When Trade Hurts Health: How Tariffs and Economic Pressure Threaten Infection Control in Low- and Middle-Income Countries

World Health Organization

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When Trade Hurts Health: How Tariffs and Economic Pressure Threaten Infection Control in Low- and Middle-Income Countries
By Heather Stoltzfus, MPH, RN, CIC

We tend to think of infection control as a matter of science, protocols, and behavior change. We do not often consider economics when developing strategies to drive down infection rates. But beneath the hand hygiene posters and antimicrobial stewardship policies lies something just as critical—and far more fragile: the global economic systems that make infection prevention possible in the first place.

On a recent World Health Organization (WHO) call, the reality of this fragility was laid bare.¹ A participant asked how proposed US trade tariffs might harm countries' ability to import critical pharmaceuticals. The answer was sobering:

“For Madagascar, Côte d’Ivoire (and others in low- and middle-income countries)—a large chunk of their GDP could be wiped out by the tariffs if they continue… These are the very countries where external aid, a large chunk of which comes from the United States, is also critical to finance the healthcare system… The bill for importing pharmaceutical products is going to get bigger. And at the same time, we see institutions such as [the US President’s Emergency Plan for AIDS Relief] PEPFAR and [United States Agency for International Development] USAID… also now being frozen or paused indefinitely. So, it is a very critical situation.¹”

Even though many pharmaceutical products are technically exempt from tariffs, US President Trump has proposed ending those exemptions, further complicating an already fragile situation in global health. Let’s break down the cascading effects—especially on infection control efforts in low- and middle-income countries.

Import-Heavy Health Systems Are Under Pressure

Sub-Saharan Africa is a net importer of pharmaceutical products, with local production meeting only about 10 to 30% of the continent’s demand.^1,2 In countries like South Africa, medicinal and pharmaceutical imports exceeded $690 million in 2023 alone.²

This reliance makes these health systems acutely vulnerable to even minor disruptions. When tariffs are imposed, shipping fees spike, or currency values plummet, the price of essential medicines and supplies skyrockets—often putting them out of reach for the low-resource hospitals and clinics that need them most.

These aren’t luxury items. These imports represent life-saving antibiotics for a child with sepsis. They’re antiretrovirals for a mother living with HIV, insulin for a teen with diabetes, IV fluids for a newborn in respiratory distress, and malaria medications for a pregnant woman.

When countries cannot afford these essentials, care doesn’t just become difficult—it becomes dangerous. Health workers are forced to make heartbreaking decisions about who receives treatment and who doesn’t. Preventable infections turn deadly. Outbreaks become harder to contain. And the most vulnerable—infants, older people, and those living with chronic illness—pay the highest price.

When Economics Break the Supply Chain

The problem doesn’t end with tariffs. In 2024, currency devaluation in Nigeria resulted in nearly $8 billion in foreign exchange losses for just three of the country’s pharmaceutical firms.³ As national currencies weaken and inflation rises globally, the cost of importing goods—even those technically exempt from tariffs—soars.

This collapse in purchasing power has clear, immediate implications for infection prevention and control (IPC) programs:

• Health workers may be forced to reuse gloves or rely on ineffective disinfectants.
• Clinics might be unable to offer safe childbirth services due to a lack of sterile equipment.
• Patients with drug-resistant tuberculosis may be treated with suboptimal medications simply because they are the only options available.
• Diagnostic testing may be delayed or skipped, leading to unchecked transmission of infectious diseases.

As local currencies falter and tariffs increase costs, the cost burden may shift from clinics to patients and families. Parents may be told to purchase antibiotics from private pharmacies at inflated prices—or go without. This deepens health inequities and causes treatment delays that turn preventable infections into life-threatening ones.

Infection Prevention Takes a Hit

When essential supplies become unaffordable or unavailable, IPC efforts begin to erode at every level of the health system:

• Health care-associated infections rise due to a lack of sterile supplies and protective equipment.
• Antimicrobial resistance worsens, as more infections require treatment and inappropriate antibiotics are used.
• Outbreak containment becomes nearly impossible without masks, gloves, and disinfectants.
• Health care workers face increased occupational risk, further demoralizing an already overstretched workforce.
• Community trust deteriorates as patients delay care or lose faith in the safety and reliability of health facilities.

Prevention programs are often the first to be cut when budgets shrink, yet we know from experience that the cost of inaction far outweighs the investments we make in IPC.

Global Health Funding Is Becoming Uncertain

According to the Kaiser Family Foundation, the US allocated roughly $12.4 billion for global health in FY2024, including support for programs like PEPFAR, which funds HIV/AIDS treatment across sub-Saharan Africa.⁴ In some countries, up to 40% of the total health care budget is supported by this type of aid.⁶

When these funds are frozen or delayed—as they currently are for several key programs—countries are forced to ration care, reduce IPC efforts, or suspend procurement altogether.

That is not just a bureaucratic inconvenience. It is a disaster for millions who depend on that funding for their basic health needs.

Clinics that once reliably dispensed life-sustaining antiretrovirals are now turning patients away, asking them to return in a few weeks—if supplies arrive. Interruptions in HIV treatment increase viral load, raise transmission risk, and accelerate drug resistance. This is not hypothetical: recent reports show that HIV medication is already being rationed in parts of Africa due to these funding gaps.⁵

Local Resilience Is Undermined

Africa currently has around 375 pharmaceutical manufacturers for a population of 1.3 billion.² Most of these facilities are concentrated in North Africa. In sub-Saharan Africa, many countries still import more than 70% of their pharmaceutical products.

Efforts like the African Continental Free Trade Area (AfCFTA) aim to boost local manufacturing and reduce reliance on imports. However, these efforts are undermined by unstable economies, high input costs, and volatile aid flows.¹ Meanwhile, 26 low- and middle-income countries, home to 1.38 billion people, remain highly dependent on US global health aid—making local production ambitions fragile at best.⁶

A Call to the Infection Control Community

What can we do?

First, we must recognize that infection prevention and public health are political. It's not only about what happens inside our hospital walls; it is about trade policies, foreign aid, and global economic systems.

Second, we must advocate. Infection preventionists know how to mobilize. We've done it before—through pandemics, shortages, and crises. Now, we must use our voices to call for policies that safeguard—not sabotage—global health.

Finally, we must remember that health is a global good. When trade policies destabilize care in one country, they increase health risks everywhere. Infectious diseases do not respect borders. But solidarity, advocacy, and prevention must cross every line.

References

1. World Economic Forum. In Africa’s Free Trade Area, investment in pharmaceuticals means impact and profit. March 2023. Accessed April 10, 2025. https://www.weforum.org/stories/2023/03/in-africa-s-free-trade-area-investment-in-pharmaceuticals-means-impact-and-profit
2. McKinsey & Company. Should Sub-Saharan Africa make its own drugs? 2022. Accessed April 10, 2025. https://www.mckinsey.com/industries/public-sector/our-insights/should-sub-saharan-africa-make-its-own-drugs
3. Business Day Nigeria. Pharmaceuticals incur FX losses on naira depreciation. 2024. Accessed April 10, 2025. https://businessday.ng/companies/article/pharmaceuticals-incur-fx-losses-on-naira-depreciation
4. Kaiser Family Foundation. Breaking down the US global health budget by program area. 2024. Accessed April 10, 2025. https://www.kff.org/global-health-policy/fact-sheet/breaking-down-the-u-s-global-health-budget-by-program-area
5. Global health experts warn of HIV medication rationing due to US aid cuts. The Guardian. March 18, 2025. Accessed April 10, 2025. https://www.theguardian.com/global-development/2025/mar/18/global-health-trump-usaid-cuts-hiv-aids-2030-drugs-vaccine-research-africa