On January 28, the Trump administration ordered a halt to all US government aid. As part of this, the United States Agency for International Development (USAID) was closed down, all funding was stopped, and all but 600 of the over 10,000 staff were told to stop working and return home within 30 days. Despite the administration claiming there are waivers to continue “emergency aid” and a federal judge ruling on February 13 that the Administration must reverse its stop-work order on existing foreign aid programs, as of February 17, as reported in detail by Devex, even the waivers have had little or no effect in releasing funds for “lifesaving” activities and the administration has not responded to the judge’s order.
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The reasons given for the freeze of all foreign aid and closing of USAID are to review all government spending by the newly formed Department of Government Efficiency (DOGE) headed by billionaire Elon Musk to ensure all government spending fits into the new administration's “America First Policy.” Elon Musk posted on X on Sunday February 2 describing USAID as “a criminal organization that needs to die,” and described his actions as “feeding USAID into the wood chipper.” According to President Trump, who has enthusiastically supported these actions, USAID is “run by a bunch of radical lunatics.” Secretary of State Mark Rubio stated that USAID will be folded into the State Department, and only those programs which meet the administrations criteria of "does it make America safer? does it make America stronger? does it make America more prosperous?" will be continued. Doing the right thing, or helping those in need, is not included.
What does USAID do and why has it been dismantled? According to the former Administrator of USAID, Sammantha Power, “Out of the $38 billion that U.S.A.I.D. spent in fiscal year 2023, nearly $20 billion was for health programs (such as those that combat malaria, tuberculosis, H.I.V./AIDS and infectious disease outbreaks) and humanitarian assistance to respond to emergencies and help stabilize war-torn regions. Other U.S.A.I.D. investments are less visible but pay dividends in the longer term, such as giving girls a chance to get an education and enter the work force or growing local economies” (NYT Guest Essay February 6, 2025). Others have pointed out what they consider dubious projects funded by USAID as reported by White House Press Secretary Karoline Leavitt: “$1.5 million to advance DEI in Serbia’s workplaces, $70,000 for production of a DEI musical in Ireland, $47,000 for a transgender opera in Colombia, $32,000 for a transgender comic book in Peru.” But as reported by FactChecker.org, only the first one was funded by USAID and the rest by the State Department. This example claims waste is $1.5 million out of $38 billion, less than 0.004% of the total spent by USAID.
My experience is very different from what the administration claims. I ran two mission hospitals in Africa for 23 years. The first time at Kuluva Hospital in Uganda (1985-1998), there were no HIV drugs available, and all of the thousands of people I treated who were infected with HIV died. The second time at Nkhoma Hospital in Malawi (2009-2018), due to the US President’s Emergency Fund for AIDS Relief (PEPFAR) and the US President’s Malaria initiative (PMI), both started under the Republican Administration of President George W Bush, there were HIV drugs available and a much larger stock of more effective drugs for malaria, the leading killer of children where I worked, so that deaths were far fewer. USAID through PEPFAR and PMI provides for the medication to treat HIV and malaria, and often funds the local staffing and clinical programs to provide this treatment. In Malawi USAID also funded new classrooms and dorms for the Nkhoma Nursing College at Nkhoma Hospital. In Malawi, the church-run nursing colleges provide 60% of all nurses for the country, government as well as church hospitals and clinics.
Funding for these types of medications and programs have stopped. Perhaps the most dire is the freeze of PEPFAR funding. People with HIV who do not get HIV drugs will die. Pregnant women with HIV will pass the infection to their unborn child.
This is a profound shift in US government policy. Compare the above listed criteria of “America First” with President George W Bush’s reasoning for why the US should provide the PEPFAR funding, expressed in his 2003 State of the Union Address when he introduced PEPFAR. “Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many.”
David Morton MD, DTM&H
Covenant College Alumnus Class of 1975
Member American College of Physicians
Member American Society of Tropical Medicine and Hygiene
Diplomate American Board of Internal Medicine
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