Devex CheckUp: The human cost of USAID's terminated awards

The twists and turns in the new U.S. administration’s foreign aid saga rival any book or movie I’ve encountered lately. That includes the latest USAID and State Department terminations of nearly 10,000 awards, many of which supported lifesaving health programs.

Health experts and organizations expressed anger, frustration, and concern when they received notices that their programs were terminated. Every health program seems to have been impacted, including HIV and AIDS, tuberculosis, malaria, family planning, and many other lifesaving interventions that depend on U.S. support. A critical program that surveys and publishes data on population trends to help countries plan and target their health interventions was also gutted.

What Lynne Wilkinson, a public health specialist based in South Africa, said particularly stuck with me: “We already know of 87 facilities that were providing post-violence care for 33,000 survivors last year whose services will disappear. These are survivors of rape and intimate partner violence with no post-exposure prophylaxis to prevent HIV infection, no psychosocial support or legal assistance or medical care.”

A court filing said over 500 awards were spared, but no one seems to have heard of a contract that wasn’t canceled. Contracting officers at USAID also did not know which programs were cut. Within hours of the award cancellations, the agency was asking organizations to provide information on their awards and a copy of the termination notice, my colleague Elissa Miolene reports.

But the plot keeps twisting.

The Stop TB Partnership, a U.N.-hosted entity that serves as a leading voice in the fight to end TB, also received a termination notice on Feb. 27. The next day, the organization sent out termination letters to its 140 grant recipients, and Lucica Ditiu, the organization’s leader, told me they were considering downsizing their secretariat.

Then, just hours after we published the story, the partnership received another letter reversing the decision. The letter stated the termination was rescinded and that they could resume their work with USAID funding.

“We assume it’s for the lifesaving work for which we had a waiver, but we don't know,” Ditiu tells me.

Some organizations that received similar reversal letters have been told that was a mistake — meaning their awards are still terminated. Some received termination notices even though they did not have active USAID grants.

Read: ‘Disaster’ as health programs reel from USAID terminations

Read more: Critical global surveys fall casualty to US foreign aid gutting

Plus: Stop TB Partnership looks at downsizing after USAID cuts

And an update: Aid freeze, waiver, termination, reversal — Stop TB awaits clarity from US

USAID cuts in numbers

To some extent, the confusion with USAID awards is not entirely surprising. The agency has been in complete chaos, with thousands of staff members either terminated or put on administrative leave. USAID’s global health bureau has lost nearly 90% of its staff, and those who were left couldn’t do much as the Department of Government Efficiency, or DOGE, run by billionaire Elon Musk, appears to be calling the shots.

Take the Ebola response in Uganda. Organizations were told they could resume their activities to prevent the disease’s spread, but the funds never arrived, according to Nicholas Enrich, a senior USAID official who was sacked on Sunday after detailing the internal mess that prevented the government from providing lifesaving assistance.

In a memo, he described how DOGE kept USAID’s financial systems “completely turned off.” USAID’s global health bureau had also been told to stop approving waivers for lifesaving programs.

But in another unsent memo — which Devex obtained a copy of — Enrich gave an estimate of the risks involved in halting lifesaving health programs.

That includes an additional 71,000 to 166,000 deaths from malaria; an additional 200,000 cases of polio per year; 1 million children suffering from severe acute malnutrition losing access to treatment; up to a 32% increase in multidrug-resistant TB globally; and more than 127,000 cases of mpox — including 34,000 in the United States.

One organization that has so far escaped the cuts is Gavi, the Vaccine Alliance. But the future of U.S. funding to the organization remains uncertain, including the Biden administration’s pledge of at least $1.58 billion over the next five years.

Read: USAID official dismissed after detailing ‘failure’ to give lifesaving aid 

ICYMI: Gavi’s core programming not impacted by US foreign aid freeze

A wake-up call

Trump’s gutting of USAID will have wide-ranging implications in Africa, which receives a substantial amount of funding from the agency for its health sector. This blow comes at a time when the continent is grappling with multiple outbreaks of infectious diseases, such as mpox and Ebola, while facing an increasing burden of noncommunicable diseases. By 2030, the number of obese adults on the continent is expected to reach 37.2 million, putting more people at risk of diabetes, heart disease, and stroke.

The funding crisis has overshadowed discussions at Amref Health Africa’s conference this week, where the key message is that African countries should use their limited resources more efficiently, my colleague Sara Jerving reports from Kigali. One way that can be done is by focusing on preventing diseases, according to Dr. Githinji Gitahi, Amref’s CEO.

Dr. Sabin Nsanzimana, Rwanda’s health minister, also urged African nations to take ownership of their health systems, and not delegate that responsibility elsewhere.

Read: The urgent need to rethink Africa's health financing

Plus: Obesity is on the rise in Africa. Here’s what UNICEF is doing about it

WHO knows?

One of the first victims of Trump’s executive orders was the World Health Organization. With the U.S. planning to exit WHO, the agency faces a significant funding loss. As a result, it must make tough decisions about its priorities at the World Health Assembly in May, though it will no doubt be a “tricky exercise,” Kümmel says.

WHO has taken several measures to cut costs, including freezing hiring and reducing travel. It has also launched a fundraising campaign, hoping to attract a wider set of donors from the general public. It hopes that member states will agree to augment the agency’s budget with another 20% increase in their dues.

Read: With WHO in crisis, prioritization can’t wait, warns German official

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Lead it be known

I spent months working on a story about Georgia, a country in Eastern Europe and West Asia known for its gorgeous mountains and wine. But I discovered it also loves its spices, so much so that people in New York with Georgian ancestry often carried spices back from their trips to the country.

But that came with health risks. New York City health officials soon found out that the spices had high lead levels, which can cause irreversible neurological and cognitive developmental impairments in children. Concerned, they alerted Georgian authorities. Multiple entities including UNICEF and Pure Earth worked with the Georgian government to assess how widespread lead poisoning was, identify its sources, and find solutions.

These efforts in Georgia helped inform the design of the Partnership for a Lead-Free Future, which aims to end global childhood lead poisoning by 2040. Samantha Power championed this work during her time as USAID administrator, although the partnership has not been spared from the latest USAID cuts.

But this isn’t a story about how one entity can jeopardize a global initiative that aims to free children from lead poisoning. Rather, it’s a story about how it takes a global village to successfully tackle one of the world’s biggest health threats to children.

Explore the visual story: Cracking the code on what’s poisoning millions of children

What we’re reading

Africa faces a critical medical supply crisis, but new alliances are stepping up with innovative solutions to bridge the gaps. [Devex]

An unknown disease is killing dozens of people in the Democratic Republic of Congo. WHO said it’s likely caused by poisoning, while African experts think it might be malaria. [The New York Times]

U.S. Health and Human Services Secretary Robert F. Kennedy Jr.'s recent op-ed published by Fox News on the measles outbreak is being criticized for subtly supporting anti-vaccine views. [NBC News]