Rachel Feltman: For Scientific American’s Science Quickly, I’m Rachel Feltman.
Last Friday the U.S. State Department formally notified Congress of its plans to dismantle the U.S. Agency for International Development, or USAID. This move came as no surprise, as USAID has drawn the attention of Elon Musk’s U.S. DOGE Service since the current administration took office.
While some of USAID’s programming will reportedly be folded into the State Department by July 1, it’s clear that the U.S. federal government is pulling back from the goals of USAID in a major way. To name just one example, the administration plans to cease U.S. support for Gavi, an immunization program that has saved the lives of an estimated 19 million children over the past 25 years, according to the New York Times.
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USAID is a massive agency that provides all kinds of assistance all over the world, so the implications of its dissolution are vast and complex. Here to talk us through it is Tanya Lewis, a senior health and medicine editor at Scientific American.
Tanya, thanks so much for coming on to chat with us today.
Tanya Lewis: Yeah, thanks for having me.
Feltman: So to start us out, what exactly is USAID?
Lewis: So USAID is the U.S. Agency for International Development. It’s basically an organization that was founded by President John F. Kennedy back in the ’60s. The main purpose was to provide foreign aid to other countries. And this takes the form of health assistance and economic aid and other things. But for the purposes here we’ll focus on the health impacts.
Feltman: And what’s been happening to their funding?
Lewis: So when Donald Trump took office in January he basically issued an executive order saying that there would be a freeze on all USAID contracts for 90 days. And during this time they immediately began to slash staff from the agency. As we all know, Elon Musk has been kind of, like, at the forefront of this effort to cut costs across the government, and he basically laid off or terminated the contracts of thousands of employees of USAID.
Feltman: Wow, and you recently wrote a piece about all of this for Scientific American, and one thing I really appreciated is that you brought in all this research about the impact of USAID, and we actually know how impactful many of its efforts have been. Could you tell us more about that?
Lewis: Yeah, so it turns out that, you know, you don’t have to take my word for it—there’s actually been studies to look at the impact of this funding. For example, I spoke with several former USAID employees or contractors, including William Weiss, a professor at Johns Hopkins Bloomberg School of Public Health, who was an adviser in the Global Health Bureau at USAID.
He and his colleagues published a study in the journal Population Health Metrics, which looked at the impact of USAID funding on a bunch of different countries, and what they did was they wanted to look at countries that received sort of an above-average level of funding because it’s impossible to kind of find countries that have almost no funding in terms of global aid, so they were basically comparing a group of countries that received a lot of funding to ones that received very little. And they were focusing specifically on the impacts to the mortality of children under 5, and a lot of this aid really goes to supporting basic, you know, health care needs for these kids—so vaccines, antibiotics, you know, basic interventions that can save lives and don’t cost a lot of money.
Because it’s kind of hard to actually pinpoint the impacts of USAID funding, what they did was they compared a group of countries that received, like I said, an above-average level of funding and they compared that with a “synthetic control” group, which is basically a group of countries that did not receive very much funding from USAID. When they compared these two groups, what they found was that the group that received above-average USAID funding had 29 fewer deaths per 1,000 live births among children under 5 during that treatment period, which was basically the years 2000 to 2016. And they found that the more funding these countries received, the bigger the benefit, essentially. So this works out to roughly 3 million children’s lives saved over that period of time.
Feltman: Wow, and did the researchers look at the impacts on any other groups?
Lewis: Yeah, so there was a more recent study, which was authored by Atul Gawande, the former head of health efforts at USAID, and his colleagues. And that study looked at women of reproductive age, and they found that if you compared countries that received USAID funding to ones that did not receive very much funding, the funded countries had about 0.8 fewer deaths per 1,000 women of reproductive age. And this actually translates to about 1 million to 1.3 million deaths prevented over time.
Feltman: Wow.
Lewis: Yeah, so it’s a pretty significant, you know, impact, even on these adult women.
Feltman: Yeah, that’s, I mean, hugely impactful, and, and obviously just the idea of all of those programs going away is inherently pretty troubling, but then there’s the fact that the funding went away so suddenly. Are we seeing anything about how the funding cuts have impacted people so far?
Lewis: Yeah, it’s a great question, and I think, almost certainly, we will see these impacts over time—it’ll probably take a while to document all of them. But we know, for example, that USAID funding doesn’t just benefit childhood health and longevity; this funding is also really critical for treating malaria, for example, which is a huge cause of death around the world. It’s also vital for tuberculosis treatments, which I think you just did an episode on.
Feltman: Yeah, yeah, and actually, when we were talking to, to John Green about his new book on tuberculosis, he pointed out that pauses in the very long antibiotic process of treating tuberculosis aren’t just detrimental to the patient, which is obviously upsetting in and of itself, but way up the risk of antibiotic-resistant TB emerging. So it’s, as is almost always the case, it is not just awful from a humanitarian perspective; it’s like—this is actually going to impact global public-health risks.
Lewis: Yeah, absolutely, and I mean, like, as we learned with COVID, these diseases do not just stay in one place, in one country. These are things that are gonna affect Americans eventually as well, so.
Just to get back to some of the impacts, I think, one of the most devastating impacts of losing USAID funding is going to be on HIV and AIDS treatment. We have effective drugs for this virus, but they have to get to people. So USAID administers funding through PEPFAR, which is the President’s Emergency Plan for AIDS Relief, which George W. Bush started. And it’s been funded by basically every Congress since then, so this is a bipartisan issue, and Americans generally support foreign aid, so it’s really devastating to see all of these programs basically just have the rug pulled out from under them.
Feltman: So obviously there’s been sort of a lot of back-and-forth and confusion with a lot of funding-related policies these days. And on March 5 the Supreme Court did rule that the Trump administration couldn’t freeze, like, $2 billion in foreign aid. What’s the deal with that? Has anything actually been halted?
Lewis: Yeah, so it is an important ruling, but what it basically says is that they need to pay their back payments to their contractors. So basically, like, you know, it’s going to help settle some of the debts that they already owe, but it’s not going to help necessarily keep funding USAID programs going forward.
I think we’ll have to wait and see what the courts say about that. But I imagine, you know, this is an ongoing issue—we’re, we’re seeing court cases coming out about these issues. So for now USAID might be able to pay some of the contractors it’s already worked with, but there’s no guarantee that any of these programs will be funded going forward.
Feltman: What other impacts might we see beyond actual mortality going up when USAID funding goes away?
Lewis: Yeah, as we all know, human health is kind of the fundamental thing that we all need to, you know, succeed in life. Like, if you’re unhealthy, you can’t get an education, you can’t be successful in your career, you know, and there, there [are] all these ripple effects. So if these thousands or millions of children don’t have access to vaccines, for example, they might develop debilitating illnesses like polio potentially, so these effects go well beyond just preventing deaths.
And as we’ve seen, just zooming out from what’s happening in these specific countries, you’re talking about global geopolitical stability, right? Like, if there’s a major disease outbreak in a country and there’s no aid or help for the people there, there’s gonna be waves of refugees or violence that erupts—so this is something that affects U.S. security as well as our, you know, general international relations. So there are lots of reasons to care about this beyond just caring for basic human life.
Feltman: Tanya, thank you so much for coming on to talk us through this, and we’ll definitely be keeping an eye out for future stories from you on the subject.
Lewis: Yeah, thanks so much for having me.
Feltman: That’s all for today’s episode. We’ll be back with our usual news roundup on Monday.
Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi, Kelso Harper, Naeem Amarsy and Jeff DelViscio. This episode was edited by Alex Sugiura. Shayna Posses and Aaron Shattuck fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news.
For Scientific American, this is Rachel Feltman. Have a good weekend!