The Destructive Consequences of Dismantling Global Supply Chains

Every day, 73-year-old Acefie Théodore chooses to take a small, round pill, knowing her life depends on it. Since she was diagnosed with HIV in 2008, Zanmi Lasante (ZL), Partners In Health's (PIH's) sister organization in Haiti, has supplied her with antiretrovirals that have kept her healthy and alive.

For the last 18 years, it didn't matter to Théodore how the medication got to Haiti, to ZL, to her clinic, and into her hands, as long as she was able to take her pill every day.

Behind the scenes, a long-established supply chain, including networks of suppliers, warehouses, and transportation, ensured lifesaving medications consistently reached the clinics and patients who needed them. However, due to reckless cuts to foreign aid funding, this consistent access to medication may be severed-not just for Théodore and for people in Haiti, but for low- and middle-income countries around the world.

A Peek Behind the Curtain

For decades, low- and middle-income countries, like Haiti, have relied on large-scale supply chain mechanisms to purchase and deliver quality public health commodities -vaccines, diagnostics, and treatment-to those who need them most, when they need them. The mechanisms-including programs between two countries or more-have ensured increased efficiency and cost savings, while also strengthening national structures through technical assistance.

Frontline care delivery organizations like PIH have relied on these established supply chains for equitable access to essential supplies, making it possible to get medication from global manufacturers into the hands of rural communities and patients like Théodore.

The United States government has funded the largest of these supply chain mechanisms working in over 90 countries: the $17 billion 10-year Global Health Supply Chain (GHSC) program. GHSC forms the commodity backbone of global health initiatives for HIV/AIDS, malaria, voluntary family planning and reproductive health, maternal and child health, and emerging public health threats such as Zika, Ebola, and COVID-19. This program made massive, lifesaving projects such as the U.S. President's Emergency Plan for AIDS Relief and the President's Malaria Initiative possible.

However, over the past year, the U.S. has abruptly pulled back funding and support to GHSC without credible transition plans in place to fill inevitable gaps, particularly in the most vulnerable communities. Now, the purchasing, storing, and distribution of lifesaving treatments and supplies are all being disrupted. Suddenly, over 90 countries are forced to quickly build up in-country procurement and supply chain systems, leaving national governments and frontline care delivery partners with short timelines to transition.

"The U.S. government's health financing transitions have had major impacts on the supply chains that our health programs depend on," said Molly McGovern, PIH senior director of global strategic partnerships. "PIH is urgently engaging in national supply chain working groups and forecast planning exercises to ensure continued availability of quality public health commodities to save lives."

These global coordination systems were built over decades, with people across the world contributing their expertise to create efficient, equitable structures that provided Théodore and countless others with consistent HIV medication. Devastatingly, these cuts in funding will overturn decades of progress for the patients and communities PIH serves.

All Systems Down

Since the Trump Administration took office, there has been a general lack of transparency in how global health is being funded. This intentional murkiness has left providers working in the unknown, unsure if a neighboring clinic will have to close its doors, if a local community health outreach partner is still providing care, or if the pharmacy will receive the medication their patient needs.

Ultimately, it will be patients like Théodore who have to bear the consequences of these unknowns.

A major question now is whether countries can rely on global supply chains as they have been for decades. For purchasing, there are often other options for countries-although they may vary in cost. For logistics and warehousing, however, there may not be consistent mechanisms set up for local governments to take on this major component of the system.

"PIH is accompanying our country government and multilateral partners to reinforce capacities and mitigate risks in financing, strategic sourcing, supply management, and planning to ensure continued availability of essential medicines at the last mile," McGovern said.

The breakdown of these critical supply chains will punish people in low- and middle-income countries that were never responsible for these systems in the first place and have consistently been left out of their critical decision-making processes for decades.

Pardon the Interruption

Health facilities in the countries where PIH works are increasingly relying on PIH to provide care for more patients. Without necessary supplies, they're unable to provide adequate care and instead refer patients to PIH-supported facilities. While PIH tries to fill the gaps, we know this isn't a sustainable solution.

The hasty decision-making being done in Washington, D.C., is already starting to cause care disruptions and put lives at risk.

In Rwanda, they're running out of family planning supplies.

In Sierra Leone, malaria tests and antimalarials are completely out of stock.

In Liberia, they've lost access to pediatric and second-line HIV treatment.

In Malawi, supplies have run out for maternal and child health commodities, as well as treatment options for moderate malnutrition.

And this is just the beginning.

"One of the cruelties of supply chain failure is that it is invisible until it is catastrophic … The system appears functional until, quite suddenly, it doesn't," wrote Dr. Alain Casséus, infectious diseases division chief for Zanmi Lasante, on his Substack. "This is why early warning indicators matter-not as an academic exercise, but as the only tool available to detect collapse before it becomes irreversible."

Global health organizations are now having to shift their focus to logistics to prevent death, suffering, and avoidable infections. PIH teams around the world are already strategizing how to cover gaps created by dismantling systems that the global health community has relied on for decades.

While aid continues to disappear, we are facing a reality where lifesaving supplies won't reach the patients who need them. As this situation evolves, PIH will continue to work to make sure quality health care is accessible in the communities we serve while also advocating for funding and policies that support the right to health globally.

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