‘We Will Pay in Lives': The Devastating Cost of Dismantling USAID

Yahoo

19-03-2025

Last month, unelected shadow president Elon Musk told President Donald Trump's Cabinet that he and the so-called Department of Government Efficiency (DOGE) had 'accidentally canceled' Ebola prevention programs funded by the United States Agency for International Development, or USAID, which the new administration has tried to dismantle.
With a chuckle, Musk told some of the most powerful figures in the U.S. government that 'we won't be perfect. But when we make a mistake we'll fix it very quickly.'
Pulitzer Prize-winning journalist Nicholas Kristof recently put names, faces, and numbers on the potential costs of such 'mistakes' in an opinion piece for The New York Times, titled 'Musk Said No One Has Died Since Aid Was Cut. That Isn't True.' Kristof recounts a recent trip to South Sudan, where he learned that individuals reliant on USAID programs to mitigate HIV/AIDS, malnutrition, and maternal mortality are already feeling the pain of the U.S.'s withdrawal — and that some have died as a result of the cuts, despite Musk's contention on Fox News Tuesday night that his work with DOGE has not caused any harm..
'I was particularly struck when I … met women who are alive because of a U.S.-funded maternity clinic, and their babies were surviving,' Kristof tells Rolling Stone. 'They thanked America for its generosity, for its commitment to saving these women's lives. What they didn't know was that the U.S. was, in fact, dismantling that program, and women, again, were going to be dying there along with their newborns. It's just heartbreaking.'
On Tuesday, a federal judge ruled that Musk and DOGE likely violated the Constitution 'in multiple ways' when they fired thousands of USAID employees and attempted to shutter the agency — primarily because Trump and his administration had not properly followed established law to appoint Musk into the position and power he currently holds. While the ruling is a win for USAID employees, and a major check on Musk's power, the Trump administration's recent enthusiasm for flouting court orders and hostility towards judges who defy their antics casts a doubt over if the decision will actually be enforced.
In his interview with Rolling Stone, Kristof further delves into the relationship between Americans and foreign aid, the history of soft power foreign politics, and what Trump and Musk get wrong about the American aid project abroad. As Kristof explains, , the damage the duo are doing to the world — and to American's safety — may not be permanent, but in the meantime 'we will end up paying in lives and treasure' to cover the damages.
Foreign aid represents around 1 percent – if not less — of the annual federal budget, yet it's being presented as this bottomless pit of waste. What are Americans getting wrong about foreign aid spending, and how did it become this flashpoint for Republicans?
Americans are kind of complicated. They think that too much money is spent on foreign aid, and they think that 25 percent of the budget is spent on foreign assistance and that it should be reduced to — different polls come up with different numbers — maybe 5 percent or 10 percent. In fact, it's 1 percent roughly.
So [Americans] both think that it should come down and that it should be at a level much higher than it actually is. But I do think that there is a weariness with the world, kind of an exhaustion. There's a perception that global poverty has either gotten worse or stayed the same over the years, and that foreign aid has been kind of a bottomless pit. In fact, maybe the most important thing that has happened in my lifetime has been an enormous reduction in global poverty, in global disease and suffering, and a huge expansion in education, in life expectancy, in well being. When I was a kid, a majority of human beings had always been illiterate throughout human history, now we're pushing 90 percent adult literacy. It's a pretty extraordinary change.
I think it's fair to say that the United States' foreign aid apparatus had a significant amount to do with those improvements, particularly when we talk about things like disease prevention. Why aren't these milestones something that Americans are constantly celebrating? What changed?
It has gone through cycles. There was a period when John F. Kennedy created the Agency for International Development that it was seen as America's responsibility — as a way to fight communism. There was sort of a heroic element to it, and people joined the Peace Corps. And then, [the Vietnam War] rather sullied that notion of American intervention in the world. A generation or two later, I think Iraq did something of the same thing. But there has truly been a bipartisan element of support for humanitarian assistance, and Ronald Reagan spoke eloquently about it. Maybe the most important aid program we have is PEPFAR which was President Bush's landmark 2003 program to combat AIDS. It's maybe the most effective government program I can think of; it has saved 26 million lives so far. So until now, there has been a lot of squabbling about aid, a lot of disagreement, but there also has been a real recognition that it both saves a lot of lives and that it genuinely advances American interests around the world.
What were the valid criticisms of USAID? What actual reforms do you think were needed?
At the moment, there's generally been agreement that it is way too bureaucratic and that far too much money goes to these 'Beltway bandit' firms that know how to contract with USAID. So much of the money from USAID doesn't actually end up in the pockets of people in poor countries, it goes to the pockets of rich people in Washington, D.C. And recent administrators have indeed worked pretty diligently to try to reduce the amount of money that is going to the Beltway bandits, and increase the share that is going to pockets abroad, but it's a slow process.
I also think that it's true that in Democratic administrations, there are liberal projects that get financed that are often fashionable and that aren't always evidence-based, and during Republican administrations there are various conservative projects that get financed that aren't always particularly evidence-based. Both sides have done things that seem fashionable and ideological.
Last month, Musk laughed during a Cabinet meeting while he told the secretaries that DOGE had 'accidentally canceled' Ebola prevention programs. I'd like to hear a little bit of your thoughts about how these cuts are being handled, and what it means for someone like Elon Musk to be the dictating force of this massive government reform that's going to have not just domestic repercussions, but massive global repercussions.
Well, the basic repercussions from slash USAID are that kids die, and that is something that can't be undone. Musk has said that, well it's a 90-day pause, and then you know that if we make mistakes, we'll fix them later. That works if you are trying to build a Tesla. It doesn't work if you're saving children's lives, and medication isn't there, and the kid dies. You're not going to resurrect that child. And that is what is happening.
There's genuinely a way in which what we're seeing in Washington now is not policy formation, it's effectively vandalism. They don't know what they're doing. In some ways, I think Musk's extraordinary achievements in manufacturing have come about because he was willing to take a lot of risks and make mistakes and try, and try again. That was one of the secrets of his extraordinary achievements in rocketry, but that has worked less well in human health, and he just doesn't know what he's doing.
I don't think he understands public health, and disease surveillance, and what happens when you drop surveillance programs for Ebola, for avian flu, drop programs against tuberculosis. We will end up paying in lives and treasure for some of these programs on disease surveillance. So it's not just kids abroad who die, but he's placing Americans at risk as well.
In justifying these cuts, USAID has been accused of essentially being a Trojan horse for American intelligence agencies like the CIA. What are critics getting wrong or right about the intelligence community's relationship with foreign aid? Or how it relates to soft power?
I think that the intelligence community side of that is vastly overstated. I think that was more true in the 1960s. I think it's much less true today. It's much more true of embassies as a whole, and there are a lot of intelligence officers who go abroad as nominally commercial officers, or agricultural officers, or whatever it may be. I think much less often as USAID people. They stick out, you know, when they don't know anything about aid.
Now in terms of soft power, President Kennedy proposed USAID not just because it was going to help people abroad, but because it was going to help the U.S. Because he thought we were in competition with communism, and this was a way to win friends and influence people worldwide, especially in Africa and in the South Pacific.
The U.S. is in competition with China, and we're trying to figure out where each side wants to have more bait, and more bases, more port visits, and more listening posts, more people who will support us in the United Nations. One way we get people to let us send warships or get people to vote with us, is by providing aid and various funds. We ended aid projects in Cambodia, and it took about 10 minutes for China to start a new project in Cambodia with UNICEF and present itself as the savior of the Cambodian people. Marco Rubio was arguing until recently that it was really important to fund USAID as part of the competition with China, that we compete with China, not only with aircraft carriers, but also with aid projects.
That seems like a major indicator of a shift in how the United States is positioning itself within the international order. Sometimes it seems like an outright abandonment of the soft power we're talking about. Is this the fulfillment of a long standing Republican policy priority, or is it the collateral damage of people who as you said — don't know what they're doing?
Traditionally, Republicans and Democrats essentially believed in multilateralism, believed in the post-1945 model in which the U.S. worked closely with allies to create an international order that advanced and reflected American interests. That was true of Kennedy and Johnson and Clinton. It was true of Reagan and [H.W.] Bush. George W. Bush began to have more skepticism about multilateralism, more of a willingness to go it alone. But it really took off under Trump in a totally different way.
The notion that you just drop out of UN organizations, drop out of global health surveillance against bird flu. NATO is more or less defunct now. If Russia invaded Estonia tomorrow, there's no way the U.S. would intervene under Article Five of the NATO Treaty. So I think there's just been a wholesale abandonment, and that's partly that's because President Trump is really transactional and doesn't believe there's much value in friendships, and I think it's partly because he doesn't understand how the world works.
So two other pieces that you wrote recently really stood out to me. The first one was titled 'With Trump's Prostration to Putin, Expect a More Dangerous World,' and the second was 'Trump is Already Making America Weaker and More Vulnerable.' Combine them, and you get a weaker America in a more dangerous world. Is the damage that's happening right now going to be permanent, and is there any way the United States is going to be able to claw back the presence and the authority it had within the international order? Or is the damage done?
Well, permanent is a long time.
We made terrible mistakes in Vietnam, and we managed to recover from them. But hundreds of thousands of Vietnamese died in the process. We made terrible mistakes in Iraq, and we sort of recovered international respect under Obama. So I don't want to say it's utterly unrecoverable, but I do think that President Trump has increased the likelihood that NATO and European security will fall apart in ways and send messages to Xi Jinping that maybe it's worth taking a bite out of Taiwan.
If there is a world war for Taiwan or the South China Sea, that might be kind of irrecoverable. So I think that he's increased all kinds of risks. If there is an avian flu pandemic comparable to what happened in 1918, yeah, we'll eventually get over it, but there'll be a lot of losses along the way. So I think we're in a more dangerous world, I think there'll be real costs. The kids that I described in my article, they're dead, they're not going to come back. But 10 years from now, will we find ways to recover our standing, to knit together allies once more? I think it's possible.
I think a lot of people think that the dissolution of organizations like USAID, while they will have international consequences like the ones you described in your article, won't necessarily have domestic repercussions. What's the potential blowback for the everyday American that thinks it's not going to affect them because it's just foreign aid?
I would probably focus on global health and disease. Over the last few decades, we've faced two major epidemics or pandemics that have started abroad and that were devastating in the U.S.
We had AIDS, which began slowly, somewhere in Congo or possibly in Cameroon, and then eventually reached the U.S. and claimed a lot of American lives. We faced a risk of that in the 2010s with Ebola, but fortunately — partly because of USAID — we were able to primarily stop it in West Africa. And then Covid-19, of course, which did come to the U.S.
We don't know what else is brewing out there. I think some kind of avian flu evolving to not just hit mammals, but spread from mammal to mammal, from person to person, is a particular nightmare. It's very hard to calculate these risks, but they are greater.
We don't have surveillance systems in place. We have just dismantled those surveillance systems. There are also novel diseases and pathogens that are going to emerge. Right now we're not even supposed to talk to the World Health Organization. I just find it remarkable that so soon after a global pandemic killed so many Americans we're dismantling our defenses and making ourselves vulnerable again.
Musk saying that [USAID] was a criminal organization, and these are folks who in some cases risk their lives, in some cases lost their lives. When has Elon Musk risked his life for something larger than himself? So, yeah, I found that quite offensive.
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