"America is great because America is good"
USAID has been essentially shut down.
USAID is a federal organization that provides international humanitarian assistance like clean water, food, and medicines to impoverished parts of the world. It accounts for less than 1% of the US budget and its purpose extends beyond charity – USAID's humanitarian work is not only a good thing to do as humans, but has also helped the United States maintain strategic partnerships with other countries.
In the last two weeks, the entire USAID budget has been frozen for 90-days, many senior officials and thousands of contractors have been fired, employees were barred from entering USAID headquarters, the USAID website has been taken offline and replaced with a message announcing personnel will be placed on administrative leave, and it has been accused of being a "criminal organization.”
To understand impacts of changes like these, sometimes stories are better than numbers. I came across this story from Anne Linn on Facebook which articulates the impacts perfectly. Anne is a global health worker from Montana who worked on the President's Malaria Initiative – a USAID-funded project that aims to stop malaria from killing kids.
This is her story.
"I lost my job on Tuesday. Along with almost 400 talented and committed people who have dedicated their lives to improving the lives and health of people around the world. But this is not about my job. My job is a drop in an immense bucket of suffering that the halt on foreign aid is causing, with cascading impacts beyond what I can describe. There is much out there about the scale of these impacts, so I want to focus on my own experience of these last days and the impact on my specific work.
On day 1 of the new administration, one of the executive orders was a halt of obligations, or funding currently with USAID (US Agency for International Development) going to projects. I was worried about this (along with orders about return to the office, since as someone who relocated to be nearer to our families, I knew that this would eventually impact me) because of new projects that were in need of funding to get their vital work started. But I resolved to roll up my sleeves to articulate how the work I was involved with was indeed aligned with Secretary Rubio’s stated goals of making American safer, stronger, and more prosperous.
My job for the past six years has been with the U.S. President’s Malaria Initiative, or PMI. Malaria still kills around 600,000 people each year—mostly children under five. But in the 30 countries where PMI works, the malaria mortality rate has been reduced by half since the initiative was launched in 2006 by George W. Bush. If this is not a show of American strength, I don’t know what is. Aid is diplomacy and fosters goodwill. Malaria harms economies when people can’t work, and PMI’s work to fight this disease allows economies to grow—and with the globalization of today’s economy, that means more shared prosperity.
Did I join this field because of these goals? No. As a Christian, I was compelled by the gospel, the words of Jesus, to use my life to try to diminish suffering for the world’s most vulnerable. This has been more than a career—it has been a vocation, where my greatest gifts have met the world’s greatest need. I have had no radical agenda other than the notion that no child should die from a mosquito bite. I have been so proud to tell my children about my work and the American greatness it represented. And now I have had to tell them that I no longer have a job, and I’ve had to explain why.
Because I did not have a chance to articulate how my work meets Secretary Rubio’s goals. On Friday, he sent a new memo adding on to the original executive order. Now all aid would be halted for a 90 day review. Stop work orders would be issued to all projects immediately, with almost no exceptions, despite the obvious lifesaving nature of our work. That’s where my layoff came to be. As contract staff, we were told that the entirety of our contract was stopped and they were unable to continue our employment. Two thirds of the PMI team at USAID just evaporated.
I have no objection to reviewing the work. By all means. But the immediate halts are nothing but cruel. And wasteful. If we want to talk about government efficiency, let me just provide a few small examples of the waste. I have been involved with a piece of work in Sierra Leone (a photo from which I have added to this post) to test how we might be able to *more cost effectively* deliver an intervention with proven outcomes. A survey was scheduled to be conducted next week to measure these outcomes, but it’s all halted, and now we won’t know whether we could have actually provided this intervention with fewer resources and achieved the same outcomes. All the resources that went into this work are wasted.
Malaria is very seasonal, as mosquitoes flourish during the rainy season. Planning things like distributions of bednets and preventive medicine for children has a precise timeline that will fall apart, making this work less effective, if it even happens at all. And children, children of God, will die unnecessarily.
I was supposed to go to a meeting on child survival next week (which of course I will not be doing on account of being laid off and the meeting being canceled because of the stop work order). My ticket was non-refundable (because that’s the cheaper option). Even if it does end up being just a “pause”, how many organizations will be able to maintain staff for three months without being able to pay them to do any work? My non-contract colleagues, the federal employees who were not laid off, have been instructed not to conduct any work. As someone who has considered myself a steward of taxpayer resources for the last six years, this waste infuriates me.
On Monday, the career (non political appointed) leadership of every bureau at USAID was escorted out of the building and placed on administrative leave. The global health leadership are people that I respect so much, that have served our country through their dedication to the mission of the agency, and I am sickened to think of them being treated as an enemy. The next morning, as contractors got our layoff notices, we heard about pictures of smiling beneficiaries of US foreign assistance being removed from their frames. Why do this other than to expressly try to terrorize the workforce, my colleagues who, to me, represent the best of America. They have been the most talented and passionate people I have ever worked with.
This is what the rhetoric from this administration looks like in practice. I will be ok. I am scrappy and privileged. But so much is not ok. No matter who you voted for, if reading this has stirred any compassion in you, please speak out. Share this post or a summary. Contact your representatives—the budgets that are frozen were approved by Congress, and the ordered halt of this work is contrary to the balance of power intended in the constitution. (Contrary to popular belief, our foreign aid budget is less than 1% of our overall national budget.) The freeze on all federal grants was rescinded because people spoke out and said that it wasn’t ok. Secretary Rubio issued a waiver for HIV treatment. We can stop this. Even if you think we should diminish foreign aid, this can be done in a more thoughtful and strategic way.
America is great because America is good. We can still be good."
This story was republished with Anne's permission, find her original story here.
You Can Know Things is a medical blog founded by Kristen Panthagani, MD, PhD, a resident physician and Yale Emergency Scholar completing a combined Emergency Medicine residency and research fellowship focusing on health literacy and communication. Kristen is also the author of Your Local Epidemiologist’s section on Health (Mis)communication. You can subscribe to her website below or find her on Substack, Instagram, or Bluesky. Views expressed belong to KP, not her employer.
