba emerged self-reliant, producing two successful vaccine candidates and leading “vaccine internationalism” — open collaboration over technologies, solidarity pricing and pooled manufacturing capacity — alongside countries like Mexico and Argentina.
Meanwhile, the Henry Reeve Brigade, a group of Cuban medical professionals with a mission of “medical internationalism”, served 35 countries, including significant contingents across Africa.
That model is now under direct attack. On 25 February, US Secretary of State Marco Rubio announced restrictions on visas for government officials in Cuba and any others worldwide who are “complicit” with these medical assistance programmes, adding to the 20 January order declaring Cuba a “state sponsor of terrorism”.
Washington’s strategy is devastatingly clear — dismantle Western-funded health systems with one hand while crushing South-South alternatives with the other. This coordinated attack leaves Africa with a stark choice that Lamola has already made: “We are committed to engaging in global health diplomacy from a position of strength, not weakness.”
Several Caribbean governments have done just that. Barbados’s Prime Minister Mia Mottley was fierce in her response to Rubio’s policy, noting that Barbados “could not have got through the pandemic without the Cuban nurses and the Cuban doctors”. Alongside her, the prime ministers of Trinidad and Tobago and of St. Vincent and the Grenadines, have publicly protested the new policy and declared they would be willing to lose their US visas.
That spirit of global solidarity, combined with progressive domestic policy, could herald an altogether new paradigm. The African Union’s 2022 New Public Health Order, which calls for strengthened public health institutions, domestic resource mobilisation, local manufacturing and health workforce development, offers such a blueprint, but lacks a leader.
The South African government could bring that vision to life, with three strategic imperatives.
First, strengthen domestic healthcare. The Pepfar crisis demonstrates that even generous external funding undermines sovereignty when donor politics comes into play. This is already in motion — the recent budget increased health allocation to R298.8 billion in 2025-26, with a projected increase to R329 billion by 2027-28. But, funding alone will not suffice; healthcare must be public and universal.
Second, pursue southern diplomacy. Cuba has succeeded in providing comparable health outcomes to developed nations but at one-tenth the per capita spending of the US. This offers valuable lessons for African countries facing similar resource constraints. A biotech hub, Cuba is celebrated by the World Intellectual Property Organisation as “a model for local manufacturing, licensing and technology transfer” that could act as a “blueprint for health emergencies”. A comprehensive biotechnology partnership between South Africa and Cuba, that transcends the existing doctor exchange programmes, could achieve just that.
Third, advance regional integration. Africa, especially Southern Africa, could benefit from collective pricing, purchasing and production systems. Latin America offers promising models: the “Medicine Price Bank” launched by the Union of South American Nations in 2016 — a simple database of drug prices — allowed governments to drive down costs at the negotiating table while challenging Big Pharma’s contractual secrecy.
The transition toward health sovereignty requires difficult but necessary choices. Increasing domestic financing means reprioritising budgets. Building pharmaceutical sovereignty means challenging powerful multinational interests. Deepening cooperation with Cuba means potentially facing further antagonism from Washington.
Yet the consequences of continued dependency have been made clear. As both Pepfar and Cuban medical missions face unprecedented threats, South Africa and Cuba confront a historic opportunity to reconfigure the global healthcare architecture — and forge a new path centered on sovereignty and sustainability.
“We should not bemoan the United States of America’s decision,” declared Lamola, “but seize this moment as a catalyst for change.” For the millions across Africa whose health security hangs in the balance, South Africa’s leadership has never been more strategically vital.
Varsha Gandikota Nellutla is the general co-coordinator of the Progressive International and a public affairs graduate of Princeton University.
Nontobeko Hlela is a research fellow with the Institute for Pan African Thought and Conversation at the University of Johannesburg.