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    The Trump administration's flip-flop on treating malnourished children

    Companies making specialized food for malnourished children saw their USAID contracts canceled, then reinstated. But the damage to the rest of the system for treating them may already be done.

    By Tania Karas, Elissa Miolene // 05 March 2025
    For two U.S.-based producers of lifesaving peanut paste to feed severely malnourished children, the past week has been whiplash. Edesia and Mana Nutrition, nonprofits whose products help save millions of children’s lives annually, received notices last Wednesday that their multimillion-dollar contracts with the U.S. government had been canceled — and that the flow of the companies’ ready-to-use therapeutic foods, or RUTFs, was being terminated “for convenience and the interests of the USG.” They were forced to halt their production lines, freezing 1.5 million cartons of the nutrient-rich food across the supply chain — enough treatment for up to 5 million children. But just 24 hours later, Edesia’s contract termination was rescinded, and 72 hours after that, Mana Nutrition’s contract was restored. Last month, they each received stop-work orders that were later rescinded too. Neither has received an explanation or apology for what had happened — and instead of celebrating, both organizations have been left shaken by all the uncertainty. The termination for their award number “is hereby rescinded,” stated the cancellation reversal Edesia received Thursday. “Please resume your normal work duties.” Edesia, for its part, has not yet resumed production since last week. CEO and founder Navyn Salem said it’s a business decision based on their lack of cash flow: The U.S. government, which funds up to 80% of its work some years, owes the company at least $22 million in contracts for orders of lifesaving RUTF with their branding, Plumpy’Nut, that they cannot ship. That’s because the Trump administration’s mass terminations of U.S. Agency for International Development grants and contracts have disrupted vast swaths of the delicate supply chain by which the ingredients for the peanut paste make it from U.S. farmers’ fields to Edesia’s Rhode Island factory for production and packaging, then sent to a port in New York and onward to children in Africa, Latin America, and the Middle East. A terminated USAID contract for any individual link in that chain affects the whole flow — and some 90% of all USAID contracts have been canceled in the past month as the Trump administration axes U.S. foreign aid as part of its “America First” agenda. “What I have said to USAID is, we need to see some payments before we can resume,” Salem said. “Obviously, the real problem here is that children are waiting, and there’s nothing else that you can feed a severely malnourished child that will rehabilitate them,” Salem added. “Every week that we wait is another week where boxes do not go on our conveyor belts and do not get into trucks and make their way around the world. And these children do not have time to waste.” Tallying the damage Billionaire Elon Musk, who runs the Department of Government Efficiency, or DOGE, which has been dismantling USAID, said Sunday in a social media post on X that Edesia “should receive payment this coming week.” So far, that money has not come through, according to Salem. Meanwhile, the U.S. government owes its USAID and State Department partners at least $2 billion in foreign aid for work completed before Feb. 13 — something the Trump administration is fighting in court. Regardless of U.S.-based RUTF makers’ contracts being restored, it’s not enough to bring back the sprawling global system of local and international NGOs, national health ministries, doctors and nurses, and community health workers who cared for these children, sometimes round-the-clock in inpatient medical clinics. “Across the humanitarian sector people received termination notices, even for the most important programs that already had lifesaving waivers,” said Jeanette Bailey, the global practice lead and director of research for nutrition at the International Rescue Committee. “Some of [these children] are going to have hours to live if they’re sent home. Some of them might have days, and some of them might survive. Most won’t.” The system was already breaking down due to the Trump administration’s 90-day aid freeze and review of all USAID-funded projects and programs announced in January. Even if their work was classified as “lifesaving” with a waiver from the foreign aid suspension, their inability to access U.S. government funds led to mass furloughs and layoffs at humanitarian and development organizations of all sizes. Now, experts tell Devex that severely malnourished children will surely go without care and die, particularly those suffering from wasting, the most severe form of acute malnutrition. For example, the termination of all U.S. government-funded projects just for one organization — the nonprofit Helen Keller Intl — is estimated to place nearly 21 million people including 11 million children at immediate risk because of halted nutrition and health care support from its programs alone. “Making sure the supply is working is essential, but if these supplies are not actually getting to the children who need them, then they don't have any impact,” said Shawn Baker, Helen Keller Intl’s chief program officer. ‘The worst of the worst’ That breakdown has happened in Ethiopia, where 32,800 children were stripped of emergency nutrition services last week — the result of just a single program termination at Mercy Corps. It’s happened in Somalia, where an Alight program treating nearly 1,000 kids for severe acute malnutrition every day was just shuttered. And it’s happened across the world, where many of the sector’s biggest organizations have seen even their most critical services shut down overnight, including the stabilization centers that provide starving children with the oxygen, treatment, and RUTFs they need to survive. “These children are lying in beds and are facing the worst of the worst: they are hooked up to IVs and are some of the most severe cases we have,” said the IRC’s Bailey. “And even one day of these facilities shutting down will kill thousands of kids.” Late last week, IRC received “a significant number” of cancellation notices for its stabilization centers and programs that were serving hundreds of children in Burkina Faso, Chad, South Sudan, and beyond. Days later, some of those cancellations were reversed — creating a dizzying back-and-forth akin to the experiences of Mana Nutrition and Edesia. The cancellation reversals continue rolling in, not just for IRC, but for organizations across the sector. Regardless of whether these programs are allowed to continue, it almost doesn’t matter. Even if some organizations have received cancellation reversals, most are still not receiving the money they’d been promised by USAID to keep these programs alive. “We are continuing to assess the impact of the termination notices on our programs for children, including nutrition, as the situation continues to evolve,” said Ricardo Pires, a communication manager at UNICEF — the U.N. agency that provides the bulk of RUTFs to children across the world. “But we already know that the initial pause has impacted programming for millions of children in roughly half of the countries where we work.” More than just a checkbook Today, nearly 150 million children — about 1 in every 5 — are malnourished, according to data from UNICEF. Some 45 million are estimated to be wasted, the deadliest form of malnutrition. Even before the Trump administration's foreign aid freeze in January, nearly 2 million children suffering from severe wasting were at risk of dying due to shortages of RUTFs. Now, that situation has become even more dire — as Nicholas Enrich, USAID’s acting assistant administrator for global health, detailed in an internal memo dated March 4. Last year, USAID invested more than $1 billion into emergency nutrition support. But now, Enrich said, USAID’s funding freeze means 1 million children will no longer be treated for severe acute malnutrition every year. Two days before Enrich could send that internal memo, he was placed on administrative leave, ostensibly for voicing his dissent. “USAID has not just been a checkbook but has had, in-house, some of the world’s global experts on treatment of wasting — and supporting partners doing cutting-edge work,” said Helen Keller Intl’s Baker, who also served as USAID’s chief nutritionist until 2023. “[The agency] has also been politically, a very strong partner … [and by bringing in other donors], it's estimated that in 2023, because of that political leadership, 7.3 million children with severe wasting were reached.” That loss, along with the system’s overall dismantling, throws even the resumption of Edesia and Mana Nutrition’s production into question. Because organizations around the world have suspended their work, there's nowhere for the RUTFs made by Edesia and Mana Nutrition to go. “You need the whole system to work for the kids in need to be identified and make sure that the frontline workers have the product in hand and have the skills necessary to provide the right treatment,” Baker said. That includes ensuring community health workers in remote regions have the training and support they need to screen and treat malnourished children — but USAID program terminations spell the end to much of that support. ‘From the American people’ Back in Rhode Island, Edesia’s Salem is still waiting for U.S. government funds to arrive before she can resume producing Plumpy’Nut. Meanwhile, her counterpart in the U.S. state of Georgia, Mana Nutrition CEO Mark Moore, is owed $20 million by the U.S. government but decided to turn his machines back on Monday. The two organizations are also unsure whether to keep printing USAID’s logo on their RUTF packets. Typically below that logo is the statement “from the American people.” Moore temporarily stopped printing the logo but has now resumed doing so. Salem said she is now inclined to leave off USAID’s name, given what’s left of the agency now that the Trump administration has culled nearly all its staff and canceled much of its work. “We don’t know if USAID exists,” she said. “If I print USAID on millions and millions of packets, what am I going to do with them? If the name changes tomorrow, it will have the wrong branding on it. So I took it off.” With solely her logo, Plumpy’Nut, she can potentially sell RUTFs and other products to UNICEF and international NGOs that care for malnourished children regardless of what happens to USAID. Moore said he hopes to do the same. “We don’t want to make food for the trash can,” Salem said. “And we await instructions.” What’s uncertain, however, is how much of the humanitarian apparatus will survive now that the world’s largest foreign aid funder has canceled so many contracts. Due to the interconnected nature of global health supply chains, the entire ecosystem of companies and projects providing nutrition services is affected — whether they receive U.S. funding or not. Both Edesia’s and Mana Nutrition’s USAID contacts are set to expire later this year. After that, they don’t know if they can keep producing RUTFs for the U.S. government. “If the distribution end of it breaks down, then we may keep making these projects products for a short period,” said Mana Nutrition’s Moore. “But the delivery side’s got to work or there's going to be a break in the overall system.”

    For two U.S.-based producers of lifesaving peanut paste to feed severely malnourished children, the past week has been whiplash.

    Edesia and Mana Nutrition, nonprofits whose products help save millions of children’s lives annually, received notices last Wednesday that their multimillion-dollar contracts with the U.S. government had been canceled — and that the flow of the companies’ ready-to-use therapeutic foods, or RUTFs, was being terminated “for convenience and the interests of the USG.”

    They were forced to halt their production lines, freezing 1.5 million cartons of the nutrient-rich food across the supply chain — enough treatment for up to 5 million children. But just 24 hours later, Edesia’s contract termination was rescinded, and 72 hours after that, Mana Nutrition’s contract was restored. Last month, they each received stop-work orders that were later rescinded too. Neither has received an explanation or apology for what had happened — and instead of celebrating, both organizations have been left shaken by all the uncertainty.

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    More reading:

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

    ► How will the rest of the world respond to lights-out at USAID? (Pro)

    ► 'God Bless America' and the death of 10,000 projects

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    About the authors

    • Tania Karas

      Tania Karas@TaniaKaras

      Tania Karas is a Senior Editor at Devex, where she edits coverage on global development and humanitarian aid in the Americas. Previously, she managed the digital team for The World, where she oversaw content production for the website, podcast, newsletter, and social media platforms. Tania also spent three years as a foreign correspondent in Greece, Turkey, and Lebanon, covering the Syrian refugee crisis and European politics. She started her career as a staff reporter for the New York Law Journal, covering immigration and access to justice.
    • Elissa Miolene

      Elissa Miolene

      Elissa Miolene reports on USAID and the U.S. government at Devex. She previously covered education at The San Jose Mercury News, and has written for outlets like The Wall Street Journal, San Francisco Chronicle, Washingtonian magazine, among others. Before shifting to journalism, Elissa led communications for humanitarian agencies in the United States, East Africa, and South Asia.

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