The Trump administration dismantled the U.S. Agency for International Development (USAID) abruptly in February, placing nearly all of its over 10,000 employees on administrative leave, freezing appropriated funds, and cancelling nearly 5,800 USAID-managed foreign assistance awards—effectively closing an agency that has led in global humanitarian assistance since it was created by President John F. Kennedy in 1961.

Shutting down the agency has dealt a devastating blow to low- and middle-income countries’ efforts to alleviate poverty, provide health care, and improve public health and education. USAID supported a wide variety of critical global programs, including  family planning, disease prevention and treatment, immunizations, and famine relief. Nurses played a critical role in USAID, providing education and training to strengthen severely limited in-country nursing and midwifery workforces, delivering direct care, and leading immunization and other health programs.

Deadly results.

An estimated 119,000 children and 57,000 adults have died as a result of USAID funding cuts, according to a real-time tracking tool developed by Boston University associate professor Brooke Nichols. Cases of malaria, pneumonia, malnutrition, diarrheal illness, tuberculosis, and HIV have increased dramatically. To date, funding termination has resulted in an estimated 2 million new cases of malaria in children and, if the cuts continue for a year, that number is expected to rise to nearly 12 million, with 168,000 deaths.

According to an analysis in Annals of Internal Medicine, with funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) cut, HIV-related deaths would increase by 600,000 in South Africa alone. Food and clean water sources have been cut off for many in countries in Africa, South America, and South Asia. According to the Associated Press (AP), Kenya has lost nutrition support for over 600,000 people living with drought and persistent malnutrition, Congo has lost nutrition support for tens of thousands of malnourished children, and Ethiopia has lost food assistance for more than 1 million people.

An abrupt end to services.

Along with denying any new awards for foreign assistance, officials put immediate stop-work orders on awards supporting programs already in progress. The abrupt end to services and dismissal of personnel has left lifesaving malaria and HIV medications, medical supplies, and food sitting in warehouses or shipping containers, with no means of getting them to their intended destinations and the people who need them. In early February, the Office of Inspector General for USAID reported that USAID staff estimated that this put more than $489 million of food assistance at risk of spoilage or diversion.

An American physician practicing in Burundi reports that ready-to-eat therapeutic food packets her youngest patients so desperately need are stored in warehouses and inaccessible because there are no USAID employees to get them out. Meanwhile, babies are starving to death. According to a New York Times report, an estimated $27 million worth of family planning products are stuck along the supply chain. One solution proposed by State Department leadership is simply to destroy these products that prevent millions of unintended pregnancies and save tens of thousands of women and girls from pregnancy and childbirth-related death every year.

To what end?

All this loss will result in little substantive savings for the government, since these funds represent a tiny fraction of the U.S. federal budget. In fiscal 2023, the federal government spent $71.9 billion on foreign aid, just 1.2% of the more than $6.1 trillion total federal budget. USAID distributed 60% of that, about $43.8 billion, while the State Department managed $21.3 billion, nearly 30%, which included military assistance and counterterrorism. Distribution of the remaining 10% was divided among 18 other agencies.

In a report in Science, Jirair Ratevosian of the Duke Global Health Institute,summarized the devastating impact of the administration’s actions. “This will be a bloodbath. Millions will suffer as a result of these actions, and global health—and the very notion of solidarity—will be unrecognizable.”

AJN news director Karen Roush, PhD, RN, FNP, will be providing regular updates on AJN Off the Charts about the details and implications of rapid and potentially momentous changes being made by the Trump administration to the public health system in the United States.

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