Under the leadership of President Donald Trump and with significant actions taken by Elon Musk, there has been a marked reduction in the resources allocated to federal agencies, with the U.S. Agency for International Development (USAID) experiencing some of the most severe cuts. Right after his inauguration on January 20, Trump executed an executive order that stopped all foreign aid for a three-month period. A few weeks later, the New York Times reported that his administration intended to drastically reduce the size of USAID, cutting its staff down from over 10,000 to just 290 employees. More recently, Marco Rubio, the Secretary of State, announced the termination of 83 percent of USAID’s programs, incorporating the remaining ones into the Department of State. On March 18, a district judge in Maryland found that Musk’s involvement with his DOGE Service likely breached constitutional law by bypassing Congressional authority and assuming a government role without official appointment. The court mandated the restoration of certain USAID operations, including staff email access, and demanded that Musk and his associates formalize an agreement to reinstate building access for the agency. Although this restoration might be short-lived, the future of the discontinued USAID contracts remains uncertain.

These reductions have been implemented swiftly and extensively. Musk declared on February 3 via X (previously known as Twitter) and now owned by him, “We spent the weekend shredding USAID through the woodchipper.”

The repercussions of these decisions have had a global impact and will continue to affect many, particularly threatening the lives of young children and women who depend on USAID for essential medical services. This includes everything from vaccinations to treatments for diarrheal illnesses and maternal healthcare. Research indicates that this funding has been critical in saving nearly three million children under five and at least one million women of reproductive age over the past few decades, according to experts.

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The dismantling of USAID jeopardizes all these advancements. “Attempting to halt an airplane midflight and then firing the crew is akin to what’s happening,” commented Atul Gawande, former head of global health at USAID.

USAID has been a significant source of health funding and support for numerous international locations. However, assessing the impact of this support—or the absence thereof—is complex. To address this, William Weiss, a professor at the Johns Hopkins Bloomberg School of Public Health and former advisor in USAID’s global health bureau, along with his team, developed a model. Their research, published in January 2022 in Population Health Metrics, utilized a “synthetic control” analysis to retroactively estimate the influence of USAID funding from 2000 to 2016 on child mortality in low- and middle-income countries. They compared a group of countries that received substantial USAID funding against a control group that did not receive similar support during the study period.

Their findings revealed that countries with higher-than-average USAID funding experienced, on average, 29 fewer deaths per 1,000 live births compared to the control group. This translates to approximately 500 fewer deaths daily. Furthermore, the study indicated a dose-response effect, showing that increased funding over time correlated with greater benefits.

“Our goal in presenting this data to Congress’s leadership was to illustrate the substantial benefits that come from prolonged and significant funding to a country,” Weiss explained.

In another study, posted as a preprint in August and set for publication in the Journal of Global Health, Weiss, Gawande, and their colleagues studied the effects of USAID funding on mortality among women of reproductive age from 2005 to 2019. This research found that countries with sustained high levels of USAID funding saw a reduction of 0.8 deaths per 1,000 women of reproductive age during the years 2009 to 2019, equating to between one million to 1.3 million prevented deaths or an increase of about four years in life expectancy.

The severe cuts to USAID under the Trump administration threaten to erase these significant gains in longevity. Despite claims that the cuts aim to reduce government waste, there is substantial American support for foreign aid.

“Support for international health aid has always been a bipartisan issue,” Weiss remarked. “Congress and the American public have historically supported these life-saving programs, especially in impoverished nations, with cost-effective solutions. This is what the American people desire, across all political spectrums.”

The U.S. Department of State, now responsible for overseeing USAID, did not respond to requests for comment.

Troy Jacobs, a pediatrician who served as a senior medical adviser for maternal and child health at USAID for over 17 years, shared, “The primary reason I joined USAID was to address the complex global health challenges in maternal and child health, which extend beyond the biomedical domain.” Before his termination in early February, Jacobs was active in Ethiopia, helping to deliver crucial maternal and child health care. “In places like Ethiopia, where there is a significant burden of infectious diseases and a rising incidence of chronic conditions like mental health issues, we were making substantial progress in reducing child mortality,” he noted. However, this progress is now on hold, causing significant confusion and delays in service delivery, as reported by his colleagues in Ethiopia. “Globally, we estimate that 95 million people are suffering from the loss of basic medical services,” he added.

The cuts to USAID have not only impacted funding for children’s and women’s health but have also terminated initiatives like the President’s Malaria Initiative, which was protecting 53 million people through bed nets, diagnostics, and treatments. They have also ceased all tuberculosis-related work and halted contracts related to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), a significant HIV program initiated by President George W. Bush in 2003 and supported by bipartisan Congressional funding ever since. PEPFAR has been providing medication to 20 million people globally.

Anna Katomski, who was hired as a program analyst in the HIV/AIDS office at USAID’s global health bureau, was laid off in late January after only two weeks. She was assigned to work on a PEPFAR-funded project aimed at scaling up HIV prevention for adolescent girls and young women in sub-Saharan Africa. “Much of this work is being stopped due to the funding cuts at USAID, and it will likely cease entirely soon,” Katomski noted. This abrupt end to the provision of long-acting medications, which cannot be suddenly discontinued without risks, could leave many vulnerable to HIV infection. “If these girls or young women engage in unprotected sex, for example, with an HIV-positive partner, their risk of contracting the virus is significantly heightened,” she explained.

On March 5, the Supreme Court ruled 5-4 that the Trump administration could not freeze approximately $2 billion in foreign aid. A federal judge later specified a date by which the administration must make back payments to USAID contractors for previously completed work, although this does not address future payments.

While the Supreme Court’s decision is critical, “the damage has already been inflicted,” Gawande pointed out. “Many of these organizations have already laid off most of their staff. They are barely functioning as organizations, but receiving their overdue payments would at least prevent bankruptcy and ensure that people’s pensions can be funded.” Now, the question remains as to how the Court will enforce this ruling, given that “the agency has been dismantled by the administration,” he added.

Editor’s Note (3/19/25): This paragraph was updated after posting to include information about a recent federal ruling.