The Trump administration’s decision to end almost all foreign aid spending from the United States Agency for International Development (USAID) is poised to plunge global health into chaos.
The contract terminations announced Wednesday will end grants for HIV treatments and prevention, tuberculosis, polio, malaria, Ebola and numerous other diseases and conditions. Nutrition assistance programs for infants in developing countries have also been halted, organizations said.
Nearly 5,800 projects funded by USAID have been terminated, ending the hope that contracts previously frozen might have been restarted.
“This reckless and unilateral move will cost millions of lives around the world,” said the Global Health Council, an alliance of nonprofit organizations and companies that receive U.S. foreign aid funding, in a statement.
“With the stroke of a pen, the U.S. government has gutted decades of progress in global health, development, and humanitarian aid — without due process, transparency, or good faith consideration of the consequences,” the council said.
The Global Health Council is one of the nonprofits that have challenged a freeze on foreign aid.
Shortly after taking office, the Trump administration suspended nearly all foreign assistance, saying the funds needed to undergo a 90-day review to ensure compliance with the administration’s policies.
The freeze led to thousands of humanitarian workers losing their jobs and life-threatening delays in food and medicine to impoverished areas around the world.
A few days later, the State Department issued stop work orders on foreign assistance funded by or through the State Department and USAID, including existing awards. The stop-work orders came without warning, sowing immediate chaos and confusion.
The State Department then issued waivers to allow certain “lifesaving” programs, including the President’s Emergency Plan for AIDS Relief (PEPFAR), to continue. But the waivers were unevenly applied, and organizations granted waivers said they still weren’t being paid.
International health groups said they were under the impression the waivers would continue to apply through the 90-day review period.
“The chaos and confusion of the last four weeks we thought had reached a fever pitch but what happened [Wednesday] night takes this to a new dimension. Every project imaginable in HIV, tuberculosis, malaria, nutritional support, has now been terminated,” said Mitchell Warren, executive director of AVAC, an international nonprofit focused on HIV prevention and one of the plaintiffs in the effort to unfreeze funding.
“The only strategy the administration seems to have is to sow chaos and confusion. There’s no effort to look at what aligns with foreign policy, diplomacy, partnerships. And no strategy to prepare for public health threats,” Warren said.
But on Wednesday night, the administration said it had concluded a “a good-faith, individualized assessment” of USAID’s 6,300 grants in less than a month.
“Secretary [of State Marco] Rubio has now made a final decision with respect to each award, on an individualized basis, affirmatively electing to either retain the award or terminate it pursuant to the terms of the instrument or independent legal authority as inconsistent with the national interests and foreign policy of the United States,” the administration said in a court filing.
The State Department has said the agency spared critical awards for lifesaving medical treatment, including those that had been operating under a waiver from the earlier funding freeze, but health groups say that is not the case.
For instance, the Elizabeth Glaser Pediatric AIDS Foundation said three of its primary USAID agreements, which had received approval to resume limited work under the State Department’s waiver for lifesaving work, were terminated.
The projects supported more than 350,000 people on HIV treatment, including nearly 10,000 children and more than 10,000 HIV-positive pregnant people in Lesotho, Eswatini, and Tanzania.
The International Rescue Committee (IRC) said 46 of its USAID and State Department programs were canceled, including funding for operating nutrition assistance centers, which help severely malnourished children. Those had been operating under a waiver.
The Joint United Nations HIV/AIDS program said its U.S. government funding was also terminated.
Global health experts said the effects of the cuts will be disastrous, both in terms of health and for how the U.S. is seen throughout the rest of the world.
If a person with HIV stops taking the medication, the virus is no longer suppressed and can multiply, leading to weakened immune systems, illness and then potential spread to others.
For malaria, the cuts mean programs that supplied mosquito nets for cribs won’t continue, which means fewer babies protected from malaria. That increases malaria infections, which then can increase deaths.
“It’s just a cascading effect on almost every level that ultimately leads to more people being ill, more people dying, and ultimately more costs associated with running these programs and caring for these people,” said Jirair Ratevosian, a fellow at Duke University’s Global Health Institute who worked as a chief of staff for the PEPFAR program.
“So it’s counterintuitive to what we’re trying to do.”
Jen Kates, a senior vice president and director of the Global Health & HIV Policy Program at KFF, said the terminations could set back years of health progress that the U.S. and others have been working toward in developing countries.
“The U.S., frankly, has been one of the main forces behind health achievements in low- and middle-income countries. So a lot of money was provided to make these gains, and they could be set back,” Kates said. “The extent of the damage is not known yet, but I think in a lot of cases it might be hard to recover easily, even with the replacement funds at some point in the future.”
Jocelyn Wyatt, CEO of the aid group Alight, said she had to terminate programs for millions of displaced people in Sudan, Somalia and South Sudan.
Wyatt said Alight was the largest health provider in Sudan, serving 2.1 million people. They operated under a waiver during the earlier funding freeze, but this week had to close 33 health clinics in the country.
In Somalia, the group had to close 13 health centers, as well as a mobile clinic. In Sudan, it had to stop water and sanitation services and close three camps for displaced people and refugees.
“We’re working in very remote regions. Humanitarian assistance was already very scarce. There were not a lot of services before, and now there’s none,” Wyatt said. “These are lifesaving services. There’s no alternative, and people will die.”
