USAID, the leading US aid agency, was dissolved this year. What has been the impact and what does the future look like for US foreign aid in health care?
SCOTT SIMON, HOST:
This has been a catastrophic year for global health. In January, the Trump administration froze billions of dollars in foreign aid funds. Then it dissolved the US Agency for International Development. These actions had a ripple effect around the world and changed the US approach to foreign aid. NPR global health correspondent Fatma Tanis covered this story last year and joins us in our studios. Fatma, thank you very much for being with us.
FATMA TANIS, BYLINE: Thanks for having me, Scott.
SIMON: Go back to early 2025. How did the shake-up in US aid programs begin?
TANIS: Well, it was pure chaos, Scott. Hundreds of agency employees were sent on leave. USAID's website went down in the middle of the night on Saturday, and thousands of programs providing critical health services, poverty solutions and more were shut down. And all this happened within a few weeks.
SIMON: And why did the administration do this?
TANIS: You know, foreign aid has historically had bipartisan support. It saves lives and is generally seen as a way for America to exert influence and build goodwill. But the Trump administration saw it differently: the way America provided foreign aid was ineffective and wasteful. USAID, in particular, was considered far left and irredeemable. These programs, providing support for LGBT people or addressing reproductive health and climate issues, were seen as part of the woke agenda that taxpayers should not fund. Here's Max Primorac of the conservative Heritage Foundation. He previously held several leadership positions at USAID.
MAX PRIMORATZ: Many of the aid programs that we have implemented have not always been aligned with our foreign policy goals, and by including aid agencies in your fold, you can better align them with our national interests as well as our values.
TANIS: So the administration shut down USAID and transferred a few parts that they wanted to keep, like humanitarian aid and several hundred employees, under the State Department.
SIMON: Let's talk about the effect. Secretary Rubio said in May that no one was killed as a result of the stabbings. This is true?
TANIS: Unfortunately, no. NPR interviewed a mother from Nigeria. Her son had sickle cell disease and developed a fever, but the USAID-funded clinic they usually went to closed and the boy died the next day. The doctor who treated the child earlier said he likely would have survived if he had received help. We also know that many people have lost access to medications that treat diseases such as HIV/AIDS. And in countries torn by conflict, many malnourished children have lost access to healthy protein foods. But we don't know the full scale of lives lost, and that's because aid teams are no longer on the ground and can't monitor what's happening.
SIMON: You went to Uganda to talk about how people there are trying to live with cutbacks. What did you see?
TANIS: Yes. I was there in August and, you know, local residents and officials were still grappling with the ripple effects not only on health care but also on the local economy because so many people had lost their jobs because of relief groups. In one rural area in southwestern Uganda, we learned that for the 200,000 people who lived there, there were only four ambulances, compared with eight ambulances previously. And that's because the US funded the drivers and fuel for these ambulances. This is just one example of how thorough and extensive US assistance was.
SIMON: So, Fatma, what does the future of American foreign aid look like?
TANIS: It looks different. Instead of funding humanitarian organizations to do health work around the world, the administration is now working directly with governments and religious groups. Until now, their focus has been on Africa. The State Department announced several agreements with nine African countries. In total, the US is set to invest $8 billion in these countries' health sectors to help fight disease, and their governments are expected to contribute as well. As part of the deal, the US wants more opportunities for American businesses and access to mineral resources. Now global health experts are warning that the challenge in the coming year will be to do more with less as millions of lives could be at stake.
SIMON: NPR's Fatma Tanis. Thank you.
TANIS: Thank you.
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