The cost of eliminating USAID
The ignominious legacy of Musk's time in government.
The most discussed story the past few days has been the fracturing Trump-Musk relationship. I’m sure you’ve heard or read about it elsewhere, so I’m not going to belabor the point.1 However, there are two aspects of this affair that merit special call-out.
The first, discussed below, is the impact Musk and DOGE have had on USAID.
During Musk’s time in government, there was a lot of talk about slashing government spending and making the federal bureaucracy more efficient. Ultimately, Musk’s Department of Government Efficiency has had little impact on the tanker that is the US government.
But the same cannot be said abroad, where DOGE has had a profound impact — despite claims to the contrary — The most impactful of which was eliminating the United States Agency for International Development (USAID).
Remember, USAID only cost around $40bn a year and a substantial portion of this budget was devoted to providing life-saving aid.
USAID’s 2023 spending obligations broken out by sector.
Yet, it was one of the first government programs to get the axe (or, in the words of Musk, get fed to the “wood chipper”).
What hath this wrought?
Impact Counter, a data analysis put together by an infectious disease modeler / public health expert, has tried to quantify the discontinuation of USAID. As of Tuesday June 10, the model estimates that, because programs that provided aid and care for variety of diseases like Malaria and HIV/AIDS were ended, over 328k people — two-thirds of whom are children — have died because of these cuts.
That being said, these are modeled estimates, not actual death tolls, so they will inherently involve a bit of guesstimation. As one New York Times columnist hopefully pointed out, Impact Monitor’s projections could be overstated largely due to the heroic work being done by unpaid professionals.
I’m not sure [the death toll is] actually that high, partly because I’ve seen some laid-off health workers continue to work without pay and some health ministries step up to pick up the slack.
But these unpaid workers and less-well-off health ministries cannot compensate for the loss of the US government.2 Reporters have visited countries like South Sudan where recipients relied on USAID for life-saving support and documented how people on the ground are now dying as a result of these programs ending.
This clear evidence hasn’t stopped officials from claiming the USAID cuts have not resulted in people dying, as Secretary of State Marco Rubio falsely claimed during a congressional hearing last month (and Musk reiterated on X). Rubio also asserted that one of the signature programs, PEPFAR, the George W Bush-era HIV and AIDS program that has saved millions of lives around the world, was still “85% operative” but neither he nor the State Department has provided any evidence to support this claim.
Additional reporting by Pro Publica and Mother Jones highlighted cables from the US State Department itself warning about the devastating impacts in underserved countries like Lesotho and Malawi if USAID cuts are not restored.
In a May 23 cable urging the State Department to restore the cuts, a diplomat in the US embassy in Maseru[, the capital of Lesotho] noted that [a PEPFAR-linked program] had been “delivering important services permitted under the Lifesaving Waiver” and warned that the cuts would have deadly consequences. “The abrupt termination of this award has severely disrupted care delivery and threatens to reverse hard won gains in controlling Lesotho’s HIV epidemic that leaves Lesotho vulnerable at this critical juncture,” the memo stated. “With a shrinking health workforce, the quality and continuity of care have markedly declined—placing approximately 125,000 adults and children at risk of illness and death.”
According to the US diplomat, the termination means “over half of those currently receiving HIV/AIDS treatment in Lesotho will lose access, leading to treatment interruptions, increased new HIV infections, and higher mortality rates.” But it was not just about people currently living with HIV; one of the major purposes of the program, according to the cable, was “prevention of mother-to-child transmission.”
What’s even more infuriating about this whole situation is that the US government ALREADY PAID FOR SOME OF THE AID. A Washington Post investigation found that the US government spent over $12mn on HIV prevention medication and contraceptives. Since January, these supplies have been parked in distribution centers awaiting deployment. But after sitting in storage for months, this aid is more likely to expire or simply be destroyed rather than given to humanitarian organizations.
Negotiations over this aid with humanitarian groups are ongoing, but these have been slowed by demands like “any USAID labeling be removed.” And unfortunately, many of the aid groups simply don’t have the funds required to purchase the supplies.
“The mandate that [the USAID negotiator] has been given is ‘get us money for it,’” said one person with knowledge of the talks. “‘And if you can’t do that, we’re just going to trash it.’”
Destroying rather than distributing aid. Talk about efficiency and putting US taxpayer dollars to good use…😔
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Cheers!
The funniest tweet from the whole blow-up? Kanye West swooping in from above to express his love.
While it is certainly true that countries like the UK and France have also cut their foreign aid budgets, and China has historically provided less aid than you expect from a country with an economy that large, the US was the pace setter in both providing and ultimately eliminating aid.