How the U.S. has changed its approach to foreign aid this year

It's been a cataclysmic year in global health. In January, the Trump administration froze billions of dollars in foreign assistance funds. Then it dismantled the United States Agency for International Development. These actions had ripple effects all around the world and changed how the U.S. approaches foreign aid. NPR global health correspondent Fatma Tanis has been covering the story for the past year - joins us in our studios. Fatma, thanks so much for being with us.

FATMA TANIS, BYLINE: Thanks for having me, Scott.

SIMON: Take us back to the beginning of 2025. How did the shake-up to U.S. aid programs begin?

TANIS: Well, it was really chaotic, Scott. Hundreds of agency staff were put on leave. The USAID website was taken down in the middle of the night on a Saturday, and thousands of programs that provided critical health services and poverty solutions and more were terminated. And this all happened within a matter of a few weeks.

SIMON: And why did the administration do that?

TANIS: You know, foreign aid has historically had bipartisan support. It saves lives and has been generally seen as a way for America to wield influence and build goodwill. But the Trump administration saw it differently, that the way America was doing foreign aid was ineffective and wasteful. USAID, in particular, was viewed as far left and irredeemable. It's programs that provided support for LGBTQ people or reproductive health and climate solutions were seen as part of a woke agenda that taxpayers shouldn't be funding. Here's Max Primorac with the conservative Heritage Foundation. He previously held several senior roles at USAID.

MAX PRIMORAC: A lot of the aid programs that we were doing were not always tied to our foreign policy objectives, and by subsuming the aid agencies, you can better align with our national interests and also with our values.

TANIS: So the administration shut down USAID and moved a handful of the parts they wanted to keep, like humanitarian relief and a few hundred staff, under the State Department.

SIMON: Let's talk about the effect. Secretary of State Rubio said in May that no one died as a result of the cuts. Is that true?

TANIS: Unfortunately, no. NPR interviewed a mother in Nigeria. Her son had sickle cell anemia, and he began running a fever, but the clinic that they usually went to, funded by USAID, had been closed, and the boy died the next day. A doctor who treated the child before said he would have likely survived if he had received care. We also know that many people lost access to drugs that treated diseases like HIV/AIDS. And in countries torn by conflict, many malnourished children lost access to therapeutic protein-filled foods. But we don't know the full scale of lives lost, and that's because aid groups are no longer on the ground able to track what's going on.

SIMON: You went to Uganda to report on how people there were trying to live with the cuts. What did you see?

TANIS: Yeah. I was there in August, and, you know, locals and officials were still grappling with the ripple effects, not just on health care but local economies, too, because so many people lost their jobs with aid groups. In one rural area in southwest Uganda, we learned that there were only four ambulances for the 200,000 people who lived there, compared to eight ambulances before. And that's because the U.S. was funding the drivers and the fuel for those ambulances. It's just one example of how thorough and extensive U.S. aid used to be.

SIMON: So, Fatma, what's the future of U.S. foreign aid look like?

TANIS: It's looking different. Instead of funding aid organizations to do health work around the world, the administration is now working directly with governments and faith-based groups. Their focus so far has been on Africa. The State Department announced several agreements with nine African countries. In total, the U.S. is going to be investing 8 billion in the health sectors of those countries to help fight diseases, and those governments are expected to chip in as well. As part of the deal, the U.S. wants more opportunities for American businesses and access to minerals. Now, global health experts are cautioning that in the year ahead, the challenge is going to be doing more with less, as millions of lives could be on the line.

SIMON: NPR's Fatma Tanis. Thanks so much.

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