AIDS, malaria, and child hunger: The consequences of shutting down USAID

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One of Trump’s first moves in his second term was to announce a 90-day suspension of all U.S. international aid. In practice, that pause has become permanent. A wide array of programs funded through the State Department and USAID — responsible for roughly 40% of all international aid worldwide — are being dismantled.

Founded in 1961 by an executive order of President John F. Kennedy, USAID was initially part of the State Department before an act of Congress made it an independent agency. To maintain a veneer of legality, Marco Rubio’s State Department directed its notification of USAID’s closure to Congress. It also stated that while the vast majority of the agency’s U.S.-based and overseas staff would be laid off, all legally mandated positions would technically remain in existence. In reality, that means just a few dozen roles out of more than ten thousand.

Hostile takeover

From the start, the new White House administration used indirect tactics to bring about the closure of USAID. On Feb. 3, Secretary of State Rubio announced that President Trump had appointed him acting head of the agency. At the same time, Rubio accused USAID of disobeying directives from the State Department. He insisted that many of the agency’s programs would continue — but only if they aligned with the foreign policy priorities of the Trump White House.

Rubio named Peter Marocco as his deputy, in effect making him the person running USAID. During Trump’s first term, Marocco held several posts, including a stint as head of USAID’s Bureau of Conflict and Stabilization Operations. Back then, his efforts to assert control over the agency and slash its funding triggered a 13-page internal complaint from staff, after which Marocco stepped down.

With Trump back in the White House, Marocco returned to USAID and began a sweeping personnel purge, putting more than 50 senior officials on unpaid leave, accusing them of disobeying presidential orders. Soon after, he fired another 500 agency staff based in the U.S.

Many of these moves were previewed in the Project 2025 agenda, a policy wishlist crafted for Trump by conservative think tanks before the 2024 election. The plan suggested using USAID as a test case for turning civil service jobs into political appointments, a goal that lies at the heart of Trump’s agenda. During his first term, Trump struggled to bend the federal bureaucracy to his will, as most career officials stay on regardless of who is president. Now, Trump and his allies are determined to greatly expand the number of government employees who come and go with each new administration.

Marocco also granted Elon Musk’s so-called Department of Government Efficiency (DOGE) access to USAID’s internal databases. Musk had described USAID as a “criminal organization” that needs “to die” and a “snake pit of radical leftist Marxists who hate America.” He even accused the agency of funding research into the development of biological weapons. In late January, DOGE staff attempted to enter USAID headquarters in Washington, demanding access to the server rooms. When security refused to let them in due to their lack of clearance, Musk made a phone call threatening to involve the U.S. Marshals Service.

After the conflict with DOGE, USAID Chief of Staff Matt Hopson — himself a Trump appointee — resigned. John Gray, the then-acting head of the agency, was removed. Agency Security Director John Voorhees and his deputy Brian McGill, who had denied DOGE access to the servers, were placed on leave.

In February, the USAID website was taken offline. The agency's headquarters in Washington was closed, and signs, the emblem, and other symbols were removed from its lobby. Soon, other USAID offices also ceased their operations.

The agency shuts down

When announcing the suspension of international aid, Rubio clarified that the move would only affect programs that were inconsistent with the new administration's foreign policy. Initially, the Secretary of State authorized the continuation of emergency food programs and military aid to Israel and Egypt, and he later agreed to resume assistance that provided essential medicines, medical services, and housing.

Nevertheless, most USAID programs were frozen, as the White House asserted that funds allocated to the agency were being spent improperly. However, the examples cited by the Trump team — such as the claim that the agency was procuring contraceptives for residents of the Gaza Strip — turned out to be erroneous or fabricated.

As early as Feb. 7, the Trump administration announced that it was furloughing almost all agency employees — more than 10,000 people. Approximately two-thirds of these worked in overseas missions in more than 60 countries worldwide. Almost all were ordered to return to the U.S. as soon as possible. Only 294 employees were allowed to continue working, with just 12 remaining in Africa, 8 in Asia, and 21 in the Middle East.

In addition, numerous U.S.-based contractors, who make up about a third of those involved in agency programs, were also affected by the mass cuts. More than a thousand such people lost their jobs. According to the head of DT Global, a major USAID contractor in international development, several thousand more will have to be laid off due to the funding halt.

The ensuing collapse of the American international aid system produced a snowball effect, leading to cuts in organizations outside the U.S. as well. For example, the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) cut over a thousand employees. Two-thirds of the staff of the President's Malaria Initiative (PMI) — a program launched under George W. Bush — were also dismissed. PMI plays a leading role in malaria research and distributes funding to scientific teams, including those working on creating a vaccine for the disease. The initiative’s fate demonstrates just how little Rubio’s assurances about preserving critical programs were worth.

Inevitable humanitarian crisis

Just a few years ago, Marco Rubio praised USAID’s work and made the argument that international aid, accounting for less than 1% of the U.S. federal budget, is critically important for national security and helps counter Chinese influence. He spoke approvingly of various agency programs, from women's education and combating drug addiction to supporting democratic initiatives. But this did not stop him — in his new role as Trump’s Secretary of State — from cutting aid amounting to approximately $50 billion.

A significant portion of the cancelled grants came from USAID's largest program, known as PEPFAR (President's Emergency Plan for AIDS Relief), which provided antiretroviral therapy to over 20 million people with HIV, including to more than half a million children. PEPFAR was launched in 2003 by the administration of Republican President George W. Bush and is considered one of the most successful international aid programs of all time. According to the World Health Organization, the initiative has saved approximately 26 million lives.

PEPFAR also provided employment for over 250,000 healthcare workers in 55 countries, but the funding halt has disrupted the network of local organizations that provided HIV medications in poor regions. In February, 275 organizations in 11 sub-Saharan African countries reported that they had stopped admitting patients. Contracts were terminated with the UN agency UNAIDS, which also supported the fight against HIV and managed the Demographic and Health Surveys project, collecting data on child and maternal mortality, nutrition, and reproductive health in 90 countries.

USAID programs provided over 50 million children with malaria prevention drugs. With the agency's assistance, homes in regions where the disease is prevalent were sprayed with insecticides before the rainy season. Over the past 20 years, these measures have helped prevent an estimated 7.6 million people from contracting malaria, which claims the lives of 450,000 children annually.

The REACH Malaria program, which protected over 20 million people living in 10 African countries, was also cut. A contract with Chemonics for the supply of 2.4 million mosquito nets, malaria drugs, and tests for 53 million people was halted, and the Evolve program for controlling malaria mosquito populations in 21 countries ceased its work as well. Numerous other USAID initiatives were also cancelled, ranging from polio prevention and combating tuberculosis in Central Asia to treating neglected tropical diseases (trachoma, lymphatic filariasis, schistosomiasis, and onchocerciasis) and rapid response to Ebola outbreaks in Africa.

USAID also ensured the distribution of medical supplies. In countries like Zambia, Mozambique, Nigeria, Malawi, and Haiti, there is no replacement for these distribution systems. In West Africa, USAID funds supported women's education and assisted smallholder farmers. In the Democratic Republic of Congo, an agency-sponsored project provided access to the only water source for 250,000 people in camps for internally displaced persons in the conflict zone in the east of the country.

In Sudan, where a civil war has been ongoing since 2023, USAID supported the operation of over a thousand community kitchens and medical clinics in the Kordofan region. Now they are forced to close. In the United States itself, companies involved in producing high-calorie food packages for distribution in famine-stricken regions have lost business.

According to the agency's own estimates, without these programs, 18 million additional malaria cases and 166,000 deaths from the disease should be expected — along with millions of polio infections, which will result in hundreds of thousands of children being paralyzed. Outbreaks of diseases like Ebola and Marburg fevers will become more frequent, which could also affect the United States itself. Around a million children annually will not receive treatment for severe acute malnutrition, which is often fatal.

And these are only the most easily predictable consequences of USAID's closure. The agency finances 70-90% of the operation of camps in northeastern Syria, where about 40,000 Islamic State fighters and their family members are held under the guard of Kurdish units. The end of U.S. support could portend another spike in violence in the region.

The end of “soft power”

The cancellation of USAID programs will also have geopolitical consequences — namely the strengthening of Chinese influence, which since 2013 has seen Beijing direct over a trillion dollars worth of investment towards infrastructure projects in Asia, Latin America, and Africa. The U.S. attempted to counter these efforts, partly by increasing USAID funding in the Pacific region. As recently as 2024, an additional $15 million was allocated for this purpose. Now, the new administration is abandoning such “soft power” tools.

Overall, the effect on global philanthropy will be enormous, says Jennifer Gaspar, executive director of Araminta, an NGO specializing in civil society development and non-profit consulting. “Of course, the international aid system has long needed reforms,” Gaspar told The Insider. “People in this field have many complaints about the efficiency of spending and the results achieved for the cost. But you can't just break something without thinking about the consequences. Because it's not just about job losses, but about people dying without help, without medicine.”

Ruslan Leviev, head of the Conflict Intelligence Team (CIT), explains how the aid cutoff is playing out in real terms: “About 70% of our budget came from a grant provided by a partner fund, which itself gets part of its financing from USAID. So when that funding was frozen higher up the chain, it wiped out that 70% for us. It hit us really hard.”

CIT has launched a fundraising campaign but is not hopeful about the prospect of quickly finding an alternative source, says Leviev:

“The world of non-profit projects is incredibly bureaucratic, slow, and rigid. It just isn’t built to respond quickly when things change. If the rules say a funding application takes two to three months to review, then even in a crisis, that’s exactly how long it’ll take.”

Jennifer Gaspar attributes the silence from affected companies — none of which responded to The Insider’s requests for official comment — to an “atmosphere of fear and uncertainty.” Many are holding out hope that funding will resume. Some are trying to accelerate a return to the status quo ante by taking their case to court.

Taking it to court!

Almost immediately after USAID operations were suspended, Democratic members of Congress gathered for an impromptu rally outside the agency’s headquarters in Washington. Some attempted to enter the building but were turned away due to an order — reportedly from Elon Musk — to keep the offices closed. Senator Chris Van Hollen (D-MD) announced that a lawsuit was being prepared to challenge the shutdown. His colleague, Congressman Jamie Raskin (D-MD), vowed that the legislative branch would push back against Musk’s attempts to dismantle USAID, emphasizing that the billionaire Tesla CEO “is not the fourth branch of government.”

Democrats argue that the Trump administration has no authority to impose sweeping cuts on the agency, and that withholding funds appropriated by Congress for USAID is illegal. On these grounds, the public service employees' union filed a lawsuit against President Trump, Secretary of State Marco Rubio, and Treasury Secretary Scott Bessent. In court filings, USAID staff described being ordered to halt operations immediately and, if stationed abroad, to return to the United States on their own — leaving behind homes, possessions, and, in some cases, families. One employee recalled fleeing Kinshasa, the capital of the Democratic Republic of Congo, by boat amid widespread protests.

Although a court temporarily blocked the removal of 2,500 USAID workers, they have not been reinstated, and the court permitted the White House to proceed with the cuts while the case remained under review. Now the plaintiffs are again pushing for legal restrictions, citing reports that agency documents are being destroyed.

In the meantime, several more lawsuits have been filed — this time by USAID contractors and the American Bar Association. They argue that the decision to suspend international aid cannot legally be made without Congressional approval, and also warn of devastating consequences in the event that the policy is not reversed: lost American jobs, and deaths among those who rely on USAID programs. One federal court did order the White House to resume issuing grants, but the Supreme Court intervened, limiting the amount that the administration is required to distribute to only a fraction of the Congressionally approved funds — about $2 billion.

Arguments in court that the administration's decision to suspend USAID operations violated the Constitution also failed to convince judges, and on March 29, an appellate court gave the green light for DOGE to continue reducing staff. These legal battles are widely expected to make their way to the Supreme Court, either through ongoing cases or via new suits brought by supporters of USAID. Yet with the White House insisting it is merely “reforming” the agency — not dismantling it — the momentum may be difficult to reverse. Millions of people around the world are already suffering the effects.