The United States is restructuring how it delivers life-saving medical supplies for HIV and malaria to low-income countries, a shift that officials and health experts warn could disrupt treatment access across parts of Africa and Asia.

The changes centre on winding down the Global Health Supply Chain Program – Procurement and Supply Management, a U.S.-funded initiative run by Chemonics, which has coordinated the delivery of critical medicines and prevention tools since 2016. According to internal communications and multiple sources familiar with the matter, U.S. officials have been instructed to begin halting implementation of the programme by May 30.

From its inception through 2024, the programme distributed more than $5 billion worth of HIV and malaria-related commodities to 90 countries, with a primary focus on sub-Saharan Africa and parts of Asia. The supplies included antiretroviral drugs, malaria treatments and insecticide-treated bed nets, forming a key component of global disease control efforts.The restructuring follows broader changes to U.S.

foreign aid policy under the administration of Donald Trump, which has prioritised reducing reliance on contractors, cutting budgets and shifting toward direct agreements with recipient governments. The overhaul also comes after the dismantling of the United States Agency for International Development, which had previously overseen much of Washington’s development assistance.

Five sources familiar with the transition said the pace of the changes risks creating supply gaps for essential medicines, particularly in countries with fragile health systems. An internal email reviewed by Reuters warned that accelerating the transition without a clear implementation plan could jeopardise continuity of services.

The communication, sent by the U.S. State Department to staff in 17 African countries and Haiti, directed country teams to prepare for the end of programme operations while outlining potential risks. It did not provide a detailed roadmap for replacement mechanisms, instead asking local offices to identify vulnerabilities and report back to Washington.

A State Department spokesperson said the agency had not issued technical instructions for Chemonics to cease operations by May 30, though the contract is set to expire on September 30 in line with other USAID awards. The official end date is listed as November.

The uncertainty has revived concerns stemming from earlier disruptions. In January last year, a freeze on international aid left millions of dollars’ worth of medical supplies stranded in ports and warehouses worldwide, including HIV drugs and malaria prevention tools. Distribution resumed only after waivers were granted for life-saving interventions.

Six sources said the United States has been in discussions with the Global Fund to Fight AIDS, Tuberculosis and Malaria about potentially using its procurement and distribution systems to replace the existing programme. The Geneva-based institution already manages approximately $2 billion in annual purchases for HIV, tuberculosis and malaria programmes through partnerships with national governments and implementing agencies.

However, two sources said earlier plans had envisaged a transition timeline extending to November 2027, allowing sufficient time for procurement cycles and logistical adjustments. Compressing this timeline into a matter of months could create operational bottlenecks, they said, noting that delivering medical supplies to remote areas can take up to a year from order to distribution.

The Global Fund declined to comment on the discussions. The State Department did not directly confirm the talks but said it would rely on pooled procurement mechanisms to secure supplies at competitive prices from private manufacturers.The policy shift is part of a broader “America First” approach to global health funding, which aims to reduce what officials describe as inefficiencies in the existing system.

A strategy document released in September argued that contractor-led programmes had contributed to waste and inflated costs, and emphasised direct funding for frontline services and national governments.

Under the new approach, Washington has signed 28 bilateral health agreements with partner countries and is increasingly channeling funds directly to national authorities. It also plans to use private logistics firms to handle distribution rather than relying on large development contractors.

Recent agreements with countries such as Kenya, Rwanda and Uganda include commitments to increase domestic health spending alongside U.S. funding. However, implementation has encountered obstacles. In Kenya, a proposed deal faces legal challenges from activists concerned about data privacy, while negotiations with Zambia have been delayed as officials seek to safeguard national interests.

Health experts and aid practitioners say the transition risks compounding existing vulnerabilities in global disease control programmes. Previous disruptions linked to funding changes have already contributed to shortages of malaria treatments for children and gaps in HIV prevention services in several countries.

The State Department defended the overhaul, describing the current system as outdated and inefficient. A spokesperson said the new model would prioritise value for American taxpayers while maintaining support for critical health interventions.

Despite those assurances, several sources involved in programme delivery said the lack of a detailed transition plan remains a central concern. They warned that without clear coordination between donors, governments and implementing partners, the shift could interrupt supply chains that millions depend on for survival.

Speaking at a Reuters Newsmaker event in New York, Gates said the world was at a crossroads, with millions of children at risk of dying if funding drops too steeply.

The Gates Foundation’s pledge matches its donation in 2022. That was the last time the Global Fund, a Geneva-based independent nonprofit, raised money on its three-year budget cycle. The announcement follows deep aid cuts from governments around the world, led by the United States.

“A kid born in northern Nigeria has a 15% chance of dying before the age of 5. You can either be part of improving that or act like that doesn’t matter,” Gates said in an interview before the foundation’s annual Goalkeepers event in New York on Monday.

The event celebrates and seeks to accelerate progress on United Nations global development goals set for 2030, including improving health and ending poverty.

“I am not capable of making up what the government cuts, and I don’t want to create an illusion of that,” he said about his pledge.

The Gates Foundation, the philanthropy started by the Microsoft co-founder and his then-wife in 2000, is one of the world’s biggest funders of global health initiatives, with a particular focus on ending preventable deaths of mothers and babies, tackling infectious diseases and lifting millions out of poverty.

Earlier this year, Gates pledged to give away almost his entire $200 billion fortune by 2045, more quickly than planned because of the urgent need worldwide.

Millions More Could Be Saved

According to the U.S.-based Institute for Health Metrics and Evaluation, global development assistance fell by 21% between 2024 and 2025 and is now at a 15-year low.

That could still change, said Gates, with organizations like the Global Fund trying to raise money before the end of the year. But if the trajectory remains the same, progress that cut child mortality in half since 2000, saving 5 million lives a year, could be in jeopardy, he said in a statement.

Gates said that there was still an opportunity to save millions of lives and end some of the deadliest childhood diseases by the time he will have donated the rest of his fortune in 2045.

That would require maintaining funding for institutions like the Global Fund as well as Gavi, the Vaccine Alliance, prioritizing primary healthcare and rolling out innovations – such as the long-acting HIV prevention drug lenacapavir – quickly.

“What’s happening to the health of the world’s children is worse than most people realize, but our long-term prospects are better than most people can imagine,” Gates said in a statement.

At the Goalkeepers event, the foundation gave Spanish Prime Minister Pedro Sánchez its annual Global Goalkeeper Award. While other countries reduced global health support, Spain increased its donations to the Global Fund this year by 12% and Gavi by 30%.

The Goalkeepers event usually involves publication of a progress report on the U.N. sustainable development goals, originally adopted in 2015. But that has been delayed until an event in Abu Dhabi in December, when global health funding will be clearer, the foundation said.