Neighbor Tuesday: USAID

Stand up.

*I can’t give you the sources for the numbers in this post because they all came from the USAID website. That website has now been taken down. All stats are from USAID unless otherwise noted.”

Photo and copyright: WFP USAID: Adrienne Bolen

The United States Agency for International Development (USAID) is an independent agency of the US government, funded by bipartisan collaboration. It began in 1961 through an executive order by President Kennedy and united several aid agencies into one. Now, USAID has an annual budget of over $50 billion, making it one of the biggest aid agencies in the world. As a comparator, the US military budget in 2023 was a whopping $820 billion. Although $50 billion sounds like a lot, it is <1% of the TOTAL federal budget. So, don’t let the headlines make you believe that cutting USAID budgets will impact the price of eggs or gas or save tax dollars. It won’t and doing so seems grandstanding, unwarranted, and fiscally irresponsible.

USAID provides an innumerable amount of needed aid, neighboring aid. USAID provides programs, such as community development, food assistance, agriculture programs, health aid, anti-poverty programs, children and maternal health programs, and disaster relief (to name a few) in over 130 countries. The relief and neighboring-aid that occurs through USAID can’t be summed in a thousand pages, so I won’t try. But it’s incredibly far-reaching. For example, nearly 54 million people gained access to water - something that should be a basic human right - regardless of where you live. Over 7.4 million women and children have been saved over the past decade from USAID’s maternal and child survival program alone. In 2021, during the pandemic, USAID continued providing access to essential and lifesaving care to over 91 million women.

So, what happened this week? Atul Gawande in the New Yorker reported that on January 27th “The top layers of civilian and foreign-service leadership-57 people in all, including the agency’s general counsel and ethics counsel had their badges turned off and were put on immediate leave. Technical experts and support staff hired through contractors-which includes half of USAID’s Global Health Workforce-were dismissed.” Marco Rubio, who has now dubbed himself head of USAID, has merged USAID into the State Department. Additionally, all existing programs have been halted and the websites are gone and archived. Here’s my screenshot from 2-3-2025 at 6:30pm.

With the abrupt halt, staff were let go immediately. No services or medicines or supplies can be given out, even if they are on the shelves in the countries. Pulling out of the WHO was catastrophic, for sure. Halting USAID is double that. I want to call it sinful, arrogant, and nonsensical, for starters. What we risk, in global health, is not hyperbole. USAID helps fund detection programs for diseases, like polio or Ebola, which easily can jump borders and kill thousands quickly (remember the awful Ebola outbreak in West Africa in 2014-2016?).

PEPFAR is now stopped completely. This provides HIV drugs to 20 million people INCLUDING over half a million children in 50+ countries. 500,000 children. I mentioned in the WHO post a week or so ago that stopping HIV treatment abruptly like this for a patient can result in drug resistance when trying to start the drug again. In other words, you can’t just start and stop these drugs without consequences.

My partners in Somaliland receive medicines and supplies for millions of women and children to save their lives in the event of pregnancy-related complications, like pre-eclampsia or hemorrhaging, through collaborations with USAID. This is now simply halted. But the women and children needing the life-saving medicines are not halted. Their lives could be though. Again, that is not hyperbole or an overstatement. Until you are at the bedside of someone dying from Ebola or a pregnant mom with spiking blood pressure or a child with polio, it’s hard to understand (for some) the impact of reckless decisions made thousands of miles away by billionaires.

(Photo: USAID Somalia)

I was at the United Nations a few years ago when I heard Atul Gawande advocate for the provision of affordable and universal health coverage for all. I was in the room when like-minded delegates and civil society members from NGOs came together in solidarity to make sure the poorest of the poor were not forgotten. To make sure that health is considered a human right and dignity is given to every human. The wiping out of USAID upends that solidarity for, well, for what? To save money? We’ve already established that the USAID budget is not going to make that big of a difference. It just doesn’t make sense and I won’t try to make sense of selfish power.

If you’ve been here a bit, you know that one of my sheroes is Samantha Powers, USAID director under Biden and US Ambassador to the UN under Obama. She said, as she signed off as USAID director, “Our fates here in the US are connected to the fates of people everywhere.” As a population-health scientist (epidemiologist), I wholeheartedly believe that. We are connected as people, as neighbors. Halting USAID, defunding USAID, stopping USAID, whatever you want to call it breaks that connection into individualism on the premise of making only one country great again. Nothing is made great again by selfishness though except pride.

I’m not sure how to end this post. Similar to the post I wrote on the federal freeze, I’m having a really hard time writing objectively, without anger. I wrote this post yesterday, edited it multiple times to take out some of the yelling, slept on it, and then edited it even more. And, I’m still angry because the wide-sweeping, careless decisions by a few billionaires who have likely never seen food given out in a slum affect millions of people.

I’ve made a long-standing promise to you all that I will write objectively, not reactively. I did that during COVID and didn’t write in click-bait, shock-factor prose and told you all before this new administration came in that I would remain even-keeled, trust-worthy, and non-reactive. I’ll give you the science, the facts, and talk about being neighborly, yes. Some times though, such as now, that objectivity is joined with empathy to become advocacy. And that includes righteous anger because neighboring is being challenged.

I was talking with a friend yesterday who does amazing work for people living with HIV in Africa. We were talking about all of this and how both of us and our work will likely be affected by the global health upending that’s happening. She then reminded me that “we take it one day at a time”. She reminded me that part of resisting is not giving into the chaos and anxiety and horror of what’s happening. But, to rise above it one day at a time.

So, I guess that’s what I’m going to do today. I’m going to do my work, to fight where I can, love who I can, neighbor loudly and widely. One day at a time. Join in this, neighbors. Neighboring is not always hard work. But it is for now and now is to time to speak up.

Take care of yourself and neighbors for this long-haul journey. I’ll be here with you.

-Emily