DISCUSSION COMMENTARY

 

"Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the world": An old lens on a new problem

 

 

Heidi Matisonn; Jantina de Vries

The EthicsLab, Department of Medicine and Neuroscience Institute, University of Cape Town, Cape Town, South Africa

Correspondence

 

 

---

ABSTRACT

SIGNIFICANCE:
In this reflection on the NIH funding cuts, we call attention not only to the effects of such cuts, but also to the failure of a South African university to implement policies that would have provided a buffer to soft-funded researchers and left them with an ability to cushion the effects of the sudden loss of funding. We also call attention to solidarity as one response to the current moment, to be understood as people standing together in a commitment to be and do better for each other.

Keywords: global health, NIH funding, academic institutions, solidarity

---

 

 

The quoted text in the title¹ by WB Yeats was originally written in 1919 in the aftermath of World War I to signal an apocalyptic time when humanity seemed to have lost its morality, and the forces or institutions that previously held society together were failing to maintain their functions. Almost a century later, these words so aptly describe the political reality today - one expression of which is the weaponisation of science evidenced through the devastating cuts by the US federal government that have affected the lives and livelihoods of millions across the planet.

The anarchy in our case has taken the form of deathly silence from our funders at the US National Institutes of Health (NIH). Our grant received a perfect score in 2022 (10/10), meaning that the three reviewers who ranked the proposal for review, agreed that our proposed new MSc degree in Global Health Ethics was outstanding - timely, necessary and of critical importance. Fast forward three years, and we are anticipating a termination letter to come through any day now. If that happens, we will have to pull the plug on our new degree as we will not have the resources to move towards implementation - meaning that our aspiration of training a generation of students to think critically about global health and its intersection with power and ethics, will also be lost.

Our grant was up for renewal on 1 April 2025, and, to date, we have not had any correspondence regarding its status. The lack of communication on the part of NIH also leaves two soft-funded researchers and our MSc students on bursaries in a precarious position: we do not know whether or when our programmes need to be terminated, and whether and when our salaries will come to an end. The lack of formal communication may be because the funders themselves are subject to gag orders, or because they also do not know what is happening.

Our precarity, however, is not only due to the whims and caprices of the Trump-Musk administration. Similarly, soft-funded academic research staff (SFARS) at our institution are affected by the collective decisions of executive members of our university. Firstly, unlike at some other public South African universities where researchers receive a share of the subsidy funding that the South African government pays the university for their graduates and publications, the University of Cape Town's policy does not appear to allow this - or if it does, we, as SFARS have never benefitted from its implementation.

Secondly, to date, our executive has failed to implement a university policy that would have meant that at least some of the indirect costs paid through grants would be deposited into a 'rainy day' fund for the benefit of SFARS and their teams.² Instead, our university has used funding generated through and by SFARS to cover funding gaps due to overall reductions in government subsidies. The consequence of both of these executive decisions is that SFARS - at least at our university - have not been able to build up a buffer to accommodate the sudden withdrawal of funding. As such, the precarity of our - and our students' - situations cannot just be blamed on decisions made from afar: responsibility for that also lies at our own doorsteps.

Whilst we could be forgiven for a sense of impending doom and uncertainty, we have experienced the opposite: a sense of hope in our common humanity. Needing only to be asked, soft-funded colleagues at our own institution have reached out to and received permission from their funders to take care of our students' scholarships; others have offered to split their salaries with us or move us onto their more secure grants. In contrast to the institutional inertia and unwillingness to think laterally, we have seen solidarity in action: as Donna Andrews puts it, solidarity as "lived experience, as political, as collective action against injustice, as transformative and emancipatory"³. Such solidaristic responses highlight for us that there is opportunity in the loss, a path through the chaos.

Moving through the current predicament will not be easy. We will need to stand together in a commitment to be and do better for each other in ways that are different from what the current flow of money and malice suggest. One such alternative is to entrench an approach to our research contexts that is not transactional but transformational⁴ and that centres social justice⁵ as a cornerstone of health and health research. It requires honouring an ethical obligation to use our collective skills and assets for the public good and to advance a fairer system of global health.

 

Funding

The EthicsLab is funded by a Wellcome Trust Research Development Award to J.d.V. and Francis Nyamnjoh (WT222784/Z/21/Z) and a Wellcome Trust Discovery Award entitled 'Moving beyond solidarity rhetoric in global health' to Caesar Atuire, J.d.V. and other colleagues (WT225230/Z/22/Z). J.d.V. and H.M. both receive salary support from these two awards. They were also supported by a Fogarty NIH grant (1R25TW012219) which also supported the development of a new MSc in Global Health Ethics degree at UCT - this grant has not been renewed and so has - apparently - lapsed.

 

Declarations

We have no competing interests to declare. We have no AI or LLM use to declare. Both authors read and approved the final manuscript.

 

References

1. Yeats WB. The second coming [webpage on the Internet]. c1989 [cited 2025 Mar 28]. Available from: https://www.poetryfoundation.org/poems/43290/the-second-coming        [ Links ]

2. University of Cape Town. Greater recognition of SFARS staff contributions and value to UCT [document on the Internet]. c2022 [cited 2025 Mar 28]. Available from: https://uct.ac.za/sites/default/files/media/documents/uct_ac_za/39/Policy_Research_SFARS_15October2022.pdf        [ Links ]

3. The EthicsLab: University of Cape Town. Solidarity embodied and enacted [webpage on the Internet]. c2025 [cited 2025 Mar 31]. Available from: https://health.uct.ac.za/ethics-lab/articles/2025-03-05-solidarity-embodied-and-enacted        [ Links ]

4. The EthicsLab: University of Cape Town. Decolonising health research in Africa [webpage on the Internet]. No date [cited 2025 Mar 31]. Available from: https://health.uct.ac.za/ethics-lab/decolonising-health-research-africa-exploring-epistemic-justice-and-change-matters        [ Links ]

5. Faden RR, Powers M. Health inequities and social justice. The moral foundations of public health. Bundesgesundheitsblatt - Gesundheitsforschung -Gesundheitsschutz. 2008;51(2):151-157. https://doi.org/10.1007/s00103-008-0443-7        [ Links ]

 

 

Correspondence:
Jantina de Vries
Email: jantinadevries@uct.ac.za

Published: 29 May 2025

 

 

Funding: Wellcome Trust (WT222784/Z/21/Z, WT225230/Z/22/Z), Fogarty US National Institutes of Health (1R25TW012219)