Devex CheckUp: Is restoring US global health aid even possible?

With the U.S. Agency for International Development being dismantled in front of our eyes, a U.S. Supreme Court justice stalled efforts to force the Trump administration to release billions of dollars the agency had committed to spending on global aid.

Nearly two weeks after the judge ordered the administration to release global aid funding frozen by its stop-work order in late January, the funds are still stuck.

U.S. District Judge Amir Ali had given the administration until midnight last night to get funds flowing. But Supreme Court Chief Justice John Roberts stepped in ahead of that deadline to offer a reprieve, after the government argued that it “is doing what it reasonably can to comply in good faith.”

The Trump administration maintains that it has the right to review, suspend, and cancel awards on a case-by-case basis, which it is doing, instead of restoring payments. And now at least 10,000 USAID and Department of State grants have been terminated.

No one, not even the people who brought the suit, was convinced that Ali’s order would translate into an immediate resumption of USAID activities, though. And now with the vast majority of USAID contracts canceled, it almost certainly will not, although the agency still owes partners at least $1.5 billion across 2,000 outstanding funding requests.

But the agency has become something of a “black box,” as my colleague Elissa Miolene describes it. A crucial system that would actually facilitate USAID payments is frozen. Thousands of contractors and full-time employees of the agency have been fired. Some have actually been fired twice. And staffers at the Washington, D.C., headquarters were only given 15 minutes this week to come and pick up their personal items.

“Even if the restraining order were followed, and even if we do get the full injunction — there’s no one left,” Mitchell Warren, head of the AVAC, one of the organizations that brought the suit, tells Elissa. “They’ve dismantled the agency. I do not believe we are ever going back to Jan. 19 in USAID foreign assistance rule of law.”

Read: Supreme Court pauses order to release billions of dollars in foreign aid

Read more: Nearly 10,000 awards cut from USAID, State Department

ICYMI: Judge orders USAID to release millions of dollars in foreign aid

+ Join us today at 3 p.m. ET for a discussion with federal contracts expert Robert Nichols about what the sweeping decision to terminate USAID projects means for development organizations around the world. The session will cover immediate legal implications, contract considerations, program wind-down processes, and ripple effects across the development sector. Register now.

This event is exclusively for Devex Pro members. Not yet gone Pro? Start your 15-day free trial now to access the event and all our exclusive offerings!

Close call

Meanwhile, evidence mounts of the impact the U.S. funding freeze is having in virtually every corner of global health.

On Jan. 30, the Ugandan government declared an Ebola outbreak following the death of a nurse at the country’s largest hospital, which is in the capital, Kampala. This would normally have instigated a flow of U.S. funding to aid the response, along with support from USAID.

Instead, funds didn’t arrive for more than a week. That left the Ugandan government and its partner organizations scrambling to reallocate other money that they had. An official with the Uganda Red Cross Society said that limited their ability to track and trace potential contacts of Ebola patients.

At the same time, USAID did not immediately offer additional assistance, which previously included helping to raise awareness of the outbreak, disposing of hazardous waste, and ensuring health facilities and partners had supplies. Instead, the Red Cross watched its stocks of personal protective equipment dwindle.

Fortunately, even without early U.S. involvement, Uganda appears to have brought the outbreak under control. Eight other confirmed cases have all recovered and been released and the country is now counting down to declaring itself Ebola-free.

Read: US delayed assistance to Uganda’s Ebola response

No recovery

Even where organizations have had some luck getting their USAID funding restarted, they are watching the broader response crumble. Consider the situation with child malnutrition.

The stop-work order hit several nonprofits producing ready-to-use therapeutic food, or RUTF, a high-calorie, nutrient-dense paste used to treat malnourished children. Many of these groups banded together and lobbied for a waiver, which they received.

But RUTFs are just part of a broader response to treating malnourished children.

And the stop-work order is still blocking many other critical interventions, including malnutrition screenings at health centers, ongoing monitoring, and the delivery of cash vouchers that help families feed children and prevent them from becoming malnourished in the first place.

The result, as my colleague Tania Karas writes, is that tens of thousands of starving children and their families are not getting the care they need. And it is not clear how many will survive the 90-day funding freeze.

Read: ‘The system is breaking’ — US aid freeze threatens child malnutrition care

+ For more content like this, sign up to Devex Dish, a weekly newsletter on the transformation of the global food system.

Bounce back

As you would expect, the global development community is not taking the situation sitting down. While replacing U.S. funding in its entirety would be a stretch, several organizations have set up emerging funding windows to help keep efforts afloat through the Trump administration’s foreign aid review.

My colleague Jenny Lei Ravelo has identified five initiatives, including the Foreign Aid Bridge. Coordinated by Unlock Aid, the effort is trying to provide emergency funding to organizations affected by the freeze. It has already made its first grants to organizations working around HIV/AIDS and responding to humanitarian crises. The GlobalGiving Community Aid Fund is also fundraising for $1 million to support local organizations.

Check out the full list and let us know if there are any initiatives we should add.

Read: 5 rapid response funds for organizations affected by the US aid freeze

How innovative

It’s not all doom and gloom in this week’s newsletter. We also wanted to highlight the introduction of a new medicine for river blindness 30 years after the first treatment became available. The new medicine, Moxidectin, is being rolled out first in a district in Ghana.

Moxidectin comes from the Australia-based Medicines Development for Global Health, which followed an unusual process to facilitate the drug’s development. That included turning to an impact investment fund for early support and then leveraging a voucher from the U.S. Food and Drug Administration to spur future research and development.

This unlikely approach might offer a model for future medicine development, particularly for neglected tropical diseases, such as river blindness, which do not attract a lot of pharmaceutical attention.

The Medicines Development for Global Health is now looking to get Moxidectin included in World Health Organization guidelines for the treatment of river blindness. At that point, they’ll need to figure out how to sustainably supply the treatment to the estimated 220 million people affected by the disease each year, primarily in 31 African countries.

Read: Innovative finance brings new river blindness medicine to Africa

What we’re reading

An unknown illness, traced to three children who ate a bat, has killed at least 53 people and infected 419 in northwestern Democratic Republic of Congo. Researchers have ruled out Ebola, dengue, Marburg, and yellow fever. [Associated Press]

The Intergovernmental Negotiating Body, established to develop the pandemic treaty, has conservatively cost $201 million. [Think Global Health]

Within the United States, the Trump administration has fired experts who do everything from responding to the ongoing bird flu outbreak to protecting crops and looking out for the safety of pet food and medicine. [The New York Times]

In the lead-up to a high-level meeting on noncommunicable diseases in September, experts, advocates, policymakers, and NGOs gathered in Kigali to start defining their priorities. [Devex]