The contract that kept antimalarials flowing to 90 countries is being wound down in weeks, not months. And nobody outside a handful of aid agencies seems to have noticed.

On Tuesday, the US State Department emailed staff in 17 African countries and Haiti: stop implementing the Global Health Supply Chain Program by May 30. The program, managed by contractor Chemonics, has delivered more than $5 billion in HIV and malaria products since 2016 — antiretrovirals, insecticide-treated bed nets, diagnostic tests — mostly to sub-Saharan Africa and Asia. The contract was set to end September 30 in line with all USAID awards, though its official end date is in November.

But the email, seen by Reuters and verified by two sources, warned of “immediate risks to service continuity if transition is rushed or incomplete.” It did not lay out a transition plan. Instead, each country office was told to design its own handover and inform Washington of any risks.

“This is a huge mess to untangle,” said Tom Cotter, CEO of Health Response Alliance, a nonprofit focused on emergency health access. He was describing the earlier aid freeze. The current moment is that mess, compounded.

The Scale of Dependency

The US government has spent approximately $1.3 billion per year directly on health commodities for HIV, TB, malaria, and polio, according to the Kaiser Family Foundation. USAID placed around $600 million in annual orders for medicines, diagnostics, and equipment. The supply chain program reached 90 countries.

That infrastructure is being replaced with bilateral agreements — memoranda of understanding between Washington and individual governments. As of March 23, 27 countries had signed MOUs covering at least $20.1 billion in spending through 2030, according to the Council on Foreign Relations. Recipient governments are expected to fund roughly 37% of that total.

Some face staggering leaps. Nigeria pledged to cover 59% of MOU spending; Botswana, 78%. African governments currently devote roughly 7% of national budgets to health on average.

The agreements are also narrower than what preceded them. Malaria — previously the second-highest category of US health assistance — was absent from Ivory Coast’s deal, despite the disease accounting for 12.63% of premature deaths there, roughly six times the global average. Tuberculosis went unmentioned in 19 of the available agreements.

What’s Already Broken

The dismantling is not a future risk. It is a present tense.

Médecins Sans Frontières (MSF) reported that in Somalia, disruptions to aid caused shipments of therapeutic milk to stop for months. At Baidoa Bay Regional Hospital, deaths among severely malnourished children rose 44% in the first half of 2025 compared to the same period in 2024. In the Democratic Republic of Congo, the cancellation of a USAID order for 100,000 post-rape kits — medication to prevent HIV and sexually transmitted infections — left MSF teams scrambling to fill gaps in North Kivu.

A State Department spokesperson described the existing system as “a bloated piece of an obsolete development model” that “does not put the American taxpayers first and instead helps to line the pockets of large U.S.-based development firms.” The spokesperson said the government had signed 28 bilateral health pacts and would mostly use private logistics firms to distribute supplies.

No Plan, No Time

The administration’s stated intention is to shift procurement to pooled mechanisms — potentially the Global Fund to Fight AIDS, Tuberculosis and Malaria, which already manages around $2 billion a year in health product procurement. Earlier discussions between the US and the Global Fund focused on a November 2027 transition, according to two sources.

The new timeline is measured in weeks.

Supply chain experts have warned that ordering medical products for hard-to-reach locations can take up to a year. The “bullwhip effect” — where small disruptions cascade through every layer of a supply chain — means that even brief pauses create backlogs that persist for months.

The consequences are not distributed evenly. Zambia rejected its proposed deal in February, citing unfair data-sharing requirements. The State Department then threatened to withhold PEPFAR HIV funding to pressure Zambia into granting access to critical minerals, according to the Council on Foreign Relations — the most explicit case yet of health agreements being leveraged for US economic interests.

Global health financing fell 21% from 2024 to 2025, according to the Institute for Health Metrics and Evaluation. The agreements now being signed are designed to shrink it further.

There is no headline event here — no summit, no vote, no catastrophe caught on camera. Just a supply chain being taken apart faster than it can be replaced, in countries where the margin between a functioning system and a health crisis is measured in weeks of stock.

Sources