WASHINGTON - The senior science official overseeing the U.S. government’s flagship HIV/AIDS initiative has left his position this week and publicly rebuked the current administration’s approach to foreign health assistance.
Mike Reid, a practicing infectious disease physician who served as chief science officer for PEPFAR within the State Department’s Bureau of Global Health Security and Diplomacy, said in a Substack post on Monday that he had remained in his post for the past 18 months to try to protect programs he viewed as vulnerable. He accused the administration of cutting foreign assistance and of leveraging health funding to obtain commercial advantages for the United States.
Reid pointed to reporting that suggested the State Department had considered withholding HIV assistance to Zambia as a means of pressing the country to sign a U.S.-favored critical-minerals agreement. In his post he warned that "when access to treatment or prevention becomes entangled with access to critical minerals or geopolitical positioning, the work is no longer what it claims to be."
He added a broader political critique, writing that the work of global health was "inherently anti-fascist" and that this mission was incompatible with what he described as an "authoritarian" turn in domestic policy under the administration.
Following Reid’s post, the State Department informed him that his employment would end immediately, Reid said in a telephone interview on Tuesday. The department did not engage directly with the substance of his criticisms when asked by Reuters; instead a State Department spokesman said Reid departed by mutual agreement after he "admitted he could no longer provide nonpartisan scientific advice."
The spokesperson reiterated that, across administrations, the president and senior team set policy and that department employees have a duty to faithfully execute that policy.
The State Department recently released data showing a sharp decline last year in the number of people tested for HIV amid interruptions to PEPFAR operations. PEPFAR, a bipartisan effort launched in 2003, is credited in department materials with saving 26 million lives and preventing HIV infections in 7.8 million babies born to mothers with HIV since the program began.
In its public statements, the department framed the current administration’s approach as an effort to end the HIV/AIDS epidemic while pursuing what it calls the America First Global Health Strategy. The department also noted that Reid acknowledged in his Substack post that the strategy aims to encourage lower-income countries to assume greater ownership of their health responses through bilateral agreements.
At the same time, Reid wrote that this shift toward country ownership has coincided with an overall reduction in U.S. funding to those countries. He said those funding changes have occurred as U.S. military spending has increased and as the administration has launched a war with Iran.
Reid told Reuters that channeling funding to government health agencies rather than non-governmental organizations can be the correct approach in principle. However, he said that key U.S. officials who previously served in oversight roles and monitored for corruption or misuse of funds had left their positions, raising concerns about accountability.
"I am concerned at the speed and the lack of oversight," Reid said.
This episode follows broader organizational changes inside the U.S. foreign assistance apparatus last year, when Republican President Donald Trump dismantled the U.S. Agency for International Development, an agency that had previously overseen much of U.S. foreign aid. Officials maintained at the time that critical life-saving work, particularly PEPFAR operations in many developing African countries, would continue despite those reorganizations.
Reid’s departure and critique draw attention to tensions between a stated policy objective of transferring greater responsibility to partner countries and concerns among some career officials and clinicians that funding reductions, staffing changes, and altered oversight could interrupt treatment and prevention services for people with HIV.
As the State Department and the White House continue to promote the administration’s global health strategy, Reid’s exit casts a spotlight on the practical and ethical questions that arise when health assistance becomes entwined with geopolitical and commercial priorities.
The immediate personnel change follows Reid’s public post and the department’s declaration that he could no longer provide nonpartisan scientific advice, while the department underscores its commitment to an America First approach to global health.