Science Friday - What Does Dismantling USAID Mean For Global Health?

Episode Date: March 10, 2025

On the very first day of Donald Trump’s second term, he signed an executive order targeting foreign aid programs, especially the U.S. Agency for International Development (USAID).Comprising less than 0.1% of the federal budget, USAID provides international humanitarian and development aid for poverty eradication, education, disease prevention, and medical programs. The Trump administration has cut off funding for these programs and most of the USAID staff was placed on leave or laid off.Since January, hospitals and clinics in places like Thailand, Syria, and India have shuttered; clinical trials on HIV and maternal health have been canceled; and projects on polio, malaria, and tuberculosis prevention have been stopped.Then, this week, the Supreme Court rejected a bid to keep some aid funds frozen. But what does that mean in practice for USAID’s global health initiatives?Host Flora Lichtman talks about the global health implications of dismantling USAID with Dr. Atul Gawande, surgeon and former head of global health at USAID; and Dr. Salim Abdool Karim, epidemiologist and director of the Centre for the AIDS Programme of Research in South Africa.Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Flora Lichten. Today in the podcast, the repercussions of dismantling USAID and withdrawing from the World Health Organization. It's sending a signal to the world that we are going to be leaders of American health. And as far as global health is concerned, that's your problem. On his first day back in office, President Trump issued an executive order targeting foreign aid. funding for the U.S. Agency for International Development, USAID, has been frozen, and most of the staff has been placed on leave or laid off. Last week, the Supreme Court rejected a bid to keep some of those funds frozen. But what does that mean in practice for the agency's global health initiatives?

That's what we're talking about today. The repercussions for people and medical care across the world and what it means and why it matters that the U.S. is stepping back from being a leader in global health. Let me introduce my guests. Dr. Atul Gawande is a surgeon and former head of global health at USAID. And Dr. Salim Abdul-Kareem is an epidemiologist and director of the Center for the AIDS Program of Research in South Africa. Welcome to Science Friday. Pleasure. Delighted to be here.

Atul, the news is changing fast. Can you just catch us up on where things stand with USAID? Yeah. The core of it is that a month ago, a freeze on foreign aid froze all funding. This is work that then last week was formally terminated with 90% of the staff being let go as well. So the results are that virtually the entirety of the president's malaria initiative reaching 53 million people, mostly children, has been terminated. Virtually all of the tuberculosis control.

program, terminated. All of the 50 country network where we work with them to strengthen their ability to detect and respond to pandemic threats, terminated, and three quarters of an HIV program keeping 20 million people alive, including 500,000 children also terminated. And that's just the global health work. We haven't gotten to humanitarian food assistance and protecting freedom abroad and stability in conflict environments. It's devastating. The Supreme Court just unfroze two billion in foreign aid funding. What does that mean exactly? What's that money for? What should we expect next? So number one, an incredibly important ruling just to indicate to us that unchecked arbitrary decisions are potentially going to be addressed by the courts.

was real doubt and concern whether that was going to happen. This is a very narrow ruling. This applies to the past funding for work that organizations across the United States and the world have done in the past that was not being paid. So when they froze the money a month ago, there was money owed to hundreds of contractors and nonprofit organizations that do work with hundreds of thousands of staff around the world. And that federal district, court that was trying to enforce that at least back payments need to be made, that court had ruled that the freeze had to be unfrozen, that it was illegal. So it sounds like the Supreme Court is kind of agreeing and saying, yes, U.S. government,

you have to pay your bills. Exactly. Solem, you work on HIV and AIDS prevention in South Africa. I want to hear about what it's like on the ground. Sounds like a project you collaborate on has been directly affected by the U.S. ID cuts. Will you tell us about it? Sure. I mean, it needs to be pointed out that USAID and CDC provide a large part of the funding for South Africa's AIDS response. So when that is terminated, that means patients can't go to the clinic and get the continuation of their

treatments. So patients have already had to stop their medication. That has a huge consequences, not least that patient is surviving because they are treatment, but because it can also lead to a drug-resistant form of HIV, and a drug-resistant form spreading is a threat not only to Africa or to South Africa, it's a threat to the world. For my own center, we have two projects that were funded by USAID through our participation in a consortium. And both those projects were brought to an immediate halt through a stop work order. And one of those projects was a phase one safety study of a new technology to prevent HIV and women. The women had the technology already inserted.

These are intravaginal rings that are for HIV prevention. And these devices were in their bodies when the funding was cut. Can I just jump in on this? How insane what he just described is, right? It is against all ethics. It's against legal human subjects requirements. You cannot abandon people in a trial with these vaginal devices inserted into them. They have to be able to be cared for.

They have to have them at least removed. You know, when you abandon this work and terminate this work, there has to be a proper wind down. Slim will have staff, and there are laws that require the U.S. to give notice. There are payments to be made to insurance and anything else that might need to be addressed. So it really is, it's a calamity for an organization like you're Slim. I have to suspect. Absolutely. And, of course, from our point of view,

You know, we simply cannot follow a stop work order. So we followed the rule that required that we not spend any further USAID funding, but we put our own funding into ensuring that every woman could come back to the clinic, that they were seen, a safety assessment was done, the rings were removed, and that we could continue and ensure that they were safely exited from the study. And we did that using our own funds. because from our point of view, our ethical obligations fast to precede any instruction to stop work. Atul, how widespread is this, patients being left mid-treatment, mid-trial without care?

There are thousands of patients in trials across the world. We collaborate with NIH and others to make global studies possible, and those include, you know, children being taken care of in TV drug trials, malaria research, and so on. And then you have all of the people who are simply in programs where there is support to enable treatments that are also abandoned. And that's where you get millions of HIV patients, for example, who are simply not being able to be treated. Until President Trump campaigned unslashing federal spending, this is something a lot of people, a lot of Americans support. Please make the case for why taxpayers should care about global health initiatives. There is a selfish reason.

We are going to see a enormous rise in measles, in HIV, in tuberculosis, and in new threats coming to our borders. An example is, you know, we've seen polio start to come back already in the world, and we're not prepared for polio to begin landing here. The prediction of the internal staff calculations at USAID are that we can expect to see 200,000 polio cases arising in the world after we've gotten it down to just a handful per year and trying to wipe it out. And so we're going to see threats like that, and we will be exposed to that. The second reason is that United States has stood for a different path in the world, one where we work cooperatively to solve big human problems. You abandoned this work and trust in the world, our alliances and partnerships are shattered. And guess what? This is a gift to China and Russia who have been attacking,

propagandizing, and trying to destabilize this kind of work because it is a major source of our influence in Africa and Asia in Eastern Europe. Do you expect Russia or China to take the U.S. place? Neither one has the commitment and resources in quite the same way. China's the best position to do that. They're already stepping in to take advantage when we didn't deliver the same level and speed of response around Ebola and Uganda. Russia had moved a laboratory into place, which is not something we've seen happen before.

China tends to take a more transactional approach that often has high commercial interest rates and all of those kinds of things. And U.S.'s approach has made us a close partner with many countries that don't necessarily cooperate with us otherwise. So part of what China and Russia are doing is simply celebrating the destabilization and the increased conflict with the United States. Perhaps to expand on what the tool was saying, this new approach of the Trump administration, it's sending a signal to the world that we as the U.S. are no longer playing a leadership role in global health. We are stepping back. We are going to be the leaders of, of American health.

And as far as global health is concerned, that's your problem. And pulling out of the WHO, which is the custodian global health, is the first serious signal that that was going to happen. So the U.S. has lost its leadership position in global health. It's now no longer a serious player. We have to take a break. And when we come back, what withdrawing from the WHO could mean for your health. O oversees the development of flu vaccines, and I don't know how we're going to get a proper flu vaccine this fall.

Stay with us. What are the repercussions of pulling out of WHO? Oh, they're very significant. At the most practical level, the U.S. is a contributor to the budget of the WHO. So pulling out of the WHO means the U.S. has less funds. In many countries, the WHO is the main primary responder to major health hazards, whether it's a pandemic or whether it's a disaster. So it has a huge impact on the WHO and its ability to respond to major challenges around the world. Secondly, its effect is to say to WHO that not only are we,

pulling out of the WHO, but we're going to stop communication through the CDC. That's a big problem. Because right now, globally, when we look at the threats that exist in terms of potential for a new pandemic, actually the number one threat is in the US from avian flu that's currently spreading in the cows and present in the milk in the US. And for the World Health Organization, which just to protect the world's health, not to have information about what is going on in that epidemic situation in the U.S. is a very serious problem. On W.O, I'll just say, to add to what Slim has to say, we don't have access to many countries in the world for information. China and Russia are examples. And the WHO oversees the development of flu vaccines. And I don't know how we're going to get

a proper flu vaccine this fall. We're no longer participating in the flu network that generates our vaccine and make sure it's tuned to the most likely type of flu virus that will arrive in the U.S. this year. I want to zoom out for a second. I've read criticisms that foreign humanitarian aid can have this imperial component, right? Rich Western countries coming in, using aid to assert control and power, pulling the plug when it doesn't suit them anymore. Is this a legitimate criticism? Yeah, it is a legitimate line of argument, right? The U.S. has delivered its foreign aid traditionally with 95 plus percent being, you know, U.S. and international organizations, delivering the aid, swooping into a country, but not necessarily putting countries on a path

to self-reliance. It's been vital that the work has really shifted in the last decade to, towards building capacity in countries, we are now pushing towards funding local organizations so that we're building up their capacity. That builds leadership and a transition pathway that moves countries off of depending on foreign aid. And there had been cycles of dependency. I think there's legitimacy to the idea that, you know, when you depend on money from outside your borders, there come strings attached. That's never avoidable. But the U.S., when John F. Kennedy created U.S. aid, he referred to the fact that the U.S. depended on loans from abroad when we became a independent nation and needed to build up our own capacity after a war that decimated

our own abilities. I think that the net effect of what's happened now has been not just a reversal, but it's been a harmful effect. This particular administration is not just about changing its priorities or its policies. It deliberately stopped the funding first. It set out to do this in a brutal way. It's set out to be harsh. It's set out to show who's in charge. It's set out to show that it carries all the cards.

It was deliberately done to create instability. This is not about, okay, we'd like to spend our money on something different. Here's a way in which we can transition to something else. This is about you are stealing our money. You are criminals at USAID giving these foreign countries our money. that's what we saw. And that is not just about undoing self-power. You know, Atul, big swaths of the American people are really fed up with government and how it spends money. If you were asked to reform USAID, what would you do? I mean, what do you think actually could work better?

There's always opportunities around waste and inefficiency. I drove. I drove. at Global Health, a set of changes where we focused on maximizing the amount of impact per dollar in reducing the percentage of deaths that happened in a country before the age of 50. And we were able to drive significant reductions in mortality with less funds through both innovation and efficiency changes. The second thing is, you know, I took over a global health team that reaches hundreds of millions of people with half the budget of the hospital system where I work and do surgery in Boston. So it is saving lives by the millions with, yes, a budget that's $8 billion.

That's a big number, but generating remarkable impact like nothing we achieve in the U.S. health system. So, you know, out of the average person paying $12,000 in taxes per year, the average family, it's $38 that gives us freedom from polio, freedom from smallpox, you know, massive control of HIV and addressing deadly diseases and help for food people who are malnourished and so on. So it is already an extraordinary buy. I want to thank you both for taking the time to join me today. Pleasure.

Thank you. Dr. Atul Gawandei is a very important. the surgeon and former head of global health at USAID. Dr. Salim Abdul-Kareem is an epidemiologist and director of the Center for the AIDS Program of Research in South Africa. And that is about all we have time for. Lots of folks helped make the show happen, including... Praise Agu Kyi.

Sandy Roberts. Robin Kasmur. Jordan Smudjik. I'm Flora Lickman. Thanks for listening.