Exclusive: Country Deadlines for Emergency Closeout of US Global Health Supply Chain
Seven countries reportedly on "immediate pause"
“Emergency closeout planning” for the US Global Health Supply Chain Program - Procurement and Supply Management (GHSC-PSM), run by Chemonics International, has begun, according to an email sent by the Task Order 1 Director HIV/AIDS on Monday March 30 to recipients at Chemonics and the Bureau of Global Health Security and Diplomacy (GHSD) at the Department of State, including the Supply Chain Division Lead.
The email, which I viewed and verified with two sources, refutes the State Department’s claim to Reuters, that GHSD had “not provided any technical direction to Chemonics to cease operations by May 30 or any other date.”1 Instead, the email details lays out a reactive, improvised plan based on cash-flow juggling, and program halts in eight countries by April 30 2026, with an additional 13 in the months that follow.2
Alt text: A screen shot of an Excel table titled “Closeout Dates Countries Based on Finances 3.27.xlsx.” The translucent title bar partly obscures column headings that read, from left to right, Country, TOs, Technical Activity Ends (incl ICL), Full Close Date, Employee Termination Notice Period (per local labor law), and Notes. Task Order 1 refers to HIV/AIDS, Task Order 2 to Malaria. Bolded task orders will deplete before September 30 2026. Another table included in the email that has almost identical information states that Namibia and Botswana end dates ‘assume bridge funds will NOT be received,’ and explains that both countries could continue longer if bridge funding arrives. I put that one in the footnotes because there is something about the heading regarding labor law that takes my breath away. There are other laws and conventions to consider including, for instance, the International Covenant on Economic, Social and Cultural Rights. Could we add that in too, do you think?3
The emergency close out will bring fresh chaos to health services and laboratories that have only recently and partially stabilized their HIV and malaria programs after the sudden destruction of USAID and long-standing US approaches to global health foreign aid last year.
It also complicates implementation of the America First Global Health Strategy. In the countries for which Memoranda of Understanding are available, five out of seven stipulate the use of a US procurement mechanism. Though GHSC-PSM was not named in any MoU, it was the only extant mechanism at the time of signing. I’ve also reviewed a late-March draft of Uganda’s detailed implementation plan that mentions GHSC-PSM by name.
Alt text: An orange-hued table that lists the seven countries with publicly-available MoUs, the language in those MoUs regarding procurement approaches for lab and other commodities, and the GHSC-PSM close date. As noted in tiny print, the Uganda language is from a draft Excel sheet of its Consolidated Companion Implementation tool that I reviewed, dated 20 March 2026. Uganda’s plan could still change, but up until quite recently, GHSC-PSM was a part of the long-term approach.
Uganda notwithstanding, no one in their right mind should have expected GHSC-PSM as implemented by Chemonics to last past the end of FY2027. Chemonics has also been the plagued by fraud allegations and controversy.4 It’s a holdover mechanism from USAID, and the America First Global Health Strategy spills significant ink over the theft and misuse of USAID-purchased commodities. Much like USAID itself, Chemonics’ GHSC-PSM is an imperfect entity with established flaws and known issues overdue for a re-think and an overhaul.
And just as Musk and his DOGE minions did last year, Secretary of State Rubio’s disciples are opting for mayhem over phased transition. In the process, the Department of State is setting up a system in which the waste, abuse and fraud5 that it so abhors are all but inevitable.
Procurement and supply chain management are where fraud happens.
Without controls, the people awarding contracts can hand select bids from folks willing to give them funds off the top. Stock can go missing, get resold. Many countries are like Zambia, in which about 70 percent of all HIV commodities were6 procured by the US government according to the most recent PEPFAR plan. That country now has nineteen working days in which to come up with a new, fraud-proof, robust plan.
It’s probably not possible. None of the existing procurement mechanisms identified as eventual replacements for the US supply chain enterprise provide the range of services, including in-country delivery and logistics, for the commodities that GHSC-PSM supported.7 And even if they did, country budgets, including Global Fund grants, have already been assembled with different assumptions about the timelines for national ownership of procurement systems.
When procurement systems wobble, people suffer and die.
On Good Friday 2025, I sat in the blue-walled office of a Ugandan HIV program with a clinical officer and executive director who explained how 25 percent of a recent cohort of babies had HIV at birth because the clinic hadn’t been re-supplied with antiretrovirals. In prior cohorts, no babies were born with HIV because their mothers had regular, reliable supplies of medication throughout their pregnancy.
That day, the executive director rested her head in her hands for a very long time, and the voices of kids playing in the courtyard outside filtered into the room. The spike in infected babies was directly attributable to the brief suspension of the GHSC-PSM contract during the early 2025 rampage of against USAID. In that time, warehouses stayed locked, drugs went undelivered and commodities languished in customs because the US-support vanished over night.
Even when the contract was reactivated, chaos reigned. The Ugandan clinic hadn’t received drugs for pregnant women because the contract for distributing drugs across Uganda remained inactive. The drugs were in the warehouse, not at the clinic, and so pregnant women and many other people went without.
That’s one example from a temporary, unplanned pause in US-supported supply chain and procurement activities.
Imagine what will unfold as countries race to close down their entire GHSC-PSM programs for good, even as the rainy season—with its surge in pediatric malaria cases—approaches.
As NPR recently covered, GHSD was slow to disburse original Bridge Plan funding, and had originally asked CDC and Department of Defense to continue Bridge activities through June 1 2026 using existing ‘pipeline’ funding.8 The email strongly suggests that this manufactured funding precarity has impacted countries’ supply chain work. (Note: this paragraph was updated after publication to correct the suggestion that GHSC-PSM funding would be included in a Congressional Notification. Individual mechanisms are not named.)
Specifically, the email states, “Without the obligation or authorization of additional funds, several countries must cease all activities and begin to close out.” The table of close out dates (see above and in footnotes) makes reference to the funding allocated under the six-month “Bridge Plan,” intended to tide HIV programs over from October 1 through March 31, with America First Global Health Strategy-funding expected thereafter. It notes that for some countries, “end dates assume bridge obligation will NOT be received.”
Relief could be coming this week. Congressional staffers have told me that they expect GHSD to send a Congressional Notification of the intention to transfer additional funding to CDC and Department of Defense which would then flow to countries. Additional funds will be a lifeline, and might forestall a smidgen of the Peter-and-Paul-pillaging that is Chemonics’ current plan.
Since the directive to shut down didn’t come with instructions, the email’s author lays out a cash flow management approach that hurts to read. “Absent additional or alternative instruction from GHSD,” the email states, “we must apply the following assumptions to enable emergency close out planning.” The steps include pooling all money within Task Order 1 (HIV) and 2 (Malaria), and between Task Orders within a given country. There are rules for how to spend limited funds and for making decisions as close out unfolds, for example:
1. “If one TO is out of money then the split will be updated to support closeout through the funded TO and
the TO that is depleted first determines the closeout timeline.”
At the same time, the email proposes development of “wind down and close out PowerPoint” plans based on “cash analysis and available levers.” In other words, the US government and its contractors will try to repackage avoidable chaos as a managed transition.
Congress may get a taste of this spin doctoring this week, since Hill staff tell me they’re expecting the presentation of some PEPFAR performance data from FY2025. If those data are anything less than the complete record of every quarter in 2025, and at least Q1 of 2026, then unfortunately they will be close to worthless, regardless of what GHSD tries to say about them.
During the lethal and avoidable chaos of the first months of FY2025, people stopped or lost access to treatment due to temporary and permanent pauses in life-saving programs. Some of those people eventually re-started, sometimes seeking HIV testing again. Without continuous data showing fluctuations over the course of the entire period in which these drastic unplanned changes unfolded, it’s just not possible to know whether people counted as newly diagnosed or newly starting treatment are new or whether they are simply finding their way back to care after major disruptions.
Even with the full data set, it will be very hard to get a complete and accurate picture of what happened to the PEPFAR program last year. Data transparency is essential—for the past and going forward. But Congressional time with GHSD this week could be better spent interrogating and averting the engineered emergency of GHSM-PSC’s accelerated closure before it is, again, too late.
https://www.reuters.com/business/healthcare-pharmaceuticals/us-upends-global-supply-program-malaria-hiv-amid-warnings-gaps-2026-04-03/
It’s photo day here in the footnotes! Actual, factual ChatGPT query whilst drafting the second paragraph. And no, I very obviously do not use Chat for writing. Too many weird typos for that. And yes, the EM dash is an exceptional punctuation mark. I wont quit it.
https://www.thebureauinvestigates.com/stories/2023-11-09/revealed-usaids-10bn-health-project-riddled-with-failings-inefficiencies-and-fraud-allegations/
Are we allowed to shift the order of the Three Musketeers, Waste, Fraud and Abuse? Can we make America more prosperous, safer and stronger? I’m really not sure.
http://copsdata.amfar.org/SDS/2022/Zambia.pdf - see page 61 for figures for each commodity procurement source (USG, Global Fund, Government of Zambia).
https://www.kff.org/global-health-policy/the-america-first-global-health-strategy-and-pooled-procurement/
https://www.vpm.org/npr-news/npr-news/2026-04-04/congress-gave-money-for-global-hiv-work-the-trump-administration-isnt-spending-it