On the night of his inauguration, President Trump signed an executive order that froze almost all international assistance. What followed was the termination of billions of dollars in aid programs and the dismantling of the U.S. Agency for International Development, USAID. Now some foreign aid money is flowing again, but it's much less than before, and the future of U.S. foreign assistance now looks very different. NPR global health correspondents Fatma Tanis and Gabrielle Emanuel have been following this all year, and they're here in the studio now. Welcome, you two.
FATMA TANIS, BYLINE: Thanks for having us. GABRIELLE EMANUEL, BYLINE: Thank you.
KELLY: Gabrielle - just reaction - the Trump administration makes this move right out of the gate. Reaction globally was what?
EMANUEL: At the beginning, total shock. Some people we spoke to called this kind of a cataclysmic event.
KELLY: OK. So Fatma, the why question. Why did the Trump administration, A, feel they need to do it and, B, do it so quickly?
TANIS: Well, it became clear quickly that the Trump administration viewed foreign aid as a big, fat problem - that it was not aligned with the national interest, it cost too much money, even though, you know, foreign aid was about 1% of the overall federal budget. So they wanted to really take the whole thing apart and recreate it in a way that fits the America-First foreign policy. USAID, as the agency that led foreign aid, was seen by Trump Republicans as a bastion of the left. And some of its programs that supported gender equity or LGBTQ rights or climate solutions or even reproductive health, they were seen as part of this woke agenda that taxpayers should not be funding. And the president even accused the agency of waste, fraud and abuse, even though the White House hasn't provided evidence of that so far. I spoke with Max Primorac. He's with the Heritage Foundation. It's the conservative think tank that was behind Project 2025. Primorac has held several senior roles at USAID in the past. Here's how he put it.
MAX PRIMORAC: We were spending money every year. It was never changing. We weren't solving problems. We were not putting Africans in the lead. And it just, through inertia, spending a lot of money without really seemingly to get the kinds of results that we wanted.
TANIS: Other global health experts disagree. You know, we talked to people who said USAID could have been certainly improved in many different ways. But they also said that, you know, burning it all down as the administration did was arbitrary and irresponsible.
KELLY: Well, and Gabrielle, say more about the burning it all down and the consequences. You were starting to describe this as, you were hearing from people, chaos, words like cataclysmic. What was the impact?
EMANUEL: Yeah, so we talked to people all over the world. One woman who - her son had died because their U.S.-funded hospital had closed, another whose baby had died because she could no longer get the treatment for severe malnutrition. When I went to Zambia about eight weeks after the foreign aid freeze went into effect, I met people who were on HIV medications and found that overnight, their neighborhood clinics had shut down. These were clinics funded by the U.S. that had been part of this kind of massive decadelong effort that was started under George W. Bush to control HIV/AIDS. The U.S. put over $100 billion into this. It's credited with saving 26 million lives, and then suddenly the doors are locked, electricity turned off and people could no longer get their daily meds.
KELLY: OK, so just make this specific. Like, is there one human story you would tell that brings this home?
EMANUEL: Yes. So one mom I met, Theresa Mwanza - she had a 10-year-old daughter. They were both HIV positive. They got their daily medication from one of these local U.S.-funded clinics in their neighborhood, and then one day, her daughter went to get their medications. Here's Theresa Mwanza.
THERESA MWANZA: So she'll run to the clinic, and then she'll come back home and say, oh, the clinic is closed. They're not there anymore. What are we going to do?
EMANUEL: I was with them at their house. The little girl was confused about what was happening. And at that point, when I met the two of them, they had completely run out of their medications, and the 10-year-old girl, the daughter, was already showing visible signs of the virus, of HIV returning because she wasn't on her meds. And this is not an isolated event. I met many others who this was happening to as well - people losing weight, developing these open sores, flu-like symptoms - all signs that HIV was progressing to AIDS. And I'll just add here that the scale is hard to overstate. One study out of the Institute of Health Metrics and Evaluation found that this is the first year this century that child deaths under age 5 went up instead of down, and that is directly due to aid cuts.
KELLY: You know, Fatma, it's so interesting because it wasn't that long ago that you would have found a largely bipartisan consensus that, in fact, foreign aid was in America's interests. It was a tool of power that America could project abroad - a soft power, but making friends, building goodwill, spreading ideals about America and American democracy. I know this is hard to answer, but are you able to track how this year's developments have changed the way people see the United States?
TANIS: It is hard to track, like you said, but in speaking to people when we were out there on the ground overseas, you could see that it had had some impact on the way people viewed the United States. I saw that when I was in Uganda in August, and there was confusion about why the U.S. - a global superpower, as people put it - would suddenly stop giving money. Some people thought it was a sign that the U.S. was struggling financially or that it wasn't as strong as it used to be. But it was also clear that years of aid had bought the U.S. some goodwill among people, like Okot Bosco. He's a refugee from South Sudan who lost his job with an aid group because of the U.S. cuts. And he told me America's foreign aid money was not just a one-way street. It wasn't just the recipients like himself who benefited.
OKOT BOSCO: America benefits, but they don't know that they're benefiting. They benefit in trust. People trust them so much.
TANIS: Bosco grew up in a camp for displaced people, and he told me he never forgot the food and medicine that he and his family got that carried the USAID logo, the American flag with the words, from the American people, on it.
KELLY: OK, so we're at this moment now, Fatma, where the U.S. is spending less money on foreign aid, and they're also spending it differently. There's a new approach they've rolled out. What is it?
TANIS: That's right. They rolled it out in September, and instead of working with nonprofits or aid groups like the old model, the U.S. is now prioritizing working directly with governments, creating opportunities for American businesses and also faith-based organizations. So the State Department recently announced one of its first major grants, $150 million to the American drone company Zipline to expand their operations in Africa - delivering medicine, blood supplies, other health supplies. They also made agreements with Kenya, Uganda and Rwanda, where the U.S. will be investing hundreds of millions of dollars to those countries, and those governments will be also putting in money, as well. Here's how Primorac with the Heritage Foundation sees this new strategy.
PRIMORAC: This administration is being a far better steward of American taxpayer monies than previous administrations were. So it's recognizing we have a debt problem, recognizing that we have to be effective around the world with less and taking the steps to do so.
KELLY: OK, so the argument there for this new approach. Gabrielle, one more question to you just before I let you all go. What happened to the little girl who couldn't get her HIV meds?
EMANUEL: So we have good news here, actually. The Zambian government heard our reporting. They went to the villages where we had profiled the community, and they reinterviewed them, saw the situation and made sure that they could access their HIV meds. It's a small number of people, relatively speaking, but it was a good sign.
KELLY: NPR's Gabrielle Emanuel and Fatma Tanis, thank you so much for your reporting.
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