What A Day - The Deadly Dismantling Of USAID

Starting point is 00:00:00 Above all, what's really missing that can be turned back on, but it's going to take work, is the bipartisan commitment to the idea that America leads with a helping hand first, that we're a force for good in the world, not a force for domination and an effort to extract and be predatory towards other countries. I'm Jane Koston, and this is Watterday, a show standing with U.S. District Judge David Hittner, who ruled that a 2023 Texas law, that would restrict drag performances was unconstitutional. In his ruling, he argued that the law was so vague it could serve to cause, quote, cheerleading, dancing, live theater, and other common public occurrences to be treated as criminal violations.

Starting point is 00:00:51 And he added that if you're offended by drag performances, there's an easy solution. Quote, just don't go! On today's show, we talk about what the destruction of USAID has meant for the world with Dr. Atul Gawande. Before we think about what Elon Musk destroyed for no reason, here's what we're following today, Wednesday, August 26th. From the beginning, this case has been about protecting young people, our children, our future, online. The data is clear.

Starting point is 00:01:22 More time on social media tends to be correlated with depression, anxiety, body image issues, susceptibility to addiction, and interference with daily life, including learning. if you're a parent like I am or a guardian or a teacher or a health care provider, sadly, you've likely seen some of that play out in real life. Meta reached a landmark settlement with nearly every state today. California Attorney General Rob Bonta was one of dozens of attorneys general who sued the tech company over claims it facilitated teen social media addiction. So what is the status update?

Starting point is 00:02:00 Well, Meta agreed to pay up to $18 billion in the adjunct. stronger child safety measures, including a hard cap on daily time limits and pauses for children using Instagram and Facebook. The settlement resolved a pivotal case years in the making that sought to hold the tech company accountable for features designed to hook young people's attention. If approved by the court, the deal will stop an avalanche of litigation by states against Meta, although the company still faces lawsuits from individuals and school districts across the U.S. As Meta scrambles to save face, one of Big Tech's top leaders came out today as an AI doomer. In fact, he's a baby boomer-dumer.

Starting point is 00:02:37 Microsoft founder Bill Gates penned a lengthy blog post, warning that the world isn't ready for AI and that it needs to be regulated ASAP. Gates wrote, quote, There's an inspections regime for nuclear weapons, regulations for international aviation, and agreements that protect the ozone layer. A new global organization for AI will need elements of all three and more. He also predicts many jobs will, quote, disappear forever, and he added that relying too much on AI could diminish humans' critical thinking skills.

Starting point is 00:03:08 But AI can be used for good. Gates told the Washington Post, quote, the name of the game here is, can we have a small amount of the bad with the large amounts of the good? Good question. Mr. President, Lindsay truly loved you and viewed you as one of his closest friends. I appreciate that bond and appreciate all that you've done for our country. Our victory would not have have been possible without you, and we are truly grateful. South Carolina is truly Trump country. Yikes. Good luck, South Carolina. U.S. Senator Darlene Graham won the Republican nomination to replace her late brother,

Starting point is 00:03:51 Lindsey Graham, on South Carolina's general election ballot. It's another win for President Donald Trump after he threw his support behind the political novice. Somehow, Graham defeated U.S. Representative Ralph Norman and Tuesday, day's special Republican primary runoff, two weeks after they were the top two finishers in a 10-way primary. In Georgia, however, nepotism did not have the same effect. Two Democrats competed in a special runoff election to replace the late Democratic U.S. representative, David Scott. Former Gwinnett County School Board Chair Everton Blair beat Marcy Scott, the late congressman's daughter for the seat. Blair will serve out the last few months of Scott's charm.

Starting point is 00:04:28 It's not news that Republicans are facing headwinds in the midterms as they try to try to hold on to the House and Senate. Midterms are always referendums on the president, and Donald Trump's polling is at 33 percent, according to the latest Reuters-Ipsos poll, and his job approval is negative in 47 states. One Trump-backed House candidate in Kentucky even removed any mention of the president from his campaign website. So why, then, is Donald Trump planning to spend millions to make the midterm elections about Donald Trump? According to reporting from the Atlantic, MAGA Inc., which receives most of the money, Trump raises through political fundraising, is planning a nationwide ad blitz highlighting Trump's

Starting point is 00:05:07 many achievements, including stock market highs and a decline in deaths from fentanyl. Because in an election based largely on fury at Donald Trump, Donald Trump thinks who Americans want to hear more from is Donald Trump. And that's the news. Let's talk about the United States Agency for International Development, or USAID. It's been more than a year since Elon Musk and the Doge Boys fed our country's biggest engine for global aid into a, quote, wood chipper. According to reporting from NPR and other outlets, the dismantling of USAID has resulted in the deaths of more than 700,000 people. In July of last year, the Medical Journal of The Lancet estimated that by 2030, the end of USAID could result in the deaths of more than 14 million people. That's because USAID worked globally to fight the spread of HIV AIDS and childhoods.

Starting point is 00:05:59 malnutrition, battle infectious diseases, and help women have healthy pregnancies and healthy babies. USAID also employed thousands of in-country aid workers, pulling people out of poverty and keeping communities safe. And now that's basically gone. Dr. Atul Gawande was a USAID administrator under the Biden administration, leading the Bureau of Global Health. Now he's warning what the gutting of the agency means for the world and for America. Dr. Atul Gawande, welcome to what a day. Thank you for having me. Before we jump into what's happened since the Trump administration effectively shuddered USAID, I want to go back to talk about why the agency exists.

Starting point is 00:06:41 USAID was established in 1961 as a lead international humanitarian and development arm of the U.S. government. What was the idea behind creating an American agency devoted to helping people in other countries? I mean, it's an unexpected idea in fundamental ways. and it was based out of the experience with the Marshall Plan. After World War II, we had defeated Germany, we defeated Italy, Europe was devastated, and what did we do? We did not do what the Soviets did, which is make a land grab, expand.

Starting point is 00:07:13 We did not turn our back. We did this historically unusual thing and invested 5% of our GDP in reviving Germany in Italy's economies, industrial capacity, along with the rest of Europe's. We said we're going to offer a helping hand instead of a punch in the nose. And the result was now more than seven decades of peace and prosperity, economic growth that benefited the United States many times over and live saved, many, many lives saved along the way. Well, JFK said, you know, we did this in Europe. Let's take this as an approach in Asia, in Latin America, and in Africa, in low-income countries.

Starting point is 00:08:03 Again, a hard sell, convincing people, sacrifice now for gain later. The spending was much, much lower, well below 1% of the U.S. budget. But it's been supported. It was supported for six decades by both Republican and Democratic administrations because it was the foundation of our success in the world. It made us economically more prosperous. And it saved lives by enormous numbers. Just the Green Revolution, for example, that shifted India from a food aid recipient

Starting point is 00:08:38 to the fourth largest exporter of food for the world, a source of food for the world, that Green Revolution saved a billion lives. And that was work of USAID. And you were already making this point, but I think that one of the arguments made by critics of USAID is that the U.S. shouldn't be responsible for helping people around the world. But providing foreign assistance is not purely altruistic. You were talking about some of the ways USAID benefits Americans, but you also mentioned that USAID is created in the shadow of the Cold War, in kind of in contrast to what the Soviet Union was doing with reference to the United. Marshall Plan. So what are the ways in which USAID benefited how the world viewed Americans, which I think is a critical element here? Yeah. As John F. Kennedy said, informing USAID, he said the point of assistance to the world is that we are assisting the U.S. itself. And it assists us in ways that we're seeing now. When we have had a year plus of experimenting with

Starting point is 00:09:47 approaching the world saying we're going to use force first, we're going to use dominance. We want to extract the maximum deal and maximum immediate payoff we can get and ignore the consequences for the future. So we cut off foreign assistance funds, but in countries like Eswatini and Equatorial Guinea said, well, we'll turn it back on if you take our deportees, third country nationals deported and put them in your jails. We said, we're going to only turn on your HIV funds if you give us access to your critical minerals in Zambia and DRC, the Congo. And the result of that is, number one, we've abandoned important goals for the U.S. and abroad, like stopping and ending HIV, stopping and ending tuberculosis, and building capacity and

Starting point is 00:10:45 surveillance that can stop outbreaks going on around the world. And so now we're in a situation where not only have we lost trust, not only have we seen a rise now in mortality, you know, hundreds of thousands of deaths that have occurred from this. But then it goes hand in hand with this $40 billion reduction in how much we're putting towards foreign assistance goes hand in hand with a half trillion dollar increase in military, Because if your approach in the world is that, it's not only not effective in securing U.S. interests, it's much more costly. I used to work in HIV AIDS prevention, specifically prevention of mother-to-child transmission

Starting point is 00:11:31 of HIV. Without USAID, without that support, what has been the impact on mother-to-child transmission of HIV or on the fight against HIV-AIDS specifically? I just posted the results a few weeks ago of the African neonatal network, which reported in an international conference that there was a jump in the risk of HIV transmission to babies. How do they know it? They saw a 300% increase in the likelihood that mothers were turning up with HIV in the first place, untreated HIV. And the consequence of that, mothers and childbirth turning up with higher rates of HIV at enormous rates, is going to be a significant increase in the number of newborns born with HIV. This is something that we've made decades of progress in stopping, and now we're going backwards in the wrong direction. I hate going backwards in the wrong direction, but maybe I just don't get how amazing that could be.

Starting point is 00:12:40 We'll be back with my conversation with Dr. Atul Gawande in a moment. In the meantime, make sure to subscribe. Leave a five-star review on Spotify and Apple Podcasts, watch us on YouTube and share with your friends. More to come after some ads. What a Day is brought to you by the International Rescue Committee. Right now, there are millions of children struggling to survive in conflict zones around the world, like Sudan and Gaza. They're not only facing hunger, but also unsafe water and little access to basic health care. That's why I've been learning more about the work of the International Rescue Committee.

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Starting point is 00:14:36 my first and only choice. Your next costly home repair is already coming. Act now and get protected with a plan through homeserve. For 50% less your first year, go to homeserve.com slash wad to find the plan that's right for you. That's homeserve.com slash wad for 50% less. Savings compared to renewal price, void in Florida. Let's get back to my conversation with Dr. Atul Gawande. What are some of the other most significant consequences since USAID has been effectively dismantled? Malnutrition is one of the biggest areas of gain over the last 20 years. The biggest reduction in child mortality of the last 20 years has come from improvements in survival from malnutrition. That has occurred because of changes in systems that USA played a lead role around the world in making happen.

Starting point is 00:15:27 Instead of waiting for children to come in with malnutrition to hospitals, we brought countries to move their systems to community health workers going to. door to door and simply measuring the circumference of arms of newborns and young children and taking their height and weight. And when they detected that there was severe malnutrition developing, they would give a therapeutic ready-to-use food, RUTF, formulated by U.S. scientists and others and produced here that then could rescue the child with giving them the calories and nutrition they need for the day and prevent them from having to go to hospitals and surviving. These approaches dropped the mortality of severe acute malnutrition from 20% to less than 1%.

Starting point is 00:16:17 Those programs have now been shuttered. I was in a refugee camp in Kenya receiving people from South Sudan, for example, and documented deaths that have resulted from that shutdown of a malnutrition system that had had dramatic effects around the world at tiny levels of cost to the U.S. And has direct effects on unrest as well. There is a report released by Refugees International in Afghanistan. The U.S. introduced through U.S. aid midwives, midwifery, to Afghanistan, train them and then protected them because women aren't ordinarily allowed to work. And through that program, they were allowed to get skills and deliver babies.

Starting point is 00:17:06 In the last year now since the cuts, two-thirds of midwives are no longer in practice across the country. And the result in several provinces is double-digit rises in rates of newborn mortality, in Herat province, a five-fold jump in maternal deaths. These are just a couple of the examples. Now, you mentioned in The New Yorker that during a recent visit to South Sudan, you encountered someone from China aid offering assistance. As the U.S. steps back from this role, what countries and organizations are you seeing step in? Well, it's totally fascinating what China has done. They usually liked working under the table and quietly. They have rebranded since the closure of USAID, literally calling their

Starting point is 00:17:50 effort China aid. You see the signs all over Juba. in South Sudan of China doing this work. They haven't nearly brought in the same level of commitment and consistent expertise in capability. But I was visiting a hospital to find out how prepared they were for Ebola, which is rising across the border in the Democratic Republic of Congo, and found that they'd had no preparation, no access to PPE, protective equipment, no access, no isolation facility. Normally, the U.S. would have been right there helping make sure that this happens in accelerating the process and supporting WHO to do work as well. And none of that was taking place. Instead, as I left out the door, it was a doctor from China aid saying,

Starting point is 00:18:44 we will help provide training. Now, I say more power to them. You know, we all should be contributing, much of China's work is straightforwardly transactional or predatory. They're maybe making a turn in this better direction. But overall, the amount of funding that has gone into this kind of work, the number of people making efforts, the systems that make such progress happen, those are largely, they've been cut severely and much of it has been dismantled. What the Chinese are doing is not very much and everybody else has followed the U.S. lead and shrunk away. I want to end with where things stand right now. You and a team of journalists have been tracking the consequences of the USAID shutdown. And you said that ultimately, the death toll as a result of that shutdown could

Starting point is 00:19:34 reach into the millions. What is your team working on right now that you think people should be paying attention to? Well, number one is simply bearing witness. You know, you have an administration that says no one has died and they deny that it has happened. And that, has also included cutting funding that was, you know, the U.S. was a leading provider of data around the world on what was happening, providing surveillance, et cetera. That was important for our own intelligence and important for the rest of the world. That's been cut. So what we're trying to do is bear witness. It's measuring, tracking, and reporting the names in people who've died as we have. As you, you know, watch, listen, and support work going on in the U.S.

Starting point is 00:20:21 and around the world, tracking what actually is the effect on people's lives at home and abroad and supporting those who are doing it is crucial because, you know, this is growing, the damage, the bomb blew in 2025, but the consequences will ripple out in years to come. I think to that point, we're a year and a half into Trump's presidency. He's increasingly unpopular. Let's say new leadership gets into office in 29 and wants to restore American foreign assistance. Is it as simple as kind of turning the spigot back on, restoring funding? Or has the U.S. damaged the infrastructure and relationships that made this work effective in the first place? Yeah, it's not, as you would guess, it's not as simple as just turning the funding back on. We have destroyed an infrastructure that had several thousand Americans and partners that we employed from the countries around the world that were on the ground in different places. For example, in 50 countries, we had outbreak response specialists from USAID who were there 24-7 to

Starting point is 00:21:36 track what was happening with outbreaks to support governments. And often they were invited by the governments to be in the emergency operations center. Those people aren't there anymore. And so you turn, you know, turning on funding is an important part of it, but it's rebuilding the capacity and infrastructure. And above all, what's really missing that can be turned back on, but it's going to take work, is the bipartisan commitment to the idea that America leads with a helping hand first, that we're a force for good in the world, not a force for domination and an effort to extract and be predatory towards other countries. That, you know, we will not get anywhere rebuilding an agency if every time a new election comes, the agency switches from offering a helping hand to being a predator in the world. And that is going to take time to rebuild the trust that the U.S. is really,

Starting point is 00:22:35 as a country committed to helping people first. Dr. Atul Gawande, thank you so much for joining me. Thank you. That was my conversation with Dr. Atul Gawande. He is a surgeon at Brigham and Women's Hospital in Boston, and he served as assistant administrator at USAID under the Biden administration. Before we go, if you're listening to this show, you've probably already heard of the pop culture triumph that is Crooked Media's Keepit podcast.

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What A Day - The Deadly Dismantling Of USAID

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