The Current - Trump’s halt to USAID means thousands will die: reporter

Episode Date: February 18, 2025

The Trump administration's abrupt USAID funding freeze has created chaos in global humanitarian work, including efforts to fight diseases like HIV, tuberculosis, and malaria. The New York Times’ global health reporter Stephanie Nolen lays out the immediate and long-term impacts on people whose health depended on that aid.

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This is a CBC Podcast. Hello, it's Matt here. Thanks for listening to The Current wherever you're getting this podcast. Before we get to today's show, wonder if I might ask a favor of you if you could hit the follow button on whatever app you're using. There is a lot of news that's out there these days. We're trying to help you make sense of it all and give you a bit of a break from some

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has been a cornerstone of global health funding. It has provided billions of dollars to fight diseases like HIV, tuberculosis, and malaria, while also bolstering maternal health and emergency response programs. But in the blink of an eye, that lifeline was severed. The Trump administration's abrupt USAID funding freeze has thrown health care systems across the world into chaos. Without US funding, people die. Without global collaboration, people die.

I've been coming to this clinic for years now. I think it's been eight years or something that I've been under their care. And now with Trump's ridiculous policies, that is all gonna change. That is why I came here today, because they're closing. This is not about the economics of making countries such as South Africa and other African

countries more independent. This is a direct attack on the humanity of LGBTQI people, of women, of girls, of children and other marginalized groups. Access to aid, I think we can begin to think of it as a thing of the past. Last Thursday, a federal judge in Washington, D.C. ordered the Trump administration to temporarily lift its foreign aid funding freeze. The judge set a five-day deadline for the administration to prove that it's complying. That deadline is today.

Stephanie Nolan is a Global Health Reporter for the New York Times. She has covered health care around the world for 30 years from many countries, particularly in the global south. She is in our Halifax studio this morning. Stephanie, good morning. Good morning, Matt. Thanks for doing this. In the work that you have done in traveling around the world, how prevalent is the presence of USAID in the communities that you have visited? Oh, I'd say it's pretty much universal. I would be hard pressed to think of a trip or a

reporting trip that I've done that didn't, where I didn't come across something that had some US funding. And so you reached out in the, in the, the, the wake of this news coming from the Trump administration, you reached out to some of the people, the contacts that you had around the world. And one of the things that you wrote about in the Times is that many of those

that you interviewed as they talked about what was going on were in tears. What was going on there? Yeah, you know, we're, we're, I guess it's today four weeks. I don't know. It's all feeling a little surreal, but I guess we're four weeks into this and every morning I wake up and I turn on my phone and my WhatsApp, my signal is just a stream of people sending me voice memos. I had another one from Uganda this morning of a woman in tears. She's gone to the clinic where she's picked up her

anti-retroviral therapy for HIV for more than a decade and they've just told her that they don't have the drugs and they don't know where she can get them. And every day I have conversations like this with patients, with researchers, with people who run national healthcare programs, mostly in African countries, which African countries got about 85% of USAID assistance, and so they're feeling this the most. But I can tell you that the devastation is still spreading, sort of still rippling out,

and I think that will be true for years to come. Who specifically, pick up on that, who were some of the people that you first thought of when you heard about these cuts and you heard what was happening? I mean, Elon Musk saying, he spent a weekend putting this agency into a woodchipper. You know, I saw that that must comment,

and I rather naively, like I guess a lot of other people, I thought this is a vast, intricate web of services that are funded and supported by USAID and you can't just dismantle them. And about 72 hours later, it was for all intents and purposes gone. And I think at this point would be very difficult to bring back. And so, uh, apparently you can just wood chip a fast global network of development support. Um, it's, you know, I thought first of patients who have people like the woman I heard from in Uganda this morning.

So I've been covering the African HIV epidemic for, as you said, about 30 years and I saw treatment arrive on the continent and saw this go from being a catastrophe to just another chronic illness that people live with in most countries. And all of a sudden, for those people, you know, most of those drugs were still supported, were still supplied by the US government. I thought about malaria programs because the US has a program called the President's Malaria Initiative that supports all kinds of tracking of mosquito species, control of larva, testing of new innovations, distribution of bed nets. Tons of that malaria work is

supported by the US government. I thought about tuberculosis. I've been speaking with the people who run national tuberculosis programs and they have stacks and stacks of tests that they can't process. So you have people showing up every morning to ask if their kid has TB or not and they don't have an answer for them. And then after kind of that sort of immediate panic, I also thought about researchers because the US is the major funder of research into infectious disease and the kinds of health problems that are prevalent in a lot of these countries where I work. And I started thinking about, you know, initially this was described as a freeze and it was

a freeze and a stop work order while there was a 90 day review was what was in the original Trump executive order. It's now become clear that there will be no 90 day review and this is not a freeze, it's a dismantling. But I thought about clinical research trials because if you have somebody testing a drug or a medical device or a new vaccine, how do you freeze that for 90 days? Can I go back to, you mentioned malaria, and if this was a freeze, even if it were to be paused, the initiative and the funding, there would still be immediate implications, right? This is something

that you wrote about suggesting that the work that is happening has to continue to happen or else there will be children who will die, even if you started funding the malaria treatments and the malaria prevention tomorrow, right? Yeah. The thing about malaria is you won't see it right away, right? So it'll be the kids whose family was due for a new bed net yesterday who didn't get one. And even if they get one in a week or two weeks or three months, there's a period of

time where they're not being covered by an insecticide-treated net. And if you don't distribute, if you don't allow clinics to give out therapeutics, you have kids who are sick today who die. If you don't allow the supply chains to move and put those drugs and the tests into rural clinics, maybe they had enough for a week or two weeks, but there will become a period of time where they run out of supplies. And that in the last few days is a thing that I've been hearing is that the fact that supply chains haven't moved at all for now a month is really starting to be felt. When it comes to HIV and AIDS, you mentioned PEPFAR and the program that was there

to help try to fight HIV and AIDS over decades now. What happens to that program? I mean, is it dead in the water? Can it be resuscitated? What happens there? Yeah, that's a great question. A question that a lot of people I talk to would like an answer to.

Um, you know, this has been really difficult to report on because, uh, you know, in the initial days after the freeze and the stop work order, there was huge outcry from HIV activists around the world, and Secretary of State Marco Rubio, who now oversees what ostensibly is going to remain of the aid effort said there would be a waiver

program and if you were doing life-saving work such as providing HIV treatment then you could apply for a waiver and you would be allowed to keep operating your program and what subsequently became clear is that that was essentially a fiction and just you know among other problems the payment system that used to disperse funds for these things has never been brought back online. And there are no people left, right? So even if you were applying for a waiver, there's nobody to send it to. So in effect, all of those HIV programs remain stopped. So what happens with that tide, the tide of illness and the tide of death that was stopped by those programs, by the work that was done? I mean, this was a bipartisan effort. It went

through various administrations. You had people here, Stephen Lewis and others who are deeply involved in trying to stop the catastrophe of HIV and AIDS in parts of Africa. What happens now? Uh, I mean, the short answer is people die. People have now not had their meds for weeks and there's no sign in a lot of places of where they're going to get them and people will die. Thousands of people will die. Countries are scrambling to try to fill those gaps. There is a hope that other donors, both philanthropies and other countries will step up but it's increasingly clear that actually certainly among other countries with the financial capability to plug some of these holes there just isn't an appetite to get involved in a much bigger foreign aid effort and

that assistance is not coming so far. Individual philanthropies may try to plug a few of those holes but the big philanthropies that do this kind of work in Africa, such as the Gates Foundation, have also said they cannot possibly take the place of the US government. And you know, some countries, South Africa, for example, which has the highest number of people living with HIV, South Africa already had taken on responsibility for much of that program themselves, I think South Africa will be okay. Smaller countries that are heavily heavily indebted and really still have really limited health care budgets like Malawi, Zambia, Zimbabwe, they are not in a position to suddenly start buying HIV treatment for

hundreds of thousands of their own citizens. You know, is that a goal that they have to be able to do that? Absolutely. That is a long-term process and something that government officials I've been talking to have been saying, we probably should have taken more responsibility for this earlier on with a transition, with notice, with a couple of years to try to make this shift, we might have been able to do it. But if tomorrow we need to be the people putting the drugs in the clinics, we can't do that. Dena Temple-Reston I'm Dena Temple-Reston, the host of the

Click Here podcast from Record of Future News. Twice a week, we tell true stories about the people making and breaking our digital world. And these days, our digital world is being overrun by hackers. I was just targeted by a nation state. And they range from reflective. It's a crime, bro. And I live with that every day. To ruthless.

Do you feel guilty about it? No, not really. Click here from Recorded Future News. You can find us wherever you get your podcasts. Tell me about the clinical trials that are taking place right now. This is something that you've written about and spoken about as well. And these are people who are participants in these clinical trials who are now in a state of limbo in the midst of trials.

Some of these people have devices in their bodies that are still being tested, right? Yeah, this was a really chilling aspect of this. You know, in terms of the overall people affected, it's thousands of people, but it's not against the scale of the larger problem here. It's maybe not the biggest problem, but I think it's a really grim one. You have people who were in clinical trials for vaccines, for drugs, for medical devices.

So for example, women who had experimental hormonal implants to control pregnancy in their bodies, they were volunteers in clinical trials and the day the stop work order kicked in, the researchers running those trials got an instruction from USAID that said, you can do no more work that is funded by the US government. You can't even communicate with the people in your trials. And so, you know, I talked, for example, with a researcher who had an experimental malaria vaccine that had been injected into volunteers in the UK, and they were not allowed to talk to them anymore. So here are these people who were getting monitored every day or two for what the effects

of this vaccine were, and now they're on their own. With, with, With the vaccine in their body, good luck with whatever goes wrong there. I was gonna say, it's just hard to imagine kind of what happens next. I mean, next week or in the next day or the next month, these people are just on their own. Yeah, so it really presented, as you might imagine,

an extraordinary ethical challenge for these scientists who on the one hand are hugely dependent on US funding and were not keen to run afoul of the new US administration. But there are also people who live in those communities. Yeah, and people who, you know, scientists, medical researchers who are governed by the code of ethics that globally is agreed for how you run a clinical trial. A lot of the people that I spoke to had decided just to violate the stop work order to call in their volunteers, tell them what had happened

in cases where that was possible to remove those medical devices. And at a minimum, try to make sure that people had some sort of a plan for where they could get care elsewhere. What do you understand about what doctors and scientists that you've spoken with, what they understand about why this is happening? Do they have any understanding as to what's going on right now, the root cause, the reason

behind this? I mean, I think for researchers who are based in the global south, it seems capricious and cruel and shocking. And there's also a sort of, I would say almost a kind of, you know, we, a sense that we were living on, we were living on, that it was never really about assistance, right? It was to serve US foreign policy interests. And we happen to be able to benefit ourselves and our communities by taking advantage of the alignment of those interests, but we no longer serve US foreign policy interests. And so, you know, on some level, we suspected this day might come. For researchers that I talked to in the US who've maybe been following the domestic plan

a little bit more closely, people who've read Project 2025, although I will say actually more researchers that I speak to based outside the US seem to have actually read Project 2025. This is the blueprint for the second Trump administration. Exactly, yeah. People who, you know, other people see USAID as the test case. They wanted to see, Elon Musk wanted to see if you move incredibly quickly and brutally against an agency, how quickly can you stun people, can you disable it so effectively that it can't be resuscitated?

And so the expectation is the same tactics that were just used against USAID will now be applied to some of the other federal institutions that Musk and Trump view as wasteful or out of control bureaucratically, and that this was the warm-up act and the same will be seen in other federal agencies. If you go to the USAID website, in enormous capital letters, it says, at USAID, waste and abuse runs deep. Is there at all a grain of truth to that, in terms of waste and abuse or? I will say I don't think I ever saw abuse in many, many years of looking at USAID projects.

I certainly saw abuse in many, many years of looking at USAID projects, I certainly saw waste. The folks I've talked to over the years who work at USAID probably would have been among the first to say that the agency was painfully bureaucratic and slow and that it spent more money than it needed to on projects. The thing that I think gets missed in some of that conversation is that a lot of that was because of rules that were made in Washington. So USAID had to buy commodities, healthcare commodities that it bought for developing countries from US producers. Those cost way more than buying them in country in Nigeria, for example.

When they bought food aid, they had to buy it from US farmers. Well, that obviously costs a lot more than buying wheat in Kenya, right? A lot of the bureaucracy and the slowness of the institution was because Congress had put layers and layers and layers of oversight over its operations and that just made it slow. Was it a perfect agency? No, not at all. And again, I think the people who worked there would have been the first people to say so. You hinted at the kind of soft power part of this as well, and have written that these programs presented a compassionate, generous image of the United States in countries where China has increasingly competed for influence. Could China step in here and pick up some of the slack?

Yeah, that's one of the things that I've been trying to report over the last few days is like, who moves into this space? And China obviously has been the first suggestion. My sense is that a bit of this will be picked up by China, but probably not a huge amount. Actually, if you kind of look closely at the spending, China had been pulling back from its investments and partnerships in Africa in the last sort of nine months or so, reflecting its own kind of fiscal challenges at

home. Also, the kinds of projects that the US was doing are not historically the kinds of things that China has shown much interest in participating in. They've been much more interested in large-scale infrastructure projects and low-cost loans for that kind of construction. I think you will see a bit of an increased role for China. Certainly, it would be an easy way to win some friends at this moment, right, among the health ministries of governments that are absolutely foundering to step in and say, we'll take over funding your supply chain, uh, your purchase of basic medicines for your citizens, but so far there hasn't been any

indication that China plans to do that. Just in the last couple of minutes that we have, how does what you're talking about and what you're reporting on, how does it, do you think lead us to think differently perhaps about aid and the role of aid and our responsibility in wealthier countries to help those who not just rely on help, but have

needed that help for some time. And it's not just in the United States, you have Pierre Poliev who leads the Conservative Party who has talked about significant cuts possibly to foreign aid to help fund, for example, projects here in Canada, particularly in the North. Is that conversation about the place of foreign aid and the place of foreign aid in countries like Canada, is that going to be different, do you think? You know, you made reference a minute ago, Matt, to the era when PEPFAR was created, when Stephen

Lewis and others were campaigning for us to pay attention to the devastation of the African HIV epidemic. And that to me feels like a very different, long ago era, when there was a consensus in countries in the global north that we had a basic responsibility to contribute to ending poverty and to helping to care for people in impoverished countries. That social consensus seems to be gone. And I think you could say that there is a much more broadly held view in the global north now that whatever extra resources there may be

or whatever resources there may be need to be spent here at home. So I think the consensus around aid has really shifted. I think what's happened with USAID is interesting because it kind of overlaps with a conversation that was already getting quite loud from the Global South about how this model of the model of aid that we had was not sustainable and it wasn't allowing countries to build sustainable systems.

Again, I think the question is kind of does this kind of nuclear detonation of the systems and the devastation that leaves in its wake, is that the question is kind of, does this kind of nuclear detonation of the systems and the devastation that leaves in his wake, is that the way to kind of transition out of the aid model? Clearly not. And in fact, it's probably set back that process rather than actually facilitating it. I'm always glad to talk to you and especially this morning. Stephanie, thank you very much. Thank you.

Thanks for having me. Stephanie Nolan is a Canadian journalist. She is the Global Health Reporter for the New York Times. She was in our Halifax studio.