The destruction of USAID is already leading to a trickle-down demise

The U.S. Agency for International Development is gone, its budget is in tatters, and grantees are in turmoil. But the agency’s sudden shuttering in February also imposed permanent and ongoing damage to organizations, projects, and services that never received a dollar of direct U.S. aid. Months later, one local leader said: “It feels like we’re going through another global pandemic, and we’re still recovering from the last one.” Another calls it “trickle-down demise.” I had the opportunity to gather 15 leaders from sub-Saharan Africa, Southeast Asia, and South America. These are the leaders we don’t hear from. The ones whose front-line organizations assist survivors of sexual violence and trafficking, people with disabilities, and victims of Agent Orange. They provide job training for jobless youth, keep girls in school, and help women launch small businesses. These kinds of initiatives often offer the best long-term hope for marginalized communities. Sophisticated and practical, some of these leaders are driven by faith, some by personal experience, and none have “radical” agendas. The U.S. government was their beacon of reliability and forward progress. Now they speak of fear and loss. Not because they received USAID funding — they didn’t — but because their sustained efforts depend on the broad scaffolding of global aid: large international NGOs, multilaterals, and expertise, led by U.S. government funding, convening power, and influence. That scaffolding was ripped from under everyone, and these leaders quickly felt the impact. Now their work dangles precariously in the space the U.S. left behind. We met via Zoom and spoke on condition of anonymity. One of these leaders in sub-Saharan Africa focuses on gender equality by building opportunities and safer communities for women and girls. Now, school fees are in jeopardy, education on reproductive health and behavior change is “out the window” because limited funds need to be redirected to clinical care, and access to lifesaving antiretroviral HIV medications, or ARVs, is unstable. We know the U.S. President’s Emergency Plan for AIDS Relief, which relied heavily on USAID funding for implementation, has saved 26 million lives and prevented millions of HIV infections. But PEPFAR isn’t one thing; it is a chain of care that is now breaking down. One leader quietly said, “We know we have family members who will die.” --— With ARV availability disrupted and uncertain, the U.S. set in motion a global recipe for the resurgence of AIDS, drug resistance, and an unimaginable toll on mental health. But as Josef Stalin is famously credited with saying, “A single death is a tragedy, a million deaths is a statistic.” So I was put in touch with Mary. Mary, which is not her real name, has been living with HIV for 26 years. Before she had access to ARVs, she was bedridden, suffered opportunistic infections including tuberculosis, and weighed just 66 pounds. Thanks to PEPFAR, it took two years, but she made a full recovery. A mother of three healthy children, Mary went back to teaching and is helping a local organization assist some 300 HIV positive people, including orphans and children, sex workers, caregivers, and the LGBTQ+ community. Yet with the dismantling of USAID, their future suddenly shifted from good to grave. Because HIV clinics have shuttered, she says people are forced to go to public health clinics where they must reveal their names and risk being stigmatized and harassed. Fear causes some to stop treatment. Among them is a mother of two. She’s deeply depressed and has been hospitalized for TB. When I asked if she was suicidal, Mary simply said, “Yes.” Mary doesn’t know what the future holds. She can no longer get her six-month supply of ARVs, so she must travel 25 miles by bus every month for medication. That’s costly and time away from work she cannot explain to her employer. “I think there is a lot of desperation.” Desperation in many forms and across many areas of global development Leaders in sub-Saharan Africa expressed concern over the “observable decline of safe water.” Unsafe water is a leading cause of preventable newborn and early child death and dozens of preventable diseases. It doesn’t help that across low-income countries, health care facilities overwhelmingly lack basic water, waste, hygiene, and sanitation services. Tragically, leaders anticipate “increased death among otherwise healthy populations.” Everyone expressed concern for the well-being of girls. But boys are at risk too. One of the leaders lives in a conflict zone rife with mass displacement, “terrible violations” of women, and boys being pulled into armed gangs. She said local programs are especially critical. A large American INGO was reaching 7,000 at-risk women and youth with vocational and entrepreneurial training and small business grants. It was “an exciting time” for her organization as a local partner incubating more than 550 youth. With training completed, grant competitions were about to get underway. Then that large American INGO, heavily funded by USAID, lost three-quarters of its overall funding. The youth lost more than job skills. “What do you tell them?” she said. “It’s led them to lose hope.” The risk that some boys will join gangs and even terrorist groups has become a lot more real. These leaders readily acknowledge the pitfalls of foreign aid. They know there’s a need for difficult internal conversations about government dysfunction and corruption. They know working toward “locally led sustainability” and “new funding models” to “increase independence” are not just buzzwords, they have real meaning. And here’s the thing: Tangible efforts were underway. One leader was fostering a promising new culture of local philanthropy. Now, economic progress is set back years, if not decades. As another leader put it, “Sustainability is a noble goal, but it’s very hard in a crisis.” A clear winner Into this gap steps China. A leader in Brazil explained that Chinese money is pouring in to meet its massive demand for soy, beef, and minerals. Brazilian industrialists are thrilled, but the land grabs from Indigenous communities, ecological harm, and climate impact will be deep and lasting. Another leader described “whole villages of factories” in Southeast Asia built and staffed by Chinese workers, leaving unwanted jobs to locals and fears of Chinese aggression launching from within. Witnessing China’s power grab, they feel the U.S. foothold rapidly collapsing. I asked what they’d like to tell the U.S. Congress, which holds the purse strings, given that the budget they appropriated to USAID — just 0.3% of the federal budget — was decimated. After a long silence, someone muttered, “They should grow some balls.” Once the gasps subsided, they added that if ever there was a time to “be bold, not timid, courage has to be now.” As senator, Marco Rubio was that bold supporter, calling foreign aid “a very cost-effective way, not only to export our values and our example, but to advance our security and our economic interests.” But now, as secretary of state, Rubio hastily canceled 83% of USAID programs in March. It appears foreign aid will become little more than a sideshow for presidential wheeling and dealing. These leaders who spoke with me know the signs of authoritarianism; many live it. Now, some organizations are restricting priorities, fearful of being targeted by the Trump administration. That’s how far the tentacles of our tyranny reach. War without bullets “We had hope,” Mary said, and for good reason. In the last 25 years, U.S. foreign aid has been key to cutting child mortality by half, bringing safe drinking water to 70 million people, and preventing 58 million people from dying from TB, more than 11 million people from malaria, and sparing 20 million people from polio. Mary wishes the U.S. Congress could feel the desperation. “It was like a bomb going off. Everything was going well until it all shattered.” The U.S. withdrawal from global health could total 25 million deaths over the next 15 years, exceeding the lives lost in World War I and ranking it among the deadliest wars in human history. -- — This war of desperation, disease, and disillusionment is in places Americans will never see and people they will never meet. Yet an overwhelming 89% of Americans across party lines say the U.S. government should invest at least 1% of the federal budget in foreign aid: 84% are Republicans and 94% are Democrats. In another recent poll, Republicans think the U.S. should spend 5% on foreign aid; Democrats say 10%. The U.S. has never spent 5% in USAID’s history, starting with President John F. Kennedy, who created USAID. The country has spent less than 1% since the 1980s, and even if we were to include foreign assistance outside of USAID, it still barely tips 1%. I felt a mix of anger and shame during much of our conversation. One percent is so little to ask. I couldn’t pretend that USAID’s destruction is reform. These leaders are asking for partnership, not charity. No country, philanthropy, or faith can replace U.S. government foreign assistance. Now the U.S. is planting a legacy where hope is replaced by an HIV positive mother of two who is ready to give up.