What the loss in USAID funding means for Global Health

USAID Flag flies outside the Washington DC headquarters (AP Photo/Carolyn Kaster)

The Trump administration has significantly scaled back the role of the US Agency for International Development (USAID) after attempts to get rid of the agency altogether. On Sunday, USAID got rid of 1600 employees. Following a review, the administration decided to cut 5,800 of the awards and funding, almost 90% of the agency's awards, keeping only around 500. The State Department similarly cut the vast majority of their foreign aid funding. The administration's decision to gut the USAID reflects an attempt to reduce “wasteful” spending within the government. 

Like many of the policies of the second Trump administration, the battle has mostly played out in the courts. On Jan. 20, President Trump ordered a 90 day pause on the payment of foreign aid. However, on Feb. 13, federal judge Amir Ali, ordered that the administration release the funding. The Trump administration refused to comply, and on Tuesday, Feb. 25, Judge Ali gave the administration until the next day to release the foreign aid funding. Mere hours before the deadline, the Supreme Court issued an administrative stay to Judge Ali’s ruling, but it did not provide a rationale. 

Many contractors who worked with USAID received an email earlier this week informing them of the termination of the contract, stating that the administration “...made a determination that continuing this program is not in the national interest."Among the funds terminated were grants that helped control the spread of malaria, provided funding for domestic violence shelters and maternal healthcare, fed malnourished children in Nigeria and Yemen, provided diagnosis and treatment for tuberculosis, and worked to eradicate polio. The cancellation of grants will have a devastating impact on global public health. A new UN report shows the extent of the negative effect of the withdrawal of US funding: Many individuals have not been able to access life-saving medication and the quality of care has worsened. Due to the uncertainty of the past several weeks, there has been a significant increase in the waiting times at clinics. Furthermore, data collection and analysis has been disrupted in many of the countries that received funding from the US, so the extent of the impact has not been fully measured.

Doctor treats toddler suffering from malnutrition and HIV (© UNICEF/Karin Schermbrucker)

Among other repercussions, the topic of HIV is a major concern because more than two-thirds of the international funding for HIV prevention comes from the US. South Africa has the largest percentage of people living with HIV and AIDS — nearly 8 million — and received 44 USAID funded grants before the cuts. Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, which works on preventative care and treatment for HIV/AIDS, stated that modeling indicated the loss in funding may lead to 500,000 deaths over the next decade. She added that the cuts were “saving dollars and spending lives.” For many individuals — particularly those in rural areas — access to mobile health clinics has been spotty at best and will only get worse with the cut in funding. Research and trials on HIV vaccines and new drugs will also likely be halted.

There are additional concerns about this defunding further stigmatizing HIV/AIDS. Previously, US funding meant organizations were able to help marginalized individuals, including sex workers and queer people, receive care with less fear of stigmatization and legal concerns than at state-run clinics. Given the Trump administration's vehement attack on diversity, equity, and inclusion programs, there are concerns about how this will specifically impact women and queer individuals who are already at greater risk. 

In an interview with Stephen Colbert, Samantha Power, the former administrator of USAID, argued for protecting USAID, stating, “The kids at those vaccination clinics, those girls who are in school because of USAID, they don’t vote in our elections…they don't have that ability to use that lever so it’s really up to the rest of us to make that case.”