South Africa’s research institutions can again apply for US National Institutes of Health grants, ending a 17-month freeze that forced laboratories, clinical trial sites and universities to cut staff and scale back programmes built over decades.
NIH director Jay Bhattacharya issued a memo, reported by Science, concluding that research grants fall outside the scope of the Foreign Assistance Act and that Congress has explicitly authorized the agency to participate in international research collaborations. That determination unlocked the reversal. The freeze had begun in February 2025, triggered by a presidential executive order directing agencies to halt assistance to South Africa.
The damage done in the interim is considerable. South Africa lost an estimated $450 million through the broader US funding cuts, which hit NIH programmes alongside other US-backed research and health initiatives. Institutions had been forced to consider staff reductions and the closure or scaling back of research programmes. The greatest danger researchers identified was not simply the loss of individual grants but the erosion of research infrastructure and expertise that took decades to build.
South Africa’s position in global clinical research is not incidental. The country carries one of the world’s largest HIV and tuberculosis burdens, hosts established research institutions and has the capacity to run large-scale clinical trials. Studies conducted there have shaped treatment and prevention strategies internationally. When South African research sites go dark, programmes far beyond the country’s borders feel the effect.
The restoration, though, is partial. Research conducted in South Africa must have a clear scientific rationale for being carried out outside the United States and must have the potential to generate knowledge relevant to American health. Projects remain subject to NIH review procedures, State Department review and US rules governing foreign awards. These conditions narrow the field of eligible work considerably.
Meanwhile, South African researchers remain excluded from training and career-development programmes run by the NIH’s Fogarty International Center. That exclusion carries consequences beyond South Africa. Fogarty-supported programmes have historically helped develop researchers and research capacity across Africa, and cutting off access limits opportunities for early-career scientists across the continent, not only those in South Africa.
For the universities, research institutes and scientists that lost grants, staff and momentum during the freeze, the task now is reconstruction. Rebuilding an ecosystem takes time that the 17-month gap has already consumed. The NIH reversal opens a door, but it does not restore what was in place before February 2025. Whether institutions can rehire lost expertise and restart interrupted studies before further attrition sets in is the operational question that will define the recovery.